2019-05-13T19:24:39-05:00 2018-06-30 990 2017-07-01 352103153 St Vincent Randolph Hospital Inc STVI 3147338000 473 Greenville Avenue Winchester IN 473949436 Tonya Mershon Tax Officer 2019-05-13 2017 2019-02-21 02:37:17Z Osborne J Morgan 473 Greenville Avenue Winchester IN 473949436 21856245 false X www.stvincent.org/Locations/Hospitals/Randolph X 2000 IN To improve the health and well-being of all people in the communities we serve. 13 9 136 27 0 0 65688 49657 25169325 21588565 1171 6234 212955 211789 25449139 21856245 0 41602 0 10126112 8181560 0 0 0 12333468 14324968 22459580 22548130 2989559 -691885 16125108 16128951 20171284 19448567 -4046176 -3319616 Our Mission as part of a Catholic health care system is to further the healing ministry of Jesus by continually improving the health and well-being of all people, especially the poor, in the communities we serve. false false 13997861 41602 21588565 St. Vincent Randolph Hospital is a 25-bed hospital campus providing services without regard to patient race, creed, national origin, economic status, or ability to pay. During fiscal year 2018, St. Vincent Randolph Hospital treated 532 adults and children for a total of 1,654 patient days of service. The hospital also provided services for 46,434 outpatient visits, which included 355 outpatient surgeries and 8,562 Emergency Room Visits. See Schedule H for a non-exhaustive list of community benefit programs and descriptions. 13997861 true true false true false false false false false true false false true true true false true false false false false false false false false true true true false true false false false false false false false false false false false false false true true true false false true 44 0 true 136 true false false false false false false true false false false X 13 9 false false false false true true true true true false false false true true true true true false false false IN X SARA OBRIEN 3147338070 11775 BORMAN DRIVE MARYLAND HEIGHTS MO 63146 OSBORNE J MORGAN CHAIR 1.0 2.0 X X 0 0 0 MARK C MCDERMIT VICE CHAIR 1.0 2.0 X X 0 0 0 DAVID C MARES MD SECRETARY 1.0 2.0 X X 0 0 0 BRIAN EDWARDS TREASURER 1.0 2.0 X X 0 0 0 CYNTHIA D ADAMS RN DIRECTOR 1.0 42.0 X 0 745872 18740 MICHAEL K SCHROYER EX-OFFICIO 10.0 31.0 X 0 528434 53599 MICHAEL D AUSTIN DIRECTOR 1.0 3.0 X 0 0 0 AARON G SHOEMAKER MD DIRECTOR 1.0 57.0 X 0 476343 50924 JOSEPH F BARNETT DDS DIRECTOR 1.0 2.0 X 0 0 0 JEAN L CHAILLE RN DIRECTOR 1.0 11.0 X 0 20151 504 SISTER EILEEN FLAVIN DIRECTOR 1.0 2.0 X 0 0 0 JOHN S PISTOLE DIRECTOR 1.0 2.0 X 0 0 0 BOBBETTE J SNYDER DIRECTOR 1.0 2.0 X 0 0 0 BETHANY L MORROW VP, FINANCE (START 1/2018) 5.0 36.0 X 0 170340 26718 FRANCIS G ALBARANO ADMINISTRATOR (END 12/2017) 20.0 22.0 X 295274 0 40829 JOHN M ARTHUR EXECUTIVE DIRECTOR, FINANCE (END 12/2017) 20.0 22.0 X 182344 0 33384 CARLA A FOUSE RN ADMINISTRATOR (START 1/2018)/CNO 40.0 1.0 X 139178 0 29406 KATHRYN A WREN MANAGER, PHARMACY 40.0 0 X 157315 0 37683 CARI A PRINKEY PHARMACIST 40.0 0 X 113106 0 36241 ANITA K HINES MANAGER, IMAGING SERVICES 40.0 0 X 112505 0 15780 KAREN J WARD MANAGER, PATIENT CARE UNIT 40.0 0 X 106049 0 7872 THOMAS J VANOSDOL FORMER OFFICER (END 12/2015) 0.0 50.0 X 0 926860 45050 1105771 2868001 396730 9 true true false MID AMERICA CLINICAL LABORATORIES PO BOX 642263 PITTSBURGH PA 15264 LAB SERVICES 1619815 INDIANA EMERGENCY PHYSICIANS LLP 4075 COPPER RIDGE DR TRAVERSE CITY MI 49684 PHYSICIANS 543015 MILESTONE CONTRACTORS LP PO BOX 421459 INDIANAPOLIS IN 46242 CONSTRUCTION 101902 3 X 39657 10000 49657 Net Patient Service Revenue 621990 21229428 21229428 Rental Income from Affiliates 531120 356269 356269 Lab Services 621500 2868 2868 0 0 0 0 21588565 1034 1034 137773 0 137773 0 137773 137773 5200 0 0 5200 5200 5200 Cafeteria/Vending Revenue 722514 63315 63315 Medical Records Fees 900099 2228 2228 Escheatment Revenue 900099 1763 1763 6710 0 0 6710 74016 21856245 21588565 0 218023 41602 41602 720416 597946 122470 5633366 4672779 960587 227715 188880 38835 1184525 982572 201953 415538 344703 70835 19863 19863 684 684 1582726 1483873 98853 0 9644 9644 48859 20031 28828 5777 902 4875 451685 9303 442382 39526 18690 20836 14757 14728 29 494675 494675 1110235 497012 613223 96553 96553 Purchased Services 3444827 1804334 1640493 Management Fee to Affiliate 2133252 2133252 Medical Supplies 2025402 2013725 11677 Corporate Expense 1433910 119069 1314841 1412593 1187712 224881 0 22548130 13997861 8550269 0 0 550 18092 91665 2828349 3309457 0 0 0 0 311812 356671 481 74436 26050708 14836110 11372021 11214598 0 0 15346 38902 1579007 1042672 16125108 16128951 2579588 2069474 0 0 17591696 17379093 20171284 19448567 X -4046176 -3319616 -4046176 -3319616 16125108 16128951 X -691885 1418445 X false true X true true true X false false false false false false false false true 684 684 false Schedule C, Part II-B, Line 1 DETAILED DESCRIPTION OF THE LOBBYING ACTIVITY Lobbying expenses represent the portion of dues paid to national and state hospital associations that is specifically allocable to lobbying. St. Vincent Randolph Hospital, Inc. does not participate in or intervene in (including the publishing or distributing or statements) any political campaign on behalf of (or in opposition to) any candidate for public office. Schedule C, Part II-B, Line 1 DETAILED DESCRIPTION OF THE LOBBYING ACTIVITY Lobbying expenses represent the portion of dues paid to national and state hospital associations that is specifically allocable to lobbying. St. Vincent Randolph Hospital, Inc. does not participate in or intervene in (including the publishing or distributing or statements) any political campaign on behalf of (or in opposition to) any candidate for public office. 696652 696652 18562999 10237861 8325138 6109762 4598249 1511513 681295 681295 11214598 Pension and Other Post Retire Assets Other Assets 29428 Due from Affiliates 697407 Other Receivables 305509 Estimated 3rd Party Payor Settlements 10328 1042672 0 Due to Affiliates 2001779 Other Liabilities 370183 Estimated 3rd Party Payor Settlement 1386344 Recovery Tail Liability 50000 Debt with Ascension Health Alliance 13570787 17379093 X Schedule D, Part X, Line 2 FIN 48 (ASC 740) footnote The System accounts for uncertainty in income tax positions by applying a recognition threshold and measurement attribute for financial statement recognition and measurement of a tax position taken or expected to be taken in a tax return. The System has determined that no material unrecognized tax benefits or liabilities exist as of June 30, 2018. true true X true X 250 true X true true true false true true 1936279 0 1936279 0.0859 6859761 3276879 3582882 0.1589 0 0.0 0 0 8796040 3276879 5519161 0.2448 8 3727 114917 0 114917 0.0051 0 0.0 0 0.0 0 0.0 2 183 3050 0 3050 0.0001 10 3910 117967 0 117967 0.0052 10 3910 8914007 3276879 5637128 0.2500 0 0.0 0 0.0 1 221 714 0 714 0.0000 0 0.0 0 0.0 1 302 617 0 617 0.0000 1 2800 4326 0 4326 0.0002 0 0.0 0 0.0 3 3323 5657 0 5657 0.0003 false 93261 0 7443077 7364316 78761 X true true 1 1 St Vincent Randolph Hospital Inc 473 Greenville Avenue Winchester IN 47394 www.stvincent.org/Locations/Hospitals/Randolph 17-005050-1 X X X X St Vincent Randolph Hospital Inc 1 false false true X X X X X X X X X 15 true true false true X https://www.stvincent.org/how-we-are-different/community-assessment X true 16 true https://www.stvincent.org/how-we-are-different/community-assessment false true X 250.0 400.0 X true true X X X true X HTTPS://WWW.STVINCENT.ORG/Billing-Services X HTTPS://WWW.STVINCENT.ORG/Billing-Services X HTTPS://WWW.STVINCENT.ORG/Billing-Services X X X X X X true X false X X X X true X false false Schedule H, Part V, Section B, Line 3E To better target community resources on the service area's most pressing health needs, the hospital participated in a group discussion with organizational decision makers and community leaders to prioritize the significant community health needs while considering several criteria: alignment with Ascension Health strategies of healthcare that leaves no one behind; care for the poor and vulnerable; opportunities for partnership; availability of existing programs and resources; addressing disparities of subgroups; availability of evidence-based practices; and community input. The significant health needs are a prioritized description of the significant health needs of the community as identified through the CHNA. See Schedule H, Part V, Line 7 for the link to the CHNA and Schedule H, Part V, Line 11 for how those needs are being addressed." Schedule H, Part V, Section B, Line 5 Facility , 1 Facility , 1 - St. Vincent Randolph Hospital, Inc.. As federally required by the Affordable Care Act, the following is an overview of the methods and process used to identify and prioritize significant health needs in Randolph County, Indiana. St. Vincent Health contracted Healthy Communities Institute (HCI) to help facilitate their system wide CHNA work and document all efforts. The secondary data included over 100 community health and quality of life indicators covering over 20 topic areas. Health indicators for Randolph County were compared to other counties in Indiana and nationwide to score health topics and compare relative areas of need. Other considerations for health areas of need included trends over time, Healthy People 2020 targets, and disparities by gender and race/ethnicity. The needs assessment was further informed by interviews with community members who have a fundamental understanding of Randolph County's health needs and represent the broad interests of the community. Five key informants provided valuable input on the county's health challenges, the sub-populations most in need, and existing resources for county residents. The informants included: *Randolph County Council *Randolph County Health Department *Randolph County Tourism Board *Randolph County YMCA * St. Vincent Randolph Schedule H, Part V, Section B, Line 6a Facility , 1 Facility , 1 - St. Vincent Randolph Hospital, Inc.. The hospital conducted its CHNA in conjunction with Community Health Network, Franciscan Health and Indiana University Health. Schedule H, Part V, Section B, Line 11 Facility , 1 Facility , 1 - ST. VINCENT RANDOLPH HOSPITAL, INC.. The St. Vincent FY 2017-2019 Implementation Strategy specifically addresses the following three SWHIPs: 1) Access to Health Services - St Vincent Randolph will use the RUAH Pathway Program to increase its reported number of completed pathways (i.e., verification from FSSA) in FY 2015 by 5% each year for FYs 2017-2019. Achieving this goal will contribute to the percentage of people who have health insurance in Randolph County.Specific action steps include the following: Health Advocate (HA) assesses for eligibility and educates individuals about coverage options; HA submits application and works through any issues or delays; and HA verifies eligibility in order to complete the Pathway. 2) Exercise, Nutrition & Weight - St. Vincent Randolph will partner with a school and a food source to provide eligible students with a weekend backpack of nutritious food throughout the school year in order to reduce the school's number of families in FY 2018 who are food insecure (based on survey responses) by 5% at the end of FY 2019 (June 30, 2019). (NOTE: FY 2017 is the planning year for the program.) Specific action steps include the following: complete the Weekend Feeding Program Preparation Checklist; meet with all stakeholders to determine program logistics; plan the specifics of your program's protocol; make final preparations for the program's "go live" date in FY 2018; and distribute and collect surveys, enter survey data into software at the beginning and end of the school year (twice a year in FY 2018 and FY 2019). 3) Behavioral Health - St. Vincent Randolph will offer Rx for Change training at no charge to anyone who works in a health care setting to increase the proportion of training participants who screen and refer to the Indiana Tobacco Quitline by 10% by the end of FY 2019 (June 30, 2019). Achieving this goal will contribute to the percentage of tobacco users who have been screened and referred to the Indiana Tobacco Quitline. Specific action steps include the following: complete the Provider Training Checklist - Action Step #1; plan at least two Rx for Change trainings in your community in FY 2018 and ensure continuing education credits are available, if applicable (See Provider Training Checklist - Action Step #2); develop a strategy to promote trainings to the community; promote and offer at least two Rx for Change trainings at no charge to your community in FY 2018; enter FY 2018 baseline survey data into database within two weeks of each training; for FY 2019 - Repeat Action Steps #2-4 to plan, develop, and promote and offer at least two Rx for Change trainings at no charge to your community in FY 2019; and enter FY 2019 baseline survey data into database within two weeks of each training. Needs That Will Not Be Addressed - The hospital is committed to improving community health by directly, and indirectly, addressing prioritized health needs. However, certain factors impact the hospital's ability to fully address all priorities health needs. The needs listed below are not included in the hospital's implementation strategy plan for the following reasons: Social Environment - This identified health need is not being monitored and evaluated in the Implementation Strategy due to limitations within the hospital's financials and human resources. However, St. Vincent Randolph supports the EPIC (Eliminating Poverty in Our Community) Coalition and other organizations that focus on this issue. Children's Health - This issue is being addressed in the Access to Health Services priority. 0 Schedule H, Part I, Line 7 CHARITY CARE AND CERTAIN OTHER COMMUNITY BENEFITS AT COST COMMUNITY BENEFIT OVERVIEW St. Vincent Randolph Hospital is a Catholic healthcare facility located in the state of Indiana. St. Vincent Randolph is a part of St. Vincent Health, a non-profit healthcare system consisting of 24 locally-sponsored ministries which includes a comprehensive network of affiliated joint ventures, medical practices, and clinics. St. Vincent Health is one of the largest healthcare employers in the state and is sponsored by Ascension Health, the nation's largest Catholic healthcare system. St. Vincent creates strong partnerships with businesses, community organizations, local, state and federal government. Working with its partners, and utilizing the CHNA completed every three years, St. Vincent Randolph Hospital is committed to addressing community health needs and developing and executing an implementation strategy to meet identified needs to improve health outcomes within the community. Community benefit is not the work of a single department or group within St. Vincent Randolph, but is part of the St. Vincent mission and cultural fabric. The hospital leadership team provides direction and resources in developing and executing the Implementation Strategy in conjunction with the St. Vincent Health Community Development & Health Improvement Department but associates at all levels of the organization contribute to community benefit and health improvement. Part I Certain Other Community Benefits at Cost Community health improvement efforts must take a comprehensive approach and utilize diverse methods to reach intended audiences. As a system, St. Vincent works to improve the health of communities through a variety of approaches, including community health improvement services, health professions education, subsided health services, generalizable research, and cash and in-kind contributions. During fiscal year 2018, St. Vincent supported the community in the following ways: Community Health Improvement Services Community Health Education St. Vincent provides health education on several topics and issues facing the local community throughout the year. The information is offered to the community through a variety of methods, which include, but are not limited to the following: health fairs, health promotion and wellness programs, lectures, school health education programs, and support groups. Community Based Clinical Services To reach individuals who are uninsured and underinsured, St. Vincent offers screenings, one-time clinics which include blood pressure, cholesterol screening, and/or immunization clinics, and free clinics which provided free and/or low-cost healthcare. Health Care Support Services To increases access to, and the quality of, healthcare to individuals, especially persons living in poverty, St. Vincent provides services such as transportation, telephone information services, chronic disease management, and assistance to enroll in public programs and access prescription medication. Cash and In-Kind Contributions St. Vincent makes cash and in-kind contributions to a variety of organizations focused on improving the health status in the community. Examples include cash donations to nonprofits in response to natural disasters, event sponsorships focused on addressing an identified community health need, donation of employee time/services to outside organizations, and the representation of the hospital on community boards and committees. Community Benefit Operations St. Vincent staff dedicates significant time and costs to lead and manage community benefit programs and activities. Resources are also allocated to conduct a community health needs assessment and develop an implementation strategy. Community benefit is tracked and reported to St. Vincent leadership, Ascension leadership, state and federal government entities. System Wide Health Improvement Priorities FY18 was the second year of the three-year SWHIP implementation strategy (FY17-19). Below is a year 2 update for each SWHIP: 1) Access to Health Services: Community benefit=$25,300 In year two of the strategy, the HA helped 82 people obtain medical insurance (FY18 goal=15; FY18 goal attainment=547%). 2) Exercise, Nutrition & Weight: Community benefit=$11,825; Staff time=9 hours FY18 was an implementation year. The hospital distributed and collected surveys, then entered survey data into a secured St. Vincent web application at the beginning and end of the school year (twice a year in FY18). Analysis of survey #1-baseline showed (aggregated at the program level): - A total of 78 families participated in the program - 15% (n=12) of families responded to the baseline survey - 42% (n=5) reported being food secure - 58% (n=7) reported being food insecure Surveys #2 was administered in FY18. Consolidation and retirement of antiquated software systems necessitated migration of this data to a new system by the IT department. Analysis of this survey was rescheduled and will be completed in FY19. Additionally, surveys #3-4 will be administered in FY19. 3) Behavioral Health: : Community benefit=$542; Staff time=12 hours The hospital offered 2 Rx for Change training to the community on May1, 2018. The trainings were both held on the same day, one in the morning and one in the evening. A total of three participants attended the training. Participants represented the Pregnancy Care Center of Randolph County and St. Vincent Randolph (community members=1, 33%; St. Vincent associates=2, 67%). Each participant was eligible to earn two continuing education units for the training. The continuing education unit request form doubled as the baseline survey. To increase the response rate, participants were allotted two weeks to complete the brief, online form. The response rate for the baseline was 67% (n=2). All participants were asked to rate their overall ability to discuss cessation with patients. On a scale of 1-5 (Poor-Excellent), 1 (50%) participants rated their overall ability as "Fair". None of the respondents self-reported being registered (or their practice site) as a "Preferred Provider" with the Indiana Tobacco Quitline (No=1; Don't know=1). As a result of this training, participants reported how likely they were to: - Ask more patients about tobacco use (n=2, 100%) - Advise more tobacco users to quit (n=2, 100%) - Recommend medications for quitting more often (n=1, 50%) - Refer patients to the tobacco quitline (n=2, 100%) Thirty days after the training, a brief, follow-up survey was emailed to all participants (email address provided by participant). To increase the response rate, participants received a friendly reminder message with link to the survey once a week for four weeks. Participants who answered the email within the 4-week follow-up period were removed from the email queue and did not receive subsequent messages. Timestamps indicate that participants completed the survey within the first week of the 4-week follow-up period. No incentives were offered for survey completion. Baseline and follow-up surveys were matched at the individual participant level using a unique ID number. Sixty-seven percent of all participants completed the baseline and 30-day follow-up surveys (n=2). Of those responding to both surveys: - 1 participant reported being/working for an organization that is registered with the quitline as a "Preferred Provider" - 2 participants reported asking more patients about tobacco use - 2 participants reported advising more tobacco users to quit - 1 participants reported recommending medications for quitting - 2 participants reported referring patients to the tobacco quitline Participants (n=2) responding to both surveys were asked to consider the 30 days following the training and approximate the number of patients that they: - Asked about tobacco use = ~8 (range of approximations = 3-5) - Advising more tobacco users to quit = ~6 (range of approximations = 1-5) - Recommending medications for quitting = ~3 (range of approximations = 0-3) - Referring patients to the quitline = ~4 (range of approximations = 1-3) Although the small size precludes detecting changes in screening behaviors with statistical significance, these findings provide may provide insight into: - Respondents awareness of their own/organizational status as a registered quitline "Preferred Provider" - Respondents perception of the number of patients they screen for tobacco uses in a 30-day period - Hospital can determine next steps, if any, for similar programs in the future. Schedule H, Part I, Line 7 Costing Methodology used to calculate financial assistance 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. Schedule H, Part II Community Building Activities 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 the root causes of health problems, ultimately influence and improve health status. Examples of community building activities include physical improvement and housing, economic development, community support, environmental improvements, leadership development and leadership training for community members, coalition building, advocacy for community health improvements and safety, and workforce development. Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount 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. After applying the cost-to-charge ratio, the share of the bad debt expense in fiscal year 2018 was $358,695 at charges, ($93,261 at cost). Schedule H, Part III, Line 3 Bad Debt Expense Methodology The provision for doubtful accounts is based upon management's assessment of expected net collections considering economic conditions, historical experience, trends in healthcare coverage, and other collection indicators. Periodically throughout the year, management assesses the adequacy of the allowance for doubtful accounts based upon historical write-off experience by payor category, including those amounts not covered by insurance. The results of this review are then used to make any modifications to the provision for doubtful accounts to establish an appropriate allowance for doubtful accounts. Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote The organization is part of the Ascension Health Alliance's consolidated audit in which the footnote that discusses the bad debt expense is located on page 21. Schedule H, Part III, Line 8 Community benefit & methodology for determining medicare costs A cost to charge ratio is applied to the organization's Medicare Expense to determine the Medicare allowable costs reported in the organization's Medicare Cost Report. Ascension Health and its 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. Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance 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. Schedule H, Part V, Section B, Line 16a FAP website - St. Vincent Randolph Hospital, Inc.: Line 16a URL: HTTPS://WWW.STVINCENT.ORG/Billing-Services; Schedule H, Part V, Section B, Line 16b FAP Application website - St. Vincent Randolph Hospital, Inc.: Line 16b URL: HTTPS://WWW.STVINCENT.ORG/Billing-Services; Schedule H, Part V, Section B, Line 16c FAP plain language summary website - St. Vincent Randolph Hospital, Inc.: Line 16c URL: HTTPS://WWW.STVINCENT.ORG/Billing-Services; Schedule H, Part VI, Line 2 Needs assessment St. Vincent Randolph uses reliable, third party reports, including data from government sources to assess the health care needs of the communities it serves. These reports provide information about key health, socioeconomic and demographic indicators that point to area of need and include but are not limited to reports from Indiana State Department of Health, Indiana Business Research Center at Indiana University, U.S. Census Bureau, Alliance for a Heathier Indiana, Tobacco Prevention & Cessation Commission and Indiana Hospital Association. St. Vincent Randolph utilizes information from these secondary sources to develop programs and provide services throughout the region. In addition, St. Vincent Randolph considers the health care needs of the overall community when evaluating internal financial and operational decisions. Schedule H, Part VI, Line 3 Patient education of eligibility for assistance St.Vincent Randolph Hospital communicates with patients in multiple ways to ensure that those who are billed for services are aware of the hospital's financial assistance 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. Schedule H, Part VI, Line 4 Community information St. Vincent Randolph Hospital is located in Winchester, Indiana and serves rural Randolph and contiguous counties, in northeast central Indiana. Randolph is a rural county with an estimated population of 24,922 and, according to the 2018 County Health Rankings, ranks 78th out of 92 Indiana counties for overall health outcomes. Within the last 20 years, renewed activities in economic development, tourism, historic preservation and cultural attractions have brought new life to Randolph County. Randolph County demographics are similar to those of the overall Indiana state population. Approximately 3.2% are Hispanic or Latino, 0.9% Black and 96.5% of residents that are Caucasian. The median household income is lower than the state at about $46,750 annually, and roughly 15.4% of Randolph County families are living in poverty, which is slightly higher than the state. Randolph County's uninsured rate is 12% which is slightly higher than the state. By the Indiana State Department of Health and U.S. Department of Health and Human Services, Randolph County is designated as a Medically Underserved Area (MUA). Schedule H, Part VI, Line 5 Promotion of community health St. Vincent Randolph's governing body is comprised of persons representing diverse aspects and interests of the community. Many members of St. Vincent Randolph's governing body reside in the organization's primary service area; who are neither employees nor independent contractors of the organization, nor family members thereof. The organization extends medical staff privileges to all qualified physicians in its community for some or all of its departments or specialties and applies surplus funds to improvements in patient care, medical education, and research. Schedule H, Part VI, Line 6 Affiliated health care system St. Vincent Randolph is an affiliate of St. Vincent Health system and Ascension Health. St. Vincent Randolph affiliates are large multi-faceted, integrated, not-for-profit ministries including hospital and non-hospital ministries (physician group practices, hospital organizations, research, home health, durable medical equipment and senior facilities). These ministries work together to care for patients, joined by common systems and a philosophy of serving as a healing presence with special concern for our neighbors especially those who are vulnerable. This community benefit happens through its focus on patient care, education and research. The organizations work together to serve their communities at the local, regional, state, and national level. Ascension Health Alliance, D/B/A Ascension (Ascension), is a Missouri nonprofit corporation formed on September 13, 2011. Ascension is the sole corporate member and parent organization of Ascension Health. A Catholic national health system consisting primarily of nonprofit corporations that own and operate local healthcare facilities, or health ministries, located in 21 of the United States and the District of Columbia. Ascension is sponsored by Ascension Sponsor, a public juridic person. The participating of Ascension sponsor are the Daughters of Charity of St. Vincent De Paul, St. Louise Province; The Congregation of St. Joseph; The Congregation of the Sisters of St. Joseph of Carondelet; The Congregation of Alexian Brothers of the Immaculate Conception Province, Inc. - American Province; and the Sisters of the Sorrowful Mother of the Third Order of St. Francis of Assisi - US/Caribbean Province. As part of St. Vincent Health, St. Vincent Randolph is dedicated to improving the health status and quality of life for the communities it serves. While designated associates at St. Vincent Randolph devote 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 & Health Improvement associates and other support 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 St. Vincent Randolph participates. true St Vincent Randolph Hospital Foundation Inc 473 Greenville Avenue Winchester IN 47394 352133006 501(c)(3) 41602 OPERATING GRANT 1 0 Schedule I, Part I, Line 2 Procedures for monitoring use of grant funds. The finance committee ensures that funds are distributed appropriately according to Ascension Health's strategic business plan and consistent with corporate policies and procedures. X true true false true false false false false false false false CYNTHIA D ADAMS RN DIRECTOR 0 468920 0 190102 0 86851 0 13500 0 5240 0 764613 0 0 MICHAEL K SCHROYER EX-OFFICIO 0 309936 0 130816 0 87682 0 16200 0 37399 0 582034 0 0 AARON G SHOEMAKER MD DIRECTOR 0 366003 0 109500 0 840 0 16200 0 34724 0 527267 0 0 THOMAS J VANOSDOL FORMER OFFICER (END 12/2015) 0 555860 0 301615 0 69385 0 17550 0 27500 0 971910 0 0 BETHANY L MORROW VP, FINANCE (START 1/2018) 0 153566 0 16468 0 307 0 10606 0 16112 0 197058 0 0 FRANCIS G ALBARANO ADMINISTRATOR (END 12/2017) 201690 0 84788 0 8796 0 16200 0 24629 0 336103 0 0 0 JOHN M ARTHUR EXECUTIVE DIRECTOR, FINANCE (END 12/2017) 137500 0 43800 0 1045 0 11196 0 22188 0 215728 0 0 0 CARLA A FOUSE RN ADMINISTRATOR (START 1/2018)/CNO 105340 0 31607 0 2231 0 9139 0 20267 0 168584 0 0 0 KATHRYN A WREN MANAGER, PHARMACY 136541 0 20134 0 640 0 10460 0 27222 0 194998 0 0 0 Schedule J, Part I, Line 1a Tax indemnification and gross-up payments St. Vincent Randolph Hospital, Inc. included imputed income for one of the individuals listed in Part VII. St. Vincent Randolph Hospital, Inc. "grossed up" applicable non-business expenses and included in the employees' W-2 as additional taxable compensation. Schedule J, Part I, Line 3 Arrangement used to establish the top management official's compensation St.Vincent Health, Inc., a related organization of St.Vincent Randolph Hospital, Inc., uses the following to establish the compensation of the organization's CEO/Executive Director: - Compensation committee - Independent compensation consultant - Compensation survey or study - Approval by the board or compensation committee Schedule J, Part I, Line 4b Supplemental nonqualified retirement plan Eligible executives participate in various non-qualified deferred compensation plans organized under Code Section 457(f). The exact purpose of each plan varies but they include: compensation limitation make-up plans, voluntary deferral plans, deferral of a portion of incentive bonus type plans, etc. Any amount ultimately paid under the program to the executive is reported as compensation on Form 990, Schedule J, Part II, Column B in the year paid. No payments were made to listed persons in Part VII under the various non-qualified deferred compensation plans during the year. Form 990, Part IV, Line 24a Tax Exempt Bond Issuance St.Vincent Randolph 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 Randolph Hospital, Inc. holds an intercompany note payable with Ascension Health, and this information is reported on the balance sheet. Form 990, Part IV, Line 20b Audited financial statements The activity of St. Vincent Randolph Hospital, Inc. is reported in the consolidated financial statements of Ascension Health Alliance. No individual audit of St. Vincent Randolph Hospital, Inc. is completed. Therefore, the attached audited financial statements are of Ascension Health Alliance and Affiliates, which include the activity of St. Vincent Randolph Hospital, Inc. Form 990, Part VI, Line 15a PROCESS TO ESTABLISH COMPENSATION OF TOP MANAGEMENT OFFICIAL THE PROCESS OF DETERMINING THE AMOUNT OF COMPENSATION PAID TO THE ORGANIZATION'S CEO, EXECUTIVE DIRECTOR OR TOP MANAGEMENT OFFICIAL IS PERFORMED BY ST. VINCENT HEALTH, INC. AND ITS SUBSIDIARY ORGANIZATIONS. ST. VINCENT HEALTH, INC. IS THE SOLE CORPORATE MEMBER OF ST. VINCENT RANDOLPH HOSPITAL, INC. THE PROCESS INCLUDED A REVIEW AND APPROVAL BY INDEPENDENT PERSONS, COMPARABILITY DATA, AND CONTEMPORANEOUS SUBSTANTIATION OF THE DELIBERATION AND DECISION. THE EXECUTIVE COMPENSATION COMMITTEE REVIEWED AND APPROVED THE COMPENSATION. IN THE REVIEW OF THE COMPENSATION, THE ORGANIZATION'S CEO, EXECUTIVE DIRECTOR OR TOP MANAGEMENT OFFICIAL'S SALARY WAS COMPARED TO INDIVIDUALS AT OTHER ORGANIZATIONS IN THE AREA WHO HOLD THE SAME TITLE. DURING THE REVIEW AND APPROVAL OF THE COMPENSATION, DOCUMENTATION OF THE DECISION WAS RECORDED IN THE MINUTES. THE INDIVIDUAL WAS NOT PRESENT WHEN THEIR COMPENSATION WAS DECIDED. Form 990, Part VI, Line 15b PROCESS TO ESTABLISH COMPENSATION OF OTHER OFFICERS OR KEY EMPLOYEES THE PROCESS OF DETERMINING THE AMOUNT OF COMPENSATION PAID TO THE ORGANIZATION'S OFFICERS AND KEY EMPLOYEES IS PERFORMED BY ST. VINCENT HEALTH, INC. AND ITS SUBSIDIARY ORGANIZATIONS. ST. VINCENT HEALTH, INC. IS THE SOLE CORPORATE MEMBER OF ST. VINCENT RANDOLPH HOSPITAL, INC. THE PROCESS INCLUDED A REVIEW AND APPROVAL BY INDEPENDENT PERSONS, COMPARABILITY DATA, AND CONTEMPORANEOUS SUBSTANTIATION OF THE DELIBERATION AND DECISION. THE EXECUTIVE COMPENSATION COMMITTEE REVIEWED AND APPROVED THE COMPENSATION. IN THE REVIEW OF THE COMPENSATION, THE OFFICERS' SALARIES WERE COMPARED TO INDIVIDUALS AT OTHER ORGANIZATIONS IN THE AREA WHO HOLD THE SAME TITLE. DURING THE REVIEW AND APPROVAL OF THE COMPENSATION, DOCUMENTATION OF THE DECISION WAS RECORDED IN THE MINUTES. INDIVIDUALS WERE NOT PRESENT WHEN THEIR COMPENSATION WAS DECIDED. Form 990, Part VI, Line 6 Classes of members or stockholders St. Vincent Randolph Hospital, Inc. has a single corporate member, St. Vincent Health, Inc. Form 990, Part VI, Line 7a Members or stockholders electing members of governing body St. Vincent Randolph 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 Randolph Hospital, Inc. Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders All decisions that have a material impact to St. Vincent Randolph 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, Line 11b Review of form 990 by governing body DURING THE RETURN PREPARATION PROCESS, THE TAX DEPARTMENT WORKS WITH OTHER FUNCTIONAL AREAS INCLUDING FINANCE, ACCOUNTING, TREASURY, LEGAL, HUMAN RESOURCES, AND CORPORATE COMPLIANCE FOR ADVICE, INFORMATION AND ASSISTANCE IN ORDER TO PREPARE A COMPLETE AND ACCURATE RETURN. UPON COMPLETION, THE FORM 990 IS REVIEWED BY THE ORGANIZATION'S INTERNAL TAX DEPARTMENT WHICH CONSISTS OF ATTORNEYS AND CPAS. A COMPLETE FINAL COPY OF THE RETURN IS PROVIDED TO THE ORGANIZATION'S PRESIDENT, FINANCIAL OFFICER, AND/OR OTHER KEY OFFICERS IN LIEU OF THE FULL BOARD. Form 990, Part VI, Line 12c Conflict of interest policy The organization regularly and consistently monitors and enforces compliance with the conflict of interest policy in that any director, principal officer, or member of a committee with governing board delegated powers, who has a direct or indirect financial interest, must disclose the existence of the financial interest and be given the opportunity to disclose all material facts to the directors and members of the committees with governing board delegated powers considering the proposed transaction or arrangement. The remaining individuals on the governing board or committee 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, Line 19 Required documents available to the public The organization will provide any documents open to public inspection upon request. Form 990, Part VIII, Line 11d Other Miscellaneous Revenue Miscellaneous Revenue - Total Revenue: 6710, Related or Exempt Function Revenue: , Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: 6710; Form 990, Part XI, Line 9 Other changes in net assets or fund balances TRANSFERS WITH ALPHA FUND - 1418445; Form 990, Part XII, Line 2c oversight of audit or selection of independent accountant St. Vincent Randolph Hospital, Inc. is included in the consolidated financial statements of Ascension Health Alliance. The Finance and Audit committee of Ascension Health Alliance's Board assumes responsibility for the consolidated organization as a whole. 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