2018-05-12T12:06:37-05:00 2017-06-30 990 2016-07-01 141347719 St Mary's Healthcare STMA 3147338000 427 Guy Park Avenue Amsterdam NY 120101054 Tonya Mershon Tax Officer 2017-10-23 2016 2021-01-29 14:40:06Z Victor Giulianelli 427 Guy Park Avenue Amsterdam NY 120101054 168444272 false 0928 X www.smha.org X 1903 NY To improve the health and well-being of all people in the communities we serve. 13 10 1935 200 647817 -134538 9749772 6032811 157346043 157581407 402935 3255727 1510408 1346644 169009158 168216589 56359 53690 0 101890274 105890058 0 0 0 64196842 66894653 166143475 172838401 2865683 -4621812 165325721 172889674 52289310 67854573 113036411 105035101 Our Mission as part of a Catholic health care system is to further the healing ministry of Jesus by continually improving the health and well-being of all people, especially the poor, in the communities we serve. false false 151323604 53690 156683182 St. Mary's Healthcare provides a substantial portion of its services to the elderly and poor. During the twelve month period ending June 30, 2017, approximately 38.32% of the values of services rendered were to elderly patients under the Medicare program and approximately 17.92% of the services were provided to patients who were deemed indigent under state, county or hospital guidelines. In the spirit of principles adopted by Ascension Health, St. Mary's has taken proactive steps to address those issues that will affect accessibility, the financing, and the delivery of healthcare to all persons, especially the uninsured, underinsured, and the underserved. During the twelve month period ending June 30, 2017, the estimated cost of providing care of persons living in poverty totaled $15.7 million, including $732,000 cost of charity care, $4.07 million in programs for persons living in poverty, and $10.9 million in the unpaid cost of public programs. These amounts vary from Schedule H due to different methods of calculation. In the twelve months ending June 30, 2017, St. Mary's Healthcare provided health care services to 7,030 inpatients and 427,639 outpatients, and 57,450 days of care to residents of the skilled nursing facility. The inpatient care covered medical/surgical, psychiatric, alcohol rehabilitation, physical rehabilitation, maternity and newborn patients. The outpatient visits included 27,017 emergency visits; 7,072 outpatient surgeries; 152,598 referred visits (including imaging, laboratory, therapies, and cardiac rehab), total other outpatient visits of 37,640 including 1,139 visits to nursing home patients, 7,507 adult day care visits, 27,418 urgent care visits, 771 occupational medicine visits and 805 visits to the diabetes center; 63,161 family health center visits; total specialty visits of 24,120 including 4,749 urology health center visits, 4,656 cancer treatment center visits 6,609 Amsterdam OB/GYN Center, 1,388 Johnstown OB Center, Cancer Center Chemotherapy 1,284, Gastroenterology 5,434 and total mental health and alcohol visits of 109,798 including , 8,969 alcohol clinic visits, and 100,829 mental health clinic visits. St. Mary's Healthcare administers one of the most comprehensive mental health outpatient programs in New York State. In the twelve months ending June 30, 2017, the Hospital provided a variety of services through various grant-funded programs including psych-social clubs, prevocational/employment assistance programs, mobile geriatric/senior citizen programs, and alcohol intervention service programs. In addition, caring families provided family care services and hospital personnel provided case management counseling under various grant-funded programs. 3265000 Community benefits are programs or activities that provide treatment and / or promote health and healing as a response to identified community needs. To promote healthy living, St. Mary's Healthcare has made available the following programs to the community: reduced cost programs providing senior citizens with Lifeline equipment enabling them to solicit help should the need arise; community continuing education programs providing information on a variety of subjects including child abuse, day-to-day parenting, seat belt use and safety. Smoking cessation, weight loss, and other wellness programs; help and support groups for victims and their family members; and providing meeting facilities for victims of alcohol abuse. 882632 898225 St. Mary's Healthcare's other program service revenue includes continuing education programs, psychological services provided to Montgomery county, medical director services, cafeteria sales to visitors and employees, and rebates / refunds of expenses. 155471236 true true false true false false false false true true true false false true true true false true false false false false false false false false true true false true true false false false false false false false false false false false false false true true true true false true 162 0 true 1935 true true true false false false false false false false false false X 13 10 false false false false true true true true true false false false true true true true true false false false NY X Rick Henze 5188417434 427 Guy Park Avenue Amsterdam NY 12010 VICTOR F GIULIANELLI PRESIDENT & CEO 40.0 2.0 X X 886698 0 40074 EMILY T ETZKORN MD CHAIRMAN 2.0 0 X X 0 0 0 ANDREW HECK VICE-CHAIRMAN 2.0 0 X X 0 0 0 SISTER MARY A HEENAN SECRETARY 2.0 0 X X 0 0 0 THOMAS F CICHY TREASURER 2.0 0 X X 0 0 0 GREGORY J ABBATTISTI CPA DIRECTOR 2.0 1.0 X 0 0 0 MOHAMMED R GHAZI-MOGHADAM MD DIRECTOR/PHYSICIAN 40.0 0 X 503421 0 38615 SISTER NANCY GREGG DIRECTOR 2.0 0 X 0 0 0 RONALD LIMONCELLI DIRECTOR 2.0 0 X 0 0 0 RONALD MARSH MD DIRECTOR/PHYSICIAN 40.0 0 X 78537 0 6278 MICHAEL J PEPE DIRECTOR 2.0 0 X 0 0 0 BRENT E PHETTEPLACE DIRECTOR 2.0 0 X 0 0 0 MICHAEL M SHERIDAN DO DIRECTOR/PHYSICIAN 40.0 0 X 137975 0 14363 FREDERICK E HENZE JR VP OF FINANCE & CFO 40.0 1.0 X 217514 0 11116 SCOTT M BRUCE VP OF OPERATIONS 40.0 1.0 X 366256 0 39308 DONALD W MASSEY VP OF CONTINUUM CARE 40.0 0 X 215749 0 26173 WILLIAM D MAYER VP OF MEDICAL AFFAIRS 40.0 0 X 422306 0 24566 DUANE S MILLER VP OF BEHAVIORAL HEALTH 40.0 0 X 179393 0 30427 ALBERT V TURO VP OF DEVELOPMENT & PLANNING (END 12/2016) 34.5 5.5 X 238894 0 22662 MICHELE M WALSH VP OF NURSING 40.0 0 X 257808 0 20126 JAMES M CHARLAND MD PHYSICIAN 40.0 0 X 587770 0 41658 MICHAEL J FINNEGAN MD PHYSICIAN 40.0 0 X 777090 0 44726 DAVID J LEHR MD PHYSICIAN 40.0 0 X 449543 0 42456 GARY SINENSKY MD PHYSICIAN 40.0 0 X 553868 0 36108 ZAINUL A SYED MD PHYSICIAN 40.0 0 X 524616 0 23315 6397438 0 461971 80 true true false ATLANTIC PROFESSIONAL SERVICES OF RI PO BOX 635988 CINCINNATI OH 45263 HOSPITALISTS 1879297 ARUP LABORATORIES 500 S CIPETA WAY SALT LAKE CITY UT 84108 LABORATORY SERVICES 982606 ST PETERS HEALTH PARTNERS MEDICAL ASSOCIATES PC 315 S MANNING BLVD ALBANY NY 122081707 MEDICAL SERVICES 738825 MOHAWK VALLEY MEDICAL ANESTH ASSC PLLC 178 CLIZBE AVE AMSTERDAM NY 12010 PHYSICIAN SERVICES 446194 MOHWAK VALLEY MRI 5010 STATE HIGHWAY 30 SUITE 205 AMSTERDAM NY 12010 MEDICAL SERVICES 316404 12 X 97374 5935437 6032811 Net Patient Revenue 621990 157159401 157159401 OTHER PROGRAM SERVICE 621990 108424 108424 intercompany shared service revenue 900099 313582 313582 0 0 0 0 157581407 3300237 3300237 85199 176173 -90974 0 -90974 -90974 7000 51510 0 -44510 -44510 -44510 LABORATORY SERVICES 621500 554515 554515 MEDICAL DIRECTOR SERVICES 623990 20414 20414 ATHLETIC TRAINING SERVICES 621400 71538 71538 791151 0 1350 789801 1437618 168216589 157581407 647817 3954554 X 13100 13100 40590 40590 3778259 566739 3211520 82807343 78220777 4586566 2317519 2171937 145582 11014204 10322311 691893 5972733 5972733 227500 170146 57354 111664 111664 23805 23805 750 750 17952384 16154698 1797686 0 71940 65454 6486 490180 411537 78643 7446307 7446307 3389069 3087096 301973 276983 208237 68746 195024 162016 33008 7006072 6481317 524755 1297831 1297831 MEDICAL SUPPLIES 19311127 19187385 123742 PROVIDER TAX 1296391 1296391 PURCHASED SERVICES AFFILIATES 3547646 3547646 EQUIPMENT RENT 655192 641236 13956 3594788 2851229 743559 0 172838401 155471236 17367165 0 1259052 1164211 21321320 21477436 0 0 0 1449565 1842570 419139 462287 115729341 60291349 58519476 55437992 0 0 1357018 1246555 81000151 91258623 165325721 172889674 18058335 16913277 1035402 1241701 49914 78782 0 33145659 49620813 52289310 67854573 X 105328979 96069179 1201912 2460177 6505520 6505745 113036411 105035101 165325721 172889674 X -4621812 1732459 -5111957 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 23805 23805 false Schedule C, Part II-B, Line 1 Detailed description of the Lobbying activity Lobbying expenses include the portion of dues paid to National and State Associations that are specifically allocable to lobbying. St. Mary's Healthcare does not participate in or intervene in (including the publishing or distributing of statements) any political campaign on behalf of (or its opposition to ) and candidate for public office. false true X 8423426 225 950998 269700 9104949 10505491 4152 170156 2256373 8423426 10044819 1760 466208 7296 10505491 9561895 11814 471685 575 10044819 8241842 8009 1317915 5871 9561895 0.0 0.71 0.29 false true true 9341923 9341923 63571070 31510554 32060516 41893722 28780795 13112927 922626 922626 55437992 Estimated Settlements from Third-Party Payor 757189 Other Receivables 5369925 Interest in Investments by Ascension Health Alliance 68015106 Interest in Net Assets of Foundation 8965923 Intangible Pension Asset 2044410 Physician Receivable 263819 intercompany receivables 5842251 91258623 Estimated Settlement to Third-Party Payor 1826134 Pension and Other Post retirement Liability 19649996 Intercompany Debt to Ascension Health Alliance 8332136 Asset Retirement Obligation 1500000 Patient Credit Liabilities 424402 IBNR Liability Third Party Advance Other Advances 239099 INCOME GUARANTEE 239 VALUATION GUARANTEE 433382 HISTORICAL ALLOWANCES 400000 RECOVERY TAIL HOSPITAL LIABILITY 563381 INTERCOMPANY ACCOUNTS PAYABLE 16252044 49620813 X Schedule D, Part IV, Line 2b Explanation of escrow agreement The Hospital maintains accounts for residents of the skilled nursing facility which totaled $78,782 at 06/30/2017 Schedule D, Part V, Line 4 Intended uses of endowment funds The intended use of the endowment fund is to assist St. Mary's Healthcare at Amsterdam to develop and expand its services to the community. 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 250 true X false true false true true 975662 160422 815240 0.0047 55142939 44245839 10897100 0.0630 0 0.0 0 0 56118601 44406261 11712340 0.0678 3377603 53420 3324183 0.0192 1011187 1011187 0.0059 15061933 12371595 2690338 0.0156 0 0.0 301238 301238 0.0017 0 0 19751961 12425015 7326946 0.0424 0 0 75870562 56831276 19039286 0.1102 0 0.0 0 0.0 13161 13161 0.0001 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0 13161 0 13161 0.0001 false 6998302 1193649 66645377 71108595 -4463218 X true true 1 1 St Mary's Healthcare 427 Guy Park Avenue Amsterdam NY 120101054 https://www.smha.org/ 2801001H X X X St Mary's Healthcare 1 false false true X X X X X X X X X 15 true true false true X http://www.smha.org/st-marys/community-health-needs-assessment1 X true 15 true http://www.smha.org/st-marys/community-health-needs-assessment1 false true X 250.0 350.0 true true X X X true 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 Healthcare. As part of the Community Health Assessment, a Community Health Survey was conducted in the Spring of 2015 to the Fall of 2015 for the reporting period of 2015-2018. A random survey 750 individuals 18 and older in St. Mary's Healthcare service area were interviewed by telephone. An online survey was also conducted to solicit input from key informants. St. Mary's Healthcare supplied a list of recommended participants including physicians, public health representatives, other health professionals, social service providers, and a variety of community leaders. The community leaders include those who work with low-income minority populations and medically underserved populations. St. Mary's Healthcare uses reliable, third-party resources, including data from government sources to assess the healthcare needs for the community it serves: Fulton and Montgomery Counties in New York State. These reports include vital information regarding key health status, socioeconomic and demographic indicators that point to areas of need and include, but are not limited to, reports from: Catholic Charities of Fulton and Montgomery Counties, FulMont Community Action Agency, Fulton County Department of Public Health, Fulton County Office for the Aging, Fulton County YMCA, HFM (Hamilton, Fulton and Montgomery) Prevention Council, Montgomery County Department of Public Health, Montgomery County Office for the Aging, US Census Bureau, etc. To access a complete listing of resources, please refer to the St. Mary's Healthcare 2015 Community Health Needs Assessment. St. Mary's Healthcare utilizes these resources to help guide community education programs and provide services throughout the region. In addition, St. Mary's Healthcare considers the healthcare needs of the overall community when evaluation internal financial and operational decisions. Input from persons representing broad interests of the community and populations which are underserved, low-income, minority and/or with chronic disease needs were included through randomized phone surveys and an online key informant survey via email. Schedule H, Part V, Section B, Line 6a Facility , 1 Facility , 1 - St. Mary's Hospital. St. Mary's Healthcare conducted its CHNA with the following other hospital facility: St. Mary's Hospital Schedule H, Part V, Section B, Line 11 Facility , 1 Facility , 1 - St. Mary's Healthcare. The CHNA Steering Committee met on January 7, 2016 to determine the health needs to be prioritized for action. The Areas of Opportunity were prioritized by the Committee as follows: Substance Abuse, Mental Health, Nutrition/Physical Activity/Weight Management, Cancer, Heart Disease & Stroke and Diabetes. St. Mary's Healthcare is continually working to meet the goals set forth in their Community Health Needs Assessment (CHNA) Implementation Strategy 2015-2018. Nutrition and Weight Status - St. Mary's is working with Johnstown Pediatric Center, Memorial Family Health Center, FulMont Head Start, Dr. Emily Etzkorn's office, and St. Mary's Institute, to implement a childhood obesity prevention program, "5210." This program will help providers talk to children and their families about the importance of healthy eating and physical activity. St. Mary's Healthcare will also enforce the "5210" message to all associates. The Hospital regularly offers free glucose testing and education as requested by local school, community and civic groups. St. Mary's has a Diabetes and Nutrition Education Center to provide nutritional counseling to the community, the Pregnancy Care Center, and Cardiac Rehabilitation. Primary care providers and their staff discuss nutritional concerns with the patients they see on a regular basis. They are able to make referrals for nutritional counseling as necessary. St. Mary's continues to stock the "Mission Cupboard," which serves as an emergency food pantry for patients. St. Mary's continues to promote "Baby Friendly" to improve maternal and child health. The goal is to increase the number of women who initiate and exclusively breastfeed without medical reason for formula to 78% by May 2019. (Baseline: 68% in 2015) Cancer Peer Education began a "Fun and Free Walking Program" for Amsterdam residents in June 2017. This continued into the fall 2017 and will begin again June 2018. Chronic Disease - St. Mary's was the recipient of a grant from the New York State Department of Health for Peer Education. This three- to five-year grant will reduce breast cancer mortality by 10% and increase awareness and education surrounding prostate cancer. In their first year, the team educated 1055 women about breast cancer screenings and 757 men about prostate cancer screenings. They referred 246 women an 158 men to resources in the community. 46 women disclosed they received mammograms after a discussion with their healthcare provider, and 56 men disclosed they had a discussion with their healthcare provider about prostate cancer. Three St. Mary's associates are trained in "The Butt Stops Here," a tobacco cessation program. Two sessions were held in January 2017 and May 2017. A third session is set for Spring 2018. The first inaugural Medical Mission at Home event was held on May 6th, 2017 at the Family Health Center at the Carondelet Pavilion. This served as an opportunity for anyone in the community to come and receive free healthcare, social and support services, regardless of health insurance status. Substance Abuse/Mental Health - St. Mary's Healthcare continues to participate as a member of the Fulton Montgomery Suicide Prevention Task Force. The hospital is available to provide educational materials and resources to schools in Fulton and Montgomery counties. A community program regarding teen cyber safety, "Born 2B Viral," was presented at the Lynch Literacy Academy in November 2016. 30 community members were in attendance. A Human Trafficking Critical Team was formed and meets monthly in order to address the gaps in services for sex and labor trafficking victims. St. Mary's implemented a human trafficking policy along with educational modules about how to respond to potential victims and survivors. St. Mary's added a new ambulatory detox center, which opened December 2016. The first inaugural Medical Mission at Home event was held on May 6th, 2017 at the Family Health Center at the Carondelet Pavilion. This served as an opportunity for anyone in the community to come and receive free healthcare, social and support services, regardless of health insurance status. Narcan kits were handed out by trained professionals to anyone who needed them. St. Mary's held a SBIRT training for other community professionals in substance abuse in April 2017. St. Mary's held a Binge Eating Disorder awareness program on May 12th, 2017, for the community at large. 20 people were in attendance. A survivor of Binge Eating Disorder came to speak about her story and the benefits of support groups, such as Overeaters Anonymous. Other Needs - St. Mary's Healthcare offers our Pregnancy Care Center, a comprehensive pre-natal program for uninsured, low-income women who become pregnant. The care includes routine pregnancy medical checkups, lab work and access to specialists. The Hospital provides information about pregnancy, labor and delivery as well as hospital care during pregnancy and delivery. Medical care is provided for the mother for at least two months after delivery and for the baby at least one year after birth. St. Mary's asks every patient they see for services if they use tobacco. Medical providers at primary care centers provide counseling and inpatients receive a visit from the Respiratory Therapy Department who provides smoking cessation counseling and materials. St. Mary's Healthcare Birth Center has been recognized by Healthgrades for the 2016 Labor and Delivery Excellence Award. In addition, St. Mary's was also recognized by Healthgrades for Superior Performance in Labor and Delivery, among the top 10% of hospitals evaluated for labor and delivery for two years in a row, a Five-star recipient for natural delivery two years in a row and five-star recipient for C-Section delivery in 2016. St. Mary's was awarded the 2017 America's 100 Best Hospitals for Orthopedic Surgery Award St. Mary's provides free flu shots to the local college and BOCES's students in the CNA, LPN, and RN nursing classes and to our migrant farm workers in the rural sections of Montgomery County. The Hospital partners with local physicians and medical providers to offer educational programs on joint, bone and back health. We have a partnership with a local orthopedic practice to offer "Joint School" which educates candidates for joint replacement on surgery, treatment, care, and management of bone and joint tissues. St. Mary's currently audits patient records to ensure that all diabetics are receiving the care they need to prevent renal disease as a result of complications from their diabetes. Schedule H, Part V, Section B, Line 16 Facility , 1 Facility , 1 - St. Mary's Healthcare. Individual letters are mailed to all uninsured patients informing them of the financial assistance programs available. 16 St Mary's Healthcare 4988 State Highway 30 Amsterdam NY 12010 Diagnostic Care, Primary Care, Cancer Medicine, and Inpatient Physical Rehab Wilkinson Residential Health Care Fac 4988 State Highway 30 Amsterdam NY 12010 Residential Health Care Facility Johnstown Family Health Center 700 S Perry Street Johnstown NY 12095 Family Health Center Amsterdam OBGYN Center 446A Guy Park Ave Amsterdam NY 12010 OB/GYN Center Canajoharie Family Health Center 48 Erie Boulevard Canajoharie NY 13317 Family Health Center Montgomery County Addiction Services 76 Guy Park Ave Amsterdam NY 12010 Addiction Services Broadalbin Health Center 3768 ST HWY 30 Broadalbin NY 12025 Family Health Center Fulton County Addiction Services 73 North Main Street Gloversville NY 12078 Addiction Services Carondelet Family Health Center 380 Guy Park Ave Amsterdam NY 12010 Family Health Center Fulton County Day Rehab Addiction Svc 57 E Fulton Street Gloversville NY 12078 Addiction Rehabilitation Center Gloversville Family Health Center 84 E State Street Gloversville NY 12078 Family Health Center Children's Mental Health Clinic 8 Northampton Road Amsterdam NY 12010 Children's Mental Health Center Diagnostic Service Center 110 Holland Circle Drive Amsterdam NY 12010 Diagnostic Care Center Northville Family Health Center 331 Bridge Street Northville NY 12134 Family Health Center Children's Day Treatment Program 234 Lincoln Street Gloversville NY 12078 Children's Treatment Center 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 7g Subsidized Health Services The organization employs its physicians at physician clinics, so the associated costs and charges relating to those physician services are included in all relevant categories in Part I. Schedule H, Part I, Line 7 Costing Methodology used to calculate financial assistance The cost of providing charity care, means tested government programs, and community benefit programs is estimated using internal cost data and is calculated in compliance with Catholic Health Association (CHA) guidelines. The organization uses a cost accounting system that addresses all patient segments (for example: inpatient, outpatient, emergency room, private insurance, Medicaid, Medicare, uninsured, or self pay). The best available data was used to calculate the amounts reported in the table. For charity care, a specific cost-to-charge ratio was applied; for other categories in the table, a cost accounting system was used. Schedule H, Part II Community Building Activities St. Mary's Healthcare provided the following community building activities in July 2016 - June 2017. * Donated turkeys to 30 migrant farm families in November 2016. A community dinner was also held for them in November 2016 at the St. Mary's Healthcare Memorial Campus. * In 2016-2017 St. Mary's Healthcare, together with leaders of local community agencies and the Department of Social Services continued to address the homeless issues in Amsterdam. Through their continued collaboration, the homeless shelter continues to operate and provide critical housing services for those in emergent need. Danielle's house also offers intensive case management services, job assistance and low-income apartment rentals for those who need a more permanent place to stay and the support of a case manager. * St. Mary's donated both funding and staff time by three associates to the local Habitat for Humanity Chapter. The first house was built by this chapter over a period of three and a half years. * November 3, 2016: St. Mary's held a Poverty Simulation at the Paul Nigra Center, Mayfield. This provided community members and associates a first-hand experience of what it might be like to live in a low-income family. * September 2016: Provided a free community Narcan training program at the St. Mary's Healthcare Carondelet Pavilion. * February 18, 2017: Healthy Women's Day at the Rao Outpatient Pavilion was a day where uninsured women could receive free mammograms, PAP smears, blood pressure screenings, and lab work, along with a chance to enroll in health insurance programs. * The first inaugural Medical Mission at Home event was held on May 6th, 2017 at the Family Health Center at the Carondelet Pavilion. This served as an opportunity for anyone in the community to come and receive free healthcare, social and support services, regardless of health insurance status. Thirteen patients were seen, 14 local community organizations showcased their programs and services, and St. Mary's had over 70 associates volunteer their time that day. This also included six healthcare providers. * A community program regarding teen cyber safety, "Born 2B Viral," was presented at the Lynch Literacy Academy in November 2016. 30 community members were in attendance. * St. Mary's held two sessions of the tobacco cessation program, "The Butt Stops Here," a 7-week program to help smokers quit tobacco use. One session was January 2017 and the other May 2017. * Cancer Peer Education began a "Fun and Free Walking Program" for the Amsterdam community, where 37 residents participated, while the peer educators were able to encourage healthy behaviors, such as eating well and exercise, along with getting screened regularly for breast and prostate cancers. * "Reach Out and Read" is a well-recognized, national literacy based program for children and primary care providers. Primary care providers "prescribe" a book for the child to read, or for the parents to read to the child. This has been ongoing at St. Mary's for three years. Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount St. Mary's Healthcare writes an accounts receivable off as a bad debt after collection efforts have been followed in accordance with the hospital's policies. Discounts and insurance payments have been applied to each patient account and reasonable efforts have been made to collect the remaining balance due from the patient. Schedule H, Part III, Line 3 Bad Debt Expense Methodology The bad debt expense attributable to patients eligible under the organization's financial assistance policy is calculated from the amount of bad debt transfers for uninsured patients. The ratio of cost to charge is applied to the total transfers less the cost of the bad debt recoveries. This bad debt is not included as a community benefit. Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote The organization is part of the Ascension Health Alliance's consolidated audit in which the footnote that discusses the bad debt expense is located on page 19. Schedule H, Part III, Line 8 Community benefit & methodology for determining medicare costs Ascension Health and related health ministries follow the Catholic Health Association (CHA) guidelines for determining community benefit. CHA community benefit reporting guidelines suggest that Medicare shortfall is not treated as 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. Schedule H, Part VI, Line 2 Needs assessment In 2012 and 2015, the Hospital contracted with Professional Research Consultants, Inc. (PRC) to conduct St. Mary's Healthcare's Community Health Needs Assessment (CHNA). The assessment, completed in December 2015, incorporated data from both quantitative and qualitative sources including random sampling of community members, key informant online surveys, and secondary data sources. The key informant survey consisted of input from persons who represent the community we serve, including business leaders, community-based and social service agencies, school districts and those with a special knowledge or expertise in public health. The data from this assessment was made available to the public via the hospital's website, http://www.smha.org/st-marys/community-health-needs-assessment1 and upon request. The hospital also used data from our county health departments' community needs surveys. Additionally, the Hospital sought input from its Board of Trustees, Medical Executive Committee, leadership staff and community partners when completing its annual Integrated Strategic, Operational, and Financial Plan (ISOFP). The ISOFP uses pertinent data and comprehensive feedback to outline current and future critical healthcare needs for the Hospital's service area, as well as the resources needed to address the identified issues. In 2016, the hospital, in collaboration with our County Health Department, used indicator data from the New York State Department of Health and it's Prevention Agenda to develop the hospital's three-year (2015-2018) Community Service Plan (CSP). Schedule H, Part VI, Line 3 Patient education of eligibility for assistance St. Mary's Healthcare, in keeping with the mission and policies of Ascension Health, strives to maintain a balance between providing care of the poor with the ability of the Hospital to maintain quality health care for the community it serves. As part of its financial assistance policies, the Hospital offers a self pay discount to all uninsured patients as a percentage off the standard charge; the discounts were set at 32% for inpatient services and 46% for outpatient services. For the twelve month period (July 2016-June 2017), the discounts provided to the uninsured were $1,981,908. The Carondelet Care assistance program is the next level of financial assistance available to the Hospital's patients. This program is available to all patients who can demonstrate a financial burden associated with their patient responsibility. Financial assistance is provided through collaboration between the health insurance enrollment and financial assistance staff. Although the two departments offer different financial assistance services, the enrollment staff is trained to help those individuals who do not qualify for any government sponsored programs to access the Carondelet Care assistance program. Similarly, the Financial Counselors often refer patients in need of insurance to our Enrollment Specialist. The enrollment staff is available to meet with community members at the main hospital, at our Memorial campus and at all six of our off-site family health centers. Staff is also trained to refer individuals to free or low cost health care programs within the community if no other options are immediately available. The Hospital enroller works collaboratively with community agencies to further expand its outreach. Large posters describing the Hospital's willingness to help patients with financial assistance are displayed in all main entrances to the Hospital and the off-site locations, as well as in our multiple registration sites and waiting rooms. The informational posters are in English and Spanish and urge patients to call if they are concerned about bill payment. Translation services are also available as needed via language line telephones and iPad video application. Brochures in English and Spanish are available at all service sites and offer detailed information about the various levels of assistance. In addition to offering discounts, St. Mary's offers options for payment plans and payment schedules. The English and Spanish brochures are also available on the Hospital web site. Information on financial assistance is also contained in the Patient Information Guide given to all inpatients at St. Mary's Healthcare. Schedule H, Part VI, Line 4 Community information St. Mary's Healthcare serves a rural community consisting of Montgomery and Fulton counties in New York State as its primary service area (PSA), and is the only acute care hospital in Montgomery County. On average, 65% of hospital admissions come from Montgomery County, and 26% come from Fulton County. The main hospital campus is located in the city of Amsterdam, though a number of vital services are available on the Memorial campus in the town of Amsterdam. The Hospital operates seven primary care centers; three sites in Montgomery County (two located in Amsterdam, one in Canajoharie) and four sites in Fulton County (Johnstown, Gloversville, Broadalbin and Northville), in addition to a cancer medicine center and specialty practices in, urology, gastroenterology, obstetrics/gynecology, and ENT. The Hospital's comprehensive behavioral health programs provide extensive mental health and addiction services, including inpatient and outpatient treatment in Montgomery and Fulton Counties. The Hospital also has three urgent care centers: two in Montgomery County (Amsterdam and St. Johnsville) and one in Fulton County. (Gloversville) The PSA represents one of the oldest regions in NYS. Estimates indicate that the 65 and older population will continue to grow. According to Cornell University's Program on Applied Demographics, the only segment of our population showing growth is the 65+, and the percentage of residents aged 65 or older is expected to grow from 18.2% from 2015, to 25.3% by 2030. In Fulton County, the percentage of residents aged 65 or older is expected to grow from 17.7% from 2015, to 23% by 2030. The unemployment rate in Fulton and Montgomery Counties continues to be among the highest in NYS, exceeding the State average of 4.8%. There are many factors that contribute to the community's poverty levels, including the high school dropout rate in both counties. Reports indicate that 30% of ninth graders entering school will not complete high school in four years in our PSA. The lack of education affects the workforce, contributes to higher unemployment and greater risk of working without health insurance. Forty-five percent of all families in poverty are headed by a single parent with children. Research indicates a decline in the Caucasian population, which is a consistent trend over several years. The Hispanic community is our largest minority community, with the largest concentration within the city of Amsterdam. The 2010 Census indicates that 26.2% of the residents of Amsterdam are identified as Hispanic and according to the estimates this segment of our population will grow by 12.7% in the next five years. The Hospital employs bilingual and bicultural healthcare professionals to meet the needs of the Hispanic community. Health statistics relevant to the community's health status are as follows: Over 71% of the St. Mary's Healthcare Service Area is overweight. Especially alarming is that 34% of our children are overweight. The relationship of being overweight with other health issues such as high blood pressure, chronic depression, arthritis and diabetes are significant. Poor nutritional habits and lack of physical activity are significant contributing factors to the overweight status of our community. Access to quality health care services is important for increasing the quality of life for everyone. It impacts overall physical, social and mental health status; the prevention of disease and disability; quality of life; preventable death and life expectancy. Uninsured individuals comprise 5% of the population in Fulton and Montgomery Counties. Over 6% of the population in St. Mary's Healthcare's service area went without any type of healthcare insurance coverage at some point in the past year. Over 6% of those with low-income went without some type of coverage the past year. These numbers are significantly less favorable than the US average of 4.8%. Additionally, nearly 40% of respondents reported some type of difficulty or delays in receiving needed health care in the past year, with those who are uninsured much more likely to report barriers when compared to the insured population. The Hospital serves a disproportionate share of the Medicaid population, and approximately 27% of the total inpatient discharges are Medicaid. Schedule H, Part VI, Line 5 Promotion of community health St. Mary's Healthcare's governing body is comprised of persons representing diverse aspects and interests of the community. Many members of St. Mary's Healthcare'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. Many surplus funds find their way to mission trips in third world countries or stay here for the annual spring Medical Mission at Home event. St. Mary's Healthcare promotes the health of its community through various activities, including the following: * During July 2016-June 2017, approximately 4,150 people were provided community education on topics such as Concussion Education, Alzheimer's disease, Arthritis, Breast, Cervical and Colorectal Cancer Screenings, Health Insurance, Childbirth Education, Bone and Joint Health, Brain Injury Awareness, Heart Health, Infant CPR, Lactation Support, Ebola, Physical Activity and Nutrition, Suicide Prevention, Health Care Proxys, General Mental Well-Being, Poverty, Gastroenterology, and other wellness areas. St. Mary's associates gave 13,415.25 hours of their time engaging in these community benefit activities. * Hosted five American Red Cross Blood Drives to address the critical need for blood in our service area. * Provided Healing Touch Treatments to women who have breast cancer or who are breast cancer survivors. * St. Mary's partnered with our local school districts hosting three school tours in the period July 2016 - June 2017, providing children first-hand knowledge and experience of the operations of a hospital. Our Registered Dieticians participated in school wellness days to teach children about the importance of healthy eating and physical activity. * From July 2016- June 2017, St. Mary's associates gave 900 hours back to their community serving on various boards including The Amsterdam Homeless Coalition, DSRIP, Teen Action Alliance, St. Jude's, NAMI, Your Home Care Network, Dear Neighbor, Breast Health Brunch Committee, Children's Steering Committee, PHIP, Health Advisory Committee, Montgomery County United Way, Community Hospice, Catholic Charities of Fulton and Montgomery Counties, Community Health Center (CHC) , Greater Amsterdam Volunteer Ambulance Corp (GAVAC), Regional Perinatal Outreach Advisory, Montgomery County Public Health Quality Assurance Committee, Minority Health Task Force, Sexual Assault Task Force, Fulton-Montgomery Community College, Fulmont Community Action, Liberty ARC Board, Montgomery County Office for the Aging, The Sanford Home, Montgomery County Habitat for Humanity, the Minority Health Task Force, the Suicide Prevention Task Force, Fulton-Montgomery Regional Chamber of Commerce, Glove City and Amsterdam Rotary, Children's Aid Society, New Dimensions in Healthcare and Fulton County Long-term Care Council Boards. * From July 2016 through June 2017, St. Mary's associates gave their time to better the community by participating in walks including the American Cancer Society's Relay for Life, Alzheimer's Association Walk to End Alzheimer's and other awareness walks as well as taking part in clean-up projects in both Fulton and Montgomery Counties. The hospital supported the work of many community groups including the Canajoharie Library, The Mental Health Association of FM Counties, The Office for Aging, Caring Together Ovarian Cancer Association, the Alzheimer's Association of NENY, Catholic Charities, St. Mary's Institute, Boy Scouts, YMCA, Liberty Foundation, Mountain Valley Hospice, Rotary Clubs, Montgomery County SPCA, Montgomery County Habitat for Humanity, Fulton County Habitat for Humanity, Wishful Thinking and numerous school clubs, sport teams and community groups through its fiscal donations. * St. Mary's providers are able to refer uninsured or underinsured patients with medication needs to the Dispensary of Hope program at the Hospital. This program provides free prescription medications to those who lack prescription drug coverage. * St. Mary's also has a partnership with Palmer's Pharmacy in Johnstown. If patients are in need of medication and cannot either pay for it or pick up their prescriptions, Palmer's will deliver to the hospital, their home, or have it ready for pick-up for the patient. * Continued to be a leader and collaborator with a group of partners from local health care entities and community agencies whose mission is to improve the health status for all we serve. During 2016, we continued to carry out our work we committed to in our Implementation Strategy and Community Service Plan. * In 2016, we continued our fourteenth year of distributing educational information on insurance eligibility for children through the school system, public service announcements, advertising and appearances at "back to school" events such as PTA meetings and open houses. * Enrolled nearly 554 individuals in State-sponsored insurance programs and programs through the newly created NY State of Health Marketplace. * Provided 510 life-saving cancer screenings to 198 uninsured individuals through the Cancer Services Program. * Supported a Promotora who provided outreach education, referral, follow-up, case management and advocacy services to our Latino and migrant community. The goal of the program is to promote needed primary health services and prevention efforts in a culturally appropriate manner. The Promotora has an average of 500 client contacts/communications per month. Additionally, there are countless other communications, educational trainings, community events, individual and family visits, and service navigation that has been made available by the program. * Maintained the importance of culturally sensitive and accurate communication with Latino patients and patients with limited English proficiency through the use of translation services which include professional phone and video translation services and the translation of key documents. English and Spanish are the most prominent languages spoken in the community, so all signage is posted in both English and Spanish throughout the organization. The iPad video services also serve those who are in need of sign language services. * Provided free blood pressure screenings at various health fairs and community events throughout the year. * Provided nutrition education to 600 individuals in the community at health events and educational programs. * Hosted eight different support groups including the Women's Cancer, Brain Injury, Behavioral/Mental Health, Ostomy, Diabetes, Survivors of a Loved One's Suicide (SOLOS), Alzheimer's Caregiver Support and Community Hospice Groups supporting nearly 150 community members who receive peer support and educational opportunities to manage their concerns. * The Medical Explorers, a group for young adults, meets monthly for education and socialization with the goal of assisting youth to explore the various options in healthcare careers. * Club 60, an educational and social group for seniors aged 60 and above, meets monthly for updates on health-related issues such as the flu vaccine and specialized primary care services. * A majority of the Hospital's Board of Trustees is comprised of persons who reside in the organization's primary service area and are neither employees nor independent contractors of the Hospital, nor family members thereof. * The Hospital established the Carondelet Community Fund, which provides modest assistance to local programs and agencies whose values and mission align with the values of St. Mary's Healthcare. Grants from the fund are made to eligible non-profit community agencies which are located within the service area of St. Mary's Healthcare and which share the values of St. Mary's with an emphasis on service to the poor and vulnerable, and holistic care. The total amount awarded from this fund during July 2016-June 2017 in $13,100. Schedule H, Part VI, Line 6 Affiliated health care system St. Mary's Healthcare (the Hospital) is a member of Ascension Health. In December 2011, Ascension Health Alliance became 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 health care facilities, or Health Ministries, located in 23 of the United States and the District of Columbia. Ascension Health Alliance is sponsored by Ascension Health Ministries, a Public Juridic Person. The Hospital, located in Amsterdam, New York, is a nonprofit acute care hospital. The consolidated financial statements include the Hospital, Medical Services Enhancement, Inc. (MSE), and an equity interest in The Foundation of St. Mary's Healthcare, Inc. (Foundation). MSE operates a medical office building to retain and attract physician specialists to better serve the healthcare needs of the community. The Foundation's primary purpose is to assist the Hospital to develop and expand its services to the community by providing a focal point as the recipient for philanthropic support and by transferring funds to the Hospital. The Hospital provides acute inpatient, outpatient, and emergency care services for the residents of Montgomery, Fulton, and Hamilton counties. The Hospital also provides an array of Behavioral Health services including inpatient mental health and alcohol rehabilitation plus outpatient mental health and alcohol related services. Admitting physicians are primarily practitioners in the local area. Additionally, the Hospital operates a 160-bed skilled nursing facility which provides housing, healthcare and other related services to residents who are severely limited in their ability to care for themselves due to illness and/or disability, and a medical adult day care program. The Hospital is related to Ascension Health's other sponsored organizations through common control. Substantially all expenses of Ascension Health and its sponsored organizations are related to providing health care services. Ascension Health Alliance directs its governance and management activities toward strong, vibrant, Catholic Health Ministries united in service and healing and dedicates its resources to spiritually centered care which sustains and improves the health of the individuals and communities it serves. In accordance with Ascension Health Alliance's mission of service to those persons living in poverty and other vulnerable persons, each Health Ministry accepts patients regardless of their ability to pay. Ascension Health Alliance uses four categories to identify the resources utilized for the care of persons living in poverty and community benefit programs. - Traditional charity care includes the cost of services provided to persons who cannot afford health care because of inadequate resources and/or who are uninsured or underinsured. - Unpaid cost of public programs, excluding Medicare, represents the unpaid cost of services provided to persons covered by public programs for persons living in poverty and other vulnerable persons. - Cost of other programs for persons living in poverty and other vulnerable persons includes unreimbursed cost of programs intentionally designed to serve persons living in poverty and other vulnerable persons of the community, including substance abusers, the homeless, victims of child abuse, and persons with Acquired Immune Deficiency syndrome. - Community benefit consists of the unreimbursed costs of community benefit programs and services for the general community, not solely for the persons living in poverty, including health promotion and education, health clinics and screenings. Discounts are provided to all uninsured patients in the acute care facility, including those with the means to pay. Discounts provided to those patients who did not qualify for assistance under charity care guidelines are not included in the cost of providing care of persons living in poverty and community benefit programs. The cost of providing care of persons living in poverty and community benefit programs is estimated using internal cost data and is calculated in compliance with guidelines established by both the Catholic Health Association (CHA) and the Internal Revenue Service (IRS). The amount of traditional charity care provided, determined on the basis of cost, excluding the provision for bad debt expense was approximately $732,000 for the twelve months ended June 30, 2017 and $332,000 for the twelve months ended June 30, 2016. The amount of unpaid cost of public programs, cost of other programs for persons living in poverty and other vulnerable persons, and community benefit cost are reported in the accompanying other financial information. Schedule H, Part VI, Line 7 State filing of community benefit report NY true Family Care - Entitlement Provider 4 4505 FMV Family Care - Entitlement Resident 10 6895 FMV Intensive Care Management - Patient Service Dollars 45 16002 FMV Supportive Care Management - Patient Service Dollars 24 2846 FMV Targeted Care Management - Patient Service Dollars 58 10342 FMV Schedule I, Part I, Line 2 Procedures for monitoring use of grant funds. The grant funds awarded are to clients of the family care, intensive case management, and supportive case management programs which are administered through the Hospital's behavioral health services division. The amounts are determined based on evaluation of client needs as determined by their individual case managers. All amounts are processed in accordance with the Hospital's disbursements practices which require evidence of supporting documentation for all required approvals. The usage of funding for Family Care and Case Management are in accordance with the Office of Mental Health procedural guidelines by program code and funding score. X X X true true false true false false false false false false false VICTOR F GIULIANELLI PRESIDENT & CEO 352312 0 438024 0 96362 0 17225 0 22849 0 926772 0 0 0 MOHAMMED R GHAZI-MOGHADAM MD DIRECTOR/PHYSICIAN 418376 0 44852 0 40193 0 14575 0 24040 0 542036 0 0 0 MICHAEL M SHERIDAN DO DIRECTOR/PHYSICIAN 131773 0 4420 0 1782 0 2781 0 11582 0 152338 0 0 0 FREDERICK E HENZE JR VP OF FINANCE & CFO 166000 0 41629 0 9885 0 8986 0 2130 0 228630 0 0 0 SCOTT M BRUCE VP OF OPERATIONS 256675 0 58114 0 51467 0 17225 0 22083 0 405564 0 0 0 DONALD W MASSEY VP OF CONTINUUM CARE 167073 0 35127 0 13549 0 9990 0 16183 0 241922 0 0 0 WILLIAM D MAYER VP OF MEDICAL AFFAIRS 335463 0 73917 0 12926 0 13250 0 11316 0 446872 0 0 0 DUANE S MILLER VP OF BEHAVIORAL HEALTH 137986 0 29073 0 12334 0 8794 0 21633 0 209820 0 0 0 ALBERT V TURO VP OF DEVELOPMENT & PLANNING (END 12/2016) 178988 0 36647 0 23259 0 11402 0 11260 0 261556 0 0 0 MICHELE M WALSH VP OF NURSING 194105 0 43394 0 20309 0 10539 0 9587 0 277934 0 0 0 JAMES M CHARLAND MD PHYSICIAN 526883 0 27481 0 33406 0 14575 0 27083 0 629428 0 0 0 MICHAEL J FINNEGAN MD PHYSICIAN 489499 0 273949 0 13642 0 14575 0 30151 0 821816 0 0 0 DAVID J LEHR MD PHYSICIAN 398220 0 49271 0 2052 0 15900 0 26556 0 491999 0 0 0 GARY SINENSKY MD PHYSICIAN 444558 0 101618 0 7692 0 13250 0 22858 0 589976 0 0 0 ZAINUL A SYED MD PHYSICIAN 496820 0 6176 0 21620 0 13250 0 10065 0 547931 0 0 0 Schedule J, Part I, Line 1a Travel for companions Per St. Mary's Healthcare's accountability plan, spousal travel is reimbursed if there is a business purpose, however the amount reimbursed is also included as income on the individual's W-2. Certain St. Mary's Healthcare employees are reimbursed for cell phone/PDA expense, which is included on the respective employee's W-2. These payments are grossed up to include tax related obligations paid. St. Mary's Healthcare offers a fitness club membership credit to all employees to reimburse half of the cost of a yearly fitness club membership up to $150 per year. St. Mary's Healthcare included imputed income for one of the individuals listed in Part VII. St. Mary's Healthcare "grossed up" applicable non-business expenses and included in the employees' W-2 as additional taxable compensation. Schedule J, Part I, Line 1a Tax indemnification and gross-up payments Ascension Health, a related organization of St. Mary's Healthcare, 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. No individuals received current year distributions. Form 990, Part IV, Line 20b audited financial statements The activity of St. Mary's Healthcare is reported in the consolidated financial statements of Ascension Health Alliance. No individual audit of St. Mary's Healthcare is completed. Therefore, the attached audited financial statements are of Ascension Health Alliance and Affiliates, which include the activity of St. Mary's Healthcare. 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. ASCENSION HEALTH IS THE SOLE CORPORATE MEMBER OF ST. MARY'S HEALTHCARE. 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 ASCENSION HEALTH. ASCENSION HEALTH IS THE SOLE CORPORATE MEMBER OF ST. MARY'S HEALTHCARE. THE PROCESS INCLUDED A REVIEW AND APPROVAL BY INDEPENDENT PERSONS, COMPARABILITY DATA, AND CONTEMPORANEOUS SUBSTANTIATION OF THE DELIBERATION AND DECISION. THE EXECUTIVE COMPENSATION COMMITTEE REVIEWED AND APPROVED THE COMPENSATION. IN THE REVIEW OF THE COMPENSATION, THE OFFICERS' SALARIES WERE COMPARED TO INDIVIDUALS AT OTHER ORGANIZATIONS IN THE AREA WHO HOLD THE SAME TITLE. DURING THE REVIEW AND APPROVAL OF THE COMPENSATION, DOCUMENTATION OF THE DECISION WAS RECORDED IN THE MINUTES. INDIVIDUALS WERE NOT PRESENT WHEN THEIR COMPENSATION WAS DECIDED. Form 990, Part VI, Line 6 Classes of members or stockholders St. Mary's Healthcare has a single corporate member, Ascension Health. Form 990, Part VI, Line 7a Members or stockholders electing members of governing body St. Mary's Healthcare has a single corporate member, Ascension Health , which has the ability to elect members to the governing body of the Hospital. Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders Ascension Health has designed a system of authority matrix which assigns authority for key decisions that are necessary in the operation of the system. Specific areas that are identified in the authority matrix are: new organization and major transactions; governing documents; appointments/removals; evaluation; debt limits; strategic and financial plans; assets; system policies and procedures. These areas are subject to certain levels of approval by Ascension per the system authority matrix. 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 describe 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 designated 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 designated powers annually signs a statement which affirms such person has received a copy of the conflict 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 the public inspection upon request. Form 990, Part VII, Section A Compensation Paid to Director During 2016, the Hospital paid the following physicians for services rendered in their role as a physician of the Hospital, not for their duties as a board member. Mohammed R Ghazi-Moghadam, MD Ronald Marsh, MD Michale M Sheridan, DO Form 990, Part VIII, Line 11d Other Miscellaneous Revenue PHYSICAL THERAPY OPEN GYM - Total Revenue: 1350, Related or Exempt Function Revenue: , Unrelated Business Revenue: 1350, Revenue Excluded from Tax Under Sections 512, 513, or 514: ; cafeteria/vending - Total Revenue: 684640, Related or Exempt Function Revenue: , Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: 684640; other revenue - Total Revenue: 105161, Related or Exempt Function Revenue: , Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: 105161; Form 990, Part IX, Line 11g Other Fees AGENCY STAFFING - Total Expense: 799380, Program Service Expense: 799380, Management and General Expenses: , Fundraising Expenses: ; PURCHASED SERVICES - Total Expense: 10977391, Program Service Expense: 10025733, Management and General Expenses: 951658, Fundraising Expenses: ; PHYSICIAN FEES - Total Expense: 2924698, Program Service Expense: 2690833, Management and General Expenses: 233865, Fundraising Expenses: ; OTHER PROFESSIONAL - Total Expense: 3250915, Program Service Expense: 2638752, Management and General Expenses: 612163, Fundraising Expenses: ; Form 990, Part XI, Line 9 Other changes in net assets or fund balances Pension Liability Adjustment - -3103107; Temporarily Restricted Interest in Foundation - 327328; Permenently Restricted Interest in Foundation - 225; Unrestricted Interest in Foundation - 930937; transfers to affiliates - -3267340; Form 990, Part XII, Line 2c oversight of audit or selection of independent accountant ST. MARY'S HEALTHCARE 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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