2017-05-15T18:04:38-05:00 2016-06-30 990 2015-07-01 461523194 St Vincent's Medical Center-Clay County Inc STVI 9043087300 4205 Belfort Road 4020 Jacksonville FL 32216 Pamela Hess CFO - Health System 2017-05-15 2015 2021-01-29 14:40:06Z Tom VanOsdol 4205 Belfort Road Jacksonville FL 32216 86043224 false 0928 X www.jaxhealth.com X 2012 FL Rooted in the loving ministry of Jesus as healer, we commit ourselves to serving all persons with special attention to those who are poor and vulnerable. Our Catholic health ministry is dedicated to spiritually centered, holistic care, which sustains and improves the health of individuals and communities. We are advocates for a compassionate and just society through our actions and our words. 9 9 596 271 0 0 6937 73404563 85117193 316242 -43946 375992 894308 74096797 85974492 0 0 25667668 28936324 0 0 42481373 41939447 68149041 70875771 5947756 15098721 120698985 109204601 8397559 9763790 112301426 99440811 Rooted in the loving ministry of Jesus as healer, we commit ourselves to serving all persons with special attention to those who are poor and vulnerable. Our Catholic health ministry is dedicated to spiritually centered, holistic care, which sustains and improves the health of individuals and communities. false false 62763871 85117193 St. Vincent's Healthcare has been part of Jacksonville for over 100 years. St. Vincent's Medical Center-Clay County is the newest hospital in the St. Vincent's umbrella and has been part of the system for just over two years. St. Vincent's Medical Center-Clay County provides care to all, but with special attention to the poor and vulnerable. Please refer to Schedule H for the Community Benefit Report. 62763871 true true false true false false false false false false true false false false true true false true false false false false false false false false true true false false true false false false false false false false true false false false false false true true true false false true 65 0 true 596 true false false false false false false false false false false X 9 9 false false false false true true true true true false false true true true true true true false false false X Maureen P Martin 9043087300 4205 Belfort Road Suite 4020 Jacksonville FL 32216 DAVID G KULIK VICE CHAIRMAN 1.0 5.0 X X 0 0 0 RICARDO MORALES JR SECRETARY/TREASURER 1.0 4.0 X X 0 0 0 SIDNEY S SIMMONS II CHAIRMAN 3.0 10.0 X X 0 0 0 PAUL J CHAPPANO MD MEMBER 1.0 4.0 X 0 0 0 CARLA HARRIS MEMBER 1.0 4.0 X 0 0 0 RICHARD JONES MEMBER 1.0 4.0 X 0 0 0 SISTER JEAN D RHOADES MEMBER 1.0 4.0 X 0 0 0 HELEN D ROWAN MEMBER 1.0 4.0 X 0 0 0 VAN D ROYAL MEMBER 1.0 4.0 X 0 0 0 KIMBERLY HODGKINSON CFO (THRU 6.8.2016) 3.0 51.0 X 0 371824 32068 MICHAEL SCHATZLEIN MD REGIONAL CEO 5.0 59.5 X 0 2906062 39144 THOMAS J VANOSDOL COO - MINISTRY MARKET JACKSONVILLE (STARTED 12/6/2015) 3.0 57.0 X 0 465623 46560 DONALD B CLAYPOOL PRESIDENT - ACUTE CARE HOSPITALS 40.0 6.0 X 325449 0 31722 KAREN F DARNELL VP/CHIEF AMBULATORY SERVICE OFFICER (THRU 3/27/15) 10.0 41.0 X 0 138819 16238 LORRAINE M KEITH CNO 0.0 40.0 X 0 262193 13492 JANICE G LIPSKY SR. VP HR/OD/CHRO (THRU 12/4/2015) 3.0 49.0 X 0 272949 35171 DENISE MCKROW SVP - SUPPORT SERVICES (THRU 10/30/2015) 3.0 51.0 X 0 197861 29012 JOHN MEYER III CSMO - MINISTRY MARKET JACKSONVILLE 3.0 49.0 X 0 246285 20869 JEFFREY MIDDLEBROOKS GENERAL COUNSEL 40.0 12.0 X 0 157060 6626 DONNIE ROMINE JR COO/ACUTE CARE HOSPITALS (THRU 10/30/2015) 3.0 51.0 X 0 492198 35098 MICHELLE ADAMOLEKUN CHIEF HUMAN RESOURCES OFFICER REGIONAL VP 3.0 23.0 X 0 249594 14528 TERESA LOFTIS VP MSN-CMIO MNSTRY MKT JAX 3.0 49.0 X 0 172010 27443 KENNETH ROTHFIELD SYS VP/CHIEF MEDICAL OFFICER 3.0 43.0 X 0 425633 36906 RENE AUGUSTA GROSDIDIER CNO - COO - CLAY 40.0 0 X 131817 0 8305 TRACY WILLIAMS COO - ACUTE CARE HOSPITALS 40.0 0 X 163794 0 29340 JON DEBARDELEBEN Assoc. General Counsel 3.0 49.0 X 0 208908 27005 William Mayher SVP - Reg Dev & Corp Resp 3.0 49.0 X 0 190977 27313 JEANINE HUMPHREYS PHARMACIST 40.0 0 X 131745 0 19580 ROSALYN SACAYANAN RN - EMERGENCY SERVICES 40.0 0 X 123506 0 25360 ELIZABETH SANTIAGO PHARMACIST 40.0 0 X 134346 0 12386 BRENDA MCGRATH RN - EMERGENCY SERVICES 40.0 0 X 135707 0 12161 AMY TEDESCHI COORDINATOR - CLINICAL PHARMACY 40.0 0 X 111650 0 23945 MOODY CHISHOLM FORMER OFFICER (THRU 3/20/15) 0.0 0.0 X 0 680696 26723 1258014 7438690 596992 10 true true false BRASFIELD & GORRIE LLC 3021 7th AVE S BIRMINGHAM AL 35233 CONSTRUCTION Services 3493683 GATE PRECAST COMPANY 402 ZOO PKWY JACKSONVILLE FL 32226 ARCHITECTURAL PRECAST CONCRETE 1285351 NORTH FLORIDA ANESTHESIA CONSULTANTS 2165 HERSCHEL ST JACKSONVILLE FL 32204 ANESTHESIA 676937 ABM HEALTH INC 2310 130th AVE NE SUITE B200 BELLEVUE WA 98005 BUILDING MAINTENANCE & FACILITY 573045 ANDRES AYUSO PO Box 9479 Fleming Island FL 32006 Physician Services 246985 10 X 0 0 0 6937 0 0 0 6937 Net Patient Revenue 621990 46708655 46708655 Medicare/Medicaid 621990 38408478 38408478 Intercompany Rev 60 60 0 0 0 0 85117193 24786 24786 1067 1067 0 1067 1067 68732 -68732 0 -68732 -68732 52096 0 52096 52096 Cafeteria/Vending 722320 374075 374075 467070 0 0 467070 841145 85974492 85117193 0 850362 375171 360164 15007 24005755 22948001 1057754 972561 929768 42793 1802853 1723527 79326 1779984 1701665 78319 1021963 976997 44966 4400 4400 5225523 4164742 1060781 0 2642 2642 7722 1712 6010 65366 45756 19610 676477 642653 33824 18527 13895 4632 16631 12473 4158 -724465 -702731 -21734 7854995 7619345 235650 532604 532604 Medical Supplies 12136704 12076020 60684 Outside Purchased Srvs 4953488 3947930 1005558 Corporate Allocation 1541808 749319 792489 System Allocation 6276566 3050411 3226155 2328496 1966978 361518 0 70875771 62763871 8111900 0 2200 2250 11620189 11494534 0 0 2091095 2201744 80938 137365 111495755 20480834 79390903 91014921 0 0 1457332 611119 528984 26902541 2367471 120698985 109204601 5858594 5499104 2538965 4264686 8397559 9763790 X 112301426 97983479 0 1457332 0 112301426 99440811 120698985 109204601 X 15098721 -395919 -27563417 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 850 850 Schedule C, Part II-B, Line 1 DETAILED DESCRIPTION OF THE LOBBYING ACTIVITY St. Vincent's Medical Center-Clay County, Inc. had lobbying expenses related to the portion of dues paid to national and state hospital associations that are specifically allocable to lobbying. St. Vincent's Medical Center-Clay County, Inc. does not participate in or intervene in (including the publishing or distributing of statements) any political campaign on behalf of (or in opposition to) any candidate for public office. Schedule C, Part II-B, Line 1 DETAILED DESCRIPTION OF THE LOBBYING ACTIVITY St. Vincent's Medical Center-Clay County, Inc. had lobbying expenses related to the portion of dues paid to national and state hospital associations that are specifically allocable to lobbying. St. Vincent's Medical Center-Clay County, Inc. does not participate in or intervene in (including the publishing or distributing of statements) any political campaign on behalf of (or in opposition to) any candidate for public office. 6969851 6969851 72532675 8163392 64369283 40158 11845 28313 21208020 9196643 12011377 10745051 3108954 7636097 91014921 Physician Guarantee Liability 34135 INTERCOMPANY DEBT WITH ASCENSION HEALTH ALLIANCE 2022220 SITF System Sponsored 250534 Pension and Other Post Retirement Liabilities 1609999 AH Savings Plan 258256 WC accrual and Sales tax 36805 AH Deferred Comp Liability 52737 4264686 X Schedule D, Part X, Line 2 FIN 48 (ASC 740) footnote FROM THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS OF ASCENSION HEALTH ALLIANCE ("THE SYSTEM") (WHICH INCLUDES THE ACTIVITY OF ST. VINCENT'S MEDICAL CENTER-CLAY COUNTY, INC.): THE SYSTEM ACCOUNTS FOR UNCERTAINTY IN INCOME TAX POSITION 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, 2016. true true X true X true X true true true false true true 1896527 1896527 0.0268 7845966 5141437 2704529 0.0382 0 0.0 0 0 9742493 5141437 4601056 0.0649 949 949 0.0000 0 0.0 0 0.0 0 0.0 236246 236246 0.0033 0 0 237195 0 237195 0.0033 0 0 9979688 5141437 4838251 0.0683 0 0.0 0 0.0 88500 88500 0.0012 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0 88500 0 88500 0.0012 false 2024982 706444 33267041 30332671 2934370 X true true 1 1 ST VINCENT'S MEDICAL CENTER-CLAY COUNTY INC 4205 BELFORT ROAD SUITE 4020 JACKSONVILLE FL 32216 WWW.JAXHEALTH.COM 4515 X X X ST VINCENT'S MEDICAL CENTER-CLAY COUNTY INC 1 false false true X X X X X X X X X 15 true true false true X HTTP://WWW.JAXHEALTH.COM/ABOUT-US/COMMUNITY-HEALTH-NEEDS-ASSESSMENT/ X true 15 true HTTP://WWW.JAXHEALTH.COM/ABOUT-US/COMMUNITY-HEALTH-NEEDS-ASSESSMENT/ false false true X 200.0 400.0 X X X X true true X X X X true X HTTP://WWW.JAXHEALTH.COM/PATIENTS-VISITORS/FINANCIAL-ASSISTANCE-PROGRAMS/ X HTTP://WWW.JAXHEALTH.COM/PATIENTS-VISITORS/FINANCIAL-ASSISTANCE-PROGRAMS/ X X X X true X false X X X X true X X false false Schedule H, Part V, Section B, Line 5 Facility , 1 Facility , 1 - ST. VINCENT'S MEDICAL CENTER CLAY COUNTY. INPUT FROM PERSONS REPRESENTING THE BROAD INTERESTS OF THE COMMUNITY, INCLUDING INDIVIDUALS WITH SPECIAL KNOWLEDGE OF OR EXPERTISE IN PUBLIC HEALTH, WAS RECEIVED FROM 185 INDIVIDUALS THROUGH ELEVEN KEY INFORMANT INTERVIEWS, SEVENTEEN FOCUS GROUPS, AND FOUR TOWN HALL MEETINGS. INTERVIEWS INCLUDED: INDIVIDUALS WITH SPECIAL KNOWLEDGE OF OR EXPERTISE IN PUBLIC HEALTH; THE LOCAL PUBLIC HEALTH DEPARTMENT; AGENCIES WITH CURRENT DATA OR INFORMATION ABOUT THE HEALTH NEEDS OF THE COMMUNITY; AND LEADERS, REPRESENTATIVES, AND MEMBERS OF MEDICALLY UNDERSERVED, LOW-INCOME, AND MINORITY POPULATIONS, AND POPULATIONS WITH CHRONIC DISEASE NEEDS. DUVAL COUNTY DEPARTMENT OF HEALTH STAFF, WORKING UNDER SUBCONTRACT WITH VERITE, CONDUCTED AND SUMMARIZED RESULTS FROM THE KEY INFORMANT INTERVIEWS AND COMMUNITY MEETINGS. Schedule H, Part V, Section B, Line 6a Facility , 1 Facility , 1 - ST. VINCENT'S MEDICAL CENTER CLAY COUNTY. ST. VINCENT'S MEDICAL CENTER CLAY COUNTY COLLABORATED WITH OTHER HOSPITAL FACILITIES WITHIN THE ST. VINCENT'S HEALTHCARE SYSTEM, AND ALSO WITH THE OTHER HOSPITAL MEMBERS OF THE JACKSONVILLE METROPOLITAN COMMUNITY BENEFIT PARTNERSHIP. THE PARTNERSHIP IS COMPRISED OF LEADERS FROM BAPTIST HEALTH, BROOKS REHABILITATION, THE CLAY COUNTY HEALTH DEPARTMENT, THE DUVAL COUNTY HEALTH DEPARTMENT, MAYO CLINIC, THE NASSAU COUNTY HEALTH DEPARTMENT, THE PUTNAM COUNTY HEALTH DEPARTMENT, UF HEALTH JACKSONVILLE (THEN SHANDS JACKSONVILLE MEDICAL CENTER), ST. VINCENT'S HEALTHCARE, AND WOLFSON CHILDREN'S HOSPITAL. Schedule H, Part V, Section B, Line 11 Facility , 1 Facility , 1 - ST. VINCENT'S MEDICAL CENTER CLAY COUNTY. In 2014, hospital members of the Partnership initiated a second CHNA. Through this work, each hospital member developed and published a 2015 CHNA report. The CHNAs were conducted to identify priority health needs within each community served by each hospital, and to inform development of implementation strategies to address identified needs. The CHNAs also were conducted to respond to federal regulatory requirements. St. Vincent's HealthCare reviewed the results of the 2015 CHNA and utilized specific criteria for selection of the needs that are most compatible with our mission. Those included: available resources and competencies, the actual impact the hospital might have on designated needs, the value stakeholders placed upon the need and community support of the need. The prioritized needs selected are: - Access - increase medical access and quality of care for St. Vincent's Healthcare's Medicare eligible patients in Duval County through Alignment Healthcare. - Diabetes - Improve health outcomes for individuals diagnosed with Diabetes in Duval County through evidence-based activities. - Maternal and Child Health - Promote infant mortality for parents in Duval County with a safe sleep educational initiative featured at St. Vincent's Southside Family Birth Place. - Obesity/Nutrition/Lifestyle - Augment an evidenced based voluntary nutrition and fitness awareness program for youth 8-11 in Duval County Schools. St. Vincent's HealthCare is committed to our mission and to the community; however, no entity can address all of the health needs presented by the 2015 CHNA. The following are those we believe are either not supported by our mission or that resources are not currently available to adequately address. - Cancer - St. Vincent's HealthCare lacks resources in the ability to provide large-scale cancer services within the Northeast Florida areas but will continue to support local organizations that offer cancer services to the community. - Dental Care- Dental Care is currently not a medical service provided by St. Vincent's HealthCare. We will continue to seek additional opportunities to expand dental services to those most in need. - Health Disparities-St. Vincent's will continue to advocate for the poor and vulnerable through various means, especially those identified as having an increasing need; i.e., the elderly and an expanding Hispanic population. St. Vincent's HealthCare supports legislative and community efforts to expand Medicaid and other social programs aimed at improving the lives of those identified as poor, vulnerable or at-risk. We continue to partner with and support local organizations who serve these needs such as WeCare. - Mental Health-St. Vincent's lacks resources in the ability to provide effective Mental Health services within the Clay County area. We will continue to advocate for services to the poor and vulnerable through in-kind and financial donations to local organizations who offer these services to the community. - Transportation- Currently, St. Vincent's HealthCare lacks capacity to improve the overall public transportation system within the Northeast Florida area. We will continue to partner with local transportation authorities to advocate for the improvement of services, especially those most in need that rely on public transportation. No actions were taken during the tax year related to the entities most recently conducted CHNA given the CHNA was adopted at the end of the tax year. Schedule H, Part V, Section B, Line 22 Facility , 1 Facility , 1 - ST. VINCENT'S MEDICAL CENTER-CLAY COUNTY. THE SELF-PAY DISCOUNT IS CALCULATED BASED UPON THE HIGHEST PAYING PAYER THAT REPRESENTS GREATER THAN 3% OF GROSS REVENUE. 0 Schedule H, Part II Community Information - Part II Various metrics are reviewed when establishing community outreach programs, the following are examples of the data Clay County collects when determining regional and community needs: St. Vincent's Medical Center-Clay County, Inc. compares county population by race against the state, St. Vincent's Medical Center-Clay County, Inc. also compares population by race in each of the zip codes. The findings from the comparison indicate that of the approximately 1,400,000 persons in the region the significant racial breakdowns are 66% white, 22% African American, and 6% Hispanic. The percentage of non-English speaking populations in the 2000 census in the region was 0.1%. St. Vincent's Medical Center-Clay County, Inc. compares the Jacksonville Metropolitan Statistical Area (MSA) in average household income against the federal poverty percentage finding that in the five county area household incomes ranged from almost $66,000 in St. John's County to $46,000 in Baker County. The percentage of persons below the Federal Poverty Rate ranged from a low of 9.6% in St. John's County to a high of 18.8% in Baker County. The Florida average was 16%. Florida CHARTS tables which are provided by the Florida Department of Health, Office of Planning, Evaluation and Data Analysis are utilized to determine Behavioral Risk Factors (BRFSS) and Chronic disease prevalence in the region. By reviewing FL CHARTS, County Profiles and BRFSS data, along with internal volume and financial data, St. Vincent's Medical Center-Clay County, Inc. is able to determine areas of need and chronic disease prevalence in relation to behavioral risk factors. The analysis below is an example of the data often compiled from the resources mentioned above. Analysis of Baker County: Baker County demonstrates the least favorable situation with comparison to the other counties in the state with regards to the following diseases: CAD (deaths), stroke (deaths and hospitalizations), lung cancer (death and smoking rate), prostate cancer (death), skin cancer (death) and diabetes (death, hospitalization and percentage of adults with diabetes). This county has the least favorable situation in comparison to all counties on the following measures in the Behavioral Risk Factors (BRFSS) Data: percentage of adults who meet vigorous physical activity recommendations, percentage of adults who engage in no leisure-time physical activity, percentage of adults who eat at least 5 servings of fruits and vegetables a day, and the percentage of adults who are obese. Analysis of Clay County: Clay County demonstrates the least favorable situation in comparison to the other counties in the state with regards to the following diseases: Cancer Deaths (smoking), Chronic Lower Respiratory Disease (CLRD), Diabetes, Motor Vehicle Deaths, and HIV/AIDS. On the Behavioral Risk Factors (BRFSS) Data Duval has one measure in the least favorable situation which is the percentage of adults who meet moderate physical activity recommendations. 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. The best available data was used to calculate the amounts reported in the table. St. Vincent's Medical Center-Clay County, Inc. posts information about availability of charity care in its emergency room and admissions areas. Referrals for charity care are made by the financial specialist, patient accounting personnel, social work personnel, collection agency personnel, physicians and community members. All patients potentially eligible for charity care status are screened by the financial specialist/collection representatives for assistance through federal, state, county and other social service programs. The financial specialists/collection representatives work collaboratively with other health care members to explore alternative financial resources for the patients. The Charity Care Policy is available to patients upon request and provided the patient does not qualify for any funded program. Medicaid patients upon exhaustion of benefits will automatically qualify for charity care allowance as long as they remain eligible for Medicaid. Patients will be denied charity based on non-compliance with attempts to obtain insurance for eligibility coverage through other programs (i.e. Medicaid-eligible individuals who have failed to keep required appointments with their case worker). Patients should be screened prior to sending to Florida Department of Children and Family Services to determine if they qualify for Medicaid. Patients can be selected for presumptive charity care by using an electronic screening process. Patients may also be referred to St. Vincent's HealthCare's community outreach programs for continuing care. Information about the Charity Care Policy is included in the patient bills indicating financial assistance is available along with information about contacting the Hospital to seek assistance. We do not provide the "criteria" within the bills themselves. Any uninsured patient or patient requesting assistance is referred to a patient financial advocate to assist with resolving the bill with the Hospital. This process includes assisting the patient with filing an application for any government sponsored health care program. All patient financial services areas maintain a list of available translators for any non-English speaking patients. There are bi- lingual associates in the patient financial services department and are available as needed to assist with non-English speaking patients. All registration staff is trained and responsible for completing an initial financial assistance screening application that is used for assessing the patient's family financial situation. The financial assistance screening application is then forwarded to a patient financial advocate who will review and assist the patient with the process. The collection agencies used by St. Vincent' s HealthCare Inc. are required to follow St, Vincent's policies regarding patient notification about the availability of financial assistance. Those patients who indicate an inability to pay for their services are referred back to the hospital to apply for Charity Care. In addition to this process, open accounts are routinely screened using computer software tools for potential charity care qualified patients. Any patient with family income less that 200% of Federal Poverty Guidelines will qualify for 100% Charity Care write-off. Schedule H, Part II Community Building Activities St. Vincent's HealthCare has been part of Jacksonville for over 100 years. It has welcomed the sick and vulnerable to its doors throughout. In its Mission Statement, St. Vincent's proclaims that it provides care to all, but with special attention to the poor and vulnerable. This is the emphasis it employs in its Community Building Programs. It uses multiple tools to determine community need including data collection from the Health Planning council, Agency for Healthcare Administration, County Health Departments, The Florida Department of Health, live estimates via Thompson Reuters, inpatient and outpatient utilization rates and State Inpatient/Outpatient data allows St. Vincent's to participate in the following programs: Following our Mission, St. Vincent's supports a number of organizations working with poor and vulnerable youth. JP Hall Children's Charity awards annual scholarships for disadvantaged high school senior's to attend college. Each Christmas, JP Hall also gives hundreds of thousands of toys to impoverished children to spread joy and the spirit of giving. Seamark Ranch provides housing, counseling, and education for abused and neglected youth on a permanent basis. The Ranch also provides an extensive therapy program for children of various abused and traumatic backgrounds in individual and group settings. St. Vincent's supports a number of organizations focused on improving the health of the disadvantaged in Clay County. The Way Free Clinic provides free and charitable health care services to all of the underserved with a large Hispanic population. Challenge Enterprises provides resources and job opportunities for the physically and mentally disabled, maintaining their independence and dignity. Quigley House provides safe housing and counseling for abused women and children. St. Vincent's HealthCare also provides financial support and expertise for the Clay County Chamber of Commerce and Clay County Economic Development luncheon. The Chamber's objectives are to drive business in the region with emphasis on initiatives for the un/under employed in the area through their Career Academies and Youth Summer Initiatives. St. Vincent's supports preparation for all members of the community for entering and remaining in the workforce. Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount St. Vincent's Medical Center-Clay County, Inc.'s bad debt allowance percentage is based on the weighted average of six twelve-to-seventeen month historical periods. The percentage is calculated monthly and analyzed for large variances Schedule H, Part III, Line 3 Bad Debt Expense Methodology St. Vincent's Medical Center-Clay County, isolates bad debts for patients who have no insurance from the patient accounting records and calculates the cost of those services in a similar manner to how charity cost is calculated, using RCC's times the charges written off. Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote From the consolidated audited financial statements of Ascension Health Alliance (which include the activity of St. Vincent's Medical Center-Clay County, Inc.): The provision for doubtful accounts is based upon management's assessment of expected net collections considering historical experience, economic conditions, 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. After satisfaction of amounts due from insurance and reasonable efforts to collect from the patient have been exhausted, the System follows established guidelines for placing certain past-due patient balances with collection agencies, subject to the terms of certain restrictions on collection efforts as determined by the System. Accounts receivable are written off after collection efforts have been followed in accordance with the System's policies. The methodology for determining the allowance for doubtful accounts and related write-offs on uninsured patient accounts has remained consistent with the prior year. 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 community benefit. Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance The Organization does have a written debt collection policy and Charity Care Policy (financial assistance). Patients without insurance are interviewed face-to-face to determine if they qualify for any third party payers or governmental programs. Patient statements contain messages requesting the patients to contact the organization should they need assistance with their debt. Patients that do not request assistance or provide the information necessary to qualify for financial assistance will follow a routing collection methodology. Schedule H, Part V, Section B, Line 16b FAP Application website - ST. VINCENT'S MEDICAL CENTER-CLAY COUNTY, INC.: Line 16b URL: HTTP://WWW.JAXHEALTH.COM/PATIENTS-VISITORS/FINANCIAL-ASSISTANCE-PROGRAMS/; Schedule H, Part V, Section B, Line 16c FAP plain language summary website - ST. VINCENT'S MEDICAL CENTER-CLAY COUNTY, INC.: Line 16c URL: HTTP://WWW.JAXHEALTH.COM/PATIENTS-VISITORS/FINANCIAL-ASSISTANCE-PROGRAMS/; Schedule H, Part VI, Line 2 Needs assessment St. Vincent's Medical Center Clay-County, Inc. uses multiple tools to determine community need. A copy is available for download on the company's website http://www.jaxhealth.com/about-us/community-health-needs-assessment/. Currently the following tools are used: data from the Health Planning Council, Agency for Healthcare Administration, County Health Departments, The Florida Department of Health, live estimates via Thomson Reuters, Inpatient and outpatient utilization rates, and state inpatient/outpatient discharge data (FHA). Schedule H, Part VI, Line 3 Patient education of eligibility for assistance The parent organization St. Vincent's HealthCare (SVHC) website provides information and phone numbers to the HOPE program, to empower all patients who need access to health care enrollment or federal assistance programs. There is a special focus on engaging patients who are 200% at or below Federal Poverty Level. Financial counselors are available to decide whether a patient qualifies for charity care. Patients who do not have insurance are eligible for discounts on their bill when they agree to a payment plan; this service is also provided by the financial counselors. The website contains a wealth of information on services which St. Vincent's Medical Center-Clay County, Inc. provides to the less fortunate. It has an active Mobile Health Outreach Mission (MHOM). This mission provides free medical services to the residents of Northeast Florida, who are un-served and under-served. This mission mainly sees migrant/rural farm workers and their families and also poor inner city families in the following counties: Clay, Duval, Nassau, Putnam, St. John's and Volusia. A mobile health unit consists of a physician, nurse practitioner, emergency medical technician and social worker assist to assist in providing care. Examples of care provided to this population are: immunizations, health screenings, physicals, laboratory, diagnostic testing, dental care, case management, health education and dispensing of free medication. MHOM case management works with patients in need to gain access to services or specialist not provided by their mobile clinics. Patients are connected with appropriate resources for follow up care. Care Management manages the Good Samaritan Fund to help those less fortunate by providing support beyond the excellent medical care provided at St. Vincent's HealthCare. In Fiscal Year, 2016, over $48,000 in financial assistance was given to those in need. Many of St. Vincent's patients need financial assistance with prescription medications, funeral expenses and other critical needs. The Good Samaritan Fund pays for these items for patients who have no other assistance available to them. Volunteers are part of the assistance given to the people of that county. Schedule H, Part VI, Line 4 Community information St. Vincent's Medical Center-Clay County, Inc. looks at the community it serves in two ways. On a regional level, five counties fall into the overall planning region: Duval, Clay, Nassau, Baker, and St. John's. On a more narrow level, 75% of the primary service area is reviewed by zip code, which is comprised of approximately 90,000 inpatient cases. The zip codes on which St. Vincent's Medical Center-Clay County, Inc. focuses on are: 32003, 32006, 32030, 32043, 32050, 32058, 32065, 32067, 32068, 32073, 32079, 32091, 32140, 32234, 32656 and 32666. The facilities within the area are: Baptist Medical Center, an acute care not-for-profit facility in Jacksonville with 676 beds; Baptist Medical Center Beaches an acute care not-for-profit facility in Jacksonville Beach with 146 beds; Baptist Medical Center Nassau, an acute care not-for-profit facility in Fernandina Beach with 54 beds; Baptist Medical Center South, an acute care not-for-profit facility in Jacksonville with 225 beds; Ed Fraser Hospital, an acute care not- for-profit facility in Macclenny with 25 beds; Flagler Hospital, an acute care not- for-profit facility in St. Augustine with 302 beds; Kindred Hospital North Florida, an acute care for-profit facility in Green Cove Springs with 80 beds; Mayo Clinic Jacksonville, an academic not-for-profit facility in Jacksonville with 249 beds; Memorial Hospital Jacksonville, an acute care for-profit facility in Jacksonville with 425 beds; Orange Park Medical Center an acute care for-profit facility in Orange Park with 297 beds; Riverpoint Behavioral Health, Jacksonville a psychiatric for-profit facility in Jacksonville with 93 beds; St. Vincent's Medical Center Riverside, an acute care not-for-profit facility in Jacksonville with 528 beds; Shands Jacksonville Medical Center, an acute care not-for-profit facility in Jacksonville with 695 beds; Specialty Hospital Jacksonville, an acute care for-profit facility in Jacksonville with 107 beds; St. Vincent's Southside, an acute care not- for-profit facility in Jacksonville with 311 beds; Ten Broeck Jacksonville, Wekiva Springs an acute care for-profit facility in Jacksonville with 68 beds. Schedule H, Part VI, Line 5 Promotion of community health St. Vincent's Medical Center-Clay County, Inc. is the newest hospital in the St. Vincent's umbrella. Like its other St. Vincent's HealthCare siblings, St. Vincent's Medical Center-Clay County, Inc. welcomes the sick and vulnerable to its doors. In its Mission Statement, St. Vincent's HealthCare proclaims that it provides care to all, but with special attention to the poor and vulnerable. This is the emphasis St. Vincent's Medical Center- Clay County, Inc. uses in its community benefit programs. St. Vincent's Medical Center-Clay County, Inc. has a medical staff open to all qualified physicians in the Northeast Florida area. The majority of the dedicated members of the Board of Directors of parent organization, St. Vincent's HealthCare, are persons who live and work in the Jacksonville area and who by virtue of their continuous service to the community, are acutely aware of the social and health needs of the Northeast Florida region. These individuals along with the members of the medical staff are committed to the Mission Statement and its call to provide healthcare for all who come to its doors. The website, www.jaxhealth.com, is an encyclopedia with wellness tools for the community to gain information to live a healthier life style. Various seminars and educational opportunities, facilitated by health care providers and subject matter experts on different topics related to health, wellness, and aging and are open to the public, with a special emphasis to engage the elderly, to enhance their health care knowledge. The Clay County campus also allows various community groups to use the hospital, free of charge, as a central meeting location for the benefit of the community. The Good Samaritan Fund of St. Vincent's disbursed approximately $48,000 to patients in financial need. These services included medications, clothing, , funeral expenses and other critical needs.. Schedule H, Part VI, Line 6 Affiliated health care system St. Vincent's Medical Center, Inc. (the Medical Center) is a wholly owned subsidiary of St. Vincent's Health System, Inc. (SVHS), which is a member of Ascension Health. Ascension Health is a Catholic, national health system consisting primarily of nonprofit corporations that own and operate local health care facilities, or Health Ministries, located in 20 of the United States and the District of Columbia. Ascension Health is sponsored by the Northeast, Southeast, East Central, and West Central Provinces of the Daughters of Charity of St. Vincent de Paul, the Congregation of St. Joseph, and the Sisters of St. Joseph of Carondelet (CSJ). The Medical Center, located in Jacksonville, Florida, is a nonprofit acute care hospital. The Medical Center provides inpatient, outpatient, and emergency care services for the residents of Northeast Florida and Southeast Georgia. Admitting physicians are primarily practitioners in the local area. The Medical Center 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. Mission: Ascension Health 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'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 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 costs of programs intentionally designed to serve the 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, and medical research. Discounts are provided to all uninsured patients, 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 who are poor 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). ADDITIONAL AFFILIATES AND MEMBERS OF THE ST. VINCENT'S HEALTH SYSTEM INCLUDE: ST. LUKE'S-ST. VINCENT'S HEALTHCARE, ST. VINCENT'S HEALTHCARE, ST. VINCENT'S AMBULATORY CARE, INC., ST. VINCENT'S PHYSICIAN'S ENTERPRISE INC., CONSOLIDATED PHARMACY SERVICES, INC. AND ST. VINCENT'S FOUNDATION, INC. Schedule H, Part VI, Line 7 State filing of community benefit report FL true true false false false false false false false MOODY CHISHOLM FORMER OFFICER (THRU 3/20/15) 0 144240 0 0 0 536455 0 3231 0 23492 0 707419 0 0 KIMBERLY HODGKINSON CFO (THRU 6.8.2016) 0 367829 0 0 0 3995 0 10446 0 21622 0 403891 0 0 MICHAEL SCHATZLEIN MD REGIONAL CEO 0 960751 0 1660416 0 284896 0 7950 0 31194 0 2945206 0 0 THOMAS J VANOSDOL COO - MINISTRY MARKET JACKSONVILLE (STARTED 12/6/2015) 0 336754 0 125195 0 3674 0 16041 0 30519 0 512183 0 0 DONALD B CLAYPOOL PRESIDENT - ACUTE CARE HOSPITALS 308229 0 15000 0 2220 0 8440 0 23282 0 357171 0 0 0 KAREN F DARNELL VP/CHIEF AMBULATORY SERVICE OFFICER (THRU 3/27/15) 0 116233 0 0 0 22587 0 3455 0 12783 0 155057 0 0 LORRAINE M KEITH CNO 0 239901 0 0 0 22292 0 6034 0 7458 0 275684 0 0 JANICE G LIPSKY SR. VP HR/OD/CHRO (THRU 12/4/2015) 0 234493 0 0 0 38456 0 7124 0 28047 0 308119 0 5079 DENISE MCKROW SVP - SUPPORT SERVICES (THRU 10/30/2015) 0 148713 0 0 0 49147 0 4692 0 24320 0 226873 0 0 JOHN MEYER III CSMO - MINISTRY MARKET JACKSONVILLE 0 244961 0 0 0 1323 0 2068 0 18801 0 267154 0 0 JEFFREY MIDDLEBROOKS GENERAL COUNSEL 0 109960 0 11240 0 35859 0 4544 0 2082 0 163686 0 0 DONNIE ROMINE JR COO/ACUTE CARE HOSPITALS (THRU 10/30/2015) 0 430630 0 0 0 61568 0 10153 0 24945 0 527296 0 0 MICHELLE ADAMOLEKUN CHIEF HUMAN RESOURCES OFFICER REGIONAL VP 0 186433 0 34617 0 28545 0 11086 0 3443 0 264122 0 0 TERESA LOFTIS VP MSN-CMIO MNSTRY MKT JAX 0 170818 0 0 0 1191 0 4983 0 22460 0 199452 0 0 KENNETH ROTHFIELD SYS VP/CHIEF MEDICAL OFFICER 0 368909 0 30000 0 26724 0 10384 0 26522 0 462539 0 22625 TRACY WILLIAMS COO - ACUTE CARE HOSPITALS 163599 0 0 0 195 0 5186 0 24154 0 193134 0 0 0 JON DEBARDELEBEN Assoc. General Counsel 0 208571 0 0 0 337 0 6148 0 20857 0 235913 0 0 William Mayher SVP - Reg Dev & Corp Resp 0 189478 0 0 0 1499 0 5625 0 21688 0 218290 0 0 JEANINE HUMPHREYS PHARMACIST 131323 0 0 0 422 0 4060 0 15520 0 151325 0 0 0 Schedule J, Part I, Line 3 Arrangement used to establish the top management official's compensation Ascension Health, a related organization of St. Vincent's Medical Center-Clay County, Inc. uses the following to establish the compensation of the organization's CEO: - Compensation Committee, - Independent Compensation Consultant, - Compensation Survey or Study, and - Approval by the Board or Compensation Committee. Schedule J, Part I, Line 4a Severance or change-of-control payment THE FOLLOWING INDIVIDUALS RECEIVED SEVERENCE PAYMENTS FROM THE ORGANIZATION OR A RELATED ORGANIZATION DURING THE CALENDAR YEAR 2015: MOODY CHISHOLM - $455,785 JANICE G LIPSKY - $9,769 DENISE MCKROW - $24,884 DONNIE ROMINE, JR - $56,808 MICHAEL ZWETSCHKENBAUM - $137,500 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 executives is reported as compensation on Form 990 Schedule J Part II Column B in the year paid. The following individual received a payout from Ascension Health's nonqualified retirement plan in the amount as noted: Janice G Lipsky- $5,079 Kenneth Rothfield - $22,625 NORTH FLORIDA ANESTHESIA CONSULTANTS (NFAC) NFAC IS MORE THAN 35% OWNED BY A BOARD MEMBER OF SVMC-CLAY COUNTY, INC. 676937 PROVIDE GOODS AND SERVICES TO ST. VINCENT'S MEDICAL CENTER-CLAY COUNTY, INC. false NORTH FLORIDA SURGEONS THE PRESIDENT OF NORTH FLORIDA SURGEONS IS A BOARD MEMBER OF SVMC-CLAY COUNTY, INC. 195008 PROVIDE HEALTHCARE SERVICES TO ST. VINCENT'S MEDICAL CENTER-CLAY COUNTY INC. false Form 990, Part IV, Line 20b Explanation of Financial Statements The activity of St. Vincent's Medical Center Clay-County, Inc. is reported in the consolidated financial statements of Ascension Health Alliance. No individual audit of St. Vincent's Medical Center Clay-County, Inc. is completed. Therefore, the attached audited financial statements are of Ascension Health Alliance and Affiliates, which include the activity of St. Vincent's Medical Center Clay-County, Inc. Form 990, Part VI, Line 15 COMPENATION IN DETERMINING THE COMPENSATION OF THE ORGANIZATION'S CEO, THE PROCESS, PERFORMED BY ASCENSION HEALTH, A RELATED ORGANIZATION OF ST. VINCENT'S MEDICAL CENTER-CLAY COUNTY, INC., INCLUDED A REVIEW AND APPROVAL BY INDEPENDENT PERSONS, COMPARABILITY DATA AND CONTEMPORANEOUS SUBSTANTIATION OF THE DELIBERATION AND DECISION. THE COMPENSATION COMMITTEE REVIEWED AND APPROVED THE COMPENSATION. IN THE REVIEW OF THE COMPENSATION, THE CEO 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 COMMITTEE MINUTES. THE INDIVIDUAL WAS NOT PRESENT WHEN HIS COMPENSATION WAS DECIDED. IN DETERMINING COMPENSATION OF OTHER OFFICERS AND KEY EMPLOYEES OF THE ORGANIZATION, THE PROCESS, PERFORMED BY ST. VINCENT'S HEALTH SYSTEM, INC., A RELATED ORGANIZATION OF ST. VINCENT'S MEDICAL CENTER-CLAY COUNTY, INC., INCLUDED A REVIEW AND APPROVAL BY INDEPENDENT PERSONS, COMPARABILITY DATA, AND CONTEMPORANEOUS SUBSTANTIATION OF THE DELIBERATION AND DECISION. THE AUDIT COMMITTEE REVIEWED AND APPROVED THE COMPENSATION. IN THE REVIEW OF THE COMPENSATION, THE OTHER OFFICERS AND KEY EMPLOYEES OF THE ORGANIZATION 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 BOARD MINUTES. Form 990, Part VI, Line 6 Classes of members or stockholders St. Vincent's Medical Center-Clay County, Inc, has a single corporate member, St. Vincent's Health System, Inc. Form 990, Part VI, Line 7a Members or stockholders electing members of governing body St. Vincent's Medical Center-Clay County, Inc. has a single corporate member, St. Vincent's Health System, Inc., who has the ability to elect members to the governing body of St. Vincent's Medical Center-Clay County, Inc. Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders All decisions that have a material impact to St. Vincent's Medical Center-Clay County, Inc. financial information or corporation as a whole are subject to approval by its sole corporate member, St. Vincent's Health System, Inc. Form 990, Part VI, Line 11b Review of form 990 by governing body Management, including certain officers works diligently to complete the Form 990 and attached schedules in a thorough manner. Management presents the Form to the Board, or a designated committee, to review. Prior to filing the return, all Board Members are provided the Form 990 and management team members are available to answer any Board Members' questions. Form 990, Part VI, Line 12c Conflict of interest policy Officers, directors or trustees, and key employees are required to complete a Conflict of Interest Attestation Statement at the time of hiring or when their service begins. Annually, the Corporate Responsibility Officer sends the Conflict of Interest Policy and Attestation Statement to all officers directors or trustees and key employees for completion and return within two weeks. Three separate mailings are sent out with two week deadlines to receive a maximum response. The responses from the returned Attestation Statement are organized in a spreadsheet and are carefully reviewed by the Corporate Responsibility Officer, the Chief Legal Officer, and the Chief Executive Officer. A full report is presented to the Audit Committee and any potential conflicts of interest are handled by the committee in an appropriate manner. Form 990, Part VI, Line 19 Required documents available to the public The organization will provide any documents open to public inspection upon request. Form 990, Part VIII, Line 11d Other Miscellaneous Revenue - Total Revenue: 467070, Related or Exempt Function Revenue: , Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: 467070; Form 990, Part XI, Line 9 Other changes in net assets or fund balances Transfers to/from Affiliates - -26114164; Deferred Pension Cost Adjustement - -1449253; ASCENSION HEALTH ALLIANCE PO BOX 45998 ST LOUIS MO 631455998 453358926 NATIONAL HEALTH SYSTEM MO 501(c)(3 Type I NA false ASCENSION HEALTH PO BOX 45998 ST LOUIS MO 63145 311662309 NATIONAL HEALTH SYSTEM MO 501(c)(3 Type I ASCENSION HEALTH ALLIANCE false ST VINCENT'S HEALTH SYSTEM INC 4205 BELFORT ROAD SUITE 4020 JACKSONVILLE FL 32216 593650609 PARENT ENTITY FL 501(c)(3 Type II ASCENSION HEALTH false ST VINCENT'S MEDICAL CENTER INC 4205 BELFORT ROAD SUITE 4020 JACKSONVILLE FL 32216 590624449 HOSPITAL FL 501(c)(3 3 ST VINCENT'S HEALTH SYSTEM INC true ST LUKE'S-ST VINCENT'S HEALTHCARE INC 4205 BELFORT ROAD SUITE 4020 JACKSONVILLE FL 32216 260479484 HOSPITAL FL 501(c)(3 3 ST VINCENT'S HEALTH SYSTEM INC true ST VINCENT'S AMBULATORY CARE INC 4205 BELFORT ROAD SUITE 4020 JACKSONVILLE FL 32216 592292041 PHYSICIAN PRACTICE FL 501(c)(3 9 ST VINCENT'S HEALTH SYSTEM INC true ST VINCENT'S FOUNDATION INC 4205 BELFORT ROAD SUITE 4020 JACKSONVILLE FL 32216 592219923 FUND RAISING FL 501(c)(3 7 ST VINCENT'S HEALTH SYSTEM INC true CONSOLIDATED PHARMACY SERVICES INC 4205 BELFORT ROAD SUITE 4030 JACKSONVILLE FL 32216 593398033 RETAIL PHARMACY & PATIENT TRANSPORT FL NA C Corporation true ADVANCED PATIENT TRANSPORTATION INC 4205 BELFORT ROAD SUITE 4030 JACKSONVILLE FL 32216 593381444 TRANSPORT SERVICES FL NA C Corporation false SETON PHARMACY INC 4205 BELFORT ROAD SUITE 4030 JACKSONVILLE FL 32216 593001427 RETAIL PHARMACY FL NA C Corporation false FAMILY MEDICINE CENTER CONDOMINIUM ASSOCIATION INC 1 SHIRCLIFF WAY JACKSONVILLE FL 32204 261983355 CONDOMINIUM ASSOCIATION FL NA C Corporation false St Vincent's Strategic Ventures Inc 4205 Belfort Road Suite 4030 Jacksonville FL 33213 593133073 LEASING FL NA C Corporation false false false true false false false false false false false true false true false false false false true true ST VINCENT'S HEALTH SYSTEM INC M 3860317 FMV CONSOLIDATED PHARMACY SERVICES R 84715 FMV ST VINCENT'S HEALTH SYSTEM INC R 106694541 FMV ST VINCENT'S AMBULATORY CARE R 385556 FMV ST VINCENT'S MEDICAL CENTER INC R 28954087 FMV ST VINCENT'S ACCOUNTABLE CARE R 68535 FMV ST LUKE'S-ST VINCENT'S MEDICAL CENTER S 1464146 FMV ST VINCENT'S FOUNDATION INC S 3311953 FMV ST LUKES-ST VINCENT'S HEALTHCARE INC K 140032 fmv