ST VINCENT SALEM HOSPITAL INC: Form 990, tax year 2017

View the entire original 990 at ProPublica ↗

Organization
ST VINCENT SALEM HOSPITAL INC (EIN 27-0847538)
Tax period
2017-07-01 to 2018-06-30
Filed
2019-05-13
IRS object ID
201921339349308102
Schema version
2017v2.2
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 ReturnHeader

FieldValueIRS element (for citing)
Return2019-05-13T19:25:21-05:00ReturnTs
Tax Period End2018-06-30TaxPeriodEndDt
Return Type990ReturnTypeCd
Tax Period Begin2017-07-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN270847538EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1St Vincent Salem Hospital IncBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlSTVIBusinessNameControlTxt
Phone3147338000PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1911 N Shelby StreetAddressLine1Txt
CitySalemCityNm
State AbbreviationINStateAbbreviationCd
ZIP47167ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonTonya MershonPersonNm
Person TitleTax OfficerPersonTitleTxt
Signature2019-05-13SignatureDt
FieldValueIRS element (for citing)
Tax2017TaxYr
Build TS2019-02-21 02:37:17ZBuildTS

Form 990 IRS990

Principal Ofcr Business Name PrincipalOfcrBusinessName

FieldValueIRS element (for citing)
Business Name Line1Dana MuntzBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line1911 N Shelby StreetAddressLine1Txt
CitySalemCityNm
State AbbreviationINStateAbbreviationCd
ZIP47167ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$17,739,452GrossReceiptsAmt
Group Return For AffiliatesfalseGroupReturnForAffiliatesInd
Group Exemption0928GroupExemptionNum
Organization501c3Yes (X)Organization501c3Ind
Website Addresswww.stvincent.org/Locations/Hospitals/SalemWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation2010FormationYr
Legal Domicile StateINLegalDomicileStateCd
Activity Or MissionTo improve the health and well-being of all people in the communities we serve.ActivityOrMissionDesc
Voting Members Governing Body9VotingMembersGoverningBodyCnt
Voting Members Independent5VotingMembersIndependentCnt
Total Employee113TotalEmployeeCnt
Total Volunteers50TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$16,875PYContributionsGrantsAmt
CY Contributions Grants$7,270CYContributionsGrantsAmt
PY Program Service Revenue$17,459,403PYProgramServiceRevenueAmt
CY Program Service Revenue$17,492,056CYProgramServiceRevenueAmt
PY Investment Income$570PYInvestmentIncomeAmt
CY Investment Income$1,392CYInvestmentIncomeAmt
PY Other Revenue$210,945PYOtherRevenueAmt
CY Other Revenue$238,734CYOtherRevenueAmt
PY Total Revenue$17,687,793PYTotalRevenueAmt
CY Total Revenue$17,739,452CYTotalRevenueAmt
PY Grants And Similar Paid$0PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$0CYGrantsAndSimilarPaidAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$7,993,533PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$6,576,671CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$8,697,698PYOtherExpensesAmt
CY Other Expenses$9,743,543CYOtherExpensesAmt
PY Total Expenses$16,691,231PYTotalExpensesAmt
CY Total Expenses$16,320,214CYTotalExpensesAmt
PY Revenues Less Expenses$996,562PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$1,419,238CYRevenuesLessExpensesAmt
Total Assets BOY$5,791,926TotalAssetsBOYAmt
Total Assets EOY$7,519,813TotalAssetsEOYAmt
Total Liabilities BOY$4,013,752TotalLiabilitiesBOYAmt
Total Liabilities EOY$4,024,152TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$1,778,174NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$3,495,661NetAssetsOrFundBalancesEOYAmt
MissionOur 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.MissionDesc
Significant New Program SrvcfalseSignificantNewProgramSrvcInd
Significant ChangefalseSignificantChangeInd
Expense$10,422,007ExpenseAmt
Revenue$17,492,056RevenueAmt
DescSt. Vincent Salem 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 Salem Hospital treated 98 adults and children for a total of 458 patient days of service. The hospital also provided services for 33,673 outpatient visits, which included 1,358 outpatient surgeries and 7,609 Emergency Room Visits. See Schedule H for a non-exhaustive list of community benefit programs and descriptions.Desc
Total Program Service Expenses$10,422,007TotalProgramServiceExpensesAmt
Described In Section501c3Yes (true)DescribedInSection501c3Ind
Schedule B RequiredfalseScheduleBRequiredInd
Political Campaign ActyfalsePoliticalCampaignActyInd
Lobbying ActivitiesYes (true)LobbyingActivitiesInd
Donor Advised FundfalseDonorAdvisedFundInd
Conservation EasementsfalseConservationEasementsInd
Collections Of ArtfalseCollectionsOfArtInd
Credit CounselingfalseCreditCounselingInd
Temp Or Permanent EndowmentsfalseTempOrPermanentEndowmentsInd
Report Land Building EquipmentYes (true)ReportLandBuildingEquipmentInd
Report Investments Other SecfalseReportInvestmentsOtherSecInd
Report Program Related InvstfalseReportProgramRelatedInvstInd
Report Other AssetsYes (true)ReportOtherAssetsInd
Report Other LiabilitiesYes (true)ReportOtherLiabilitiesInd
Include FIN48 FootnoteYes (true)IncludeFIN48FootnoteInd
Independent Audit Fincl StmtfalseIndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtYes (true)ConsolidatedAuditFinclStmtInd
School OperatingfalseSchoolOperatingInd
Foreign OfficefalseForeignOfficeInd
Foreign ActivitiesfalseForeignActivitiesInd
More Than5000 K To OrgfalseMoreThan5000KToOrgInd
More Than5000 K To IndividualsfalseMoreThan5000KToIndividualsInd
Professional FundraisingfalseProfessionalFundraisingInd
Fundraising ActivitiesfalseFundraisingActivitiesInd
Gaming ActivitiesfalseGamingActivitiesInd
Operate HospitalYes (true)OperateHospitalInd
Audited Financial Stmt AttYes (true)AuditedFinancialStmtAttInd
Grants To OrganizationsfalseGrantsToOrganizationsInd
Grants To IndividualsfalseGrantsToIndividualsInd
Schedule J RequiredYes (true)ScheduleJRequiredInd
Tax Exempt BondsfalseTaxExemptBondsInd
Engaged In Excess Benefit TransfalseEngagedInExcessBenefitTransInd
PY Excess Benefit TransfalsePYExcessBenefitTransInd
Loan OutstandingfalseLoanOutstandingInd
Grant To Related PersonfalseGrantToRelatedPersonInd
Business Rln With Org MemfalseBusinessRlnWithOrgMemInd
Business Rln With Fam MemfalseBusinessRlnWithFamMemInd
Business Rln With Officer EntfalseBusinessRlnWithOfficerEntInd
Deductible Non Cash ContrifalseDeductibleNonCashContriInd
Deductible Art ContributionfalseDeductibleArtContributionInd
Terminate OperationsfalseTerminateOperationsInd
Partial LiquidationfalsePartialLiquidationInd
Disregarded EntityfalseDisregardedEntityInd
Related EntityYes (true)RelatedEntityInd
Related Organization Ctrl EntYes (true)RelatedOrganizationCtrlEntInd
Transaction With Control EntYes (true)TransactionWithControlEntInd
Trnsfr Exmpt Non Chrtbl Rltd OrgfalseTrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted PrtshpfalseActivitiesConductedPrtshpInd
Schedule O RequiredYes (true)ScheduleORequiredInd
IRP Document33IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (true)BackupWthldComplianceInd
Employee113EmployeeCnt
Employment Tax Returns FiledYes (true)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over LimitfalseUnrelatedBusIncmOverLimitInd
Foreign Financial AccountfalseForeignFinancialAccountInd
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTransInd
Taxable Party NotificationfalseTaxablePartyNotificationInd
Nondeductible ContributionsfalseNondeductibleContributionsInd
Quid Pro Quo ContributionsfalseQuidProQuoContributionsInd
Form8282 Property Disposed OfYes (true)Form8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft CntrctfalseRcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft CntrctfalsePayPremiumsPrsnlBnftCntrctInd
Indoor Tanning ServicesfalseIndoorTanningServicesInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members9GoverningBodyVotingMembersCnt
Independent Voting Member5IndependentVotingMemberCnt
Family Or Business RlnfalseFamilyOrBusinessRlnInd
Delegation Of Mgmt DutiesYes (true)DelegationOfMgmtDutiesInd
Change To Org DocumentsfalseChangeToOrgDocumentsInd
Material Diversion Or MisusefalseMaterialDiversionOrMisuseInd
Members Or StockholdersYes (true)MembersOrStockholdersInd
Election Of Board MembersYes (true)ElectionOfBoardMembersInd
Decisions Subject To ApprovaYes (true)DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (true)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (true)MinutesOfCommitteesInd
Officer Mailing AddressfalseOfficerMailingAddressInd
Local ChaptersfalseLocalChaptersInd
Form990 Provided To Gvrn BodyfalseForm990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (true)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (true)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (true)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (true)WhistleblowerPolicyInd
Document Retention PolicyYes (true)DocumentRetentionPolicyInd
Compensation Process CEOfalseCompensationProcessCEOInd
Compensation Process OtherfalseCompensationProcessOtherInd
Investment In Joint VenturefalseInvestmentInJointVentureInd
States Where Copy Of Return Is FldINStatesWhereCopyOfReturnIsFldCd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1SARA OBRIENBusinessNameLine1Txt
FieldValueIRS element (for citing)
Phone3147338070PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line111775 BORMAN DRIVEAddressLine1Txt
CityMARYLAND HEIGHTSCityNm
State AbbreviationMOStateAbbreviationCd
ZIP63146ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (14 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtKey EmployeeKeyEmployeeIndHighest Compensated EmployeeHighestCompensatedEmployeeInd
STEPHEN KEMKER MD
CHAIR1.055.0Yes (X)Yes (X)$0$146,569$0
AARON LEE
VICE CHAIR1.00Yes (X)Yes (X)$0$0$0
JEFFREY SOUDER
SECRETARY/TREASURER1.00Yes (X)Yes (X)$0$0$0
BARRY S MOFFITT
DIRECTOR1.042.0Yes (X)$0$424,688$44,728
JANETTE L HELM
DIRECTOR1.040.0Yes (X)$0$138,939$26,991
JEFFREY G MORGAN MD
DIRECTOR1.055.0Yes (X)$0$432,623$46,463
SANDRA BRANDENBURG
DIRECTOR1.00Yes (X)$0$0$0
JOE COX
DIRECTOR1.00Yes (X)$0$0$0
LARRY MEDLOCK
DIRECTOR1.00Yes (X)$0$0$0
WAYNE R KNIGHT
EXECUTIVE DIRECTOR, FINANCE5.036.0Yes (X)$0$231,257$36,025
DANA M MUNTZ
ADMINISTRATOR/CNO20.020.0Yes (X)$248,968$0$41,935
JENNIFER L STANLEY MD
CMO20.035.0$0$278,530$46,495Yes (X)
JAMES D PASSERENI JR
MANAGER, PHARMACY40.00$158,410$0$37,799Yes (X)
KEVIN W NANCE
MANAGER, REHAB SERVICES40.00$113,239$0$33,710Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$520,616TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$1,652,606TotReportableCompRltdOrgAmt
Total Other Compensation$314,145TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K3IndivRcvdGreaterThan100KCnt
Former Ofcr Employees ListedfalseFormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (true)TotalCompGreaterThan150KInd
Compensation From Other SrcsfalseCompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (3 entries)

Address Line1ContractorAddress/USAddress/AddressLine1TxtCityContractorAddress/USAddress/CityNmState AbbreviationContractorAddress/USAddress/StateAbbreviationCdZIPContractorAddress/USAddress/ZIPCdServicesServicesDescCompensationCompensationAmt
MID AMERICA CLINICAL LABORATORIES
PO BOX 642263PITTSBURGHPA15264LAB SERVICES$901,904
AMERIPATH INDIANAPOLIS LLC
2560 N SHADELAND AVE STE AINDIANAPOLISIN46219LAB SERVICES$145,890
SIMPLEX GRINNELL
10255 FORTUNE PKWYJACKSONVILLEFL32256ACTIVE FIRE PROTECTION SYSTEMS$100,245
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K3CntrctRcvdGreaterThan100KCnt
Info In Schedule O Part VIIIYes (X)InfoInScheduleOPartVIIIInd
Government Grants$7,120GovernmentGrantsAmt
All Other Contributions$150AllOtherContributionsAmt
Total Contributions$7,270TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (3 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
Net Patient Service Revenue621990$17,183,253$17,183,253
Rental Income from Affiliates531120$208,835$208,835
State Program Revenue900099$99,968$99,968

Total Oth Program Service Rev TotalOthProgramServiceRevGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt
Related Or Exempt Func Income$0RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$0ExclusionAmt
FieldValueIRS element (for citing)
Total Program Service Revenue$17,492,056TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$1,392TotalRevenueColumnAmt
Exclusion$1,392ExclusionAmt

Gross Rents GrossRentsGrp

FieldValueIRS element (for citing)
Real$170,441RealAmt

Less Rental Expenses LessRentalExpensesGrp

FieldValueIRS element (for citing)
Real$0RealAmt

Rental Income Or Loss RentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Real$170,441RealAmt
Personal$0PersonalAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$170,441TotalRevenueColumnAmt
Exclusion$170,441ExclusionAmt

Gain Or Loss GainOrLossGrp

FieldValueIRS element (for citing)
Securities$0SecuritiesAmt
Other$0OtherAmt

Other Revenue Misc OtherRevenueMiscGrp (3 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtExclusionExclusionAmt
Cafeteria/Vending Revenue722514$54,073$54,073
Medical Records Fees900099$11,357$11,357
Escheatment Revenue900099$750$750

Miscellaneous Revenue MiscellaneousRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$2,113TotalRevenueColumnAmt
Related Or Exempt Func Income$0RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$2,113ExclusionAmt
FieldValueIRS element (for citing)
Other Revenue Total$68,293OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$17,739,452TotalRevenueColumnAmt
Related Or Exempt Func Income$17,492,056RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$240,126ExclusionAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$290,903TotalAmt
Program Services$232,722ProgramServicesAmt
Management And General$58,181ManagementAndGeneralAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$4,817,990TotalAmt
Program Services$3,891,101ProgramServicesAmt
Management And General$926,889ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$189,410TotalAmt
Program Services$152,993ProgramServicesAmt
Management And General$36,417ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$949,990TotalAmt
Program Services$767,086ProgramServicesAmt
Management And General$182,904ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$328,378TotalAmt
Program Services$265,082ProgramServicesAmt
Management And General$63,296ManagementAndGeneralAmt

Fees For Services Management FeesForServicesManagementGrp

FieldValueIRS element (for citing)
Total$154,151TotalAmt
Program Services$154,151ProgramServicesAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$2,258TotalAmt
Management And General$2,258ManagementAndGeneralAmt

Fees For Services Lobbying FeesForServicesLobbyingGrp

FieldValueIRS element (for citing)
Total$588TotalAmt
Management And General$588ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$889,963TotalAmt
Program Services$843,583ProgramServicesAmt
Management And General$46,380ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$7,826TotalAmt
Management And General$7,826ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$41,830TotalAmt
Program Services$13,181ProgramServicesAmt
Management And General$28,649ManagementAndGeneralAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$511TotalAmt
Program Services$63ProgramServicesAmt
Management And General$448ManagementAndGeneralAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$359,909TotalAmt
Management And General$359,909ManagementAndGeneralAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$19,893TotalAmt
Program Services$8,760ProgramServicesAmt
Management And General$11,133ManagementAndGeneralAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$9,950TotalAmt
Program Services$10,853ProgramServicesAmt
Management And General-$903ManagementAndGeneralAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$471,147TotalAmt
Program Services$303,897ProgramServicesAmt
Management And General$167,250ManagementAndGeneralAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$55,803TotalAmt
Management And General$55,803ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmt
PURCHASED SERVICES$2,990,213$1,758,672$1,231,541
MANAGEMENT FEE TO AFFILIATE$1,631,748$1,631,748
CORPORATE ALLOCATIONS$1,029,727$20,673$1,009,054
MEDICAL SUPPLIES$938,009$913,032$24,977

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$1,140,017TotalAmt
Program Services$1,086,158ProgramServicesAmt
Management And General$53,859ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$16,320,214TotalAmt
Program Services$10,422,007ProgramServicesAmt
Management And General$5,898,207ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$650EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$26,972BOYAmt
EOY$0EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$2,304,098BOYAmt
EOY$2,413,796EOYAmt

Receivables From Officers Etc ReceivablesFromOfficersEtcGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

FieldValueIRS element (for citing)
BOY$321,716BOYAmt
EOY$343,052EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$166,747BOYAmt
EOY$151,399EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$7,185,946LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$3,005,157LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$2,577,484BOYAmt
EOY$4,180,789EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt

Investments Program Related InvestmentsProgramRelatedGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt

Intangible Assets IntangibleAssetsGrp

FieldValueIRS element (for citing)
BOY$4,470BOYAmt
EOY$20,130EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$390,439BOYAmt
EOY$409,997EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$5,791,926BOYAmt
EOY$7,519,813EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$1,305,702BOYAmt
EOY$1,043,061EOYAmt

Loans From Officers Directors LoansFromOfficersDirectorsGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$2,708,050BOYAmt
EOY$2,981,091EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$4,013,752BOYAmt
EOY$4,024,152EOYAmt
FieldValueIRS element (for citing)
Organization Follows SFAS117Yes (X)OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

FieldValueIRS element (for citing)
BOY$1,712,031BOYAmt
EOY$3,429,368EOYAmt

Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp

FieldValueIRS element (for citing)
BOY$66,143BOYAmt
EOY$66,293EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$1,778,174BOYAmt
EOY$3,495,661EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$5,791,926BOYAmt
EOY$7,519,813EOYAmt
FieldValueIRS element (for citing)
Info In Schedule O Part XIYes (X)InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss$1,419,238ReconcilationRevenueExpnssAmt
Other Changes In Net Assets$298,249OtherChangesInNetAssetsAmt
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or ReviewfalseAccountantCompileOrReviewInd
FS AuditedYes (true)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Consolidated Basis Fincl StmtYes (X)ConsolidatedBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (true)AuditCommitteeInd
Federal Grant Audit RequiredYes (true)FederalGrantAuditRequiredInd
Federal Grant Audit PerformedYes (true)FederalGrantAuditPerformedInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
HospitalYes (X)HospitalInd

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
VolunteersfalseVolunteersInd
Paid Staff Or ManagementfalsePaidStaffOrManagementInd
Media AdvertisementsfalseMediaAdvertisementsInd
Mailings MembersfalseMailingsMembersInd
Publications Or BroadcastfalsePublicationsOrBroadcastInd
Grants Other OrganizationsfalseGrantsOtherOrganizationsInd
Direct Contact LegislatorsfalseDirectContactLegislatorsInd
Rallies DemonstrationsfalseRalliesDemonstrationsInd
Other ActivitiesYes (true)OtherActivitiesInd
Other Activities$588OtherActivitiesAmt
Total Lobbying Expenditures$588TotalLobbyingExpendituresAmt
Not Described Section501c3falseNotDescribedSection501c3Ind

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Schedule C, Part II-B, Line 1 DETAILED DESCRIPTION OF THE LOBBYING ACTIVITYLobbying expenses represent the portion of dues paid to national and state hospital associations that is specifically allocable to lobbying. St. Vincent Salem 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 ACTIVITYLobbying expenses represent the portion of dues paid to national and state hospital associations that is specifically allocable to lobbying. St. Vincent Salem 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 D IRS990ScheduleD

Land LandGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$180,000OtherCostOrOtherBasisAmt
Book Value$180,000BookValueAmt

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$3,549,054OtherCostOrOtherBasisAmt
Depreciation$893,430DepreciationAmt
Book Value$2,655,624BookValueAmt

Leasehold Improvements LeaseholdImprovementsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$859,079OtherCostOrOtherBasisAmt
Depreciation$857,840DepreciationAmt
Book Value$1,239BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$2,290,354OtherCostOrOtherBasisAmt
Depreciation$1,235,405DepreciationAmt
Book Value$1,054,949BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$307,459OtherCostOrOtherBasisAmt
Depreciation$18,482DepreciationAmt
Book Value$288,977BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$4,180,789TotalBookValueLandBuildingsAmt

Other Assets Org OtherAssetsOrgGrp (3 entries)

DescDescBook ValueBookValueAmt
Other Assets$8,658
Due from Affiliates$193,477
Other Receivables$207,862
FieldValueIRS element (for citing)
Total Book Value Other Assets$409,997TotalBookValueOtherAssetsAmt
Federal Income Tax Liability$0FederalIncomeTaxLiabilityAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (6 entries)

DescDescAmtAmt
Pension and Other Post retirement Liability
Due to Affiliates$1,653,704
Other Liabilities$237,241
Estimated 3rd Party Payor Settlement$1,009,871
Recovery Tail Liability$80,000
Accrued Tax Liability$275
FieldValueIRS element (for citing)
Total Liability$2,981,091TotalLiabilityAmt
Footnote TextYes (X)FootnoteTextInd

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceSchedule D, Part X, Line 2 FIN 48 (ASC 740) footnoteFormAndLineReferenceDesc
ExplanationThe 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.ExplanationTxt

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Financial Assistance PolicyYes (true)FinancialAssistancePolicyInd
Written PolicyYes (true)WrittenPolicyInd
All Hospitals PolicyYes (X)AllHospitalsPolicyInd
FPG Reference Free CareYes (true)FPGReferenceFreeCareInd

Free Care Oth Percentage FreeCareOthPercentageGrp

FieldValueIRS element (for citing)
OtherYes (X)OtherInd
Free Care Other250FreeCareOtherPct
FieldValueIRS element (for citing)
FPG Reference Discounted CareYes (true)FPGReferenceDiscountedCareInd
Percent400Yes (X)Percent400Ind
Free Care Medically IndigentYes (true)FreeCareMedicallyIndigentInd
Financial Assistance BudgetYes (true)FinancialAssistanceBudgetInd
Expenses Exceed BudgetYes (true)ExpensesExceedBudgetInd
Unable To Provide CarefalseUnableToProvideCareInd
Annual Community Bnft ReportYes (true)AnnualCommunityBnftReportInd
Report Publically AvailableYes (true)ReportPublicallyAvailableInd

Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp

FieldValueIRS element (for citing)
Total Community Benefit Expns$999,159TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$0DirectOffsettingRevenueAmt
Net Community Benefit Expns$999,159NetCommunityBenefitExpnsAmt
Total Expense0.0612TotalExpensePct

Unreimbursed Medicaid UnreimbursedMedicaidGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$4,302,161TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$1,002,434DirectOffsettingRevenueAmt
Net Community Benefit Expns$3,299,727NetCommunityBenefitExpnsAmt
Total Expense0.2022TotalExpensePct

Unreimbursed Costs UnreimbursedCostsGrp

FieldValueIRS element (for citing)
Net Community Benefit Expns$0NetCommunityBenefitExpnsAmt
Total Expense0.0TotalExpensePct

Total Financial Assistance Typ TotalFinancialAssistanceTyp

FieldValueIRS element (for citing)
Activities Or Programs0ActivitiesOrProgramsCnt
Persons Served0PersonsServedCnt
Total Community Benefit Expns$5,301,320TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$1,002,434DirectOffsettingRevenueAmt
Net Community Benefit Expns$4,298,886NetCommunityBenefitExpnsAmt
Total Expense0.2634TotalExpensePct

Community Health Services CommunityHealthServicesGrp

FieldValueIRS element (for citing)
Activities Or Programs20ActivitiesOrProgramsCnt
Persons Served2211PersonsServedCnt
Total Community Benefit Expns$145,130TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$0DirectOffsettingRevenueAmt
Net Community Benefit Expns$145,130NetCommunityBenefitExpnsAmt
Total Expense0.0089TotalExpensePct

Health Professions Education HealthProfessionsEducationGrp

FieldValueIRS element (for citing)
Net Community Benefit Expns$0NetCommunityBenefitExpnsAmt
Total Expense0.0TotalExpensePct

Subsidized Health Services SubsidizedHealthServicesGrp

FieldValueIRS element (for citing)
Net Community Benefit Expns$0NetCommunityBenefitExpnsAmt
Total Expense0.0TotalExpensePct

Research ResearchGrp

FieldValueIRS element (for citing)
Net Community Benefit Expns$0NetCommunityBenefitExpnsAmt
Total Expense0.0TotalExpensePct

Cash And In Kind Contributions CashAndInKindContributionsGrp

FieldValueIRS element (for citing)
Activities Or Programs5ActivitiesOrProgramsCnt
Persons Served1889PersonsServedCnt
Total Community Benefit Expns$22,645TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$0DirectOffsettingRevenueAmt
Net Community Benefit Expns$22,645NetCommunityBenefitExpnsAmt
Total Expense0.0014TotalExpensePct

Total Other Benefits TotalOtherBenefitsGrp

FieldValueIRS element (for citing)
Activities Or Programs25ActivitiesOrProgramsCnt
Persons Served4100PersonsServedCnt
Total Community Benefit Expns$167,775TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$0DirectOffsettingRevenueAmt
Net Community Benefit Expns$167,775NetCommunityBenefitExpnsAmt
Total Expense0.0103TotalExpensePct

Total Community Benefits TotalCommunityBenefitsGrp

FieldValueIRS element (for citing)
Activities Or Programs25ActivitiesOrProgramsCnt
Persons Served4100PersonsServedCnt
Total Community Benefit Expns$5,469,095TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$1,002,434DirectOffsettingRevenueAmt
Net Community Benefit Expns$4,466,661NetCommunityBenefitExpnsAmt
Total Expense0.2737TotalExpensePct

Physical Imprv And Housing PhysicalImprvAndHousingGrp

FieldValueIRS element (for citing)
Net Community Benefit Expns$0NetCommunityBenefitExpnsAmt
Total Expense0.0TotalExpensePct

Economic Development EconomicDevelopmentGrp

FieldValueIRS element (for citing)
Activities Or Programs1ActivitiesOrProgramsCnt
Persons Served820PersonsServedCnt
Total Community Benefit Expns$33,783TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$0DirectOffsettingRevenueAmt
Net Community Benefit Expns$33,783NetCommunityBenefitExpnsAmt
Total Expense0.0021TotalExpensePct

Community Support CommunitySupportGrp

FieldValueIRS element (for citing)
Activities Or Programs1ActivitiesOrProgramsCnt
Persons Served1016PersonsServedCnt
Total Community Benefit Expns$14,698TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$0DirectOffsettingRevenueAmt
Net Community Benefit Expns$14,698NetCommunityBenefitExpnsAmt
Total Expense0.0009TotalExpensePct

Environmental Improvements EnvironmentalImprovementsGrp

FieldValueIRS element (for citing)
Net Community Benefit Expns$0NetCommunityBenefitExpnsAmt
Total Expense0.0TotalExpensePct

Leadership Development LeadershipDevelopmentGrp

FieldValueIRS element (for citing)
Net Community Benefit Expns$0NetCommunityBenefitExpnsAmt
Total Expense0.0TotalExpensePct

Coalition Building CoalitionBuildingGrp

FieldValueIRS element (for citing)
Net Community Benefit Expns$0NetCommunityBenefitExpnsAmt
Total Expense0.0TotalExpensePct

Health Improvement Advocacy HealthImprovementAdvocacyGrp

FieldValueIRS element (for citing)
Net Community Benefit Expns$0NetCommunityBenefitExpnsAmt
Total Expense0.0TotalExpensePct

Workforce Development WorkforceDevelopmentGrp

FieldValueIRS element (for citing)
Activities Or Programs1ActivitiesOrProgramsCnt
Persons Served307PersonsServedCnt
Total Community Benefit Expns$8,637TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$0DirectOffsettingRevenueAmt
Net Community Benefit Expns$8,637NetCommunityBenefitExpnsAmt
Total Expense0.0005TotalExpensePct

Other Communtity Building Acty OtherCommuntityBuildingActyGrp

FieldValueIRS element (for citing)
Net Community Benefit Expns$0NetCommunityBenefitExpnsAmt
Total Expense0.0TotalExpensePct

Total Communtity Building Acty TotalCommuntityBuildingActyGrp

FieldValueIRS element (for citing)
Activities Or Programs3ActivitiesOrProgramsCnt
Persons Served2143PersonsServedCnt
Total Community Benefit Expns$57,118TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$0DirectOffsettingRevenueAmt
Net Community Benefit Expns$57,118NetCommunityBenefitExpnsAmt
Total Expense0.0035TotalExpensePct
FieldValueIRS element (for citing)
Bad Debt Expense ReportedfalseBadDebtExpenseReportedInd
Bad Debt Expense$51,944BadDebtExpenseAmt
Bad Debt Expense Attributable$0BadDebtExpenseAttributableAmt
Reimbursed By Medicare$7,577,497ReimbursedByMedicareAmt
Cost Of Care Reimbursed By Medcr$7,510,789CostOfCareReimbursedByMedcrAmt
Medicare Surplus Or Shortfall$66,708MedicareSurplusOrShortfallAmt

Costing Methodology Used CostingMethodologyUsedGrp

FieldValueIRS element (for citing)
Cost To Charge RatioYes (X)CostToChargeRatioInd
FieldValueIRS element (for citing)
Written Debt Collection PolicyYes (true)WrittenDebtCollectionPolicyInd
Financial Assistance PrvsnYes (true)FinancialAssistancePrvsnInd
Hospital Facilities1HospitalFacilitiesCnt

Hospital Facilities HospitalFacilitiesGrp

FieldValueIRS element (for citing)
Facility1FacilityNum

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1StVincent Salem Hospital IncBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line1911 N Shelby StreetAddressLine1Txt
CitySalemCityNm
State AbbreviationINStateAbbreviationCd
ZIP46167ZIPCd
FieldValueIRS element (for citing)
Website Addresswww.stvincent.org/Locations/Hospitals/SalemWebsiteAddressTxt
State License17-005087-1StateLicenseNum
Licensed HospitalYes (X)LicensedHospitalInd
General Medical And SurgicalYes (X)GeneralMedicalAndSurgicalInd
Critical Access HospitalYes (X)CriticalAccessHospitalInd
Emergency Room24 HrsYes (X)EmergencyRoom24HrsInd

Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1StVincent Salem Hospital IncBusinessNameLine1Txt
FieldValueIRS element (for citing)
Facility1FacilityNum
First Licensed CY Or PYfalseFirstLicensedCYOrPYInd
Tax Exempt Hospital CY Or PYfalseTaxExemptHospitalCYOrPYInd
CHNA ConductedYes (true)CHNAConductedInd
Community DefinitionYes (X)CommunityDefinitionInd
Community DemographicsYes (X)CommunityDemographicsInd
Existing ResourcesYes (X)ExistingResourcesInd
How Data ObtainedYes (X)HowDataObtainedInd
Community Health NeedsYes (X)CommunityHealthNeedsInd
Other Health IssuesYes (X)OtherHealthIssuesInd
Community Hlth Needs Id ProcessYes (X)CommunityHlthNeedsIdProcessInd
Consulting ProcessYes (X)ConsultingProcessInd
Prior CHNA ImpactYes (X)PriorCHNAImpactInd
CHNA Conducted15CHNAConductedYr
Take Into Account Others InputYes (true)TakeIntoAccountOthersInputInd
CHNA Conducted With Other FcltsYes (true)CHNAConductedWithOtherFcltsInd
CHNA Conducted With Non FcltsfalseCHNAConductedWithNonFcltsInd
CHNA Report Widely AvailableYes (true)CHNAReportWidelyAvailableInd
Rpt Available On Own WebsiteYes (X)RptAvailableOnOwnWebsiteInd
Own Website URLhttps://www.stvincent.org/how-we-are-different/community-assessmentOwnWebsiteURLTxt
Paper Copy Public InspectionYes (X)PaperCopyPublicInspectionInd
Implementation Strategy AdoptYes (true)ImplementationStrategyAdoptInd
Implementation Strategy Adpt16ImplementationStrategyAdptYr
Strategy Posted WebsiteYes (true)StrategyPostedWebsiteInd
Strategy Website URLhttps://www.stvincent.org/how-we-are-different/community-assessmentStrategyWebsiteURLTxt
Organization Incur Excise TaxfalseOrganizationIncurExciseTaxInd
Elig Criteria ExplainedYes (true)EligCriteriaExplainedInd
FPG Family Incm Lmt Free DscntYes (X)FPGFamilyIncmLmtFreeDscntInd
FPG Family Incm Lmt Free Care250.0FPGFamilyIncmLmtFreeCarePct
FPG Family Incm Lmt Dscnt Care400.0FPGFamilyIncmLmtDscntCarePct
Asset Level CriteriaYes (X)AssetLevelCriteriaInd
Explained BasisYes (true)ExplainedBasisInd
App Financial Asst ExplnYes (true)AppFinancialAsstExplnInd
Described InfoYes (X)DescribedInfoInd
Described Suprt DocYes (X)DescribedSuprtDocInd
Includes Publicity MeasuresYes (true)IncludesPublicityMeasuresInd
FAP Available On WebsiteYes (X)FAPAvailableOnWebsiteInd
FAP Available On Website URLHTTPS://WWW.STVINCENT.ORG/Billing-ServicesFAPAvailableOnWebsiteURLTxt
FAP App Available On WebsiteYes (X)FAPAppAvailableOnWebsiteInd
FAP App Available On Website URLHTTPS://WWW.STVINCENT.ORG/Billing-ServicesFAPAppAvailableOnWebsiteURLTxt
FAP Summary On WebsiteYes (X)FAPSummaryOnWebsiteInd
FAP Summary On Website URLHTTPS://WWW.STVINCENT.ORG/Billing-ServicesFAPSummaryOnWebsiteURLTxt
FAP Avlbl On Request No ChargeYes (X)FAPAvlblOnRequestNoChargeInd
FAP App Avlbl On Request No ChrgYes (X)FAPAppAvlblOnRequestNoChrgInd
FAP Sum Avlbl On Request No ChrgYes (X)FAPSumAvlblOnRequestNoChrgInd
Notified FAP Copy Bill DisplayYes (X)NotifiedFAPCopyBillDisplayInd
Communtity Notified FAPYes (X)CommuntityNotifiedFAPInd
FAP TranslatedYes (X)FAPTranslatedInd
FAP Actions On NonpaymentYes (true)FAPActionsOnNonpaymentInd
Permit No ActionsYes (X)PermitNoActionsInd
Collection ActivitiesfalseCollectionActivitiesInd
Provided Written NoticeYes (X)ProvidedWrittenNoticeInd
Made Effort Orally NotifyYes (X)MadeEffortOrallyNotifyInd
Processed FAP ApplicationYes (X)ProcessedFAPApplicationInd
Made Presumptive Elig DetermYes (X)MadePresumptiveEligDetermInd
Nondis Emergency Care PolicyYes (true)NondisEmergencyCarePolicyInd
Look Back Medicare PrivateYes (X)LookBackMedicarePrivateInd
Amounts Generally BilledfalseAmountsGenerallyBilledInd
Gross ChargesfalseGrossChargesInd

Supplemental Information SupplementalInformationGrp (4 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Schedule H, Part V, Section B, Line 3ETo 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 , 1Facility , 1 - St.Vincent Salem 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 Washington 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 Washington 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 Washington 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: *Hoosier Hills PACT - Tobacco Prevention & Cessation *Purdue Cooperative Extension *Washington County Community Foundation *Washington County Family YMCA *Washington County Health Department
Schedule H, Part V, Section B, Line 6a Facility , 1Facility , 1 - st. vincent salem 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 , 1Facility , 1 - ST. VINCENT SALEM HOSPITAL, INC.. The St. Vincent FY 2017-2019 Implementation Strategy specifically addresses the following three SWHIPs: 1) Access to Health Services - St Vincent Salem 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 Salem 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 Salem 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 Salem 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: Transportation - 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 Salem supports the effort of organizations that are focusing on this issue. Children's Health - This issue is being addressed in the Access to Health Services and Exercise, Nutrition, & Weight priorities.
FieldValueIRS element (for citing)
Facility0FacilityNum

Supplemental Information Detail SupplementalInformationDetail (16 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Schedule H, Part I, Line 7 CHARITY CARE AND CERTAIN OTHER COMMUNITY BENEFITS AT COSTCOMMUNITY BENEFIT OVERVIEW St. Vincent Salem Hospital is a Catholic healthcare facility located in the state of Indiana. St. Vincent Salem 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 Salem 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 Salem, 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. Social and Environmental Improvement Activities Programs and activities that improve the health of persons in the community by addressing the determinants of health, which include the social, economic and physical environment, which includes removal of harmful materials in public housing, participations in community coalitions to increase jobs with health insurance and conducing a separate assessment for community disaster preparedness. 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=$25,756 In year two of the strategy, the HA helped 27 people obtain medical insurance (FY18 goal=12; FY18 goal attainment=225%). 2) Exercise, Nutrition & Weight: Community benefit=$6,385; Staff time=9.5 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 50 families participated in the program - 26% (n=13) of families responded to the baseline survey - 23% (n=3) reported being food secure - 77% (n=10) 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=$1,813; Staff time=32 hours The hospital offered 2 Rx for Change training to the community on October 26, 2017 and February 22, 2018. A total of twenty-two participants attended the training. Participants represented Lifespring, CareSource, Anthem, Baptist Health Floyd, Washington Co Health Dept, WIC office, St. Vincent Medical Group, St. Vincent RUAH department, and St. Vincent Salem (community members=13, 59%; St. Vincent associates=9, 41%). 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 68% (n=15). NOTE: Due to a miscommunication between the hospital and Rx for Change teams, baseline questions about "Preferred Provider" status and changes in ask/advise/recommend/refer as a result of the training were not asked at baseline in any training before February 2018 (participants impacted=8). However, all participants were asked to rate their overall ability to discuss cessation with patients. On a scale of 1-5 (Poor-Excellent), 6 (40%) participants rated their overall ability as "Good". Six of the reported being/working for an organization that is registered as a "Preferred Provider" with the Indiana Tobacco Quitline (Yes=6; Don't know=1; Question not on survey=8). As a result of this training, participants reported how likely they were to*: - Ask more patients about tobacco use (n=6, 86%) - Advise more tobacco users to quit (n=7, 100%) - Recommend medications for quitting more often (n=7, 100%) - Refer patients to the tobacco quitline (n=7, 100%) *% does not include those that were not asked the question on the survey. Denominator=7 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. No incentives were offered for survey completion. A total of 16 participants completed the 30-day follow-up survey. Of those completing the follow-up survey: - 10 (63%) participants reported being/working for an organization that is registered with the quitline as a "Preferred Provider" - 13 (81%) participants reported asking more patients about tobacco use - 15 (94%) participants reported advising more tobacco users to quit - 14 (88%) participants reported recommending medications for quitting - 14 (88%) participants reported referring patients to the tobacco quitline Participants were also asked to consider the 30 days following the training and approximate the number of patients that they: - Asked about tobacco use = ~199 (range of approximations = 0-48) - Advising more tobacco users to quit = ~166 (range of approximations = 2-166) - Recommending medications for quitting = ~117 (range of approximations = 0-30) - Referring patients to the quitline = ~74 (range of approximations = 0-30) 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 use 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 assistanceThe 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 ActivitiesResearch 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 amountAfter 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 $192,384 at charges, ($51,944 at cost).
Schedule H, Part III, Line 3 Bad Debt Expense MethodologyThe 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 footnoteThe 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 costsA 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 assistanceThe 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 Salem Hospital, Inc.: Line 16a URL: HTTPS://WWW.STVINCENT.ORG/Billing-Services;
Schedule H, Part V, Section B, Line 16b FAP Application website- St.Vincent Salem 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 Salem Hospital, Inc.: Line 16c URL: HTTPS://WWW.STVINCENT.ORG/Billing-Services;
Schedule H, Part VI, Line 2 Needs assessmentSt. Vincent Salem 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 Salem utilizes information from these secondary sources to develop programs and provide services throughout the region. In addition, St. Vincent Salem 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 assistanceSt. Vincent Salem 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 informationSt. Vincent Salem Hospital is located in Salem, Indiana and serves rural Washington and contiguous counties, in south Central Indiana. Washington County has an estimated population of 27,827. According to the 2018 County Health Rankings, Washington County ranks 73rd out of 92 Indiana counties in overall health outcomes. Washington County demographics are similar to those of the overall Indiana state population. Of the population, 98.2% percent of Washington County residents are Caucasian and 1.3% are Hispanic or Latino. The median household income is about $48,939 annually, which is about $3,000 less than that of the state median, and roughly 14%of Washington County families are living in poverty, which is the same as the state. Washington County's uninsured rate is 13% which is higher than the state's rate of 11%. By the Indiana State Department of Health and U.S. Department of Health and Human Services, Washington County is not designated as a Medically Underserved Area (MUA) and Population (MUP). According to the 2015 County Health Rankings, Washington County ranks 75th out of 92 Indiana counties in overall health outcomes. Washington County demographics are similar to those of the overall Indiana state population. Less than 3 percent of Washington County residents are non-white or Caucasian, and 98 percent of Washington County residents speak only English at home. The median household income is about $42,500 annually, which is about $9,000 less than that of the state median, and roughly 12 percent of Washington County families are living in poverty, which is slightly higher than the state. Washington County's uninsured rate is 16% which is higher than the state's rate of 14%. By the Indiana State Department of Health and U.S. Department of Health and Human Services, Washington County is not designated as a Medically Underserved Area (MUA) and Population (MUP) as of December, 2016.
Schedule H, Part VI, Line 5 Promotion of community healthSt. Vincent Salem's governing body is comprised of persons representing diverse aspects and interests of the community. Many members of St. Vincent Salem'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 systemSt. Vincent Salem is an affiliate of St. Vincent Health system and Ascension Health. St. Vincent Salem 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 Salem is dedicated to improving the health status and quality of life for the communities it serves. While designated associates at St. Vincent Salem 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 Salem participates.

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Severance PaymentfalseSeverancePaymentInd
Supplemental Nonqual Rtr PlanYes (true)SupplementalNonqualRtrPlanInd
Equity Based Comp ArrngmfalseEquityBasedCompArrngmInd
Comp Based On Revenue Of Flng OrgfalseCompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related OrgsfalseCompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng OrgfalseCompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd OrgsfalseCompBsdNetEarnsRltdOrgsInd
Any Non Fixed PaymentsfalseAnyNonFixedPaymentsInd
Initial Contract ExceptionfalseInitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (7 entries)

TitleTitleTxtBase Compensation Filing OrgBaseCompensationFilingOrgAmtCompensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmtBonus Filing OrganizationBonusFilingOrganizationAmountBonus Related OrganizationsBonusRelatedOrganizationsAmtOther Compensation Filing OrgOtherCompensationFilingOrgAmtOther Compensation Rltd OrgsOtherCompensationRltdOrgsAmtDeferred Compensation Flng OrgDeferredCompensationFlngOrgAmtDeferred Comp Rltd OrgsDeferredCompRltdOrgsAmtNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmtNontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmtTotal Compensation Filing OrgTotalCompensationFilingOrgAmtTotal Compensation Rltd OrgsTotalCompensationRltdOrgsAmtComp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmtComp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
BARRY S MOFFITT
DIRECTOR$0$290,448$0$132,696$0$1,544$0$12,806$0$31,921$0$469,416$0$0
JANETTE L HELM
DIRECTOR$0$102,927$0$34,647$0$1,365$0$5,324$0$21,667$0$165,930$0$0
JEFFREY G MORGAN MD
DIRECTOR$0$234,203$0$196,356$0$2,064$0$13,250$0$33,213$0$479,086$0$0
WAYNE R KNIGHT
EXECUTIVE DIRECTOR, FINANCE$0$174,812$0$53,829$0$2,616$0$13,157$0$22,868$0$267,283$0$0
DANA M MUNTZ
ADMINISTRATOR/CNO$177,008$0$71,348$0$611$0$12,749$0$29,186$0$290,903$0$0$0
JENNIFER L STANLEY MD
CMO$0$275,992$0$1,980$0$558$0$14,650$0$31,845$0$325,024$0$0
JAMES D PASSERENI JR
MANAGER, PHARMACY$136,957$0$20,793$0$660$0$9,080$0$28,719$0$196,209$0$0$0

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Schedule J, Part I, Line 3 Arrangement used to establish the top management official's compensationSt.Vincent Health, Inc., a related organization of St.Vincent Salem 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 planEligible 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.

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (13 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Form 990, Part IV, Line 20b Audited financial statementsThe activity of St. Vincent Salem Hospital, Inc. is reported in the consolidated financial statements of Ascension Health Alliance. No individual audit of St. Vincent Salem Hospital, Inc. is completed. Therefore, the attached audited financial statements are of Ascension Health Alliance and Affiliates, which include the activity of St. Vincent Salem Hospital, Inc.
Form 990, Part VI, Line 15a PROCESS TO ESTABLISH COMPENSATION OF TOP MANAGEMENT OFFICIALTHE 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 SALEM 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 EMPLOYEESTHE 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 SALEM 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 3 Delegation of management dutiesTHE REGIONAL CFO OPERATIONS AT ST.VINCENT SALEM HOSPITAL ARE ADMINISTERED BY A MANAGEMENT COMPANY, AS DIRECTED BY THE BOARD. JOHN LINES (REGIONAL CFO) IS AN EMPLOYEE OF BRADLEY & ASSOCIATES, P.C.
Form 990, Part VI, Line 6 Classes of members or stockholdersSt. Vincent Salem Hospital, Inc. has a single corporate member, St. Vincent Health, Inc.
Form 990, Part VI, Line 7a Members or stockholders electing members of governing bodySt. Vincent Salem 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 Salem Hospital, Inc.
Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholdersAll decisions that have a material impact to St. Vincent Salem 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 bodyDURING 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 policyThe 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 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 publicThe organization will provide any documents open to public inspection upon request.
Form 990, Part VIII, Line 11d Other Miscellaneous RevenueMiscellaneous Revenue - Total Revenue: 2113, Related or Exempt Function Revenue: , Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: 2113;
Form 990, Part XI, Line 9 Other changes in net assets or fund balancesTRANSFERS WITH ALPHA FUND - 298249;
Form 990, Part XII, Line 2c oversight of audit or selection of independent accountantSt. Vincent Salem 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.

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (39 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdExempt Code SectionExemptCodeSectionTxtPublic Charity StatusPublicCharityStatusTxtBusiness Name Line1DirectControllingEntityName/BusinessNameLine1TxtControlled OrganizationControlledOrganizationInd
ASCENSION HEALTH ALLIANCE
PO BOX 45998ST LOUISMO63145453358926NATIONAL HEALTH SYSTEMMO501(c)(3)Type INAfalse
ASCENSION HEALTH
PO BOX 45998ST LOUISMO63145311662309NATIONAL HEALTH SYSTEMMO501(c)(3)Type IASCENSION HEALTH ALLIANCEfalse
ST VINCENT HEALTH INC
10330 N MERIDIAN STREET STE 430NINDIANAPOLISIN46290352052591PARENT COMPANYIN501(c)(3)Type III-FIASCENSION HEALTHfalse
CENTRAL INDIANA HEALTH SYSTEM CARDIAC SERVICES INC
2001 W 86TH STREETINDIANAPOLISIN46260351869951FREESTANDING OUTPATIENT CENTERIN501(c)(3)Type III-FIST VINCENT HEALTH INCYes (true)
SVH REAL ESTATE INC
10330 N MERIDIAN STREET STE 430NINDIANAPOLISIN46290205002285REAL ESTATE HOLDING COMPANYIN501(c)(3)Type III-FIST VINCENT HEALTH INCYes (true)
ST JOSEPH HOSPITAL & HEALTH CENTER INC
1907 W SYCAMORE STREETKOKOMOIN46901350992717HOSPITALIN501(c)(3)3ST VINCENT HEALTH INCYes (true)
ST VINCENT ANDERSON REGIONAL HOSPITAL INC
2015 JACKSON STREETANDERSONIN46016460877261HOSPITALIN501(c)(3)3ST VINCENT HEALTH INCYes (true)
ST VINCENT CARMEL HOSPITAL INC
13500 N MERIDIAN STREETCARMELIN46032743107055HOSPITALIN501(c)(3)3ST VINCENT HEALTH INCYes (true)
ST VINCENT CLAY HOSPITAL INC
1206 E NATIONAL AVENUEBRAZILIN47834352112529CRITICAL ACCESS HOSPITALIN501(c)(3)3ST VINCENT HEALTH INCYes (true)
ST VINCENT DUNN HOSPITAL INC
1600 23RD STREETBEDFORDIN47421272192831CRITICAL ACCESS HOSPITALIN501(c)(3)3ST VINCENT HEALTH INCYes (true)
ST VINCENT FISHERS HOSPITAL INC
13861 OLIO ROADFISHERSIN46037454243702HOSPITALIN501(c)(3)3ST VINCENT HEALTH INCYes (true)
ST VINCENT FRANKFORT HOSPITAL INC
1300 S JACKSONFRANKFORTIN46041352099320CRITICAL ACCESS HOSPITALIN501(c)(3)3ST VINCENT HEALTH INCYes (true)
ST VINCENT HEALTH WELLNESS AND PREVENTIVE CARE INSTITUTE INC
8333 NAAB ROAD STE 301INDIANAPOLISIN46260461227327HEALTH AND WELLNESS SERVICESIN501(c)(3)10ST VINCENT HEALTH INCYes (true)
ST VINCENT HOSPITAL AND HEALTH CARE CENTER INC
2001 W 86TH STREETINDIANAPOLISIN46260350869066HOSPITALIN501(c)(3)3ST VINCENT HEALTH INCYes (true)
ST VINCENT JENNINGS HOSPITAL INC
301 HENRY STREETNORTH VERNONIN47265351841606CRITICAL ACCESS HOSPITALIN501(c)(3)3ST VINCENT HEALTH INCYes (true)
ST VINCENT MADISON COUNTY HEALTH SYSTEM INC
1331 SOUTH A STREETELWOODIN46036350876389HOSPITALIN501(c)(3)3ST VINCENT HEALTH INCYes (true)
ST VINCENT MEDICAL GROUP INC
8425 HARCOURT ROADINDIANAPOLISIN46260272039417PHYSICIAN PROFESSIONAL SERVICESIN501(c)(3)10ST VINCENT CARMEL HOSPITAL INCYes (true)
ST VINCENT RANDOLPH HOSPITAL INC
473 GREENVILLE AVENUEWINCHESTERIN47394352103153CRITICAL ACCESS HOSPITALIN501(c)(3)3ST VINCENT HEALTH INCYes (true)
ST VINCENT RAS INC
10330 N MERIDIAN STREET STE 400NINDIANAPOLISIN46290471289091RETAIL AMBULATORY SERVICESIN501(c)(3)10ST VINCENT HEALTH INCYes (true)
ST VINCENT SETON SPECIALTY HOSPITAL INC
8050 TOWNSHIP LINE RDINDIANAPOLISIN46260351712001LONG TERM CARE HOSPITALIN501(c)(3)3ST VINCENT HEALTH INCYes (true)
ST VINCENT WILLIAMSPORT HOSPITAL INC
412 N MONROE STREETWILLIAMSPORTIN47993350784551CRITICAL ACCESS HOSPITALIN501(c)(3)3ST VINCENT HEALTH INCYes (true)
ST MARY'S HEALTH INC
3700 WASHINGTON AVENUEEVANSVILLEIN47750350869065HOSPITALIN501(c)(3)3ST VINCENT HEALTH INCYes (true)
ST MARY'S WARRICK HOSPITAL INC
1116 MILLIS AVENUEBOONVILLEIN47601351343019HOSPITALIN501(c)(3)3ST VINCENT HEALTH INCYes (true)
ST JOSEPH FOUNDATION OF KOKOMO INDIANA INC
1907 W SYCAMORE STREETKOKOMOIN46901237313206SUPPORTING ORGANIZATIONIN501(c)(3)Type IST JOSEPH HOSPITAL & HEALTH CENTER INCYes (true)
ST MARY'S AT HOME INC
3700 WASHINGTON AVENUEEVANSVILLEIN47750351899560DME/HOME CAREIN501(c)(3)Type IST MARY'S HEALTH INCYes (true)
ST MARY'S BUILDING CORPORATION
3700 WASHINGTON AVENUEEVANSVILLEIN47750237248362REAL ESTATE HOLDING COMPANYIN501(c)(2)ST MARY'S HEALTH INCYes (true)
ST MARY'S HEALTH SERVICES INC
3700 WASHINGTON AVENUEEVANSVILLEIN47750351679526INVESTMENT SERVICESIN501(c)(3)Type III-FIST MARY'S HEALTH INCYes (true)
ST MARY'S CARE PARTNERS INC
3700 WASHINGTON AVENUEEVANSVILLEIN47750351899562TAX-EXEMPT AFFILIATE REIMBURSEMENTSIN501(c)(3)Type IST MARY'S HEALTH INCYes (true)
ST MARY'S HEALTH FOUNDATION INC
3700 WASHINGTON AVENUEEVANSVILLEIN47750237045370SUPPORTING ORGANIZATIONIN501(c)(3)Type IST MARY'S HEALTH INCYes (true)
ST MARY'S MEDICAL GROUP LLC
3700 WASHINGTON AVENUEEVANSVILLEIN47750261356310PHYSICIAN PROFESSIONAL SERVICESIN501(c)(3)10ST VINCENT MEDICAL GROUP INCYes (true)
ST MARY'S OHIO VALLEY HEARTCARE LLC
901 ST MARYS DRIVEEVANSVILLEIN47714273474697DORMANTIN501(c)(3)Type IST MARY'S MEDICAL GROUP LLCYes (true)
PRIMARY PHYSICIAN NETWORK LLC
3700 WASHINGTON AVENUEEVANSVILLEIN47750208775914DORMANTIN501(c)(3)10ST MARY'S HEALTH INCYes (true)
ST VINCENT ANDERSON REGIONAL HOSPITAL FOUNDATION INC
2015 JACKSON STREETANDERSONIN46016352053693SUPPORTING ORGANIZATIONIN501(c)(3)Type IST VINCENT ANDERSON REGIONAL HOSPITAL INCYes (true)
ST VINCENT FRANKFORT HOSPITAL FOUNDATION INC
1300 S JACKSONFRANKFORTIN46041351531734SUPPORTING ORGANIZATIONIN501(c)(3)Type IST VINCENT FRANKFORT HOSPITAL INCYes (true)
ST VINCENT HOSPITAL FOUNDATION INC
10330 N MERIDIAN STREET STE 430NINDIANAPOLISIN46290356088862SUPPORTING ORGANIZATIONIN501(c)(3)Type IST VINCENT HOSPITAL AND HEALTH CARE CENTER INCYes (true)
ST VINCENT MERCY HOSPITAL FOUNDATION INC
1331 SOUTH A STREETELWOODIN46036311066871SUPPORTING ORGANIZATIONIN501(c)(3)Type IST VINCENT MADISON COUNTY HEALTH SYSTEM INCYes (true)
ST VINCENT RANDOLPH HOSPITAL FOUNDATION INC
473 GREENVILLE AVENUEWINCHESTERIN47394352133006SUPPORTING ORGANIZATIONIN501(c)(3)Type IST VINCENT RANDOLPH HOSPITAL INCYes (true)
ST VINCENT WILLIAMSPORT HOSPITAL FOUNDATION INC
412 N MONROE STREETWILLIAMSPORTIN47993743130159SUPPORTING ORGANIZATIONIN501(c)(3)Type IST VINCENT WILLIAMSPORT HOSPITAL INCYes (true)
ST MARY'S WARRICK EMERGENCY MEDICAL SERVICES INC
3700 WASHINGTON AVENUEEVANSVILLEIN47750205342518AMBULANCE SERVICESIN501(c)(4)ST MARY'S HEALTH SERVICES INCYes (true)

Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (7 entries)

Address Line1USAddress/AddressLine1TxtAddress Line2USAddress/AddressLine2TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdBusiness Name Line1DirectControllingEntityName/BusinessNameLine1TxtPredominant Income TypePredominantIncomeTypeTxt
ENDOSCOPY CENTER LLC
13421 OLD MERIDIAN STREETSTE 150CARMELIN46032320029881ENDOSCOPY CENTERINNAN/A
STVINCENT HEART CENTER OF INDIANA LLC
10580 N MERIDIAN STREETINDIANAPOLISIN46290364492612HEART HOSPITALINNAN/A
CARMEL AMBULATORY SURGERY CENTER LLC
13421 OLD MERIDIAN STSTE 150CARMELIN46032320014795AMBULATORY SURGERY CENTERINNAN/A
NAAB ROAD SURGERY CENTER LLC
8260 NAAB ROADSTE 100INDIANAPOLISIN46260351991390AMBULATORY SURGERY CENTERINNAN/A
TRI-STATE COMMUNITY CLINICS LLC
8601 N KENTUCKY AVENUESUITE JEVANSVILLEIN47711270885968PRIMARY CARE PHYSICIAN PRACTICESINNAN/A
THP - ST VINCENT VENTURE LLC
1415 LOUISIANA STREET27TH FLOORHOUSTONTX77002813184703FREESTANDING ED'STXNAN/A
AMBROSE PARKWOOD WEST II LLC
55 MONUMENTAL CIRCLESTE 450INDIANAPOLISIN46204270532924LAND HOLDINGSINNAN/A

Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp

Related Organization Name RelatedOrganizationName

FieldValueIRS element (for citing)
Business Name Line1ST MARY'S MEDICAL GROUP INCBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line13700 WASHINGTON AVEAddressLine1Txt
CityEVANSVILLECityNm
State AbbreviationINStateAbbreviationCd
ZIP47750ZIPCd
FieldValueIRS element (for citing)
EIN352076827EIN
Primary ActivitiesINVESTMENTPrimaryActivitiesTxt
Legal Domicile StateINLegalDomicileStateCd

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1NABusinessNameLine1Txt
FieldValueIRS element (for citing)
Entity TypeC CorporationEntityTypeTxt
Controlled OrganizationYes (true)ControlledOrganizationInd
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts RyltsfalseReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth OrgfalseGiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth OrgfalseGiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other OrgfalseLoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth OrgfalseLoansOrGuaranteesFromOthOrgInd
Div Related OrganizationfalseDivRelatedOrganizationInd
Asset Sale To Other OrgfalseAssetSaleToOtherOrgInd
Asset Purchase From Other OrgfalseAssetPurchaseFromOtherOrgInd
Asset ExchangefalseAssetExchangeInd
Rental Of Facilities To Oth OrgYes (true)RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth OrgfalseRentalOfFcltsFromOthOrgInd
Perform Of Services For Oth OrgYes (true)PerformOfServicesForOthOrgInd
Perform Of Services By Other OrgfalsePerformOfServicesByOtherOrgInd
Sharing Of FacilitiesfalseSharingOfFacilitiesInd
Paid Employees SharingYes (true)PaidEmployeesSharingInd
Reimbursement Paid To Other OrgYes (true)ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other OrgYes (true)ReimbursementPaidByOtherOrgInd
Transfer To Other OrgYes (true)TransferToOtherOrgInd
Transfer From Other OrgfalseTransferFromOtherOrgInd

Transactions Related Org TransactionsRelatedOrgGrp (2 entries)

Transaction TypeTransactionTypeTxtInvolvedInvolvedAmtMethod Of Amount DeterminationMethodOfAmountDeterminationTxt
St Vincent Hospital and Health Care Center Inc
L$62,383FAIR MARKET VALUE
St Vincent Medical Group Inc
J$208,835FAIR MARKET VALUE

Comments

Anonymous: no account or email. Up to 2,000 characters, at most one link. Comments are checked automatically; some wait for review.