2017-05-15T14:00:31-05:00 2016-06-30 990 2015-07-01 351343019 ST MARYS WARRICK HOSPITAL INC STMA 8124854178 1116 MILLIS AVENUE BOONVILLE IN 47601 JOHN L ZABROWSKI III CHIEF FINANCIAL OFFICER 2017-05-15 2015 2021-01-29 14:40:06Z DAN PAROD 1116 MILLIS AVENUE BOONVILLE IN 47601 16200223 false X WWW.STMARYS.ORG X 1971 IN ST. MARY'S WARRICK HOSPITAL, INC. IS A CRITICAL ACCESS HOSPITAL IN RURAL WARRICK COUNTY. THE HOSPITAL PROVIDES ACUTE CARE AND OUTPATIENT SERVICES TO PERSONS REGARDLESS OF ABILITY TO PAY. 19 15 168 27 90212 39140 4103397 16698 14397326 15910394 25417 4288 335489 268843 18861629 16200223 1915647 0 0 6131420 6669238 0 0 8558233 8814273 16605300 15483511 2256329 716712 12278970 10654838 10262869 8687575 2016101 1967263 ST. MARY'S WARRICK HOSPITAL, INC. IS A CRITICAL ACCESS HOSPITAL IN RURAL WARRICK COUNTY. THE HOSPITAL PROVIDES ACUTE CARE AND OUTPATIENT SERVICES TO PERSONS REGARDLESS OF ABILITY TO PAY. false false 8094710 15906371 ST. MARY'S WARRICK HOSPITAL, INC. (SMW) IS A NOT-FOR-PROFIT GENERAL SHORT-TERM CRITICAL ACCESS HOSPITAL SERVING WARRICK, POSEY, SPENCER, AND OTHER RURAL POPULATED COUNTIES SURROUNDING THE AREA WITHOUT REGARD TO PATIENT RACE, CREED, NATIONAL ORIGIN, ECONOMIC STATUS, OR ABILITY TO PAY. DURING THE FISCAL YEAR ENDING JUNE 30, 2016, THE HOSPITAL PROVIDED HEALTHCARE TO 652 PATIENTS IN THE COMMUNITY FOR A TOTAL OF 6,853 PATIENT DAYS OF SERVICE. ADDITIONALLY, THE HOSPITAL ALSO PROVIDED SERVICES TO 21,626 OUTPATIENTS, INCLUDING 417 OUTPATIENT SURGERY SERVICES AND 6,713 EMERGENCY ROOM VISITS. SEE SCHEDULE H FOR A NON-EXHAUSTIVE LIST OF COMMUNITY BENEFIT PROGRAMS AND DESCRIPTIONS. 2679843 SMW PROVIDES A SUBSTANTIAL PORTION OF ITS CORE HEALTH SERVICES TO THE POOR, UNINSURED, OR UNDER INSURED AND HAS PROACTIVELY TAKEN STEPS TO ADDRESS ACCESSIBILITY, AND THE FINANCING, AND DELIVERY OF HEALTHCARE TO THE UNDERSERVED. DURING THE FISCAL YEAR ENDING JUNE 30, 2016, THE UNREIMBURSED COST OF FREE OR DISCOUNTED SERVICES PROVIDED TO PATIENTS WHO WERE DEEMED INDIGENT UNDER STATE, COUNTY, OR HOSPITAL GUIDELINES WAS $2,679,843 WHICH INCLUDED $222,077 OF TRADITIONAL FINANCIAL ASSISTANCE AND $2,457,766 IN UNPAID COSTS OF CARE FOR THOSE QUALIFYING FOR MEDICAID OR OTHER PUBLIC PROGRAMS FOR THE POOR. SEE SCHEDULE H FOR A NON-EXHAUSTIVE LIST OF COMMUNITY BENEFIT PROGRAMS AND DESCRIPTIONS. 18424 IN ADDITION TO CORE MEDICAL SERVICES, SMW AND COMMUNITY PARTNERS ASSESS COMMUNITY ASSETS AND NEEDS AND WORK TOGETHER TO ADDRESS ISSUES IMPACTING HEALTH AND QUALITY OF LIFE, WITH SPECIAL EMPHASIS ON THE POOR AND VULNERABLE. IN FISCAL YEAR 2016, SMW PROVIDED $18,424 IN UNBILLED SERVICES TO THE POOR AND TO THE BROADER COMMUNITY. (WHEN COMBINED WITH THE COSTS OF FREE OR DISCOUNTED SERVICES FOR THE POOR LISTED IN LINE 4B, SMW PROVIDED A TOTAL COMMUNITY BENEFIT OF $2,698,267 IN FISCAL YEAR 2016.) SMW SERVES AND SUPPORTS ITS COMMUNITY THROUGH SUCH PROGRAMS AS HEALTH FAIRS AND SCREENINGS, TRANSPORTATION FOR PATIENT AT NO COST TO PATIENT, AS WELL AS VARIOUS COMMUNITY SUPPORT GROUPS. SEE SCHEDULE H FOR A NON-EXHAUSTIVE LIST OF COMMUNITY BENEFIT PROGRAMS AND DESCRIPTIONS. 10792977 true true false true false false false false false false true false false true true true false true false false false false false false false false true true false false true false false false false false false false false false false false false false true true true false false true 25 0 true 168 true true true false false false false false false false false false X 19 15 true false false false true true true true true false false true true true true true true false false true true IN X JOHN L ZABROWSKI III 8124854178 3700 Washington Avenue Evansville IN 47750 MICHAEL HERRELL MD CHAIR (THRU 11/15) 1.0 0.3 X X 0 0 0 LLOYD MCGINNIS MD VICE CHAIR (THRU 11/15) 1.0 55.0 X X 0 204538 14923 LAURENCE STEENBERG CHAIR 1.0 2.0 X X 0 0 0 TRUDY STOCK TREASURER 1.0 2.0 X X 0 0 0 SUSAN HARDWICK VICE CHAIR 1.0 2.0 X X 0 0 0 GWEN SANDEFUR SECRETARY/TREASURER (THRU 8/2015) 1.0 60.0 X X 0 227697 22256 PHILLIP L STIVER MD SECRETARY 1.0 2.0 X X 0 0 0 JERRY AIGNER BOARD MEMBER (THRU 11/15) 1.0 0 X 0 0 0 MICHAEL ANDREAS BOARD MEMBER (THRU 11/15) 1.0 0 X 0 0 0 RITA EYKAMP BOARD MEMBER 1.0 2.3 X 0 0 0 KATHY HALL EX-OFFICIO 1.0 55.0 X 0 238740 44771 JUDGE DONALD HENDRICKSON BOARD MEMBER (THRU 11/15) 1.0 0 X 0 0 0 KEITH JEWELL EX-OFFICIO 1.0 64.6 X 0 783468 52981 SHARON KAZEE BOARD MEMBER 1.0 2.0 X 0 0 0 KELLY MITCHELL BOARD MEMBER (THRU 11/15) 1.0 1.0 X 0 0 0 JAMES MOONEY MD BOARD MEMBER (THRU 11/15) 1.0 0 X 11125 0 0 JOSEPH O MURDOCK BOARD MEMBER 1.0 42.0 X 0 590385 42598 STEWART PHILLIPS BOARD MEMBER (THRU 11/15) 1.0 0 X 0 0 0 SALLY RIDEOUT BOARD MEMBER 1.0 2.0 X 0 0 0 KARL SASH MD BOARD MEMBER 1.0 56.0 X 0 497146 65992 SISTER SHARON RICHARDT BOARD MEMBER 1.0 2.0 X 0 0 0 JAMES SANDGREN BOARD MEMBER 1.0 2.0 X 0 0 0 BRIAN SCHYMIK MD BOARD MEMBER 1.0 2.0 X 0 0 0 JEFFERY WOLF BOARD MEMBER 1.0 2.0 X 0 0 0 NADINE COUDRET BOARD MEMBER 1.0 2.0 X 0 0 0 LYNN JOHNSON BOARD MEMBER 1.0 1.0 X 0 0 0 TERRY KEATING BOARD MEMBER 1.0 1.0 X 0 0 0 MICHAEL R HINTON BOARD MEMBER 1.0 2.2 X 0 0 0 MARK MARCHINO EXECUTIVE DIRECTOR 45.0 5.0 X 135528 15600 38256 JOHN SCHELLHASE RN, EMERGENCY SERVICES 50.0 0 X 116549 0 14763 263201 2557574 296540 2 false true false HORIZON MENTAL HEALTH MANAGEMENT PO Box 840839 DALLAS TX 75284 Physician Services 480905 KENNETH R PARKER MD 2222 Huffman RD BOONVILLE IN 47601 Physician Services 201600 EVANSVILLE SURGICAL ASSOCIATES INC 520 Mary Street EVANSVILLE IN 47710 Physician Services 151414 SIGHTPATH MEDICAL INC 5775 W Old Shakopee Road BLOOMINGTON MN 55437 Physician Services 106078 4 X 16698 16698 INPATIENT REVENUE 621990 5294110 5294110 OUTPATIENT REVENUE 621990 10534112 10534112 REFERENCE LAB FEES 541380 82172 82172 0 0 0 0 15910394 4288 4288 90050 90050 0 90050 90050 0 0 JAIL CLINIC 621990 93646 93646 VENDING MACHINE/CAFETERIA 900099 58206 58206 GYM MEMBERSHIP 900099 22924 22924 4017 -4023 8040 0 178793 16200223 15824199 90212 269114 11125 11125 5433640 4445821 987819 837542 685590 151952 386931 316732 70199 283727 283727 36168 36168 0 0 0 0 82210 22632 59578 177509 1100 176409 418358 342457 75901 11107 4610 6497 7866 2897 4969 145327 43282 102045 692602 206275 486327 63923 63923 PURCHASED SERVICES 3411343 1025625 2385718 PROVIDER TAX EXPENSE 747864 747864 MEDICAL FEES 1717964 1717964 MEDICAL SUPPLIES 757616 748652 8964 260689 186624 74065 0 15483511 10792977 4690534 0 1016596 1586947 2245464 1915064 0 0 167686 158026 14341 14341 19852519 15591610 4582815 4260909 0 17767 19208 255151 250203 3979150 2450140 12278970 10654838 1980187 1521152 8282682 7166423 10262869 8687575 X 2016101 1967263 2016101 1967263 12278970 10654838 X 716712 -28622 -736928 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 305 305 false Schedule C, Part II-B, Line 1 DETAILED DESCRIPTION OF THE LOBBYING ACTIVITY LOBBYING EXPENSES REPRESENT THE PORTION OF DUES PAID TO NATIONAL AND STATE HOSPITAL ASSOCIATIONS THAT IS SPECIFICALLY ALLOCABLE TO LOBBYING. ST. MARY'S WARRICK HOSPITAL, INC. DOES NOT PARTICIPATE IN OR INTERVENE IN (INCLUDING THE PUBLISHING OR DISTRIBUTING OR STATEMENTS) ANY POLITICAL CAMPAIGN ON BEHALF OF (OR IN OPPOSITION TO) ANY CANDIDATE FOR PUBLIC OFFICE. Schedule C, Part II-B, Line 1 DETAILED DESCRIPTION OF THE LOBBYING ACTIVITY LOBBYING EXPENSES REPRESENT THE PORTION OF DUES PAID TO NATIONAL AND STATE HOSPITAL ASSOCIATIONS THAT IS SPECIFICALLY ALLOCABLE TO LOBBYING. ST. MARY'S WARRICK HOSPITAL, INC. DOES NOT PARTICIPATE IN OR INTERVENE IN (INCLUDING THE PUBLISHING OR DISTRIBUTING OR STATEMENTS) ANY POLITICAL CAMPAIGN ON BEHALF OF (OR IN OPPOSITION TO) ANY CANDIDATE FOR PUBLIC OFFICE. 181810 181810 11670469 8585418 3085051 14267 14267 0 7722541 6729393 993148 263432 262532 900 4260909 RECEIVABLE FROM 3RD PARTY PROGRAM 92218 AH DEFERRED COMPENSATION 141586 OTHER CURRENT ASSETS 252738 INTEREST IN INVESTMENTS HELD BY ASCENSION HEALTH ALLIANCE 827535 PHYSICIAN GUARANTEE 1127666 INTERCOMPANY RECEIVABLES 8397 2450140 INTERCOMPANY DEBT WITH ASCENSION HEALTH ALLIANCE 3551539 PENSION LIABILITY 1725246 INTERCOMPANY PAYABLE TO ST. MARY'S HEALTH, INC. 620386 DEFERRED COMPENSATION 141586 PHYSICIAN GUARANTEE 1127666 7166423 X Schedule D, Part X, Line 2 FIN 48 (ASC 740) footnote THE SYSTEM ACCOUNTS FOR UNCERTAINTY IN INCOME TAX POSITIONS BY APPLYING A RECOGNITION THRESHOLD AND MEASUREMENT ATTRIBUTE FOR FINANCIAL STATEMENT RECOGNITION AND MEASUREMENT OF A TAX POSITION TAKEN OR EXPECTED TO BE TAKEN IN A TAX RETURN. THE SYSTEM HAS DETERMINED THAT NO MATERIAL UNRECOGNIZED TAX BENEFITS OR LIABILITIES EXIST AS OF JUNE 30, 2016. true true X true X true X true true false true true 222077 222077 0.0143 3101331 643565 2457766 0.1587 0 0.0 0 0 3323408 643565 2679843 0.1731 3 750 26267 14400 11867 0.0008 0 0.0 0 0.0 0 0.0 3 815 6557 6557 0.0004 6 1565 32824 14400 18424 0.0012 6 1565 3356232 657965 2698267 0.1743 0 0.0 1 55 730 730 0.0000 1 1250 2645 2645 0.0002 0 0.0 0 0.0 0 0.0 1 25 250 250 0.0000 1 11 391 391 0.0000 0 0.0 4 1341 4016 0 4016 0.0003 false 668158 66816 11279302 11359871 -80569 X true true 1 1 ST MARY'S WARRICK HOSPITAL INC 1116 MILLIS AVENUE BOONVILLE IN 47601 WWW.STMARYS.ORG/WARRICK 15-005111-1 X X X X ST MARY'S WARRICK HOSPITAL INC 1 false false true X X X X X X X X X 15 true true true true X http://www.stmarys.org/about-us/chna/ X http://www.healthyswin.org X true 15 true http://www.stmarys.org/about-us/chna/ false false true X 200.0 300.0 X true true X X true X http://www.stmarys.org/patients-visitors/financial-assistance/ X http://www.stmarys.org/patients-visitors/financial-assistance/ X http://www.stmarys.org/patients-visitors/financial-assistance/ X X X X X true X false X X X X true X false false Schedule H, Part V, Section B, Line 5 Facility , 1 Facility , 1 - ST. MARY'S WARRICK HOSPITAL, INC.. IN CONDUCTING ITS CHNA, THE HOSPITAL FACILITY CONDUCTED INTERVIEWS AND FOCUS GROUPS WITH COMMUNITY MEMBERS WHO HAVE A FUNDAMENTAL UNDERSTANDING OF WARRICK COUNTY'S HEALTH NEEDS AND REPRESENT THE BROAD INTERESTS OF THE COMMUNITY. EIGHT KEY INFORMANT INTERVIEWS AND TWO FOCUS GROUP DISCUSSIONS PROVIDED INPUT ON THE COUNTY'S HEALTH CHALLENGES, THE SUB-POPULATIONS MOST IN NEED, AND EXISTING RESOURCES FOR THE COUNTY RESIDENTS. IN TOTAL, 26 INDIVIDUALS PARTICIPATED IN PRIMARY DATA COLLECTION TO PROVIDE COMMUNITY INPUT. Schedule H, Part V, Section B, Line 6a Facility , 1 Facility , 1 - ST. MARY'S WARRICK HOSPITAL, INC.. THE OTHER HOSPITAL FACILITIES WITH WHICH THE REPORTING HOSPITAL FACILITY CONDUCTED ITS CHNA INCLUDES ST. MARY'S HEALTH, INC. AND DEACONESS HEALTH SYSTEM. Schedule H, Part V, Section B, Line 6b Facility , 1 Facility , 1 - ST. MARY'S WARRICK HOSPITAL, INC.. THE OTHER NON-HOSPITAL ORGANIZATIONS WITH WHICH THE REPORTING HOSPITAL FACILITY CONDUCTED ITS CHNA INCLUDES ECHO COMMUNITY HEALTH CARE, UNITED WAY OF SOUTHWESTERN INDIANA, AND WELBORN BAPTIST FOUNDATION. Schedule H, Part V, Section B, Line 11 Facility , 1 Facility , 1 - ST. MARY'S WARRICK HOSPITAL, INC.. USING THE CHNA COMPLETED IN FISCAL YEAR 2016, THE HOSPITAL DEVELOPED, ADOPTED, AND WORKED ON EXECUTING A 2017-2019 COMMUNITY WIDE IMPLEMENTATION STRATEGY TO ADDRESS PRIORITY COMMUNITY HEALTH NEEDS. THE ORGANIZATION IS WORKING TO ADDRESS THE FOLLOWING NEEDS: 1. IMPROVE THE OVERALL BEHAVIORAL HEALTH OF WARRICK COUNTY BY: -SUPPORTING OPPORTUNITIES TO EDUCATE AND INCREASE ACCESS FOR MENTAL HEALTH AND SUBSTANCE ABUSE. -JOINING A GROUP OF LOCAL AGENCIES AND ORGANIZATIONS THAT MEET ON A REGULAR BASIS AS WELL AS SUB-COMMITTEES FOR SUBSTANCE ABUSE, MENTAL HEALTH ASSET MAPPING AND THE YOUTH MENTAL HEALTH FIRST AID GRANT. -INCREASING AWARENESS OF SUICIDE THROUGH COMMUNITY OUTREACH AND RESOURCES FOR ASSISTANCE THROUGH A FOCUSED EFFORT EDUCATION ON WHAT TO DO IF SOMEONE IS IN A PSYCHIATRIC CRISIS. -INCREASING AWARENESS THROUGH MARKETING IN YOUR HEALTH MAGAZINE. -IMPROVING ACCESS FOR MENTAL HEALTH SERVICES. 2. REDUCE THE PERCENTAGE OF ADULTS AGED 20 AND OLDER WHO ARE OBESE BY: -IMPLEMENTING A COMMUNITY-WIDE CAMPAIGN THAT INTEGRATES EDUCATION AND OPPORTUNITIES FOR MORE ACTIVE MOVEMENT AND ACCESS TO HEALTH FOODS. -OFFERING FREE DIABETES AND PRE-DIABETES EDUCATION CLASSES TO THE PUBLIC. -PROVIDING RESOURCES TO TEACHERS FOR HEALTHY EATING. -PARTICIPATING IN LOCAL COMMUNITY INITIATIVES TO MAXIMIZE RESOURCES AND SUPPORT OBESITY PREVENTION EFFORTS. 3. REDUCE THE AGE ADJUSTED DEATH RATE DUE TO CANCER BY: -IMPLEMENTING A COMMUNITY-WIDE CAMPAIGN THAT INTEGRATES EDUCATION AND BARRIER REDUCTION TO INCREASE BREAST CANCER AWARENESS AND SCREENINGS. -FINALIZING THE DATA REVIEW WHERE TO BEST TARGET THE NEED IN WARRICK COUNTY FOR MOBILE MAMMOGRAPHY. -DISTRIBUTING EDUCATIONAL BROCHURES AT COMMUNITY HEALTH FAIRS. -PROVIDING FREE SCREENINGS TO LOW-INCOME, UNINSURED AND UNDERINSURED WOMEN IN THE COMMUNITY. -INCREASING AWARENESS THROUGH MARKING IN YOUR HEALTH MAGAZINE AND MASS MEDIA. THE HOSPITAL FACILITY'S CHNA IDENTIFIED SUBSTANCE ABUSE, ACCESS TO HEALTH SERVICES, TRANSPORTATION, WOMEN'S AND MEN'S HEALTH, IMMUNIZATION AND INFECTIOUS DISEASE, AND ORAL HEALTH AS NEEDS TO THE COMMUNITY. THE HOSPITAL FACILITY DID NOT TAKE ACTION TO ADDRESS THESE NEEDS AS IT HAS LIMITED FINANCIAL AND OTHER RESOURCES. USING THE CHNA COMPLETED IN FISCAL YEAR 2013, THE HOSPITAL HAD MANY IMPLEMENTATION SUCCESSES DURING FISCAL YEAR 2016. THE HOSPITAL HAD 80 IMPLEMENTATION TACTICS, AND AMONG THE SUCCESSUL ONES WERE: -Promotion of QuitNowIndiana.com to patients as well as DrugFree.org and exceeding the goal of 100 clicks to each site from the stmarys.org website. - Child Abuse - Vanderburgh and Warrick both had a total number of substantiated Physical and Sexual Abuse cases below the FY16 goal. For Vanderburgh, the percentage of substantiated cases for all three typEs of abuse (Neglect, Physical and Sexual) are below or meeting the goal for FY16. For Warrick, the percentage of substantiated cases for Physical and Sexual abuse are below or meeting the goal for FY16. - Healthy Lives Fitness Center - Memberships made FREE to all St. Mary's Health associates and those connected to the health system through Medexcel, Touchpoint, AIS, TriMedx, Mission Point and MACL. - Joslin Diabetes Program - St. Mary's Joslin Diabetes program is now offered FREE of charge to the community as of March 1, 2016 and has seen an increase in individual visits as well as number of referring physicians. Schedule H, Part V, Section B, Line 22 Facility , 1 Facility , 1 - ST. MARY'S WARRICK HOSPITAL, INC.. THE DISCOUNT WAS DETERMINED BY REVIEWING THE LOWEST DISCOUNT PROVIDED TO MANAGED CARE PAYERS THAT COMPRISE AT LEAST 3% OF OUR VOLUME WITH AN ADDED PROMPT PAY DISCOUNT TO THE HIGHEST PAID DISCOUNT PROVIDED TO OUR MANAGED CARE PAYERS. 0 Schedule H, Part I, Line 3c ELIGIBILITY FOR RECEIVING FREE CARE THE ORGANIZATION PROVIDES MEDICALLY NECESSARY CARE TO ALL PATIENTS, REGARDLESS OF RACE, COLOR, CREED, ETHNIC ORIGIN, GENDER, DISABILITY, OR ECONOMIC STATUS. THE HOSPITAL USES A PERCENTAGE OF FEDERAL POVERTY LEVEL (FPL) TO DETERMINE FREE AND DISCOUNTED CARE. AT A MINIMUM, PATIENTS WITH INCOME LESS THAN OR EQUAL TO 200% OF THE FPL, WILL BE ELIGIBLE FOR 100% CHARITY CARE WRITE OFF OF CHARGES FOR SERVICES THAT HAVE BEEN PROVIDED TO THEM. ALSO, AT A MINIMUM, PATIENTS WITH INCOMES ABOVE 200% OF THE FPL BUT NOT EXCEEDING 300% OF THE FPL, ARE ELIGIBLE TO RECEIVE A DISCOUNT ON THE SERVICES PROVIDED TO THEM. 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 AN ACCOUNTING SYSTEM THAT ADDRESSES ALL PATIENT SEGMENTS (FOR EXAMPLE, INPATIENT, OUTPATIENT, EMERGENCY ROOM, PRIVATE INSURANCE, MEDICAID, MEDICARE, UNINSURED, OR SELF PAY). THE BEST AVAILABLE DATA WAS USED TO CALCULATE THE AMOUNTS REPORTED IN THE TABLE. FOR THE INFORMATION IN THE TABLE, A COST-TO-CHARGE RATIO WAS CALCULATED AND APPLIED. Schedule H, Part II Community Building Activities WHILE MOST OF ST. MARY'S WARRICK HOSPITAL, INC.'S COMMUNITY BENEFIT ACTIVITIES DIRECTLY IMPACT THE HEALTH OF ITS COMMUNITIES, ST. MARY'S WARRICK HOSPITAL, INC. ALSO INVESTS IN COMMUNITY BUILDING ACTIVITIES THAT INDIRECTLY IMPROVE HEALTH BY IMPROVING QUALITY OF LIFE WITHIN THE COMMUNITY. RESEARCH HAS ESTABLISHED THAT FACTORS SUCH AS ECONOMIC STATUS, EMPLOYMENT, HOUSING, EDUCATION LEVEL, AND BUILT ENVIRONMENT CAN ALL BE POWERFUL SOCIAL DETERMINANTS OF HEALTH. ADDITIONALLY, HELPING TO CREATE GREATER CAPACITY WITHIN THE COMMUNITY TO ADDRESS A BROAD RANGE OF QUALITY OF LIFE ISSUES ALSO IMPACTS HEALTH. Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount AFTER SATISFACTION OF AMOUNTS DUE FROM INSURANCE AND REASONABLE EFFORTS TO COLLECT FROM THE PATIENT HAVE BEEN EXHAUSTED, THE CORPORATION FOLLOWS ESTABLISHED GUIDELINES FOR PLACING CERTAIN PAST-DUE PATIENT BALANCES WITHIN COLLECTION AGENCIES, SUBJECT TO THE TERMS OF CERTAIN RESTRICTIONS ON COLLECTION EFFORTS AS DETERMINED BY ASCENSION HEALTH. ACCOUNTS RECEIVABLE ARE WRITTEN OFF AFTER COLLECTION EFFORTS HAVE BEEN FOLLOWED, IN ACCORDANCE WITH THE CORPORATION'S POLICIES. AFTER APPLYING THE COST-TO-CHARGE RATIO, THE SHARE OF BAD DEBT EXPENSE IN FISCAL YEAR 2016 WAS $1,832,579 AT CHARGES ($668,158 AT COST). Schedule H, Part III, Line 3 Bad Debt Expense Methodology THE PROVISION FOR DOUBTFUL ACCOUNTS IS BASED UPON MANAGEMENT'S ASSESSMENT OF EXPECTED NET COLLECTIONS CONSIDERING HISTORICAL EXPERIENCE, ECONOMIC CONDITION, TRENDS IN HEALTHCARE COVERAGE, AND OTHER COLLECTION INDICATORS. PERIODICALLY THROUGHOUT THE YEAR, MANAGEMENT ASSESSES THE ADEQUACY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS BASED UPON HISTORICAL WRITE-OFF EXPERIENCE BY PAYOR CATEGORY, INCLUDING THOSE AMOUNTS NOT COVERED BY INSURANCE. THE RESULTS OF THIS REVIEW ARE THEN USED TO MAKE ANY MODIFICATIONS TO THE PROVISION FOR DOUBTFUL ACCOUNTS TO ESTABLISH AN APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS. Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote THE ORGANIZATION IS A PART OF THE ASCENSION HEALTH ALLIANCE'S CONSOLIDATED AUDIT IN WHICH THE FOOTNOTE THE DISCUSSES THE BAD DEBT EXPENSE IS LOCATED ON PAGE 18. Schedule H, Part III, Line 8 Community benefit & methodology for determining medicare costs A COST-TO-CHARGE RATIO IS APPLIED TO THE ORGANIZATION'S MEDICARE EXPENSE TO DETERMINE THE MEDICARE ALLOWABLE COST REPORTED IN THE ORGANIZATION'S MEDICARE COST REPORT. ASCENSION HEALTH AND ITS RELATED HEALTH MINISTRIES FOLLOW THE CATHOLIC HEALTH ASSOCIATION ("CHA") GUIDELINES FOR DETERMINING COMMUNITY BENEFIT. CHA COMMUNITY BENEFIT REPORTING GUIDELINES SUGGEST THAT MEDICARE SHORTFALL IS NOT TREATED AS A COMMUNITY BENEFIT. Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance THE ORGANIZATION HAS A WRITTEN DEBT COLLECTION POLICY THAT ALSO INCLUDES A PROVISION ON THE COLLECTION PRACTICES TO BE FOLLOWED FOR PATIENTS WHO ARE KNOWN TO QUALIFY FOR CHARITY CARE OR FINANCIAL ASSISTANCE. IF A PATIENT QUALIFIES FOR CHARITY OR FINANCIAL ASSISTANCE CERTAIN COLLECTION PRACTICES DO NOT APPLY AND THE FINANCIAL ASSISTANCE PROGRAM IS FOLLOWED. Schedule H, Part V, Section B, Line 16a FAP website - ST. MARY'S WARRICK HOSPITAL, INC: Line 16a URL: http://www.stmarys.org/patients-visitors/financial-assistance/; Schedule H, Part V, Section B, Line 16b FAP Application website - ST. MARY'S WARRICK HOSPITAL, INC: Line 16b URL: http://www.stmarys.org/patients-visitors/financial-assistance/; Schedule H, Part V, Section B, Line 16c FAP plain language summary website - ST. MARY'S WARRICK HOSPITAL, INC: Line 16c URL: http://www.stmarys.org/patients-visitors/financial-assistance/; Schedule H, Part VI, Line 2 Needs assessment COMMUNITIES ARE DYNAMIC IN WHICH MULTIPLE FACTORS INTERACT TO IMPACT QUALITY OF LIFE AND HEALTH STATUS. AS A PART OF THE ST. MARY'S HEALTH SYSTEM, THE GOAL OF ST. MARY'S WARRICK HOSPITAL, INC. IS TO WORK WITH ITS COMMUNITY TO CONDUCT AN ASSESSMENT AT LEAST EVERY THREE YEARS IN PARTNERSHIP WITH ST. MARY'S HEALTH, INC. ASSESSMENTS MAY INCLUDE PRIMARY SURVEY DATA, SECONDARY SURVEY DATA, FOCUS GROUP INPUT, COMMUNITY LEADERS' SURVEY AND OTHER DATA. RESULTS ARE MADE AVAILABLE TO ORGANIZATIONS AND INDIVIDUALS THROUGHOUT THE COMMUNITY. THESE NEEDS ASSESSMENTS ARE ALSO UTILIZED IN CREATING THE HOSPITAL'S INTEGRATED STRATEGIC FINANCIAL AND OPERATIONAL PLAN. TO THAT END, ST. MARY'S WARRICK HOSPITAL, INC. HAS BROUGHT TOGETHER A COMMUNITY ROUNDTABLE WITH THE PURPOSE OF DETERMINING THE RESOURCES AND NEEDS, PRIORITIZING ACTION AND WORKING IN PARTNERSHIP TO ADDRESS IDENTIFIED CHALLENGES WITHIN A DESIGNATED AREA SURROUNDING THE HOSPITAL. ST. MARY'S WARRICK HOSPITAL, INC. ALSO IDENTIFIES COMMUNITY HEALTH NEEDS BY EMPLOYING OTHER PUBLIC AGENCY NEEDS ASSESSMENTS SUCH AS WELBORN BAPTIST FOUNDATION AND THE UNITED WAY. Schedule H, Part VI, Line 3 Patient education of eligibility for assistance ST. MARY'S WARRICK HOSPITAL, INC. COMMUNICATES WITH PATIENTS IN MULTIPLE WAYS TO ENSURE THAT THOSE WHO ARE BILLED FOR SERVICES ARE AWARE OF THE HOSPITAL'S CHARITY CARE PROGRAM AS WELL AS THEIR POTENTIAL ELIGIBILITY FOR LOCAL, STATE OR FEDERAL PROGRAMS. SIGNS ARE PROMINENTLY POSTED IN EACH SERVICE AREA. IN ADDITION, THE HOSPITAL CONTRACTS HEALTH ACCESS WORKERS AND ENROLLMENT SPECIALISTS WHO CONSULT WITH PATIENTS ABOUT THEIR ELIGIBILITY FOR FINANCIAL ASSISTANCE PROGRAMS AND HELP PATIENTS IN APPLYING FOR ANY PUBLIC PROGRAMS FOR WHICH THEY MAY QUALIFY. Schedule H, Part VI, Line 4 Community information ST. MARY'S WARRICK HOSPITAL, INC. IS A CRITICAL ACCESS HOSPITAL LOCATED IN BOONVILLE, INDIANA SERVING WARRICK, POSEY, SPENCER AND OTHER RURAL POPULATED COUNTIES SURROUNDING THE AREA. ACCORDING TO THE 2016 COUNTY AND HEALTH RANKINGS, WARRICK COUNTY HAS A POPULATION OF 61,149 AND 11% OF THE CHILDREN IN WARRICK COUNTY ARE DEEMED TO LIVE IN HOUSEHOLDS BELOW THE POVERTY GUIDELINES. IN ADDITION, 14% OF THE ADULTS AND 7% OF THE CHILDREN LIVING IN WARRICK COUNTY DO NOT HAVE HEALTH INSURANCE. CHILD AND ADULT OBESITY CONTINUES TO BE ONE OF THE HIGHEST COMMUNITY ISSUES FOR WARRICK COUNTY WITH 28% OF ADULTS WITH A BODY MASS GREATER THAN 30. OTHER COMMUNITY ISSUES INCLUDE: - FAMILIES' UNDERSTANDING OF FINANCES, BUDGETING, AND TAX CREDITS; - UNDERSTANDING THE CYCLE OF POVERTY THAT OCCURS IN SUCCESSIVE GENERATIONS; - COST OF PRESCRIPTION MEDICINE; AND - AFFORDABLE AND ACCESSIBLE HEALTH CARE FOR LOW TO MODERATE INCOME INDIVIDUALS. Schedule H, Part VI, Line 5 Promotion of community health TO PROVIDE THE HIGHEST QUALITY HEALTHCARE TO ALL PERSONS IN THE COMMUNITY, AND IN KEEPING WITH ITS NOT-FOR-PROFIT STATUS, ST. MARY'S WARRICK HOSPITAL, INC.: - DELIVERS PATIENT SERVICES, INCLUDING EMERGENCY DEPARTMENT SERVICES, TO ALL INDIVIDUALS REQUIRING HEALTHCARE, WITHOUT REGARD TO PATIENT RACE, ETHNICITY, ECONOMIC STATUS, INSURANCE STATUS OR ABILITY TO PAY. - MAINTAINS AN OPEN MEDICAL STAFF THAT ALLOWS CREDENTIALED PHYSICIANS TO PRACTICE AT ITS FACILITIES. - PARTICIPATES IN GOVERNMENT-SPONSORED PROGRAMS SUCH AS MEDICAID AND MEDICARE TO THE POOR AND ELDERLY. - HOLDS MEMBERSHIP ON OTHER PUBLIC AGENCY BOARDS TO ENHANCE THE WELL BEING OF THE COMMUNITY IN PARTNERSHIP PROGRAMS. Schedule H, Part VI, Line 6 Affiliated health care system AS A PART OF ST. MARY'S HEALTH SYSTEM, ST. MARY'S WARRICK HOSPITAL, INC. IS DEDICATED TO IMPROVING THE HEALTH STATUS AND QUALITY OF LIFE FOR THE COMMUNITIES IT SERVES. WHILE DESIGNATED ASSOCIATES AT ST. MARY'S WARRICK HOSPITAL, INC. DEVOTE SIGNIFICANT PORTIONS OF TIME TO LEADING AND ADMINISTERING LOCAL COMMUNITY-BASED PROGRAMS AND PARTNERSHIPS, ASSOCIATES THROUGHOUT THE ORGANIZATION ARE ACTIVE PARTICIPANTS IN COMMUNITY OUTREACH. THEY ARE ASSISTED AND SUPPORTED BY DESIGNATED ST. MARY'S HEALTH COMMUNITY DEVELOPMENT AND SERVICE STAFF WHO WORK WITH EACH OF ITS HEALTHCARE FACILITIES TO ADVOCATE FOR AND PROVIDE TECHNICAL ASSISTANCE FOR COMMUNITY OUTREACH, NEEDS ASSESSMENTS AND PARTNERSHIPS AS WELL AS TO SUPPORT REGIONAL AND STATE-WIDE PROGRAMS, COMMUNITY PROGRAMS SPONSORED BY ST. MARY'S HEALTH IN WHICH ST. MARY'S WARRICK HOSPITAL, INC. PARTICIPATES. false true false false false false false false false LLOYD MCGINNIS MD VICE CHAIR (THRU 11/15) 0 122887 0 79563 0 2088 0 9872 0 5051 0 219461 0 0 GWEN SANDEFUR SECRETARY/TREASURER (THRU 8/2015) 0 227118 0 0 0 579 0 1000 0 21256 0 249952 0 0 KATHY HALL EX-OFFICIO 0 185089 0 52859 0 792 0 15280 0 29490 0 283510 0 0 KEITH JEWELL EX-OFFICIO 0 490240 0 287459 0 5770 0 33812 0 19169 0 836450 0 0 JOSEPH O MURDOCK BOARD MEMBER 0 385269 0 148207 0 56909 0 9275 0 33323 0 632983 0 0 KARL SASH MD BOARD MEMBER 0 304462 0 136981 0 55704 0 27911 0 38081 0 563138 0 54512 MARK MARCHINO EXECUTIVE DIRECTOR 119219 15550 16080 0 230 50 8304 498 26056 3399 169887 19497 0 0 Schedule J, Part I, Line 3 CEO COMPENSATION ASCENSION HEALTH, A RELATED ORGANIZATION OF ST. MARY'S WARRICK HOSPITAL, INC., USES THE FOLLOWING TO ESTABLISH THE COMPENSATION OF THE ORGANIZATION'S CEO/EXECUTIVE DIRECTOR: COMPENSATION COMMITTEE INDEPENDENT COMPENSATION CONSULTANT COMPENSATION SURVEY OR STUDY APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE Schedule J, Part I, Line 4b Supplemental nonqualified retirement plan ELIGIBLE EXECUTIVES PARTICIPATE IN VARIOUS NON-QUALIFIED DEFERRED COMPENSATION PLANS ORGANIZED UNDER CODE SECTION 457(F). THE EXACT PURPOSE OF EACH PLAN VARIES, BUT THEY INCLUDE: COMPENSATION LIMITATION MAKE-UP PLANS, VOLUNTARY DEFERRAL PLANS, DEFERRAL OF A PORTION OF INCENTIVE BONUS TYPE PLANS, ETC. ANY AMOUNT ULTIMATELY PAID UNDER THE PROGRAM TO THE EXECUTIVE IS REPORTED AS COMPENSATION ON FORM 990, SCHEDULE J, PART II, COLUMN B IN THE YEAR PAID. THE FOLLOWING INDIVIDUALS RECEIVED CURRENT YEAR DISTRIBUTIONS OF: KARL SASH, MD $54,512 Form 990, Part IV, Line 24a PART IV, LINE 24A ST. MARY'S WARRICK HOSPITAL, INC. IS A HEALTH FACILITY THAT IS PART OF THE ASCENSION HEALTH SYSTEM. ASCENSION HEALTH SYSTEM IS THE HOLDER OF THE TAX EXEMPT HOSPITAL REVENUE BONDS. ST. MARY'S WARRICK HOSPITAL, INC. HOLDS AN INTERCOMPANY NOTE PAYABLE WITH ASCENSION HEALTH AND THIS INFORMATION IS REPORTED ON THE BALANCE SHEET. Form 990, Part VI, Line 16b PART VI, LINE 16B ST. MARY'S HEALTH, INC. AND SUBSIDIARIES (ST. MARY'S) JOINT VENTURE OPERATING AGREEMENTS ARE NEGOTIATED WITH OTHER MEMBERS OF THE JOINT VENTURE TO ENSURE THAT ADEQUATE SAFEGUARDS ARE IN PLACE TO PROTECT ST. MARY'S EXEMPT STATUS. EACH AGREEMENT CONTAINS SPECIFIC LANGUAGE RELATED TO THE PROVISION OF HEALTH CARE SERVICES WITH A FOCUS ON COMMUNITY HEALTH BENEFIT AND MUST FOLLOW A FORMAL REVIEW PROCESS PRIOR TO CONTRACT EXECUTION. ST. MARY'S CONTINUALLY ENSURES THAT ITS EXEMPT STATUS IS PROTECTED BY ACTIVELY PARTICIPATING IN THE GOVERNANCE OF ALL ST. MARY'S JOINT VENTURES. Form 990, Part VI, Line 15 PART VI, LINE 15 IN DETERMINING THE COMPENSATION OF THE ORGANIZATION'S CEO, THE PROCESS, PERFORMED BY ASCENSION HEALTH, A RELATED ORGANIZATION OF ST. MARY'S WARRICK HOSPITAL, 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 THEIR COMPENSATION WAS DECIDED. COMPENSATION DETERMINATIONS OF ST. MARY'S WARRICK HOSPITAL, INC.'S OTHER OFFICERS OR KEY EMPLOYEES ARE MADE BY ST. MARY'S HEALTH, INC.'S MANAGEMENT. IN DETERMINING COMPENSATION OF OTHER OFFICERS OR KEY EMPLOYEES OF THE ORGANIZATION, THE PROCESS INCLUDED A REVIEW AND APPROVAL BY INDEPENDENT PERSONS, COMPARABILITY DATA, AND CONTEMPORANEOUS SUBSTANTIATION OF THE DELIBERATION AND DECISION. IN THE REVIEW OF THE COMPENSATION, THE OTHER OFFICERS OR KEY EMPLOYEES OF THE ORGANIZATION WERE COMPARED TO THE OTHER HOSPITALS' EMPLOYEES IN THE AREA THAT HOLD THE SAME POSITION. Form 990, Part VI, Line 2 Family/business relationships amongst interested persons TRUDY STOCK AND KEITH JEWELL - Business relationship, TRUDY STOCK AND JAMES SANDGREN - Business relationship, KEITH JEWELL AND JAMES SANDGREN - Business relationship, JAMES SANDGREN AND JEFFERY WOLF - Business relationship Form 990, Part VI, Line 6 Classes of members or stockholders ST. MARY'S WARRICK HOSPITAL, INC. HAS A SINGLE CORPORATE MEMBER, ST. MARY'S HEALTH, INC. Form 990, Part VI, Line 7a Members or stockholders electing members of governing body ST. MARY'S WARRICK HOSPITAL, INC. HAS A SINGLE CORPORATE MEMBER, ST. MARY'S HEALTH, INC., WHO HAS THE ABILITY TO ELECT MEMBERS TO THE GOVERNING BODY OF THE ST. MARY'S WARRICK HOSPITAL, INC. BOARD Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders ALL DECISIONS THAT HAVE A MATERIAL IMPACT TO ST. MARY'S WARRICK HOSPITAL, INC.'S FINANCIAL INFORMATION OR CORPORATION AS A WHOLE ARE SUBJECT TO APPROVAL BY ITS SOLE CORPORATE MEMBER, ST. MARY'S HEALTH, INC. Form 990, Part VI, Line 11b Review of form 990 by governing body THE FORM 990 IS PROVIDED TO THE ST. MARY'S HEALTH, INC.'S GOVERNING BODY VIA A SECURE WEB-BASED PORTAL. THE GOVERNING BODY WILL REVIEW THE FORM 990 PRIOR TO THE FILING DATE AND ASK ANY QUESTIONS REGARDING THE FORM 990. ANY QUESTIONS AND RESPONSES WILL BE POSTED TO THE WEB-BASED PORTAL BEFORE THE RETURN IS FILED. ALL QUESTIONS AND RESPONSES WILL BE REVIEWED AND DISCLOSED IN THE MEETING MINUTES OF THE NEXT BOARD MEETING FOLLOWING THE REVIEW OF THE FORM 990. Form 990, Part VI, Line 12c Conflict of interest policy THE ORGANIZATION REGULARLY AND CONSISTENTLY MONITORS AND ENFORCES COMPLIANCE WITH THE CONFLICT OF INTEREST POLICY IN THAT ANY DIRECTOR, PRINCIPAL OFFICER, OR MEMBER OF A COMMITTEE WITH GOVERNING BOARD DELEGATED POWERS, WHO HAS A DIRECT OR INDIRECT FINANCIAL INTEREST, MUST DISCLOSE THE EXISTENCE OF THE FINANCIAL INTEREST AND BE GIVEN THE OPPORTUNITY TO DISCLOSE ALL MATERIAL FACTS TO THE DIRECTORS AND MEMBERS OF THE COMMITTEES WITH GOVERNING BOARD DELEGATED POWERS CONSIDERING THE PROPOSED TRANSACTION OR ARRANGEMENT. THE REMAINING INDIVIDUALS ON THE GOVERNING BOARD OR COMMITTEE WILL DECIDE IF CONFLICTS OF INTEREST EXIST. EACH DIRECTOR, PRINCIPAL OFFICER AND MEMBER OF A COMMITTEE WITH GOVERNING BOARD DELEGATED POWERS ANNUALLY SIGNS A STATEMENT WHICH AFFIRMS SUCH PERSON HAS RECEIVED A COPY OF THE CONFLICTS OF INTEREST POLICY, HAS READ AND UNDERSTANDS THE POLICY, HAS AGREED TO COMPLY WITH THE POLICY, AND UNDERSTANDS THAT THE ORGANIZATION IS CHARITABLE AND IN ORDER TO MAINTAIN ITS FEDERAL TAX EXEMPTION IT MUST ENGAGE PRIMARILY IN ACTIVITIES WHICH ACCOMPLISH ITS TAX-EXEMPT PURPOSE. Form 990, Part VI, Line 19 Required documents available to the public THE ORGANIZATION WILL PROVIDE ANY DOCUMENTS OPEN TO PUBLIC INSPECTION UPON REQUEST. Form 990, Part VIII, Line 11d Other Miscellaneous Revenue NET INCOME WITH JV - Total Revenue: 1441, Related or Exempt Function Revenue: 1441, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ; GOVERNMENT INCENTIVES - Total Revenue: -5914, Related or Exempt Function Revenue: -5914, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ; INTERCOMPANY DRUG SCREENS - Total Revenue: 450, Related or Exempt Function Revenue: 450, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ; HOUSEKEEPING - Total Revenue: 8040, Related or Exempt Function Revenue: , Unrelated Business Revenue: 8040, Revenue Excluded from Tax Under Sections 512, 513, or 514: ; Form 990, Part XI, Line 9 Other changes in net assets or fund balances FAS 158 PENSION - -793555; NET ASSET TRANSFER WITH RELATED ENTITIES - 56627; ASCENSION HEALTH ALLIANCE PO BOX 45998 ST LOUIS MO 63145 453358926 NATIONAL HEALTH SYSTEM 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