2018-05-12T12:10:07-05:00 2017-06-30 990 2016-07-01 351343019 ST MARYS WARRICK HOSPITAL INC STMA 3147338000 1116 MILLIS AVENUE BOONVILLE IN 47601 Tonya Mershon Tax Officer 2017-10-12 2016 2022-09-23 18:48:47Z ST VINCENT WARRICK DAN PAROD 1116 MILLIS AVENUE BOONVILLE IN 47601 15469369 false 0928 X http://www.stvincentevansville.org/ X 1971 IN St. Mary's Warrick Hospital, Inc. is a nonprofit hospital dedicated to providing healthcare that leaves no one behind. X 16 14 167 14 101821 41525 16698 5691 15910394 15339345 4288 148 268843 124185 16200223 15469369 561 0 6669238 6990605 0 0 8814273 9354255 15483511 16345421 716712 -876052 10654838 14028874 8687575 13412448 1967263 616426 St. Mary's Warrick Hospital, Inc. is dedicated to providing spiritually-centered, holistic healthcare that sustains and improves the health of those served, with special attention to the poor and vulnerable. Both inpatient and outpatient health services are provided without regard to patient race, creed, national origin, economic status, insurance status or ability to pay. This mission extends well beyond the provision of core medical services to encompass medical and scientific research programs, the training and educating of health care professionals and active support of community-based partnerships and programs to improve health and quality of life. false false 7490545 561 15245564 St. Mary's Warrick Hospital, Inc. (SMWH) is a 25-bed, critical access hospital serving rural Warrick and contiguous counties and providing services without regard to patient race, creed, national origin, economic status, or ability to pay. SMWH provides inpatient and outpatient health care services with a 24- hour emergency department that is staffed with an on-site physician. During fiscal year 2017, SMWH treated 596 adults and children for a total of 6,010 patient days of service. The hospital also provided services for 23,337 outpatient visits, including 453 outpatient surgeries and 22,884 Emergency Room and Minor Care Visits. St. Mary's Warrick Hospital, Inc. provides the following hospital services: Cardiopulmonary Rehabilitation, Day Treatment and Infusion Services, Medical Imaging, Multi-Specialty Clinic, Respiratory Therapy, Surgery Services, and Wellness Services. Some of these services operate at a loss in order to ensure that comprehensive services are available to the community. 3602995 St. Mary's Warrick Hospital, Inc. provides a substantial portion of its core health services to the poor, uninsured or underinsured and has proactively taken steps to address the accessibility, financing, and delivery of healthcare to the underserved. During the fiscal year ending June 30, 2017, the unreimbursed cost of free or discounted services provided to patients who were deemed indigent under state, county, or hospital guidelines was $3,602,995 which included $825,905 of traditional charity care and $2,777,090 in unpaid costs of care for those qualifying for Medicaid or other public programs for the poor. 19604 In addition to core medical services, St. Mary's Warrick Hospital, Inc. (SMWH) partners with its community to assess community assets and needs and to work together to address issues impacting health and quality of life, with special emphasis on the poor and vulnerable. In fiscal year 2017, SMWH provided $19,604 in unbilled services to the poor and to the broader community. (When combined with the costs of free or discounted services for the poor listed in Line 4b, SMWH provided a total community benefit of $3,622,599 in fiscal year 2017.) SMWH serves and supports its community through such programs as Health Advocates, health fairs and health education. Such community-focused programs improve access to healthcare, advocate for the poor and vulnerable, promote health through free education and screenings and help to build better communities by improving quality of life. 11113144 true true false false false false false false false false true false false true true true false true false false false false false false false false true true false false true false false false false false false false false false false false true false true true true false false true 40 0 true 167 true true true false false false false false false false false false X 16 14 true false false false true true true true true false false false true true true true true false false true true IN X CRAIG POLKOW 8124854178 3700 Washington Avenue Evansville IN 47750 KEITH JEWELL EX-OFFICIO (END 2/2017) 1.0 63.6 X X 0 883729 26418 DANIEL PAROD EX-OFFICIO (START 2/2017) 1.0 63.6 X X 0 213901 12825 LAURENCE STEENBERG CHAIRMAN 1.0 2.0 X X 0 0 0 SUSAN HARDWICK VICE-CHAIRMAN 1.0 2.0 X X 0 0 0 PHILLIP L STIVER MD SECRETARY 1.0 2.0 X X 0 0 0 TRUDY STOCK TREASURER 1.0 2.0 X X 0 0 0 NADINE COUDRET BOARD MEMBER 1.0 2.0 X 0 0 0 RITA EYKAMP BOARD MEMBER 1.0 2.0 X 0 0 0 MICHAEL R HINTON BOARD MEMBER 1.0 2.2 X 0 0 0 E LYNN JOHNSON BOARD MEMBER 1.0 2.0 X 0 0 0 SHARON KAZEE BOARD MEMBER 1.0 2.0 X 0 0 0 SISTER SHARON RICHARDT BOARD MEMBER 1.0 2.0 X 0 0 0 SALLY RIDEOUT BOARD MEMBER 1.0 2.0 X 0 0 0 JAMES SANDGREN BOARD MEMBER 1.0 2.0 X 0 0 0 KARL W SASH MD BOARD MEMBER 1.0 56.0 X 0 721814 65510 BRIAN SCHYMIK MD BOARD MEMBER 1.0 2.0 X 0 0 0 JEFFERY WOLF BOARD MEMBER 1.0 2.0 X 0 0 0 MARK L MARCHINO Executive Director 55.0 0 X 154896 0 33630 JOHN L SCHELLHASE RN, Emergency Services 55.0 0 X 126592 0 14664 281488 1819444 153047 2 false true false EMERGENCY PROFESSIONAL SERVICE INC P O BOX 634850 CINCINNATI OH 452634850 MEDICAL SERVICES 1305548 HORIZON MENTAL HEALTH MANAGEMENT PO BOX 840839 DALLAS TX 75284 PHYSICIAN SERVICES 583394 KENNETH R PARKER MD 2222 HUFFMAN RD BOONVILLE IN 47601 PHYSICIAN SERVICES 344400 MEDICAL STAFFING SOLUTIONS LLC 9700 HIGHWAY 57 SUITE A EVANSVILLE IN 477251458 MEDICAL STAFFING SERVICES 167631 EVANSVILLE SURGICAL ASSOCIATES INC 520 MARY STREET EVANSVILLE IN 47710 PHYSICIAN SERVICES 144478 5 X 5691 5691 INPATIENT/OUTPATIENT REVENUE 621990 15118831 15118831 REFERENCE LAB FEES 621500 93781 93781 Intercompany Rent 531120 57440 57440 Jail clinic REVENUE 621990 45149 45149 fitness revenue 713940 23457 23457 687 687 0 0 15339345 148 148 60100 60100 0 60100 60100 0 0 0 0 0 0 0 0 0 0 0 0 0 CAFETERIA/VENDING 722514 59190 59190 HOUSEKEEPING 561720 8040 8040 -3145 0 0 -3145 64085 15469369 15245564 101821 116293 X 561 561 5695285 4707148 988137 13999 11570 2429 899697 743599 156098 381624 315412 66212 288133 288133 780 780 1725100 1690416 34684 0 11496 11496 64979 35426 29553 10555 10555 417981 417981 4901 2604 2297 2460 1746 714 153775 153775 628874 227092 401782 42925 42925 PURCHASED SERVICES 3741428 1061618 2679810 PROVIDER TAX 897100 897100 MEDICAL SUPPLIES 688332 688332 CONTRACT LABOR 222534 222534 452902 209298 243604 0 16345421 11113144 5232277 0 1586947 1751084 1915064 2590946 0 0 0 158026 157363 14341 14341 19822635 15947372 4260909 3875263 0 19208 19895 250203 139231 2450140 5480751 10654838 14028874 1521152 1444899 7166423 11967549 8687575 13412448 X 1967263 616426 1967263 616426 10654838 14028874 X -876052 -474785 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 181810 181810 13772879 10602297 3170582 14267 14267 0 5525235 5068046 457189 328444 262762 65682 3875263 INTEREST IN INVESTMENTS HELD BY ASCENSION HEALTH ALLIANCE PHYSICIAN GUARANTEE 4180580 Total Deferred Compensation Asset 135974 Intra/Intercompany AR 110875 Estimated Settlements from Third-Party Payor 752654 Other Receivables 200446 Miscellaneous Current Assets 100222 5480751 0 INTERCOMPANY PAYABLE TO ST. MARY'S HEALTH, INC. 568647 DEFERRED COMPENSATION 135974 PHYSICIAN GUARANTEE 4180580 Estimated Settlement to Third-Party Payor 464624 intra/intercompany accounts payable 1213564 INTERCOMPANY DEBT WITH ASCENSION HEALTH ALLIANCE 3504981 PENSION AND POSTRETIREMENT LIABILITY 1784979 TAIL LIABILITY 40000 AH SAVINGS PLAN LIABILITY 74200 11967549 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, 2017. true true X true X true X true true false true true 819897 819897 0.0502 3475226 717031 2758195 0.1687 0 0.0 0 0 4295123 717031 3578092 0.2189 9 514 10588 0 10588 0.0006 0 0.0 0 0.0 0 0.0 4 1096 9016 0 9016 0.0006 13 1610 19604 0 19604 0.0012 13 1610 4314727 717031 3597696 0.2201 0 0.0 1 50 500 0 500 0.0000 1 1082 9031 0 9031 0.0006 0 0.0 0 0.0 0 0.0 0 0.0 1 78 758 0 758 0.0000 0 0.0 3 1210 10289 0 10289 0.0006 false 518407 51841 11260608 11342648 -82040 X true true 1 1 ST MARY'S WARRICK HOSPITAL INC 1116 MILLIS AVENUE BOONVILLE IN 47601 http://www.stvincentevansville.org/locations/locations-profile/?id=95 15-005111-1 X X X X ST MARY'S WARRICK HOSPITAL INC 1 false false true X X X X X X X X X 15 true true true true X https://www.stvincent.org/how-we-are-different/community-assessment X http://www.healthyswin.org X true 15 true https://www.stvincent.org/how-we-are-different/community-assessment false true X 200.0 300.0 X true true X X true X http://www.stvincentevansville.org/patients-visitors/financial-assistance/ X http://www.stvincentevansville.org/patients-visitors/financial-assistance/ X http://www.stvincentevansville.org/patients-visitors/financial-assistance/ X X X X X X true X false X X X X true X false false Schedule H, Part V, Section B, Line 5 Facility , 1 Facility , 1 - ST. MARY'S WARRICK 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 Warrick County, Indiana. St. Mary's 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 Warrick 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 focus groups and interviews with community members who have a fundamental understanding of Warrick County's health needs and represent the broad interests of the community. Twenty-six key informants provided valuable input on the county's health challenges, the sub-populations most in need, and existing resources for county residents. Schedule H, Part V, Section B, Line 6a Facility , 1 Facility , 1 - ST. MARY'S WARRICK HOSPITAL, INC.. The hospital conducted its CHNA in conjunction with St. Mary's Health, Inc. and Deaconess Health System. Schedule H, Part V, Section B, Line 6b Facility , 1 Facility , 1 - ST. MARY'S WARRICK HOSPITAL, INC.. The hospital conducted its CHNA in conjunction with United Way of Southwestern Indiana, Vanderburgh County Health Department, ECHO Community Health Care, and Welborn Baptist Foundation. Schedule H, Part V, Section B, Line 11 Facility , 1 Facility , 1 - ST. MARY'S WARRICK HOSPITAL, INC.. The St. Mary's FY 2017-2019 Implementation Strategy specifically addresses the following three SWHIPs: 1) Access to Health Services St Mary's Warrick 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 Warrick County. Specific action steps include the following: HAW assesses for eligibility and educates individuals about coverage options; HAW submits application and works through any issues or delays; and HAW verifies eligibility in order to complete the Pathway. 2) Exercise, Nutrition & Weight St. Mary's Warrick 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. Mary's Warrick 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. Mary's Warrick supports the effort of organizations that are focusing on this issue. Economy - This identified health need is not being monitored and evaluated in the Implementation Strategy because it is outside the scope of the hospital's core mission. However, St. Mary's Warrick does support efforts of organizations focused on economic development for Warrick County. 0 Schedule H, Part V, Section B, Line 17 Billing and Collection Policy During tax year 2017, the organization learned via verbal comments of IRS agents at public events that the IRS intends that the "readily obtainable" standard in the 501(r) regulations for the AGB calculation and billing and collection policy is only met if those items are posted to the organization's web site. The organization had interpreted that web posting standard to be a safe harbor after consulting with external counsel and tax advisors, and timely took other steps to make the information readily obtainable. Consequently, the organization does not believe its decision to not post these documents to its web site rises to the level of a failure, nor does it believe the circumstances were either willful or egregious, having otherwise timely taken the steps necessary to attain and continue to maintain compliance with the other requirements related to the billing and collection policy and the AGB, as part of its policies and procedures for ensuring compliance with all aspects of 501(r). However, the organization is making this voluntary disclosure in order to communicate to the IRS the changes it is undertaking in response to the recent IRS informal guidance on this specific point concerning the "readily obtainable" standard, and the fact that the organization has started the work necessary to post its AGB information and billing and collection policy to its web site and will complete those additional postings as soon as reasonably possible. The other web postings required under 501(r) (i.e., those related to the community health needs assessment and the financial assistance policy) were timely completed and continue to remain in place as required. The organization believes its safeguards worked as intended in this case (i.e., the organization has regular communications with a number of external law firms and tax consultants and the timely attention to the recent guidance was supported by the framework of regular access to subject matter experts). These changes are in the process of being incorporated into corporate policies and procedures that apply to the organization. Schedule H, Part I, Line 7 Costing Methodology used to calculate financial assistance The cost of providing charity care, means-tested government programs, and other 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 Extensive research has shown that social determinants, such as poverty level, education level, employment and housing, have significant impact on health outcomes, equal to or greater than the impact of health care, health education and direct health behaviors. Efforts to improve health within our communities must include both traditional community benefit activities that directly address health outcomes as well as community building activities that address some of the underlying factors that help to determine the overall health and well-being of individuals and communities served. An example of community building is the Back to School Program which provides school supplies and back packs for children. Purchasing school items can be a financial burden which affects the mental and physical health of families. 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 BAD DEBT EXPENSE IN FISCAL YEAR 2017 WAS $1,401,099 AT CHARGES ($518,407 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 HISTORICAL EXPERIENCE, ECONOMIC CONDITION, 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 A PART OF THE ASCENSION HEALTH ALLIANCE'S CONSOLIDATED AUDIT IN WHICH THE FOOTNOTE THE DISCUSSES THE BAD DEBT EXPENSE IS LOCATED ON PAGE 19. 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 COST 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 A 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 AND THE FINANCIAL ASSISTANCE PROGRAM IS FOLLOWED. Schedule H, Part V, Section B, Line 16a FAP website - ST. MARY'S WARRICK HOSPITAL, INC: Line 16a URL: http://www.stvincentevansville.org/patients-visitors/financial-assistance/; Schedule H, Part V, Section B, Line 16b FAP Application website - ST. MARY'S WARRICK HOSPITAL, INC: Line 16b URL: http://www.stvincentevansville.org/patients-visitors/financial-assistance/; Schedule H, Part V, Section B, Line 16c FAP plain language summary website - ST. MARY'S WARRICK HOSPITAL, INC: Line 16c URL: http://www.stvincentevansville.org/patients-visitors/financial-assistance/; Schedule H, Part VI, Line 2 Needs assessment St. Mary's Warrick Hospital, Inc. 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 Healthier Indiana, Tobacco Prevention & Cessation Commission and Indiana Hospital Association. St. Mary's Warrick Hospital, Inc. utilizes information from these secondary sources to develop programs and provide services throughout the region. In addition, St. Mary's Warrick Hospital, Inc. 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. MARY'S WARRICK HOSPITAL, INC. COMMUNICATES WITH PATIENTS IN MULTIPLE WAYS TO ENSURE THAT THOSE WHO ARE BILLED FOR SERVICES ARE AWARE OF THE HOSPITAL'S CHARITY CARE PROGRAM AS WELL AS THEIR POTENTIAL ELIGIBILITY FOR LOCAL, STATE OR FEDERAL PROGRAMS. SIGNS ARE PROMINENTLY POSTED IN EACH SERVICE AREA. IN ADDITION, THE HOSPITAL CONTRACTS 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. Mary's Warrick Hospital, Inc. is located in Boonville, Indiana. St. Mary's Warrick serves Warrick and contiguous counties in Southern Indiana. Warrick County has an estimated population of 61,740 residents. Warrick County borders Vanderburgh County and is located near the Ohio River, which marks the state border between Indiana and Kentucky. According to the 2015 County Health Rankings, Warrick County ranks 30th out of 92 Indiana Counties in overall health outcomes. Warrick County demographics are similar to those of the overall Indiana state population, with about 2% less 18-24-year-old and 1.5% more 65 and older. Less than 6% of Warrick County residents are nonwhite or Caucasian. The median household income is about $66,500 annually which is about $17,500 more than that of the state median, and roughly 6.6% of Warrick County families are living in poverty, which is lower than the state. Warrick County's uninsured rate is 10% which is lower than the state's rate of 14%. By the Indiana State Department of Health and U.S. Department of Health and Human Services, Warrick 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 health St. Mary's Warrick Hospital, Inc.'s governing body is comprised of persons representing diverse aspects and interests of the community. Many members of St. Mary's Warrick Hospital, Inc.'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. Mary's Warrick Hospital, Inc. is an affiliate of St. Vincent Health system and Ascension Health. St. Mary's Warrick 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 23 of the United States and the District of Columbia. Ascension is sponsored by Ascension Sponsor, a public juridic person. The participating ORGANIZATIONS/ENTITIES of Ascension sponsor are the Daughters of Charity of St. Mary's 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. Mary's Warrick Hospital, Inc. is dedicated to improving the health status and quality of life for the communities it serves. While designated associates at St. Mary's Warrick Hospital, Inc. 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. Mary's Warrick Hospital, Inc. participates. false true false false false false false false false KEITH JEWELL EX-OFFICIO (END 2/2017) 0 536721 0 281655 0 65353 0 13250 0 13168 0 910147 0 0 DANIEL PAROD EX-OFFICIO (START 2/2017) 0 109051 0 40000 0 64850 0 381 0 12444 0 226726 0 0 KARL W SASH MD BOARD MEMBER 0 334483 0 352373 0 34958 0 33596 0 31914 0 787324 0 33281 MARK L MARCHINO Executive Director 134727 0 19506 0 663 0 9055 0 24575 0 188526 0 0 0 Schedule J, Part I, Line 3 CEO COMPENSATION ASCENSION HEALTH, A RELATED ORGANIZATION OF ST. MARY'S WARRICK 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 a program that provides for supplemental retirement benefits. The payment of benefits under the program, if any, is entirely dependent upon the facts and circumstances under which the executive terminates employment with the organization. Benefits under the program are unfunded and non-vested. Due to the substantial risk of forfeiture provision, there is no guarantee that these executives will ever receive any benefit under the program. 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. The following individuals received payment from the supplemental nonqualified retirement plan in the amount as noted: KARL SASH, MD $33,281 CASH ACCOUNTS TRANSFERRED TO PARENT'S BALANCE SHEET 2016-07-01 827535 FMV 453358926 ASCENSION HEALTH ALLIANCE PO BOX 45998 ST LOUIS MO 63145 501(C)(3) false false false false Schedule N, Part II CASH TRANSFERRED ST. MARY'S WARRICK HOSPITAL, INC. TRANSFERRED ITS BEGINNING HSD CASH BALANCES TO ASCENSION HEALTH ALLIANCE (45-3358926) AS OF JULY 1, 2016. Form 990, Part IV, Line 24a PART IV, LINE 24A ST. MARY'S WARRICK HOSPITAL, INC. IS A HEALTH FACILITY THAT IS PART OF THE ASCENSION HEALTH SYSTEM. ASCENSION HEALTH SYSTEM IS THE HOLDER OF THE TAX EXEMPT HOSPITAL REVENUE BONDS. ST. MARY'S WARRICK 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. MARY'S WARRICK HOSPITAL, INC. IS REPORTED IN THE CONSOLIDATED FINANCIAL STATEMENTS OF ASCENSION HEALTH ALLIANCE. NO INDIVIDUAL AUDIT OF ST. MARY'S WARRICK HOSPITAL, INC. IS COMPLETED. THEREFORE, THE ATTACHED AUDITED FINANCIAL STATEMENTS ARE OF ASCENSION HEALTH ALLIANCE AND AFFILIATES, WHICH INCLUDE THE ACTIVITY OF ST. MARY'S WARRICK 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 ASCENSION HEALTH AND ITS SUBSIDIARY ORGANIZATIONS. ASCENSION HEALTH IS THE NATIONAL HEALTH SYSTEM PARENT. 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. MARY'S WARRICK 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 2 Family/business relationships amongst interested persons TRUDY STOCK AND KEITH JEWELL - Business relationship, TRUDY STOCK AND JAMES SANDGREN - Business relationship, KEITH JEWELL AND JAMES SANDGREN - Business relationship, JAMES SANDGREN AND JEFFERY WOLF - Business relationship Form 990, Part VI, Line 6 Classes of members or stockholders ST. MARY'S WARRICK 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. MARY'S WARRICK HOSPITAL, INC. HAS A SINGLE CORPORATE MEMBER, ST. VINCENT HEALTH, INC., WHO HAS THE ABILITY TO ELECT MEMBERS TO THE GOVERNING BODY OF THE ST. MARY'S WARRICK HOSPITAL, INC. BOARD. Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders ALL DECISIONS THAT HAVE A MATERIAL IMPACT TO ST. MARY'S WARRICK 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 2f Other Program Service Revenue JOINT VENTURE INCOME - Total Revenue: 687, Related or Exempt Function Revenue: 687, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ; Form 990, Part VIII, Line 11d Other Miscellaneous Revenue OTHER MISCELLANEOUS INCOME - Total Revenue: -3145, Related or Exempt Function Revenue: , Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: -3145; Form 990, Part IX, Line 11g Other Fees Other Professional Fees - Total Expense: 31307, Program Service Expense: 22667, Management and General Expenses: 8640, Fundraising Expenses: ; Consulting - Total Expense: 40488, Program Service Expense: 17917, Management and General Expenses: 22571, Fundraising Expenses: ; Physician Fees - Total Expense: 1653305, Program Service Expense: 1649832, Management and General Expenses: 3473, Fundraising Expenses: ; Form 990, Part XI, Line 9 Other changes in net assets or fund balances FAS 158 PENSION - -285633; NET ASSET TRANSFER WITH RELATED ENTITIES - 638383; TRANSFER TO ALPHA FUND AS OF 7/1/2016 - -827535; Form 990, Part XII, Line 2c Audit Committee St. Mary's WARRICK 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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