ST VINCENT CLAY HOSPITAL INC: Form 990, tax year 2011
View the entire original 990 at ProPublica ↗
- Organization
- ST VINCENT CLAY HOSPITAL INC (EIN 35-2112529)
- Tax period
- 2011-07-01 to 2012-06-30
- Filed
- 2013-05-14
- IRS object ID
- 201341349349306839
- Schema version
- 2011v1.5
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule G
- Schedule H
- Schedule I
- Schedule J
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2013-05-14T15:06:27-05:00 | Timestamp |
| Tax Period End Date | 2012-06-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 861065772 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Deloitte Tax LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 111 Monument Circle Suite 2000 | AddressLine1 |
| City | Indianapolis | City |
| State | IN | State |
| ZIP Code | 462045108 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2011-07-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 352112529 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | StVincent Clay Hospital Inc | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | STVI | NameControl |
| Phone | 8124422623 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1206 East National Avenue | AddressLine1 |
| City | Brazil | City |
| State | IN | State |
| ZIP Code | 478342718 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Jerry R Laue | Name |
| Title | Hospital Administrator | Title |
| Phone | 8124422601 | Phone |
| Date Signed | 2013-05-14 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Shawna M Jimenez | Name |
| PTIN | P01222873 | PTIN |
| Phone | 3174648600 | Phone |
| Date Prepared | 2013-05-09 | DatePrepared |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2011 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | Jerry R Laue | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1206 East National Avenue | AddressLine1 |
| City | Brazil | City |
| State | IN | State |
| ZIP Code | 478342718 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 26189318 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | www.stvincent.org | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 2000 | YearFormation |
| State Legal Domicile | IN | StateLegalDomicile |
| Activity Or Mission Description | We are a nonprofit hospital dedicated to providing healthcare that leaves no one behind. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 8 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 4 | NbrIndependentVotingMembers |
| Total Nbr Employees | 224 | TotalNbrEmployees |
| Total Nbr Volunteers | 25 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 76606 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 63074 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 23204675 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 24517042 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 1987602 | InvestmentIncomePriorYear |
| Investment Income Current Year | 1358168 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | -104328 | OtherRevenuePriorYear |
| Other Revenue Current Year | -101793 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 25164555 | TotalRevenuePriorYear |
| Total Revenue Current Year | 25836491 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 17817 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 32585 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 9342065 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 9187011 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 11724297 | OtherExpensePriorYear |
| Other Expenses Current Year | 13132319 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 21084179 | TotalExpensesPriorYear |
| Total Expenses Current Year | 22351915 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 4080376 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 3484576 | RevenuesLessExpensesCY |
| Total Assets BOY | 39634037 | TotalAssetsBOY |
| Total Assets EOY | 42629989 | TotalAssetsEOY |
| Total Liabilities BOY | 11862021 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 13498723 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 27772016 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 29131266 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | St.Vincent Clay Hospital is dedicated to providing spiritually-centered, holistic healthcare that sustains and improves the health of those served, with special attention to the poor and vulnerable. Both inpatient and outpatient health services are provided without regard to patient race, creed, national origin, economic status, insurance status or ability to pay. This mission extends well beyond the provision of core medical services to encompass medical and scientific research programs, the training and educating of health care professionals and active support of community-based partnerships and programs to improve health and quality of life. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 15742441 | Expense |
| Grants | 32585 | Grants |
| Revenue | 24517042 | Revenue |
| Description | St.Vincent Clay Hospital (SVCH) is a 25-bed, critical access hospital serving rural Clay and contiguous counties and providing services without regard to patient race, creed, national origin, economic status, or ability to pay. During fiscal year 2012, SVCH treated 742 adults and children for a total of 3,008 inpatient days of service. The hospital also provided services for 31,951 outpatient visits, including 1,144 outpatient surgeries and 10,379 emergency room and minor care visits. See Schedule O for a non-exhaustive list of community benefit programs and descriptions. | Description |
Activity2 Activity2
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 3079452 | Expense |
| Description | St.Vincent Clay Hospital (SVCH) 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, 2012, the unreimbursed cost of free or discounted services provided to patients who were deemed indigent under state, county, or hospital guidelines was $3,079,452, which included $1,486,083 of traditional charity care and $1,593,369 in unpaid costs of care for those qualifying for Medicaid or other public programs for the poor. See Schedule O for a non-exhaustive list of community benefit programs and descriptions. | Description |
Activity3 Activity3
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 116456 | Expense |
| Description | In addition to core medical services, St.Vincent Clay Hospital (SVCH) 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 2012, SVCH provided $116,456 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, SVCH provided a total community benefit of $3,195,908 in fiscal year 2012.) SVCH serves and supports its community through such programs as Rural and Urban Access to Health, health careers classes and diabetes education. See Schedule O for a non-exhaustive list of community benefit programs and descriptions. | Description |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expense | 18938349 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 1 | LobbyingActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 0 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 1 | ReportOtherAssets |
| Report Other Liabilities | 1 | ReportOtherLiabilities |
| Report Fin48 Footnote | 0 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 0 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 1 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 1 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 1 | Hospital |
| Financial Stmt Attached | 1 | FinancialStmtAttached |
| Grants To Organizations | 0 | GrantsToOrganizations |
| Grants To Individuals | 1 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 1 | RelatedOrgControlledEntity |
| Transaction Related Entity | 0 | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 23 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 224 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 0 | UnrelatedBusinessIncome |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 8 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 4 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 1 | MembersOrStockholders |
| Election Of Board Members | 1 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 1 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 1 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| States Where Copy Of Return Is Filed | IN | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Wayne R Knight | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 8124422623 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1206 E National Avenue | AddressLine1 |
| City | Brazil | City |
| State | IN | State |
| ZIP Code | 478342718 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | X | InfoInScheduleOPartVII |
Form990 Part VII Section A Form990PartVIISectionA (12 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|
| Lynsey B Lunsford | |||||||
| Chair | 1.00 | X | X | 0 | 0 | 0 | |
| Craig A Johnson DO | |||||||
| Vice Chair | 40.00 | X | X | 30619 | 0 | 21402 | |
| Kirk A Freeman PhD | |||||||
| Secretary | 1.00 | X | X | 0 | 0 | 0 | |
| Jeffrey A Boyll | |||||||
| Director | 1.00 | X | 0 | 0 | 0 | ||
| Joe A Milner | |||||||
| Director | 1.00 | X | 0 | 0 | 0 | ||
| Katherine Humphreys | |||||||
| Director | 1.00 | X | 0 | 410815 | 61578 | ||
| Mark Thiemann Thru 51112 | |||||||
| Director | 1.00 | X | 0 | 0 | 0 | ||
| Jane E Sweeney | |||||||
| Director | 1.00 | X | 0 | 111133 | 54417 | ||
| Jerry R Laue | |||||||
| CEO | 40.00 | X | X | 0 | 223639 | 58244 | |
| Wayne R Knight | |||||||
| CFO | 40.00 | X | 0 | 170401 | 36906 | ||
| Edward J Allison | |||||||
| CRNA | 40.00 | 174181 | 0 | 35100 | X | ||
| Elaine J Kelley | |||||||
| Nurse Anesthetist | 40.00 | 164119 | 0 | 17516 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 368919 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 915988 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 285163 | TotalOtherCompensation |
| Number Individuals GT100 K | 2 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| Indiana Physician Management | |||||
| 4420 N Pennsylvania Street | Indianapolis | IN | 462051728 | Physician services | 755294 |
| Comprehensive Pharmacy Services | |||||
| PO Box 116474 | Atlanta | GA | 303686474 | Pharmacy services | 379784 |
| Bill Dunbar and Associates LLC | |||||
| 2601 Fortune Circle E 301A | Indianapolis | IN | 46241 | Revenue management consulting | 206934 |
| Mid America Clinical Labs | |||||
| 2560 N Shadeland Avenue | Indianapolis | IN | 46219 | Lab testing | 178009 |
| EmCare Inc | |||||
| 1717 Main Street Suite 5200 | Dallas | TX | 75201 | Emergency physicians | 131896 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 6 | NumberOfContractorsGT100K |
| Related Organizations | 225 | RelatedOrganizations |
| Government Grants | 21513 | GovernmentGrants |
| All Other Contributions | 41336 | AllOtherContributions |
| Total Contributions | 63074 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (2 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| Net patient revenue | 621990 | 13258793 | 13258793 |
| Net Medicare/Medicaid | 621990 | 11258249 | 11258249 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 24517042 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 1356068 | TotalRevenueColumn |
| Exclusion | $1,356,068 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 182604 | Real |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 329072 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | -146468 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -146468 | TotalRevenueColumn |
| Exclusion | -$146,468 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 2100 | Other |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 0 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 2100 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 2100 | TotalRevenueColumn |
| Exclusion | $2,100 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Income Fundraising Events | 30300 | GrossIncomeFundraisingEvents |
| Fundraising Direct Expenses | 23755 | FundraisingDirectExpenses |
Net Income From Fundraising Events NetIncomeFromFundraisingEvents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 6545 | TotalRevenueColumn |
| Exclusion | $6,545 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc (2 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | ExclusionExclusionAmount |
|---|---|---|---|
| Cafeteria revenue | 722210 | 32315 | $32,315 |
| Pharmacy revenue | 446110 | 5815 | $5,815 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 38130 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 25836491 | TotalRevenueColumn |
| Related Or Exempt Function Income | 24517042 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $1,256,375 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 113 | Total |
| Program Services | 113 | ProgramServices |
Grants To Domestic Individuals GrantsToDomesticIndividuals
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 32472 | Total |
| Program Services | 32472 | ProgramServices |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 52021 | Total |
| Management And General | 52021 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 7126937 | Total |
| Program Services | 5867693 | ProgramServices |
| Management And General | 1259244 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 173935 | Total |
| Program Services | 143203 | ProgramServices |
| Management And General | 30732 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1373044 | Total |
| Program Services | 1130444 | ProgramServices |
| Management And General | 242600 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 461074 | Total |
| Program Services | 379608 | ProgramServices |
| Management And General | 81466 | ManagementAndGeneral |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1282309 | Total |
| Program Services | 1055740 | ProgramServices |
| Management And General | 226569 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 17635 | Total |
| Program Services | 14519 | ProgramServices |
| Management And General | 3116 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 115950 | Total |
| Program Services | 95463 | ProgramServices |
| Management And General | 20487 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 58046 | Total |
| Program Services | 47790 | ProgramServices |
| Management And General | 10256 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 359061 | Total |
| Program Services | 295619 | ProgramServices |
| Management And General | 63442 | ManagementAndGeneral |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 47569 | Total |
| Program Services | 39164 | ProgramServices |
| Management And General | 8405 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 294373 | Total |
| Program Services | 242361 | ProgramServices |
| Management And General | 52012 | ManagementAndGeneral |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 604389 | Total |
| Program Services | 497601 | ProgramServices |
| Management And General | 106788 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 46083 | Total |
| Program Services | 46083 | ProgramServices |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| Community benefit | 3195908 | 3195908 | |
| Supplies | 2354816 | 1938748 | 416068 |
| Purchased services | 1913658 | 1575538 | 338120 |
| Miscellaneous | 869900 | 716198 | 153702 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1972622 | Total |
| Program Services | 1624084 | ProgramServices |
| Management And General | 348538 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 22351915 | Total |
| Program Services | 18938349 | ProgramServices |
| Management And General | 3413566 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2156070 | BOY |
| EOY | 2516795 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2768144 | BOY |
| EOY | 2782423 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 443520 | BOY |
| EOY | 423970 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 495118 | BOY |
| EOY | 234560 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 19078918 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 12219038 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 7008071 | BOY |
| EOY | 6859880 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 26763114 | BOY |
| EOY | 29812361 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 39634037 | BOY |
| EOY | 42629989 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2078090 | BOY |
| EOY | 2083510 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 9783931 | BOY |
| EOY | 11415213 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 11862021 | BOY |
| EOY | 13498723 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 26340694 | BOY |
| EOY | 27732634 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1431322 | BOY |
| EOY | 1398632 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 27772016 | BOY |
| EOY | 29131266 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 39634037 | BOY |
| EOY | 42629989 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | 3484576 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | -2125326 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
| Audit Committee | 1 | AuditCommittee |
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Federal Grant Audit Required | 1 | FederalGrantAuditRequired |
| Federal Grant Audit Performed | 1 | FederalGrantAuditPerformed |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | Volunteers |
| Paid Staff Or Management | 0 | PaidStaffOrManagement |
| Media Advertisements | 0 | MediaAdvertisements |
| Mailings Members | 0 | MailingsMembers |
| Publications Or Broadcast | 0 | PublicationsOrBroadcast |
| Grants Other Organizations | 0 | GrantsOtherOrganizations |
| Direct Contact Legislators | 0 | DirectContactLegislators |
| Rallies Demonstrations | 0 | RalliesDemonstrations |
| Other Activities | 1 | OtherActivities |
| Other Activities | $881 | OtherActivitiesAmount |
| Total Lobbying Expenditures IIB | 881 | TotalLobbyingExpendituresIIB |
| Not Described In501c3 | 0 | NotDescribedIn501c3 |
Form990 Schedule C Part IV Form990ScheduleCPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | Explanation of Lobbying Activities: | Identifier |
| Return Reference | Part II-B, Line 1: | ReturnReference |
| Explanation | Lobbying expenses represent the portion of dues paid to national and state hospital associations that is specifically allocable to lobbying. | Explanation |
Schedule D IRS990ScheduleD
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 2500 | OtherCostOrOtherBasis |
| Book Value | 2500 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 8987556 | OtherCostOrOtherBasis |
| Depreciation | 3685839 | Depreciation |
| Book Value | 5301717 | BookValue |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 312487 | OtherCostOrOtherBasis |
| Depreciation | 299803 | Depreciation |
| Book Value | 12684 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 9552622 | OtherCostOrOtherBasis |
| Depreciation | 8233396 | Depreciation |
| Book Value | 1319226 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 223753 | OtherCostOrOtherBasis |
| Book Value | 223753 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 6859880 | TotalOfBookValueLandBuildings |
Other Assets OtherAssets (4 entries)
| DescriptionDescription | Book ValueBookValue |
|---|---|
| Funds restricted by donor | 1398632 |
| Interest in investments held by Ascension Health Alliance | 26489763 |
| Receivables from third party programs | 636251 |
| Other | 1287715 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | 29812361 | TotalBookValueOtherAssets |
Other Liabilities OtherLiabilities (5 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| Due to St.Vincent Hospital and Health Care | $718,436 |
| Pension liability | $109,413 |
| Payables to third party programs | $1,711,680 |
| Intercompany debt with Ascension Health Alliance | $8,060,936 |
| Other liabilities | $814,748 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 11415213 | TotalOfAmounts |
Schedule G IRS990ScheduleG
Events Information EventsInformation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Event1 | Festival of Trees | NameOfEvent1 |
| Gross Receipts Event1 | 30300 | GrossReceiptsEvent1 |
| Gross Revenue Event1 | 30300 | GrossRevenueEvent1 |
| Non Cash Prizes Event1 | 10802 | NonCashPrizesEvent1 |
| Rent Facility Costs Event1 | 6109 | RentFacilityCostsEvent1 |
| Other Direct Expenses Event1 | 6844 | OtherDirectExpensesEvent1 |
| Gross Receipts Total | 30300 | GrossReceiptsTotal |
| Gross Revenue Total Events | 30300 | GrossRevenueTotalEvents |
| Non Cash Prizes Total Events | 10802 | NonCashPrizesTotalEvents |
| Rent Facility Costs Total Events | 6109 | RentFacilityCostsTotalEvents |
| Other Direct Expenses Total Events | 6844 | OtherDirectExpensesTotalEvents |
| Direct Expense Summary Events | 23755 | DirectExpenseSummaryEvents |
| Net Income Summary | 6545 | NetIncomeSummary |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | 1 | CharityCarePolicy |
| Written Policy | 1 | WrittenPolicy |
| Policy Applied To All Hospitals | X | PolicyAppliedToAllHospitals |
| FPG Reference Free Care | 1 | FPGReferenceFreeCare |
| Pcent200 | X | Pcent200 |
| FPG Reference Discounted Care | 1 | FPGReferenceDiscountedCare |
| Pcent400 | X | Pcent400 |
| Free Disc Care Medically Indigent | 1 | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | 1 | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | 1 | ExpensesExceededBudget |
| Unable To Provide Care | 0 | UnableToProvideCare |
| Annual Community Benefit Report | 1 | AnnualCommunityBenefitReport |
| Report Publically Available | 1 | ReportPublicallyAvailable |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1486083 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 1486083 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.06650 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 4186043 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 2592674 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1593369 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.07130 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 5672126 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 2592674 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 3079452 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.13780 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 308 | PersonsServed |
| Total Community Benefit Expense | 93316 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 93316 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00420 | PercentOfTotalExpense |
Health Professions Education HealthProfessionsEducation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 24 | PersonsServed |
| Total Community Benefit Expense | 22600 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 22600 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00100 | PercentOfTotalExpense |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 20 | PersonsServed |
| Total Community Benefit Expense | 540 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 540 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00000 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 352 | PersonsServed |
| Total Community Benefit Expense | 116456 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 116456 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00520 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 352 | PersonsServed |
| Total Community Benefit Expense | 5788582 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 2592674 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 3195908 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.14300 | PercentOfTotalExpense |
Community Support CommunitySupport
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 361 | PersonsServed |
| Total Community Building Expense | 7240 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 7240 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00030 | PercentOfTotalExpense |
Health Improvement Advocacy HealthImprovementAdvocacy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 1 | PersonsServed |
| Total Community Building Expense | 9600 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 9600 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00040 | PercentOfTotalExpense |
Other Other
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 1 | PersonsServed |
| Total Community Building Expense | 19200 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 19200 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00090 | PercentOfTotalExpense |
Total Total
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 363 | PersonsServed |
| Total Community Building Expense | 36040 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 36040 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00160 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReported |
| Bad Debt Expense | $635,939 | BadDebtExpenseAmount |
| Amount Attributable To | 190782 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 8312775 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 8230470 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | 82305 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | X | CostToChargeRatio |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | 1 | WrittenDebtCollectionPolicy |
| Provision For Charity Care | 1 | ProvisionForCharityCare |
| Number Of Hospital Facilities | 1 | NumberOfHospitalFacilities |
Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Number | 1 | FacilityNumber |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | StVincent Clay Hospital Inc | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1206 E National Avenue | AddressLine1 |
| City | Brazil | City |
| State | IN | State |
| ZIP Code | 47834 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| General Medical And Surgical | X | GeneralMedicalAndSurgical |
| Critical Access Hospital | X | CriticalAccessHospital |
| Er24 Hours | X | Er24Hours |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | StVincent Clay Hospital Inc | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
| Eligibility Criteria Explained | 1 | EligibilityCriteriaExplained |
| Uses FPG Free | 1 | UsesFPGFree |
| FPG Free Percent | 200.000000000000 | FPGFreePercent |
| Uses FPG Discounted | 1 | UsesFPGDiscounted |
| FPG Discount Percent | 400.000000000000 | FPGDiscountPercent |
| Explains Basis | 1 | ExplainsBasis |
| Income Level | X | IncomeLevel |
| Asset Level | X | AssetLevel |
| Explains Application Method | 1 | ExplainsApplicationMethod |
| Includes Publicity Measures | 1 | IncludesPublicityMeasures |
| Attached To Invoices | X | AttachedToInvoices |
| Posted In Emergency Room | X | PostedInEmergencyRoom |
| Posted In Admission Office | X | PostedInAdmissionOffice |
| Actions On Nonpayment | 1 | ActionsOnNonpayment |
| Collection Activities | 0 | CollectionActivities |
| Nondiscrim Emergency Care Policy | 1 | NondiscrimEmergencyCarePolicy |
| Used Other Method | X | UsedOtherMethod |
| Amounts Generally Billed | 0 | AmountsGenerallyBilled |
| Gross Charges | 0 | GrossCharges |
Form990 Schedule H Part VI Form990ScheduleHPartVI (17 entries)
| ExplanationExplanation | IdentifierIdentifier | Return ReferenceReturnReference |
|---|---|---|
| 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 Clay 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. SVCH 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: Area 7 Agency on Aging, Clay City Jr/Sr High School, District 7 Emergency Preparedness, Northview High School, Step Ahead Community Roundtable, YMCA. | ||
| Part III, Line 4: The organization is a part of the St.Vincent Health System consolidated audit. The provision for bad debts 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 modifications to the provision for bad debts to establish an appropriate allowance for uncollectible 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 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. The share of the bad debt expense in fiscal year 2012 was $1,945,959 at charges ($635,939 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 shortfall is not treated as community benefit. | ||
| Part III, Line 9b: The organization has a written debt collection policy that also includes a provision on the collection practices to be followed for patients who are known to qualify for charity care or financial assistance. If a patient qualifies for charity or financial assistance certain collection practices do not apply. | ||
| Part V, Section B, Line 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.Vincent Clay Hospital, 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.Vincent Clay 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) 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). | St.Vincent Clay Hospital, 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 by methods 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 15: | St.Vincent Clay Hospital, 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 V, Section B, Line 16: | St.Vincent Clay Hospital, Inc.: |
| Part VI, Line 2: Communities are dynamic systems in which multiple factors interact to impact quality of life and health status. St.Vincent Clay Hospital (SVCH) helps to lead a community roundtable called Step Ahead/Literacy Council whose purpose is to periodically assess assets and needs within the community, prioritize action and work in partnership to address identified challenges. As part of the St.Vincent Health System, the goal of SVCH 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. | ||
| Part VI, Line 3: St.Vincent Clay Hospital 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, 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 Clay Hospital is located in Brazil, Indiana which is the county seat and serves Clay and contiguous counties, in west Central Indiana. Clay County is a very rural county which has an estimated population of 26,894, has experienced no population growth over 2010, and whose population over age 45 is higher than state average. Per Capita Personal Income and Median Household Income are below state averages and the annual unemployment rate exceeds state average. Manufacturing provides the largest percentage of employment in the County, followed by Government. While the overall poverty rate is below state average, the poverty rate among children under age 18 exceeds state average. | ||
| 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 Clay 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 Clay Hospital (SVCH) is dedicated to improving the health status and quality of life for the communities it serves. While designated associates at SVCH 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 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.Vincent Health in which SVCH participates. | ||
| IN | Reports Filed With States | Part VI, Line 7 |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Records Maintained | 1 | RecordsMaintained |
Form990 Schedule I Part III Form990ScheduleIPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Type Of Grant | Tuition assistance | TypeOfGrant |
| Number Of Recipients | 3 | NumberOfRecipients |
| Amount Of Cash Grant | 32472 | AmountOfCashGrant |
Form990 Schedule I Part IV Form990ScheduleIPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | Procedure for Monitoring Grants in the U.S.: | Identifier |
| Return Reference | Part I, Line 2: | ReturnReference |
| Explanation | Schedule I, Part I, Line 2: The finance committee ensures that funds are distributed appropriately according to Acension Health's strategic business plan and consistent with corporate policies and procedures. | Explanation |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Idemnification Gross Up Payments | X | IdemnificationGrossUpPayments |
| Written Policy Re T And E Expenses | 1 | WrittenPolicyReTAndEExpenses |
| Substantiation Required | 1 | SubstantiationRequired |
| Compensation Committee | X | CompensationCommittee |
| Independent Consultant | X | IndependentConsultant |
| Written Employment Contract | X | WrittenEmploymentContract |
| Compensation Survey | X | CompensationSurvey |
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 0 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (6 entries)
| Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Katherine Humphreys | |||||||||||||
| 0 | 337361 | 0 | 73454 | 0 | 0 | 0 | 46882 | 0 | 14696 | 0 | 472393 | 0 | 0 |
| Jane E Sweeney | |||||||||||||
| 0 | 97489 | 0 | 13644 | 0 | 0 | 0 | 27916 | 0 | 26501 | 0 | 165550 | 0 | 0 |
| Jerry R Laue | |||||||||||||
| 0 | 176327 | 0 | 47312 | 0 | 0 | 0 | 40605 | 0 | 17639 | 0 | 281883 | 0 | 0 |
| Wayne R Knight | |||||||||||||
| 0 | 148428 | 0 | 21973 | 0 | 0 | 0 | 20206 | 0 | 16700 | 0 | 207307 | 0 | 0 |
| Edward J Allison | |||||||||||||
| 170207 | 0 | 3974 | 0 | 0 | 0 | 15677 | 0 | 19423 | 0 | 209281 | 0 | 0 | 0 |
| Elaine J Kelley | |||||||||||||
| 160374 | 0 | 3745 | 0 | 0 | 0 | 12256 | 0 | 5260 | 0 | 181635 | 0 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Reference | Part I, Line 1a | ReturnReference |
| Explanation | St.Vincent Clay Hospital paid for cell phone usage for three of the listed officers/directors and highest compensated employees in Part VII. St.Vincent Clay 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 Clay Hospital "grossed up" the above applicable non-business expenses and included in the employees' W-2 as additional taxable compensation. | Explanation |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (15 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| Form 990, Part VI, Section A, line 6 | St.Vincent Clay Hospital, Inc. has a single corporate member, St.Vincent Health, Inc. | |
| Form 990, Part VI, Section A, line 7a | St.Vincent Clay 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 Clay Hospital, Inc. | |
| Form 990, Part VI, Section A, line 7b | All decisions that have a material impact to St.Vincent Clay 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 returns, 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. | |
| Form 990, Part VI, Section B, line 15 | Compensation determinations of St.Vincent Clay Hospital's CEO, executive director, or top management officials are made by a compensation committee of St.Vincent Clay Hospital, Inc. and/or St.Vincent Health, Inc. In determining compensation of the organization's CEO, executive director, or top management officials, 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 Clay Hospital's other officers or key employees are made by a compensation committee of St.Vincent Clay Hospital, Inc. and/or 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 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 VII, Section A: | The average hours per week that was devoted to related organizations during the year: Katherine Humphreys - 40 hours Jane E Sweeney - 40 hours | |
| Form 990, Part XI, line 5: | Net unrealized losses on investments: -1,852,553. FAS 158 pension liability -272,773. Total to Form 990, Part XI, Line 5: -2,125,326. | Changes in Net Assets or Fund Balances: |
| Part I, Line 6: | The total number of volunteers for the organization is 25. This consists of volunteers participating in multiple areas throughout the hospital such as hospitality services. Some volunteers also participate in the various community service programs that the hospital performs within the community. | Total Number of Volunteers |
| Part IV, Line 24A: | St.Vincent Clay Hospital, Inc. is a health facility that is part of Ascension Health System. Ascension Health is the borrower for tax exempt hospital revenue bonds. St.Vincent Clay Hospital, Inc. holds an intercompany note payable with Ascension Health, and this information is reported on the balance sheet. | Tax Exempt Bond Issuance |
| Form 990, Part III, Line 4a, 4b and 4c: | St.Vincent Clay Hospital provides the following hospital services: Bone Health (Orthopedics), Cancer (Oncology), Diabetes Care, Digestive Health (Gastroenterology), Emergency Medicine, Laboratory, Pastoral Care, Radiology, Rehabilitation Therapy, Respiratory Care, Surgery. Some of these services operate at a loss in order to ensure that comprehensive services are available to the community. Such community-focused programs improve access to healthcare, advocate for the poor and vulnerable, promote health through free education and screenings and help build better communities by improving quality of life. | Community Benefit Report |
| St.Vincent Clay Hospital (SVCH) is part of St.Vincent Health, a non-profit healthcare system consisting of 20 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 Clay 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 Clay associates and others. Community benefit is not the work of a single department or group within St.Vincent Clay, but is part of the St.Vincent mission and cultural fabric. It is initiated and implemented at all levels of the organization, by each ministry, and in every community. | Community Benefit Overview | |
| 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. SVCH is committed to 100% access, and is proactive in providing healthcare that leaves no one behind. Public Program Participation St.Vincent Clay 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 Assessment True community benefit responds to the particular needs and challenges of the community, building on its unique strengths and assets. So in each of its communities, 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. 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. St.Vincent Clay Hospital works with Indiana State University to complete their community health needs assessments using primary and secondary data. St.Vincent Clay Hospital also participates in the Step Ahead/Literacy Council which is the local community roundtable group that serves Clay County. This council's main focus is to serve any Clay County resident in need of human and social services. Approximately fifteen agencies are represented in this group. Rural and Urban Access to Health As part of its commitment to 100% access, St.Vincent Clay is one of eight St.Vincent Health ministries who participate in Rural and Urban Access to Health (RUAH), a community-based care coordination program. Effective care coordination provides a strategy for addressing certain social determinants of health by assuring barriers to care are addressed and individuals are connected to critical prevention and treatment services. Central to the program is a Health Access Worker whose role is to connect the hospital to the community by helping individuals address barriers to health care, and referring them to other local resources as needed. The Health Access Worker assists individuals with finding a medical home; applying for public programs such as Medicaid, food stamps, and the Healthy Indiana Plan; and in assessing needs so referrals can be made for other forms of community-based assistance. The Health Access Worker also advocates for clients with service providers and serves as a system navigator. RUAH outcomes are measured using the Pathways Model as a means of tracking interventions and improving accountability towards positive measurable changes in patients' lives. During fiscal year 2012, the Health Access Worker opened 659 pathways and completed 571 pathways. Medication Assistance In addition to care coordination, RUAH assists patients who meet income guidelines in obtaining free or reduced-cost prescription drugs. St.Vincent Clay provides a medication assistant who works with a sophisticated and continually-updated database to track eligibility and requirements that vary by company and by medication. In 2012, the medication assistant helped patients obtain a total of 402 medications for which the average wholesale price totaled $294,211. Health Fairs and Screenings St.Vincent Clay Hospital participates in several health fairs and screenings throughout the year, including the Area 7 on Aging Health Fair and Clay County 4H Fair. Participants can be tested for blood pressure, cholesterol tests, and more at low or no cost. Materials on health information and preventative services are a vital part of health fairs and screenings. During fiscal year 2012, SVCH served approximately 200 people through its participation in these health fairs and screenings. Diabetes Education Diabetes is a major and growing health concern in Central Indiana. Uncontrolled, it can take a significant toll on health and lives. St.Vincent Clay offers a Diabetic Education class, a six-week course held throughout the year, free of charge. Instructors, including a nurse, dietician, physical therapist, and pharmacist, focus on problems associated with living with and managing diabetes. The professional team assists diabetics with gaining a better understanding of their disease, teaching them how to adjust their lifestyles and behaviors to develop diabetes self-management skills that will help them live healthier, longer lives. Health Occupations Vocational Instruction St.Vincent Clay Hospital associates provide instruction for the Vocational Health Careers course offered through Clay Community Schools. This course introduces students to various aspects of the health care industry. Students have the opportunity to explore a number of health-related disciplines, learn associated entry level skills, and compare the educational requirements, credentialing and job opportunities of each with their personal abilities and interests as a means to making informed career choices. Varied instructional strategies and technologies are used to introduce medical terminology, anatomy and physiology, and health service legalities, with emphasis on a healthy lifestyle, wellness, health maintenance, and disease prevention. In the second semester, students serve an internship in an area of their interest. 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. In fiscal year 2012, these organizations included: Area 7 Agency on Aging, Clay City Jr/Sr High School, District 7 Emergency Preparedness, and Step Ahead Community Roundtable. | Charity Care and Certain Other Community Benefits at Cost | |
| 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. Athletic Training St.Vincent Clay Hospital maintains a close relationship with Northview High School. As part of that partnership, the hospital pays for a full-time athletic trainer for the school. The athletic trainer assists athletes in achieving their optimum sports performance by recommending and monitoring proper training routines, preventing injuries, and providing immediate care, treatment, and rehabilitation after athletic trauma. The trainer serves as the liaison between players, coaches, physicians and family and is on-call at all of the sports programs. If more than one player is hurt at the same time, the trainer will prioritize the severity of injury. With her walkie-talkie and cell phone, she is prepared for any emergency. This effort is just one way the hospital exhibits its dedication to making sure the children are safe while they play sports. YMCA Partnership YMCA of Clay County and SVCH believe that putting Christian principles into practice through programs that build healthy spirits, minds and bodies will result in a stronger community. Both believe it is important to touch kids' lives with a good foundation and teach important values for them to carry throughout their lives. With the financial support from SVCH, and in conjunction with the "Strong Kids Campaign," the YMCA ensures all children, even those children unable to pay, can participate in its programs. | Community Building Activities |
Schedule R IRS990ScheduleR
Form990 Schedule R Part I Form990ScheduleRPartI (5 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Total IncomeTotalIncome | EOY AssetsEOYAssets | Business Name Line1DirectControllingEntityName/BusinessNameLine1 |
|---|---|---|---|---|---|---|---|---|---|
| CIHS Newco LLC | |||||||||
| 8425 Harcourt Road | Indianapolis | IN | 46260 | 352174403 | Land holding company | IN | 723127 | 5783692 | Central Indiana Health System Cardiac Services Inc |
| HRH SVH Real Estate Development Co LLC | |||||||||
| 10330 N Meridian Ste 430N | Indianapolis | IN | 46290 | 272933470 | Land holding company | IN | -53 | 3078 | StVincent Health Inc |
| StJoseph Primary Care LLC | |||||||||
| 1907 W Sycamore Street | Kokomo | IN | 46901 | 742979291 | Physician practices | IN | 2466221 | 1093367 | StJoseph Hospital & Health Center Inc |
| Quality Healthcare Solutions LLC | |||||||||
| 8425 Harcourt Road | Indianapolis | IN | 46260 | 272818049 | Health care consulting | IN | 12511241 | 33190971 | StVincent Health Inc |
| StVincent Physician Network LLC | |||||||||
| 10330 N Meridian Ste 300 | Indianapolis | IN | 46290 | 201338729 | Physician practices | IN | 75733004 | 24853307 | StVincent Health Inc |
Form990 Schedule R Part II Form990ScheduleRPartII (28 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Direct Controlling Entity NADirectControllingEntityNA | Controlled OrgControlledOrg | Business Name Line1DirectControllingEntityName/BusinessNameLine1 |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Ascension Health | |||||||||||
| PO Box 45998 | St Louis | MO | 63145 | 311662309 | National health system | MO | 501(C)(3) | 11A, I | N/A | 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 | 1 | StVincent Hospital & Health Care Center Inc | |
| Jubilee Partnerships Inc | |||||||||||
| 2301 N Park Avenue | Indianapolis | IN | 46205 | 352060765 | Outreach activities | IN | 501(C)(3) | 1 | 1 | StVincent Hospital & Health Care Center Inc | |
| Rehabilitation Hospital of Indiana Inc | |||||||||||
| 4141 Shore Drive | Indianapolis | IN | 46254 | 351786005 | Rehabilitation hospital | IN | 501(C)(3) | 3 | 1 | StVincent Health Inc | |
| StJohn's Foundation Inc | |||||||||||
| 2015 Jackson Street | Anderson | IN | 46016 | 352053693 | Supporting organization | IN | 501(C)(3) | 11A, I | 1 | StVincent Madison County Health System Inc | |
| StJoseph Hospital & Health Center Inc | |||||||||||
| 1907 W Sycamore Street | Kokomo | IN | 46901 | 350992717 | Hospital | IN | 501(C)(3) | 3 | 1 | StVincent Health Inc | |
| StJoseph Foundation of Kokomo Indiana Inc | |||||||||||
| 1907 W Sycamore Street | Kokomo | IN | 46901 | 237313206 | Supporting organization | IN | 501(C)(3) | 11A, I | 1 | StJoseph Hospital & Health Center Inc | |
| StVincent Carmel Hospital Inc | |||||||||||
| 13500 N Meridian Street | Carmel | IN | 46032 | 743107055 | Hospital | IN | 501(C)(3) | 3 | 1 | StVincent Health Inc | |
| StVincent Dunn Hospital Inc | |||||||||||
| 1600 23rd Street | Bedford | IN | 47421 | 272192831 | Critical access hospital | IN | 501(C)(3) | 3 | 1 | StVincent Health Inc | |
| StVincent Fishers Hospital Inc | |||||||||||
| 13861 Olio Road | Fishers | IN | 46037 | 454243702 | Hospital | IN | 501(C)(3) | 3 | 1 | StVincent Health Inc | |
| StVincent Frankfort Hospital Inc | |||||||||||
| 1300 S Jackson | Frankfort | IN | 46041 | 352099320 | Critical access hospital | IN | 501(C)(3) | 3 | 1 | StVincent Health Inc | |
| StVincent Frankfort Hospital Foundation Inc | |||||||||||
| 1300 S Jackson | Frankfort | IN | 46041 | 351531734 | Supporting organization | IN | 501(C)(3) | 11A, I | 1 | StVincent Frankfort Hospital Inc | |
| StVincent Health Inc | |||||||||||
| 8425 Harcourt Road | Indianapolis | IN | 46260 | 352052591 | Parent company | IN | 501(C)(3) | 11C, III-FI | 0 | Ascension Health | |
| StVincent Hospital and Health Care Center Inc | |||||||||||
| 2001 W 86th Street | Indianapolis | IN | 46260 | 350869066 | Hospital | IN | 501(C)(3) | 3 | 1 | StVincent Health Inc | |
| StVincent Hospital Foundation Inc | |||||||||||
| 10330 N Meridian Street Ste 430N | Indianapolis | IN | 46290 | 356088862 | Supporting organization | IN | 501(C)(3) | 11A, I | 1 | StVincent Hospital & Health Care Center Inc | |
| StVincent Jennings Hospital Inc | |||||||||||
| 301 Henry Street | North Vernon | IN | 47265 | 351841606 | Critical access hospital | IN | 501(C)(3) | 3 | 1 | StVincent Health Inc | |
| StVincent Madison County Health System Inc | |||||||||||
| 1331 South A Street | Elwood | IN | 46036 | 350876389 | Hospital | IN | 501(C)(3) | 3 | 1 | StVincent Health Inc | |
| StVincent Medical Group Inc | |||||||||||
| 8425 Harcourt Road | Indianapolis | IN | 46260 | 272039417 | Physician professional services | IN | 501(C)(3) | 9 | 1 | StVincent Health Inc | |
| StVincent Mercy Hospital Foundation Inc | |||||||||||
| 1331 South A Street | Elwood | IN | 46036 | 311066871 | Supporting organization | IN | 501(C)(3) | 11A, I | 1 | StVincent Madison County Health System Inc | |
| StVincent New Hope Inc | |||||||||||
| 8450 N Payne Road | Indianapolis | IN | 46260 | 351733591 | Intermediate care facility | IN | 501(C)(3) | 9 | 1 | StVincent Health Inc | |
| StVincent Pediatric Rehab Center Inc | |||||||||||
| 1707 W 86th Street | Indianapolis | IN | 46260 | 352048898 | Specialty hospital | IN | 501(C)(3) | 3 | 1 | StVincent Hospital & Health Care Center Inc | |
| StVincent Randolph Hospital Inc | |||||||||||
| 473 Greenville Avenue | Winchester | IN | 47394 | 352103153 | Critical access hospital | IN | 501(C)(3) | 3 | 1 | StVincent Health Inc | |
| StVincent Randolph Hospital Foundation Inc | |||||||||||
| 473 Greenville Avenue | Winchester | IN | 47394 | 352133006 | Supporting organization | IN | 501(C)(3) | 11A, I | 1 | StVincent Randolph Hospital Inc | |
| StVincent Salem Hospital Inc | |||||||||||
| 911 N Shelby Street | Salem | IN | 47167 | 270847538 | Critical access hospital | IN | 501(C)(3) | 3 | 1 | StVincent Health Inc | |
| StVincent Seton Specialty Hospital Inc | |||||||||||
| 8050 Township Line Road | Indianapolis | IN | 46260 | 351712001 | Long term care hospital | IN | 501(C)(3) | 3 | 1 | StVincent Health Inc | |
| StVincent Williamsport Hospital Inc | |||||||||||
| 412 N Monroe Street | Williamsport | IN | 47993 | 350784551 | Critical access hospital | IN | 501(C)(3) | 3 | 1 | StVincent Health Inc | |
| StVincent Williamsport Hospital Foundation Inc | |||||||||||
| 412 N Monroe Street | Williamsport | IN | 47993 | 743130159 | Supporting organization | IN | 501(C)(3) | 11A, I | 1 | StVincent Williamsport Hospital Inc | |
| SVSM Inc | |||||||||||
| 2001 W 86th Street | Indianapolis | IN | 46260 | 810607827 | Holding company | IN | 501(C)(3) | 11A, I | 1 | StVincent Health Inc | |
Form990 Schedule R Part III Form990ScheduleRPartIII (14 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivityPrimaryActivity | Legal Domicile StateLegalDomicileState | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Predominant Income TypePredominantIncomeType | Share Of Total IncomeShareOfTotalIncome | Share Of EOY AssetsShareOfEOYAssets | Disproportionate AllocationsDisproportionateAllocations | General Or Managing PartnerGeneralOrManagingPartner | Percentage OwnershipPercentageOwnership |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Breast MRI Leasing Company LLC | |||||||||||||
| 10330 N Meridian St Ste 430N | Indianapolis | IN | 46290 | 426662493 | Sale and rental services | IN | StVincent Hospital and Health Care Center Inc | Related | 175851 | 43187 | 0 | 0 | 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 | 5550103 | 2123722 | 0 | 0 | 0.45000 |
| Chartwell Midwest Indiana LLC | |||||||||||||
| 8040 Castleway Drive | Indianapolis | IN | 46250 | 351985233 | Home care IV/infusion services | IN | StVincent Hospital and Health Care Center Inc | Related | 21594 | 0 | 0 | ||
| Cooperative Managed Care Services LLC | |||||||||||||
| 6602 E 75th Street Suite 300 | Indianapolis | IN | 46250 | 351999227 | Case management | IN | StVincent Hospital and Health Care Center Inc | Unrelated | 225965 | 1948010 | 0 | 0 | 0.50000 |
| Endoscopy Center LLC | |||||||||||||
| 13421 Old Meridian St Ste 150 | Carmel | IN | 46032 | 320029881 | Endoscopy center | IN | StVincent Carmel Hospital Inc | Related | 739619 | 386382 | 0 | 0 | 0.51000 |
| Fishers Ambulatory Surgery Center LLC | |||||||||||||
| 136914 E State Road 238 | Fishers | IN | 46037 | 262001288 | Ambulatory surgery center | IN | StVincent Hospital and Health Care Center Inc | Related | -277416 | 1482158 | 0 | 0 | 0.81720 |
| 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 | -2449051 | 1776331 | 0 | 0 | 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 | 1742 | 1794248 | 0 | 0 | 0.50000 |
| Lafayette Heart Program Holding LLC | |||||||||||||
| 11515 W Dragoon Trail | Mishawaka | IN | 46544 | 383750811 | Cardiac care services | IN | Central Indiana Health System Cardiac Services Inc | Related | 8000000 | 0 | 0 | 0.49000 | |
| Meridian Heights Associates LLC | |||||||||||||
| 6100 W 96th Street Ste 250 | Indianapolis | IN | 46278 | 264020296 | Real estate holding | IN | StVincent Carmel Hospital Inc | Related | -509229 | 2230351 | 0 | 0 | 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 | 169059 | 1983633 | 0 | 0 | 0.50000 |
| StVincent HealthUSP LLC | |||||||||||||
| 15305 Dallas Pkwy Ste 1600 | Addison | TX | 75001 | 203749962 | Ambulatory surgery center | IN | StVincent Health Inc | Related | 140666 | 445060 | 0 | 0 | 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 | 18258387 | 78629927 | 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 | -57227 | 264483 | 0 | 0 | 0.58900 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 1 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 1 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 0 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 0 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 0 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 0 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 0 | SharingOfFacilities |
| Sharing Of Paid Employees | 0 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 1 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |