2016-05-12T13:27:41-05:00 2015-06-30 ERNST & YOUNG US LLP 111 MONUMENT CIRCLE SUITE 4000 INDIANAPOLIS IN 46204 990 2014-07-01 352007327 ST MARY MEDICAL CENTER INC % MARY ANN SHACKLETT STMA 2199420551 1500 SOUTH LAKE PARK AVENUE HOBART IN 46342 MARY ANN SHACKLETT SR VP FINANCE & CFO 2016-05-12 BEN PITCHKITES P00362066 3176817000 2014 2016-08-17 19:52:53Z MARY ANN SHACKLETT 10010 DONALD S POWERS DR 201 MUNSTER IN 46321 239981067 false X WWW.COMHS.ORG X 1973 IN ST. MARY MEDICAL CENTER,INC. IS COMMITTED TO PROVIDING THE HIGHEST QUALITY CARE IN THE MOST COST-EFFICIENT MANNER, RESPECTING THE DIGNITY OF THE INDIVIDUAL. 17 14 1505 165 1158188 201312 1071601 1925577 223378954 234758269 254723 862166 1761073 1675385 226466351 239221397 172519 125248 0 0 76562640 78765689 0 0 0 134804387 136655178 211539546 215546115 14926805 23675282 163405216 185031443 51367164 34908966 112038052 150122477 X ST. MARY MEDICAL CENTER,INC. IS COMMITTED TO PROVIDING THE HIGHEST QUALITY CARE IN THE MOST COST-EFFICIENT MANNER, RESPECTING THE DIGNITY OF THE INDIVIDUAL, PROVIDING FOR THE WELL-BEING OF THE COMMUNITY AND SERVING THE NEEDS OF ALL PEOPLE, INCLUDING THE POOR AND DISADVANTAGED. false false 198241036 125248 235666304 St. Mary Medical Center, Inc. is a 195 bed acute care hospital that offers a broad range of services to care for its patients without regard to their ability to pay. St. Mary Medical Center, Inc. provides leading-edge care to patients in northwest Indiana. Through its dedication to quality and innovation, St. Mary Medical Center, Inc. has earned a multitude of accreditations, awards, and certifications in its pursuit of improving the health of its patients and community. 198241036 true true false false false false false false false false true false false false true false false true false false false false false false false false true true true false true false false false false false false false false false false false false false true true true false false true 140 0 true 1505 true true true false false false false false false false false false X 17 14 true false false false true true true true true false false true true true true true true false true true true IN X MARY ANN SHACKLETT 2199348250 10010 DONALD S POWERS DR 201 MUNSTER IN 46321 X CARY BOSAK DIRECTOR START 7/1/2014 1.0 0.0 X 0 0 0 PEGGY BUFFINGTON PHD DIRECTOR 1.0 0.0 X 0 0 0 LINDA BUZINEC MAYOR DIRECTOR 1.0 0.0 X 0 0 0 FRANKIE FESKO DIRECTOR 1.0 16.0 X 0 98645 0 LISA FIELD DIRECTOR 1.0 0.0 X 0 0 0 MILTON GASPARIS MD DIRECTOR 1.0 0.0 X 0 0 0 THOMAS GOLUBSKI MD DIRECTOR START 7/1/2014 1.0 0.0 X 0 0 0 SHARON HARIG MD DIRECTOR START 7/1/2014 1.0 0.0 X 0 0 0 FAY IORIO DIRECTOR START 7/1/2014 1.0 0.0 X 0 0 0 PETER MAVRELIS MD DIRECTOR 1.0 0.0 X 0 0 0 HON JAMES MOODY DIRECTOR 1.0 0.0 X 0 0 0 JOHN WALSH DIRECTOR START 7/1/2014 1.0 0.0 X 0 0 0 ROBERT WELSH DIRECTOR 1.0 1.0 X 0 16200 0 KEN KRUPINSKI CPA PRESIDENT 1.0 0.0 X X 0 0 0 SR MICHELE DVORAK PHJC VICE PRESIDENT 40.0 0.0 X X 0 0 0 BILL JOINER SECRETARY AND TREASURER 1.0 0.0 X X 0 0 0 JANICE RYBA ADMINISTRATOR 40.0 1.0 X X 0 612574 55523 MARY ANN SHACKLETT SR VP FINANCE & SYSTEM CFO 1.0 47.0 X 0 707309 59253 MARY SUDICKY VP OF FINANCE/CFO 40.0 0.0 X 302673 0 62791 TAMMIE JONES VP PATIENT CARE SERVICES/CNO 40.0 0.0 X 301178 0 29347 RANDY NORRIS DIRECTOR SUPPORT SERVICES 40.0 0.0 X 134469 0 48227 MICHELLE MEYER DIRECTOR PHARMACY 40.0 0.0 X 138998 0 35489 TIA S SPARKS SR PHARMACIST 40.0 0.0 X 130852 0 36024 ANDREW KASIANCHUK CLINICAL PHARMACIST 40.0 0.0 X 121356 0 31743 PETER DYBA DIRECTOR IMAGING SERVICES 40.0 0.0 X 113722 0 35338 1243248 1434728 393735 57 false true false WALSH CONSTRUCTION 929 WEST ADAMS STREET CHICAGO IL 60607 CONSTRUCTION 4759861 REHABCARE GROUP INC PO BOX 502096 ST LOUIS MO 63150 REHAB CARE SERVICES 3019721 LAKESHORE ANESTHESIA PC 1755 FULTON STREET ELKHART IN 46514 ANESTHESIA SERVICES 2710483 YOUNA MECHANICAL INC 350 CROSSEN AVENUE ELK GROVE VILLAGE IL 60007 CONSTRUCTION 2438460 INCOMPASS HEALTH INC 318 MAXWELL ROAD SUITE 500 ALPHARETTA GA 30009 HOSPITALIST SERVICES 980982 31 1783740 141837 1925577 NET PATIENT SERVICE REVENUE 622110 232649081 232649081 MEDICAL LABORATORY 621511 1158188 1158188 INTERCOMPANY RENT REVENUE 531120 951000 951000 234758269 625850 625850 0 0 650071 696460 -46389 0 -46389 -46389 299526 63210 236316 236316 236316 0 0 0 CAFETERIA 722514 765049 765049 LEGAL SETTLEMENT 900099 563616 563616 EDUCATION AND TRAINING 611430 198439 198439 194670 192369 2301 1721774 239221397 234508116 1158188 1629516 125248 125248 0 0 0 710824 710824 0 61777639 57000494 4777145 2945668 2687322 258346 8588226 7366845 1221381 4743332 4327324 416008 646336 646336 229736 229736 15137 15137 0 0 0 19372535 17355255 2017280 673290 637424 35866 2395843 1635443 760400 144111 141852 2259 0 3257984 3183779 74205 114212 98168 16044 0 31020 23811 7209 1196516 1196516 17041 17041 9912007 9042687 869320 874001 797348 76653 MEDICAL SUPPLIES 49980480 49980480 CORPORATE ALLOCATION 22258193 20306066 1952127 MEDICAID ASSESSMENT FEE 11456649 11456649 PHYSICIAN ALLOCATION 8436271 7696378 739893 5643816 4361422 1282394 215546115 198241036 17305079 0 X 0 0 6360969 4519730 0 0 29625144 29835298 0 0 0 0 0 0 5550829 6114609 795869 768499 230090765 93210302 115774743 136880463 0 0 0 0 0 0 2403157 2403157 2894505 4509687 163405216 185031443 19396340 15452077 0 0 298415 320142 0 0 0 0 0 0 0 0 0 0 31672409 19136747 51367164 34908966 X 111925897 149941444 112155 181033 0 0 112038052 150122477 163405216 185031443 X 23675282 14409143 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 12606822 12606822 115639314 41261406 74377908 277004 180192 96812 65778446 46088070 19690376 35789179 5680634 30108545 136880463 0 DEVELOPER REIMBURSEMENT 13755318 LT LEGAL CLAIM LIABILITY 1993193 CONSTRUCTION RETAINAGE 1601271 61ST AVE. WIDENING 1000000 LEASE OBLIGATIONS 432407 MISCELLANEOUS OBLIGATIONS 237934 3RD PARTY LIABILITIES 116624 19136747 true true X true X true X true true false true true 1430 3239645 146005 3093640 0.01440 23530 32718608 19956171 12762437 0.05920 24960 35958253 20102176 15856077 0.07360 244 6688 488177 73285 414892 0.00190 137 1262 1313693 1313693 0.00610 19 383080 346694 36386 0.00020 89 125248 125248 0.00060 470 7969 2310198 419979 1890219 0.00880 470 32929 38268451 20522155 17746296 0.08240 1 11219 9425 1794 1 44 8222 8222 18 697 16047 16047 0.00010 27 962 21044 21044 0.00010 47 1703 56532 9425 47107 0.00020 true 2320097 23201 100724345 108208284 -7483939 X true true 1 1 ST MARY MEDICAL CENTER INC 1500 SOUTH LAKE PARK AVENUE HOBART IN 46342 COMHS.ORG/STMARY 14-005786-1 X X X ST MARY MEDICAL CENTER INC 1 false false true X X X X X X X X X 13 true true false true X http://www.comhs.org/stmary X http://chsstmary.healthforecast.net X true 13 true http://www.comhs.org/stmary false false true X 200. 300. X X X X true true X X X X true X comhs.org/stmary/charity-care.asp X comhs.org/stmary/charity-care.asp X comhs.org/stmary/charity-car X X X X X true X false X X X X true X false false Part V, Section B, Line 5 - Community stakeholders Focus groups held as part of this CHNA incorporated input from 44 key informants (or community stakeholders) in the area with special emphasis on persons who work with or have special knowledge about vulnerable populations in the four counties, including low income individuals, minority populations, those with chronic conditions, and other medically underserved residents. The five groups consisted of Doctors, Other Health Providers, Social Service Providers, Business Leaders, and Other Community Leaders. The complete list can be found on pages 103 and 104 of our CHNA. Part V, Section B, Line 6a - Hospital facilities CHNA was conducted with Community Healthcare System: Community Hospital St. Catherine Hospital, Inc. Franciscan Alliance: St. Anthony Health St. Margaret Health - Hammond St. Margaret Health - Dyer The Methodist Hospitals, Inc.: Northlake campus Southlake campus Part V, Section B, Line 11 - CHNA significant needs identified Our hospitals chose four priority areas: Diabetes, Heart Disease & Stroke, Nutritional & Weight Status and Maternal, Infant & Child Health. All of these areas have a common link to modifiable lifestyle risk factors, education and access to medical services. Key issues of concerns among our community informant included access to healthcare services, health education and prevention, obesity and substance abuse, and as such align with the focus areas chosen. In targeting these four areas for health improvement, the hospitals will seek to: " Align and re-align resources to focus on these health issues " Develop partnerships and collaborations for outreach screening and education initiatives as well as to target at-risk populations " Expand best practice efforts through the primary care setting, in particular, our employed physicians group " Seek additional opportunities to achieve our goals " Leverage our resources to provide services by partnering with other community groups and seeking grant funding The Community Health Needs assessment conducted by the hospitals of the Community Healthcare System identified areas of concern not identified in the hospital's implementation plan. These areas include: " Access to Health Services " Cancer " Chronic Kidney Disease " Family Planning " Injury & Violence Prevention " Oral Health Many of these areas are being addressed by the hospitals of the Community Healthcare System as well as by other community organizations. For example, Community Healthcare System supports a large cancer program with a separate research foundation focused on improving access to clinical trials for area residents as well as providing free support and mind-body services through its Cancer Resource Centre. All hospitals provide routine low-cost and free screening programs for a variety of cancers. As the hospital focuses on lifestyle, education, prevention and access to care issues surrounding its four focused areas, positive outcomes will likely have positive effects on the health needs not addressed. To have the greatest impact, however, the hospital has chosen to focus on three of the most serious diseases and the related lifestyle issues facing our community as well as investing in the health of the most vulnerable residents - our newborns. Part V, Section B, Line 22d - FAP Eligibility OUR MAXIMUM AMOUNTS THAT CAN BE CHARGED TO FAP-ELIGIBLE INDIVIDUALS FOR EMERGENCY OR OTHER MEDICALLY NECESSARY CARE ARE BASED ON A SLIDING SCALE. UP TO 200% OF FEDERAL POVERTY GUIDELINES (FPG) IS 100% FREE CARE. 201%-300% IS CHARGED BASED ON MEDICARE RATES. OVER 300% IS CHARGED BASED ON AVERAGE OF MEDICARE AND LOWEST MANAGED CARE RATES COMBINED. PATIENTS MAY ALSO BE ELIGIBLE FOR SELF-PAY/PROMPT PAY DISCOUNTS REGARDLESS OF FEDERAL POVERTY LEVEL. WE OFFER 30% DISCOUNT TO TRUE SELF-PAY ACCOUNTS AND AN ADDITIONAL 10% DISCOUNT FOR PROMPT PAYMENT. 10 Outpatient Surgery at Lake Park 7921 Grand Boulevard Hobart IN 46342 Outpatient Surgery Center for Imaging & Radiation Oncology 300 WEST 61st Avenue Hobart IN 46342 Radiology OUTPATIENT REHABILITATION 320 WEST 61ST AVENUE HOBART IN 46342 REHABILITATION WOMEN'S DIAGNOSTIC CENTER 320 WEST 61st Avenue Hobart IN 46342 DIAGNOSTIC CENTER PORTAGE HEALTH CENTER II 3545 ARBORS STREET PORTAGE IN 46368 OUTPATIENT CENTER WILLOWCREEK HEALTH CENTER 3170 WILLOWCREEK ROAD PORTAGE IN 46368 Outpatient Center WINFIELD FAMILY HEALTH CENTER 10607 RANDOLPH STREET CROWN POINT IN 46307 Outpatient Center Health & Rehabilitation Spectrum 1354 SOUTH Lake Park Avenue Hobart IN 46342 Outpatient Center Home Health of St Mary Medical Center 1439 SOUTH Lake Park Avenue Hobart IN 46342 Home Health VALPARAISO HEALTH CENTER 3800 ST MARY DRIVE VALPARAISO IN 46383 OUTPATIENT CENTER PART I, lINE 3C - FACTORS OTHER THAN FPG USED TO DETERMINE FAP ELIGIBILITY N/A - FPG is the only factor used PART I, LINE 6A - WAS A COMMUNITY BENEFIT REPORT PREPARED: THE STATE OF INDIANA ACCEPTS FORM 990 SCHEDULE H IN LIEU OF A COMMUNITY BENEFIT REPORT. St. Mary Medical Center, Inc. makes its 990 available to the public. PART I, LINE 7 - FINANCIAL ASSISTANCE & OTHER COMMUNITY BENEFITS AT COST: COST ACCOUNTING SYSTEM WAS USED FOR COMPUTATIONS. BAD DEBT IS EXCLUDED FROM THE CALCULATION. MEDICAID DIRECT OFFSETTING REVENUE INCLUDES THE INCREASED HAF REIMBURSEMENT. THE EXPENSE INCLUDES THE HAF FEE. PART II - COMMUNITY BUILDING ACTIVITIES Community Support (line 3) - This category can include "disaster readiness and public health emergency activities, such as readiness training beyond what is required by accrediting bodies or government entities." Expenses and revenues relating to the Bio-terrorism department of the hospital have been included in this category. Leadership development and training for community member (line 5) - This category includes "training in conflict resolution; civic, cultural or language skills; and medical interpreter skills for community residents." The costs reported here relate to a mentoring program that is held at a local high school. Coalition building (line 6) - This category is to include "participation in community coalitions and other collaborative efforts with the community to address health and safety issues." The costs reported here pertain to participation in functions with the local Chamber of Commerce. Community health improvement advocacy (line 7) - This category is to include "efforts to support policies and programs to safeguard or improve public health access to health care services." The primary activities of the hospital in this category have been sponsorships of a number of community health fairs. PART III, LINE 2 - METHODOLOGY USED TO ESTIMATE BAD DEBT AT COST: THE COST TO CHARGE RATIO PER THE S-10 WORKSHEET OF THE MEDICARE COST REPORT IS USED TO ESTIMATE BAD DEBT AT COST. PART III, LINE 3 - BAD DEBT EXPENSE ATTRIBUTABLE TO FAP ELIGIBLE PATIENTS: WE ESTIMATE 1% OF THE BAD DEBT EXPENSE TO BE ATTRIBUTABLE TO PATIENTS ELIGIBLE FOR FINANCIAL ASSISTANCE. PART III, LINE 4 - BAD DEBT EXPENSE FOOTNOTE FROM AUDIT: Patient service revenue, net of contractual allowances and discounts, is reduced by the provision for bad debts, and net accounts receivable are reduced by an allowance for uncollectible accounts. The provision for bad debts is based upon management's assessment of historical and expected net collections, taking into consideration the trends in health care coverage, economic trends, and other collection indicators. Management regularly assesses the adequacy of the allowances based upon historical write-off experience by major payor category and aging bucket. The results of the review are then utilized to make modifications, as necessary, to the provision for bad debts to provide for an appropriate allowance for bad debts. A significant portion of the hospitals' uninsured patients will be unable or unwilling to pay for services provided, and a significant portion of the hospitals' insured patients will be unable or unwilling to pay for co-payments and deductibles. Thus, the hospitals record a significant provision for bad debts related to uninsured patients in the period the services are provided. After all reasonable collection efforts have been exhausted in accordance with CFNI's policy, accounts receivable are written off and charged against the allowance for bad debts. PART III, LINE 8 - WHY MEDICARE SHORTFALL SHOULD BE COMMUNITY BENEFIT: WE PROVIDE NECESSARY SERVICES REGARDLESS OF THE PATIENT'S ABILITY TO PAY FOR THE SERVICE PROVIDED OR THE REIMBUSEMENT RECEIVED FROM MEDICARE, QUALIFYING THE SHORTFALL AS A COMMUNITY BENEFIT. THE medicare allowable costs of care were CALCULATED BY USING INFORMATION FROM THE COST ACCOUNTING SYSTEM. PART III, LINE 9B - COLLECTION PRACTICES FOR QUALIFYING FA PATIENTS: COLLECTION POLICIES ARE THE SAME FOR ALL PATIENTS. PATIENTS ARE SCREENED FOR ELIGIBILITY FOR FINANCIAL ASSISTANCE BEFORE COLLECTION PROCEDURES BEGIN. IF AT ANY POINT IN THE COLLECTION PROCESS, DOCUMENTATION IS RECEIVED THAT INDICATES THE PATIENT IS POTENTIALLY ELIGIBLE FOR FINANCIAL ASSISTANCE BUT HAS NOT APPLIED FOR IT, THE ACCOUNT IS REFERRED BACK FOR A FINANCIAL ASSISTANCE REVIEW. 2. NEEDS ASSESSMENT IN COLLABORATION WITH COMMUNITY HEALTHCARE SYSTEM, FRANCISCAN ALLIANCE, AND THE METHODIST HOSPITALS, inc., ST. MARY MEDICAL CENTER, INC., CONTRACTED WITH A THIRD PARTY TO PERFORM OUR COMMUNITY HEALTH NEEDS ASSESSMENT AS PER REGULATION 501(R). The most recent CHNA was conducted in 2013 and is available ON the following websites: HTTP://WWW.COMHS.ORG/STMARY HTTP://WWW.CHSSTMARY.HEALTHFORECAST.NET 3. PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE PATIENTS WHO ARE ADMITTED WITHOUT INSURANCE ARE DIRECTED TO THE HOSPITAL'S FINANCIAL COUNSELORS. THE FINANCIAL COUNSELORS PERFORM AN INTERVIEW WITH THE PATIENTS TO EXPLAIN TO THEM THE PROCESS NECESSARY TO RECEIVE FINANCIAL ASSISTANCE. THIS PROCESS INCLUDES APPLYING FOR MEDICAID OR OTHER GOVERNMENT AID. THE APPLICANT THEN MUST FILL OUT A FINANCIAL INFORMATION WORKSHEET AND SUBMIT VARIOUS INFORMATION TO DETERMINE IF THEY QUALIFY FOR FINANCIAL ASSISTANCE IN ACCORDANCE WITH THE FINANCIAL ASSISTANCE POLICY. THE POLICY IS POSTED IN THE EMERGENCY ROOM AREA AS WELL AS AT EACH INPATIENT WAITING DESK. THE INFORMATION IS ALSO AVAILABLE ON OUR WEBSITE. 4. COMMUNITY INFORMATION LOCATED IN HOBART, INDIANA, THE COMMUNITY SERVED INCLUDES NORTHWEST INDIANA. LATEST U.S. CENSUS BUREAU DEMOGRAPHIC INFORMATION COMPARING HOBART TO THE STATE OF INDIANA: Hobart Indiana Persons under 18 years, percent, 2010 23.1% 24.8% Persons 65 years and over, percent, 2010 14.4% 13.0% White alone, percent, 2010 (a) 85.3% 84.3% Black or African American alone, percent, 2010 (a) 7.0% 9.1% Hispanic or Latino, percent, 2010 (b) 13.9% 6.0% White alone, not Hispanic or Latino, percent, 2010 76.9% 81.5% High school graduate or higher, age 25+, 2010-2014 88.5% 87.6% Bachelor's degree or higher, age 25+, 2010-2014 15.8% 23.6% Median household income, 2010-2014 $55,840 $48,737 Persons in poverty, percent, 2010-2014 10.4% 15.2% (a) Includes persons reporting only one race. (b) Hispanics may be of any race, so also are included in applicable race categories. 5. PROMOTION OF COMMUNITY HEALTH Since 1973, St. Mary Medical Center, Inc. has met the healthcare needs of the Northwest Indiana community, having started through the ministry of the Poor Handmaids of Jesus Christ. This order of Ancilla Domini sisters began their ministry in Lake County when they came to Mercy Hospital in Gary in 1913. The sisters continue their mission here today, at St. Mary Medical Center, Inc. and throughout Lake County. In 2001, St. Mary Medical Center, Inc. became part of Community Healthcare System, comprised of St. Mary Medical Center in Hobart, St. Catherine Hospital, Inc. in East Chicago, and Community Hospital in Munster. St. Mary Medical Center, Inc. remains dedicated to its Roman Catholic tradition. It is our goal to be the premier hospital system in Indiana. Our dedication to this end is evident in the caring spirit of our staff, coupled with the best facilities and technologies we can offer our patients and their families. In 2004, the hospital expanded with a new $40 million Patient Tower offering comfortable, private rooms and advanced bedside technology. During the next decade, growth continued with the opening of a new advanced imaging center, a new and expanded emergency department, the opening of additional outpatient locations in Portage, Hobart and Valparaiso. In 2015, the hospital opened a new $40 million surgical pavilion, furthering our commitment to providing the highest quality care with the most advanced technologies, to provide patients of Northwest Indiana the finest health care available today. St. Mary Medical Center, Inc. takes pride in being responsive to the needs of our community. Below, we have listed current programs to meet those needs. THE DESIGNATED POPULATION THAT ST. MARY MEDICAL CENTER IS FOCUSING ON INCLUDES THOSE INDIVIDUALS WHOSE LIFE-STYLE BEHAVIORS PUT THEM AT RISK FOR DISEASE AND ILLNESS. OUR PRIMARY FOCUS THIS YEAR IS ON DISEASES THAT HAVE BEEN IDENTIFIED AS HEALTH DISCREPANCIES IN LAKE COUNTY, INDIANA - DIABETES, HEART DISEASE & STROKE, AND MATERNAL INFANT & CHILD HEALTH. THE INCIDENCE OF THESE DISEASES IN OUR REGION SURPASSED STATE AND NATIONAL AVERAGES, AND THEREFORE DEMANDED OUR PRIMARY FOCUS. ALL OF THESE AREAS HAVE A COMMON LINK TO MODIFIABLE LIFESTYLE RISK FACTORS, EDUCATION, PREVENTION AND ACCESS TO MEDICAL SERVICES. ST. MARY MEDICAL CENTER HAS INVESTED GREATLY IN RECENT YEARS IN TREATMENT AND EDUCATION PROGRAMS AND IN OFFERING PATIENTS ACCESS TO TREATMENTS NOT AVAILABLE ELSEWHERE IN THE COUNTY. WE ARE EXPANDING BEST PRACTICE EFFORTS THROUGH THE PRIMARY CARE SETTING, IN PARTICULAR OUR EMPLOYED PHYSICIANS GROUP. THE FOCUS OF OUR COMMUNITY BENEFIT IS TO USE RESOURCES TO REACH BEYOND THE TREATMENT OF THESE DISEASES TO HELP EDUCATE, SUPPORT AND EMPOWER INDIVIDUALS TO LOWER THEIR RISKS. Alzheimer's Support Group - Alzheimer's Support Group meets the third Tuesday of each month at St. Mary Medical Center. This group is for patients, family and friends dealing with Alzheimer's. Participants in support groups receive emotional support, practical assistance in coping with the issues they face and the latest information about research. American Cancer Society Road to Recovery Volunteer Program - This volunteer training program prepares volunteers to transport patients with cancer to and from appointments when they are unable to transport themselves. The hospital provides space, organization and professionals to help train volunteers. Bariatric Seminar - Using a team approach to achieving weight loss, bariatric surgeons and medical weight-loss professionals discuss the etiology of obesity, its effect on an individual's physical, emotional and psychological health. The goal is to improve the medical complications of life-threatening obesity. Beat the Holiday Blues - Presentation on recognizing the signs and symptoms of depression and various treatment options and coping mechanisms. Blood Profile Screening - These screenings offer a way for those concerned about heart health to monitor cholesterol, HDL, triglycerides or glucose. No physician order is necessary for the screening. Blood Pressure Screening - These are blood pressure screenings free to the public at the Portage YMCA. Participants are counseled by an RN and given educational material regarding blood pressure and how it relates to their health. BMI/Body Fat Analysis - These are BMI and body fat screenings free to the public at the Portage YMCA. Participants are counseled by an RN and given educational material regarding BMI and body fat percentage and how it relates to their health. Breastfeeding Class - This class provides education and support for women who what to breastfeed. Teens, partners, and grandparents welcome. Cancer Survivors Day - The Cancer Resource Centre and St. Mary Medical Center provide a local celebration of this national event, honoring the strength and courage of those who have lived - and continue to live - with cancer. Prizes are raffled and each attendee receives a motivational gift as well as food and entertainment. Cancer Survivorship Symposium - This symposium featured vendors, activities, and keynote speaker who provide support for those living with, through and beyond a cancer diagnosis. Attendees learned about food and nutritional needs that can support them through the various stages of living with cancer. Cardiopulmonary Rehab "Breathless" Support Group - This support group provides patients with information about how to live and thrive while dealing with cardiopulmonary issues. Group provides a supportive resource for patients and family members. Choices in Childbirth - Six educational classes are offered each session for those in their last trimester of pregnancy. Classes include informative lectures about comfort measures and medication available for pain. The last session focuses on management of breast-feeding and newborn behavior patterns. Clinical Education for Ministry - Training college students for pastoral care. Cooking Demonstrations - Chef Ryan C. Smith demonstrates delectable appetizers, salads, entrees, desserts and more in these fun and interactive demonstrations that helps participants learn about nutrition and attainable food preparation. Coronary Health Appraisal - This appraisal helps to determine risk for heart disease and other related medical conditions. This discounted screening includes: cholesterol (total, HDL, LDL, triglycerides), blood sugar, metabolic syndrome, blood pressure, body mass index and a Heart Health Profile. Coumadin Class - A pharmacist and dietician discuss appropriate diet and medications to avoid while taking Coumadin. Diabetes Class - This is a class that discusses diabetes management, the proper use of medication, glucose monitoring, meal planning and diabetes complications. Duneland Chamber of Commerce - Art after Dark event, St. Mary Medical Center physicians manned a kids' booth for attendees and their children to learn health safety tips, and healthy childhood nutrition. Health Education and Seminars - St. Mary Medical Center physicians offered numerous free community presentations on a variety of health topics including heart disease, arthritis, spine care, ENT/sinus, pulmonary health, gastroenterology, and more. Healthy Kids Day YMCAs - St. Mary Medical Center manned a booth and provided support and health education information for the Healthy Kids Days at the Portage and Hobart Family YMCAs. Hearts of Hope - The Hearts of Hope tree at St. Mary Medical Center shines with the help and support of donations to cardiac research. The Hearts of Hope tree is decorated with lights that represent contributions made in honor of or in memory or someone who has been affected by heart disease. Monies raised through donations fund vitally needed research for heart disease. Donors and honorees are invited to a Hearts of Hope tree lighting ceremony that celebrates cardiac research success stories of St. Mary Medical Center. Hobart Chamber of Commerce Business Expo - Various hospital departments provide information about service lines and screenings, such as blood pressure, body composition, bone density, and grip strength testing. Hope Network Cancer Support Group - The last Wednesday of each month this group meets for informative sessions where they can share thoughts and feelings in a comfortable and confidential atmosphere. IUN - HIT Summer Clinical - 10 days of free clinical nursing education and training for IUN nursing students. Knox Suite - Knox Suite is similar to a hotel room that is located on the fourth floor of the hospital and accommodates families that need a place to stay. Look Good-Feel Better - This class helps improve the physical appearance of cancer patients by helping them with make-up and wigs to aide in their mental and emotional well-being in their struggle with cancer. This class is put on by the staff from Women's Diagnostic Center in conjunction with the American Cancer Society. Medical Student Internships - Medical students interested in lea 6. AFFILIATED HEALTH CARE SYSTEM ST. MARY MEDICAL CENTER, INC. IS PART OF AN AFFILIATED SYSTEM. EACH HOSPITAL IN THE SYSTEM PROVIDES MEDICAL SERVICES TO THEIR COMMUNITIES AND ADJOINING COMMUNITIES. EACH ENTITY'S PURPOSE IS TO PROVIDE HEALTH CARE TO THOSE WHO NEED IT, INCLUDING THE UNINSURED OR UNDERINSURED. 7. STATE FILING OF COMMUNITY BENEFIT REPORT INDIANA false PORTAGE TOWNSHIP YMCA 3100 WILLOWCREEK ROAD PORTAGE IN 46368 351404478 501(C)3 63942 SPONSORSHIP GREATER VALPARAISO CHAMBER OF COMMERCE 162 WEST LINCOLNWAY VALPARAISO IN 46383 350727140 501(C)6 6000 SPONSORSHIP HOBART CHAMBER OF COMMERCE 1001 LILLIAN STREET HOBART IN 46342 350982628 501(c)6 5230 SPONSORSHIP 1 2 PART IV SUPPLEMENTAL INFORMATION REQUESTS FOR DONATIONS FROM QUALIFIED 501(C)(3) CHARITIES, UNIVERSITIES, AND OTHER EXEMPT ORGANIZATIONS ARE EVALUATED AS TO WHETHER THE POTENTIAL DONEE ORGANIZATION WILL USE THE FUNDS IN A MANNER CONSISTENT WITH OUR CHARITABLE MISSION AND THE INTENTION OF THE CONTRIBUTION. OUR DONATIONS/CONTRIBUTIONS ARE PRIMARILY MADE TO LOCAL ORGANIZATIONS. SINCE THESE ARE NOT GRANTS, THERE IS NO NEED TO MONITOR. X true true false false false false false false false true false JANICE RYBA ADMINISTRATOR 0 392427 0 196225 0 23922 0 39520 0 16003 0 668097 0 0 MARY ANN SHACKLETT SR VP FINANCE & SYSTEM CFO 0 397935 0 287098 0 22276 0 39520 0 19733 0 766562 0 0 MARY SUDICKY VP OF FINANCE/CFO 217878 0 84094 0 701 0 39520 0 23271 0 365464 0 0 0 TAMMIE JONES VP PATIENT CARE SERVICES/CNO 191670 0 108549 0 959 0 10734 0 18613 0 330525 0 0 0 RANDY NORRIS DIRECTOR SUPPORT SERVICES 132790 0 0 0 1679 0 28011 0 20216 0 182696 0 0 0 MICHELLE MEYER DIRECTOR PHARMACY 138717 0 0 0 281 0 6153 0 29336 0 174487 0 0 0 TIA S SPARKS SR PHARMACIST 130768 0 0 0 84 0 6104 0 29920 0 166876 0 0 0 ANDREW KASIANCHUK CLINICAL PHARMACIST 120786 0 0 0 570 0 12048 0 19965 0 153369 0 0 0 PART I, LINE 1A - PROVIDED TO/FOR A PERSON IN 990, PART VII, SEC. A, LN 1A THE ORGANIZATION PAYS HEALTH/SOCIAL CLUB DUES ON BEHALF OF CERTAIN OFFICERS, KEY EMPLOYEES, AND FIVE HIGHEST PAID EMPLOYEES, WHICH IS THEN TAXED AS A FRINGE BENEFIT TO THE INDIVIDUAL. PART I, LINE 3 - USED TO ESTABLISH COMPENSATION OF ORG. CEO/EXEC. DIR. ST. MARY MEDICAL CENTER, INC. FOLLOWS ITS PARENT, (CFNI), COMPENSATION POLICIES. THE CFNI BOARD HAS ADOPTED EXECUTIVE AND BOARD OF DIRECTORS COMPENSATION PHILOSOPHY AND REASONABLENESS STANDARDS. THIS IS TO ASCERTAIN THAT THESE STANDARDS ARE ADHERED TO. THEIR PROCESS FOR COLLECTING AND ASSEMBLING MARKET DATA IS CONSISTENT WITH THE REBUTTABLE PRESUMPTION CHECKLIST AND GUIDELINES ALONG WITH FAIR MARKET VALUE USED BY THE IRS IN CONDUCTING EXECUTIVE COMPENSATION REVIEWS AS WELL AS CONTEMPORARY COMPENSATION PRACTICES. ALL MARKET DATA IS ASSEMBLED FROM REPUTABLE COMMERCIALLY AVAILABLE SURVEYS. PART I, LINE 7 - NON-FIXED PAYMENTS NOT DESCRIBED IN LINES 5 AND 6 DESCRETIONARY BONUS IS PAID BASED ON FINANCIAL PERFORMANCE AND QUALITY INDICATORS TO CERTAIN EXECUTIVES. PART VI, LINE 6 - MEMBERS OR STOCKHOLDERS COMMUNITY FOUNDATION OF NORTHWEST INDIANA, INC. IS THE SOLE MEMBER/SHAREHOLDER. PART VI, LINE 7A - WHO HAS THE POWER TO ELECT MEMBERS OF GOVERNING BODY COMMUNITY FOUNDATION OF NORTHWEST INDIANA, INC. (CFNI) IS THE PARENT COMPANY OF ST. MARY MEDICAL CENTER, INC. AND HAS CONTROL TO ELECT MEMBERS OF THE GOVERNING BODY. PART VI, LINE 7B - GOVERNANCE ISSUES RESERVED OTHER THAN GOVERNING BODY COMMUNITY FOUNDATION OF NORTHWEST INDIANA, INC. IS THE PARENT COMPANY OF ST. MARY MEDICAL CENTER, INC. AND HAS RIGHTS TO APPROVE DECISIONS MADE BY ST. MARY MEDICAL CENTER, INC. PART VI, LINE 11B - GOVERNING BODY 990 REVIEW PROCESS THE 990 IS SUBMITTED TO THE SR VP AND SYSTEM CFO FOR REVIEW, ONCE THIS REVIEW IS COMPLETE THE RETURNS ARE THEN PRESENTED TO SENIOR LEADERSHIP FOR REVIEW. THE 990 IS ALSO REVIEWED BY AN INDEPENDENT ACCOUNTING FIRM BEFORE IT IS POSTED TO A SECURE WEBSITE TO ALLOW THE BOARD OF DIRECTORS TO REVIEW PRIOR TO FILING. PART VI, LINE 12C - PROCESS TO MONITOR CONFLICT OF INTEREST AS PART OF THE ORGANIZATION'S ANNUAL MONITORING & ENFORCEMENT PROCEDURE RELATING TO ITS CONFLICT OF INTEREST POLICY, ALL CONFLICT OF INTEREST QUESTIONNAIRES ARE REVIEWED BY THE VP OF CORPORATE COMPLIANCE AND THOSE OFFICERS, DIRECTORS, OR KEY EMPLOYEES WHO DO NOT RETURN OR FULLY COMPLETE THE QUESTIONNAIRE ARE CONTACTED TO RECONCILE THE OMISSION. RESTRICTIONS ON MEMBERS WITH A CONFLICT - MEMBERS WITH A CONFLICT ARE REQUIRED TO RECUSE THEMSELVES FROM ANY DELIBERATION AND MUST ABSTAIN FROM THE VOTE. PART VI, LINE 15 - EXECUTIVE & BOARD COMPENSATION THE CFNI BOARD HAS ADOPTED EXECUTIVE AND BOARD OF DIRECTORS COMPENSATION PHILOSOPHY AND REASONABLENESS STANDARDS. THIS IS TO ASCERTAIN THAT THESE STANDARDS ARE ADHERED TO. THEIR PROCESS FOR COLLECTING AND ASSEMBLING MARKET DATA IS CONSISTENT WITH THE REBUTTABLE PRESUMPTION CHECKLIST AND GUIDELINES ALONG WITH FAIR MARKET VALUE USED BY THE IRS IN CONDUCTING EXECUTIVE COMPENSATION REVIEWS AS WELL AS CONTEMPORARY COMPENSATION PRACTICES. ALL MARKET DATA IS ASSEMBLED FROM REPUTABLE COMMERCIALLY AVAILABLE SURVEYS. PART VI, LINE 19 - PUBLIC AVAILABILITY OF FS, COI POLICY, & GOVERNING DOCS ST. MARY MEDICAL CENTER, INC. DOES NOT MAKE ITS GOVERNING DOCUMENTS OR CONFLICT OF INTEREST POLICY AVAILABLE TO THE PUBLIC. IN ACCORDANCE WITH BOND COVENANTS, ST. MARY MEDICAL CENTER, INC. THROUGH COMMUNITY FOUNDATION OF NORTHWEST INDIANA, INC. MAKES ITS FINANCIAL STATEMENTS AND DISCLOSURES AVAILABLE TO THE PUBLIC THROUGH THE EMMA DATABASE. PART VII, SECTION A - OFFICERS, DIRECTORS, KEY EMPLOYEES AND HIGHEST COMP CERTAIN SALARIES AND MEDICAL DIRECTORSHIPS ARE PAID BY A RELATED ORGANIZATION, USUALLY THE PARENT (CFNI), WHILE THE HOURS ARE APPLICABLE TO THE REPORTING ORGANIZATION. PART XI, LINE 9 - OTHER CHANGES IN NET ASSETS TRANSFERS FROM RELATED ORGS 19,865,218 TRANSFERS TO RELATED ORGS (5,456,074) TOTAL CHANGE IN NET ASSETS 14,409,144 COMMUNITY FOUNDATION OF NW INDIANA INC 10010 DONALD S POWERS DR 201 MUNSTER IN 46321 311128781 SUPPORT ORG IN 501(c)(3) 11(c) NA false MUNSTER MEDICAL RESEARCH FNDNINC 901 MACARTHUR BOULEVARD MUNSTER IN 46321 351107009 HOSPITAL IN 501(c)(3) 3 CFNI true ST CATHERINE HOSPITAL INC 4321 FIR STREET EAST CHICAGO IN 46312 351738708 HOSPITAL IN 501(c)(3) 3 CFNI true COMMUNITY CANCER RESEARCH FNDN INC 901 MACARTHUR BOULEVARD MUNSTER IN 46321 352146374 Cancer Funds IN 501(c)(3) 7 MMRF true COMMUNITY VILLAGE INC 10000 COLUMBIA AVENUE MUNSTER IN 46321 351956395 RETIRMT HOME IN 501(c)(3) 9 CFNI true CVPA HOLDING COMPANY 1040 RIDGE ROAD MUNSTER IN 46321 351938136 TITLE HLDG CO IN 501(c)(2) N/A CFNI true THEATRE AT THE CENTER INC 1040 RIDGE ROAD MUNSTER IN 46321 351939427 PLAYS & ARTS IN 501(c)(3) 9 CFNI true COMMUNITY CARE NETWORK INC 901 MACARTHUR BOULEVARD MUNSTER IN 46321 454158203 PHYS SERVICES IN 501(c)(3) 3 MMRF SCH SMM true VALPARAISO MED DEV 3800 ST MARY DRIVE VALPARAISO IN 46383 453194502 REAL ESTATE IN SMMC RELATED -51841 8748852 false true 0.50000 COMMUNITY RESOURCES INC 907 RIDGE ROAD MUNSTER IN 46321 351727711 MGMT SERVICES IN CFNI C CORP 0 0 true COMMUNITY MEDICAL & PROFESSIONAL CENTER 800 MACARTHUR BOULEVARD MUNSTER IN 46321 237437942 CONDO ASSOC IN CFNI C CORP 0 0 true false true true false false false true false true false false false false true true true false false ST CATHERINE HOSPITAL INC B 85544 FMV COMMUNITY CARE NETWORK INC C 5022252 FMV MUNSTER MEDICAL RESEARCH FOUNDATION INC C 1347731 FMV COMMUNITY CARE NETWORK INC H 51028 FMV COMMUNITY CARE NETWORK INC J 980517 FMV COMMUNITY CARE NETWORK INC O 18418099 FMV MUNSTER MEDICAL RESEARCH FOUNDATION INC O 932250 FMV ST CATHERINE HOSPITAL INC O 76985 FMV COMMUNITY CARE NETWORK INC P 9859151 FMV MUNSTER MEDICAL RESEARCH FOUNDATION INC P 1298000 FMV ST CATHERINE HOSPITAL INC P 242876 FMV ST CATHERINE HOSPITAL INC Q 461463 FMV COMMUNITY CARE NETWORK INC Q 324321 FMV MUNSTER MEDICAL RESEARCH FOUDNATION INC Q 166980 FMV