2012-05-10T10:37:32-05:00 2011-09-30 Arnett & Foster PLLC P O Box 2629 Charleston WV 25329 990 2010-10-01 550688201 Pallottine Health Services Inc PALL 3045261224 2900 First Avenue Huntington WV 25702 Michael G Sellards 3045261224 2012-05-08 1 Harry C Harless 3043460441 2010 2016-02-24 21:20:13Z Michael G Sellards 2900 First Avenue Huntington WV 25702 7918381 0 0928 X N/A X 1988 WV The organization provides management services, advice and consultation to West Virginia affiliates sponsored by the religious community of the Missionary Sisters of the Catholic Apostolate (Pallottine). 10 9 5 7 1744 0 0 0 962089 1172783 179942 1182695 110767 884411 1252798 3239889 43750 33000 0 0 1162244 1611423 0 0 0 693609 702567 1899603 2346990 -646805 892899 17228178 17150011 9898324 10416101 7329854 6733910 X The mission of Pallottine Health Services, Inc. is to sponsor Health Care institutions that promote and demonstrate the human\religious, professional and economic values of the Pallottine sisters which are consistent with the teachings of the Roman Catholic Church and the ethical and religious directives for Catholic health care services. Adherence to these values will ensure that services provided in Pallottine health facilities respect the dignity of the human person and the sacredness of human life; are carried out in a spirit of ecumenisn and equality in an atmosphere of Christian community; and respond, within the limits of available resources, to the health need of the communities they serve with special concern for the poor. 0 0 1957672 33000 1172783 Management services, advice and consultation provided to the West Virginia Affiliates sponsored by the religious community of Missionary Sisters of the Catholic Apostolate (Pallottine) - St. Joseph's Hospital of Buckhannon, Inc. and St. Mary's Medical Center, Inc. 1957672 1 0 0 0 0 0 0 0 0 1 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 3 0 1 5 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 10 9 0 0 0 0 1 1 1 1 1 0 1 1 1 1 1 1 1 1 1 1 0 CA NY NC X Angela Swearingen 3045261224 2900 First Avenue Huntington WV 25702 Sr M Celeste Lynch SAC 37.00 X X 0 0 0 Sr M Diane Bushee SAC 2.00 X X 0 0 0 Sr M Francesca Lowis SAC 2.00 X X 0 0 0 Sr Barbara Jakschik SAC 1.00 X 0 0 0 Sr Mary Grace Barile SAC 2.00 X 0 0 0 Sr Marian Creamer SAC 2.00 X 0 0 0 Sr Gail Borgmeyer SAC 2.00 X 0 0 0 Barbara Stevens 2.00 X 0 0 0 Robert Yost 1.00 X 0 0 0 David Alkire 1.00 X 0 0 0 Michael G Sellards 2.00 X 628376 0 74071 Sue Johnson-Phillippe 2.00 X 290212 0 0 Todd Campbell 2.00 X 0 346813 53551 J Thomas Jones X 148994 0 0 S David Creech X 558248 0 0 1625830 346813 127622 4 1 1 0 0 Management fees 561000 1172783 1172783 1172783 726416 726416 5134771 4678492 456279 456279 456279 Premier Purchasing, LL 900003 882554 1744 880810 Other Income 900099 1857 1857 884411 3239889 1172783 1744 2065362 33000 33000 1483437 1281986 201451 45206 39067 6139 9092 7857 1235 25543 22074 3469 48145 41607 6538 67185 67185 300 300 19408 19408 552008 477045 74963 1156 999 157 6350 5488 862 14467 12502 1965 1122 970 152 5833 5041 792 21004 18152 2852 Dues & subscriptions 7862 6794 1068 Other expenses 5872 5090 782 2346990 1957672 389318 0 1740305 940893 991758 1043781 7316216 7420668 11305 12007 10081 119783 80049 66495 19387 13554 6115339 6031049 1023787 1568276 17228178 17150011 8048218 9098985 17624 10858 1832482 1306258 9898324 10416101 X 7329854 6733910 7329854 6733910 17228178 17150011 X 892899 -1488843 X X 0 1 1 X 0 X X 0 0 0 St Joseph's of Buckhannon Inc 550356996 3 1 1 1 2000 St Mary's Medical Center Inc 550357050 3 1 1 1 0 St Joseph's Foundation of Buckhannon Inc 550727650 3 0 1 1 7000 St Mary's Medical Center Foundation 141887211 3 0 1 1 10000 4 19000 80049 66495 13554 13554 Premier Purchasing Partners 453962 Chart Services 1114314 1568276 Separation Liability 262477 Retirement Funds Payable 1043781 1306258 3239889 2346990 892899 -635623 -39075 -814145 -1488843 -595944 2425744 68409 68409 2357335 882554 882554 3239889 2346990 0 2346990 0 2346990 Part XI, Line 8 - Other Adjustments: Premier Purchasing dividends 68,409. Premier Purchasing K-1 income -882,554. Part XII, Line 2d - Other Adjustments: Premier Purchasing dividends 68,409. Part XII, Line 4b - Other Adjustments: Premier Purchasing K-1 income 882,554. 0 St Mary's Medical Center Foundation 2900 First Avenue Huntington WV 25702 141887211 501(c)(3) 10000 To support 2011 Gala. St Joseph's Hospital Foundation 1 Amalia Drive Buckhannon WV 26201 550356996 501(c)(3) 3000 To support 2011 Gala. St Joseph's Hospital Foundation 1 Amalia Drive Buckhannon WV 26201 550356996 501(c)(3) 1000 To support 2011 Golf Tournament. St Joseph's Hospital Foundation 1 Amalia Drive Buckhannon WV 26201 550356996 501(c)(3) 3000 To be used for general purposes of the tax-exempt organization. Procedure for Monitoring Grants in the U.S.: Part I, Line 2: Schedule I, Part I, Line 2: Grants paid in the U.S. are only paid to healthcare providers sponsored by religious community of Missionary Sisters of the Catholic Apostolate (Pallottine). As disclosed on schedule A, Part I the filing organization is organizaed and operated to mainly support the West Virginia affiliates of Pallotine, St. Joseph's Hospital of Buckhannon, Inc. and St. Mary's Medical Center and their related foundations. The use of the grants to these organizations is monitored through a review of their financial statements and budgets. X X 1 1 X X X X 1 1 0 0 0 0 0 0 0 Michael G Sellards 522720 0 0 0 105656 0 57688 0 17543 0 703607 0 94386 0 Sue Johnson-Phillippe 290212 0 0 0 0 0 0 0 0 0 290212 0 0 0 Todd Campbell 0 346813 0 0 0 0 16500 15607 0 22267 16500 384687 0 0 J Thomas Jones 0 0 0 0 148994 0 0 0 0 0 148994 0 0 0 S David Creech 0 0 0 0 558248 0 0 0 0 0 558248 0 0 0 Part I, Line 1a Michael Sellards, the CEO, is entitled to reimbursement for reasonable travel expense for his spouse to accompany him to three educational meetings per year; one of which being the West Virginia Hospital Association annual meeting. Part I, Lines 4a-b S. David Creech, a former officer, received severance payments during the year in the amount of $553,221, Tony Atkins, a former officer received noncompete payments in the amount of $73,139. During 2011 fiscal year, the following officers of the organization received payment under a supplemental non-qualified retirement (SERP) plan: Michael G. Sellards - $94,376 Todd Campbell - $27,757 West Virginia Hospital Finance Authority 621256910 956624AL4 2003-12-18 61000000 See Schedule O. 0 0 0 West Virginia Hospital Finance Authority 621256910 956624AM2 2006-04-26 35000000 See Schedule O. 0 0 0 West Virginia Hospital Finance Authority 621256910 NoneAvail 2009-06-23 17500000 See Schedule O. 0 0 0 63222662 4335455 546375 38872275 2006 1 0 1 1 37212762 462632 34778643 2013 0 0 0 1 17543356 120000 17432510 2010 0 0 1 1 0 0 1 0 1 0.50000 0.00000 0.50000 1 0 0 0 0 1 0.00000 0.00000 0.00000 1 0 0 0 0 1 0.00000 0.00000 0.00000 1 0 1 0 0 0 0 1 1 1 Fifth Third Bank 2.000000000000 0 0 1 0 1 0 0 1 0 0 0 0 Form 990, Part VI, Section A, line 6 The organization is a membership (not a stock) Corporation under West Virginia state law. The organization's sole Corporate sponsor is Pallottine Missionary Sisters(PMS), a related not-for-profit organization. Form 990, Part VI, Section A, line 7a In accordance with the terms and requirements of its governing documents (i.e. bylaws), on an annual basis, the organization's current board members recommend the list of candidates for membership to the governing body for the subsequent term. The Board of Directors of its sponsor, PMS, approve these candidates to serve as the organization's Board of Directors. Form 990, Part VI, Section A, line 7b Pallottine Missionary Sisters, as the sole Corporate member, also has the right to approve or ratify significant decisions of the organization's governing body including the amendment of bylaws and charters, removal of members of the governing body, and the decision to dissolve the organization. Form 990, Part VI, Section B, line 11 The Form 990 is reviewed by the organization's management in consultation with an independent accounting firm. The financial review is based on the organization's audited financial statements for the relevant time period. The Board of Directors has reviewed the Form 990 at the board meeting on April 18, 2012 prior to filing the Form 990. Form 990, Part VI, Section B, line 12c Upon employment and annually thereafter each key employee and officer of the organization is required to complete a conflict of interest and disclosure form, providing sufficient information about his/her personal interests and relationships so the organization can: (1) determine whether any potential or actual conflicts of interest may exist, and (2) monitor work or service assignments to avoid placing the key employee, officer or director in a position where there may be an appearance, potential or actual, of a conflict of interest or a question of objectivity. The completed conflicts of interest and disclosure forms for directors are returned to the organization. In the event that any board member is deemed to lack independence or a conflict of interest exists, he/she is required to leave the room and cannot be part of the discussion or vote. Form 990, Part VI, Section B, line 15 On a regular basis, the organization provides documentation to the compensation committee of the board with respect to the compensation of the organization's officers and key employees for review and approval. Such information includes comparable data from similar size tax-exempt organizations in the Huntington, West Virginia community as well as compensation for these positions (as disclosed on form 990) with other organizations in the health care industry that are of similar size, demographics, and geography. Review and approval of the compensation arrangement by the officers/executive committee is documented. Form 990, Part VI, Section C, line 19 The organization makes its governing documents, conflict of interest policy, and financial statements available to the public upon request at its office at 2900 First Avenue, Huntington, WV 25702. A nominal fee is charged if copies are requested. Changes in Net Assets or Fund Balances: Form 990, Part XI, line 5: Net unrealized losses on investments: -635,623. Prior period adjustments: -39,075. Premier Purchasing dividends 68,409. Premier Purchasing K-1 income -882,554. Total to Form 990, Part XI, Line 5: -1,488,843. Audit oversight Part XII, Line 2c There was no change in the procedure for oversight of the audit of financial statements from prior year. Description of purpose Schedule K, column F The tax exempt bonds are reported in the accounting records of St. Josephs's Hospital of Buckhannon, Inc. and St. Mary's Medical Center. Since the bond proceeds are issued on behalf of Pallottine Health Services, Inc., we have reported them on our form 990. SCHEDULE K, PART I, LINE A, COLUMN (F): Constructing/renovating and equipping healthcare facilities. Refunded bonds issued November 24, 1987. SCHEDULE K, PART I, LINE B, COLUMN (F): Constructing/renovating and equipping healthcare facilities. SCHEDULE K, PART I, LINE C, COLUMN (F): Constructing/renovating and equipping healthcare facilities. St Mary's Medical Center 2900 First Avenue Huntington WV 25702 550357050 Hospital WV 501(c)(3) Line 3 N/A 0 Pallottine Missionary Sisters 15270 Old Halls Ferry Road Florissant MO 63034 431783315 Church MO 501(c)(3) Line 1 N/A 0 St Joseph's Hospital of Buckhannon 2900 First Avenue Huntington WV 25702 550356996 Hospital WV 501(c)(3) Line 3 N/A 0 St Joseph's Foundation of Buckhannon 1 Amalia Drive Buckhannon WV 26201 550727650 Foundation WV 501(c)(3) Line 11b, II St Joseph Hospital of Buckhannon 0 St Mary's Medical Center Foundation 2900 First Avenue Huntington WV 25702 141887211 Foundation WV 501(c)(3) Line 11b, II St Mary's Medical Center 0 St Mary's Occupational Health Services 2900 First Avenue Huntington WV 25702 542136110 Medical Services WV St Mary's Medical Center Related 0 1 Tri State Cyberknife 2900 First Avenue Huntington WV 25702 205744723 Medical Services WV St Mary's Medical Center Related 0 1 Tri State MRI PO Box 3108 Huntington WV 25702 550669726 Medical Services WV St Mary's Medical Center Related 0 1 Claire Frances Health Services PLLC 200 Mall Road Suite 3 Ashland KY 41101 311517507 Medical Services WV St Mary's Medical Center Related 0 1 Huntington Area MRI Services LLC 2900 First Avenue Huntington WV 25702 261877332 Medical Services WV Related 0 1 Vanguard Financial Services 2900 First Avenue Huntington WV 25702 450496141 Collection AG WV St Mary's Medical Center C Upshur Medical Management Services 1 Amalia Drive Buckhannon WV 26201 550727649 Medical Services WV St Joseph's Hospital of Buckhannon C 0 0 0 1 1 0 0 0 0 0 1 0 0 0 0 1 0 0 St Joseph's Hospital of Buckhannon D 1540000 St Mary's Medical Center D 8161555 St Mary's Medical Center K 872783 St Joseph's Hospital of Buckhannon K 300000 St Mary's Medical Center P 8794091 St Joseph's Hospital of Buckhannon P 549321