2016-05-09T16:01:48-05:00 2015-06-30 990 2014-07-01 352099320 ST VINCENT FRANKFORT HOSPITAL INC STVI 7656563542 1300 S JACKSON STREET FRANKFORT IN 460410669 KRISTI L BLEDSOE INTERIM ADMINISTRATOR 2016-05-09 2014 2016-08-17 19:52:53Z KRISTI L BLEDSOE 1300 S JACKSON STREET FRANKFORT IN 460410669 26116871 false X WWW.STVINCENT.ORG X 2000 IN We are a nonprofit hospital dedicated to providing healthcare that leaves no one behind. 9 4 156 70 0 0 32197 115055 29457747 24307034 1770850 1456232 248478 238550 31509272 26116871 2967735 600 0 0 9888691 9602097 0 0 0 12630966 11594659 25487392 21197356 6021880 4919515 55300473 51153087 7613137 3398107 47687336 47754980 St. Vincent Frankfort Hospital is dedicated to providing spiritually-centered, holistic healthcare that sustains and improves the health of those served, with special attention to the poor and vulnerable. Both inpatient and outpatient health services are provided without regard to patient race, creed, national origin, economic status, insurance status or ability to pay. This mission extends well beyond the provision of core medical services to encompass medical and scientific research programs, the training and educating of health care professionals and active support of community-based partnerships and programs to improve health and quality of life. false false 18064601 600 24307034 St. Vincent Frankfort Hospital (SVFH) is a 25-bed, critical access hospital serving rural Clinton and contiguous counties and providing services without regard to patient race, creed, national origin, economic status, or ability to pay. SVFH provides inpatient and outpatient health care services with a 24 hour emergency department that is staffed with an on-site physician. During fiscal year 2015, SVFH treated 894 adults and children for a total of 3,307 patient days of service. The hospital also provided services for 30,506 outpatient visits, including 317 outpatient surgeries and 12,180 Emergency Room and Minor Care Visits. See Schedule H for a non-exhaustive list of community benefit programs and descriptions. 18064601 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 false false false true 0 0 156 true false false false false false false false false false false X 9 4 false false false false true true true true true false false true true true true true true false true false IN X WAYNE KNIGHT CFO 7656563452 1300 S JACKSON STREET FRANKFORT IN 460410669 STEPHEN D THARP CMO 40.00 0.00 X X 0 167457 22812 GLORIA PONTON CHAIR 0.20 0 X X 0 0 0 THOMAS D CRAWFORD ADMINISTRATOR 40.00 0.40 X X 204713 0 30263 WAYNE R KNIGHT REGIONAL CFO 15.00 30.20 X X 0 194346 23783 KRISTI BLEDSOE CNO 40.00 0 X X 120678 0 17838 JOSEPH D DOMINIK MD DIRECTOR 0.20 40.00 X 0 131798 20192 BRETT EATON MD DIRECTOR 0.20 0 X 0 0 0 RANDY RIDGWAY DIRECTOR 0.20 0 X 0 0 0 JAMES MOORE DIRECTOR 0.20 0 X 0 0 0 DONALD H JACOBY MANAGER-PHARMACY 40.00 0 X 163265 0 6165 KRISTA K WRIGHT DIRECTOR OF HR 40.00 0.20 X 111388 0 17618 BRIAN E BRINKLEY MANAGER-IMAGING SERVICES 40.00 0 X 103731 0 24793 703775 493601 163464 5 false true false 0 115055 115055 Net Medicare/Medicaid 621990 10989273 10989273 Net patient revenue 621990 13317761 13317761 0 0 0 0 24307034 1358755 1358755 119068 119068 0 119068 119068 97477 0 97477 97477 97477 Cafeteria Revenue 722210 111928 111928 Pharmacy Revenue 446110 7554 7554 0 0 0 0 119482 26116871 24307034 0 1694782 600 600 373492 373492 7283403 6312453 970950 29822 25846 3976 1465445 1270087 195358 449935 389954 59981 999995 866686 133309 12548 10875 1673 412 357 55 47512 41178 6334 0 642801 557109 85692 52898 45846 7052 15407 13353 2054 294468 255212 39256 125171 125171 PURCHASED SERVICES 3426617 2969815 456802 CORPORATE EXPENSE 1995902 1729828 266074 SUPPLIES 1475785 1279048 196737 EQUIPMENT RENTAL/MAINTENANCE 1243336 1077587 165749 1261807 1093596 168211 0 21197356 18064601 3132755 0 118241 562425 5898952 2733635 0 0 495978 431235 163500 69755 8122873 5789963 2367937 2332910 0 0 46255865 45023127 55300473 51153087 3194128 1920122 4419009 1477985 7613137 3398107 X 47633643 47725661 53693 29319 47687336 47754980 55300473 51153087 X 4919515 -1798409 -3053462 X false true X true true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 1039 1039 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. VINCENT FRANKFORT HOSPITAL, INC. DOES NOT PARTICIPATE IN OR INTERVENE IN (INCLUDING THE PUBLISHING OR DISTRIBUTION OR STATEMENTS) ANY POLITICAL CAMPAIGN ON BEHALF OF (OR IN OPPOSITION TO) ANY CANDIDATE FOR PUBLIC OFFICE. 160146 160146 2646735 1397091 1249644 66241 47700 18541 5062724 4345172 717552 187027 187027 2332910 Interest in investments held by Ascension Health Alliance 44888686 Other receivables 14098 Restricted by donor or grantor 29319 Receivables from third party payors 80193 Pension plan INTERCOMPANY RECEIVABLES 10831 45023127 INTERCOMPANY PAYABLES 8502 Other Payable to third party programs 960269 Intercompany debt with Ascension Health Alliance 485559 Pension Liability 23655 1477985 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, 2015. true true X true X true X true true true false true true 1326721 1326721 0.0626 4489015 3576587 912428 0.0430 0 0.0 0 0 5815736 3576587 2239149 0.1056 2342 36380 36380 0.0017 0 0.0 0 0.0 0 0.0 29 9540 9540 0.0005 0 2371 45920 0 45920 0.0022 0 2371 5861656 3576587 2285069 0.1078 20 20 0.0000 60 60 0.0000 116 891 891 0.0000 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 116 971 0 971 0.0000 false 621329 186399 8476494 8392568 83926 X true true 1 1 St Vincent Frankfort Hospital Inc 1300 S Jackson Street Frankfort IN 460410669 http://www.stvincent.org/St-Vincent-Fr 14-005039-1 X X X X St Vincent Frankfort Hospital Inc 1 false false true X X X X X X X X X 12 true false false true X www.stvincent.org/CHNA/ X true 12 true www.stvincent.org/CHNA/ false false true X 2.0 4.0 X true true X X X true 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. Vincent Frankfort Hospital, Inc.. In conducting its CHNA, the hospital facility took into account input from representatives of the community as well as those with special knowledge or expertise in public health. The hospital formed a CHNA Task Force, which was the group primarily responsible for overseeing the CHNA process, consisting of internal St. Vincent Frankfort Hospital staff. However, due to her expertise in public health and epidemiology, the effort was led by Pauline Shen, an Indiana-based epidemiologist and consultant with extensive experience in public health. Throughout this process, the task force met monthly to discuss strategy and the progress made toward the completion of the comprehensive community health needs assessment. Other organizations who participated in the CHNA included Wesley Manor, Purdue Extension, Head Start, YMCA, Learning Network, Frankfort Public Schools, Clinton County Health Department, Community Counseling Center, WIC, Clinton County Tobacco Prevention & Cessation Program, Chamber of Commerce, government officials, and more. Schedule H, Part V, Section B, Line 11 Facility , 1 Facility , 1 - ST. VINCENT FRANKFORT HOSPITAL, INC.. Using the CHNA completed in fiscal year 2013, the hospital developed, adopted, and worked on executing a 2014-2016 Community-wide Implementation Strategy to address priority community health needs. As part of the implementation, a community benefit section was included in operational plans and a budget for provision of the services that addressed the needs identified was adopted. The organization is working to address the following needs: 1. Tobacco Use Educate children of the harms of smokeless tobacco, provide smoking cessation program, create new policy, systems, and environmental changes with new grant funding - Educate all Clinton County elementary schools about the harms of smokeless tobacco. - Continue providing smoking cessation classes. - Manage ITPC and ACHIEVE grant funds in partnership with Healthy Communities of Clinton County Coalition. 2. Obesity Initiate a healthy foods policy/pledge and guidelines for the hospital - Work with Touch Point in creating policy/pledge and plan. - Create stoplight and healthy food percentages. - Present to administrator for approval. - Educate the associates. 3. Drug Use & Abuse Organize a "Get rid of your Prescription Drugs" Day and a Prescription Drug Seminar - Plan a Prescription Drug Drop Off Day. - Partner with Sheriff's Department at health fair. - Plan a prescription Drug Seminar. - Create pamphlet packet of drug abuse for physicians and emergency department. 4. Access to Healthcare Coordinate access for vulnerable community members through a Health Access Worker (HAW) - Work with community based agencies, programs, services and providers to coordinate care for vulnerable community members. - Access referrals and assist clients based on Pathway indicators. - Document client intervention/assistance in eCAP. - Report completed Pathways on a quarterly basis and work on identified barriers to access with community stakeholders (goal of 300 completed Pathways a year). The needs below are not being addressed directly by the organization in its current year as part of its implementation strategy, for the following reasons: Dental - Addressing this issue is not a direct priority of St. Vincent Frankfort; however, the hospital supports the efforts of organizations focused on dental issues. Educational Attainment - Addressing this issue is not a direct priority of St. Vincent Frankfort; however, the hospital provides a clinic site for the certified nursing assistant program in Clinton County. Teen Pregnancy - Addressing this issue is not a direct priority of St. Vincent Frankfort; however, the hospital does support efforts of the PEERS Program that focuses on abstinence for high school students. Schedule H, Part V, Section B, Line 22 Facility , 1 Facility , 1 - St. Vincent Frankfort 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 VI, Line 7 STATE FILING OF COMMUNITY BENEFIT REPORT The State of Indiana no longer requires a separate Community Benefit Report, but will reference the Form 990. St. Vincent Frankfort Hospital and its related St. Vincent affiliates publish a Community Benefit Report which is available to the public. A copy of the full report (including the St. Vincent Frankfort Hospital section) is available at http://www.stvincent.org/St-Vincent-Frankfort/. Schedule H, Part I, Line 7 COMMUNITY BENEFIT OVERVIEW St. Vincent Frankfort Hospital is part of St. Vincent Health, a non-profit healthcare system consisting of 20 locally-sponsored ministries serving over 57 counties throughout Central Indiana. Sponsored by Ascension Health, the nation's largest Catholic healthcare system, St. Vincent Health is one of the largest healthcare employers in the state. As part of St. Vincent Health, the St. Vincent Frankfort vision is to deliver a continuum of holistic, high-quality health services and improve the lives and health of Indiana individuals and communities, with special attention to the poor and vulnerable. This is accomplished through strong partnerships with businesses, community organizations, local, state and federal government, physicians, St. Vincent Frankfort associates and others. Working with its partners, and utilizing the CHNA completed every three years, St. Vincent Frankfort Hospital is committed to addressing community health needs and developing and executing an implementation strategy to meet identified needs to improve health outcomes within the community. Community benefit is not the work of a single department or group within St. Vincent Frankfort, but is part of the St. Vincent mission and cultural fabric. The hospital leadership team provides direction and resources in developing and executing the Implementation Strategy in conjunction with the St. Vincent Health Community Development & Health Improvement Department, but associates at all levels of the organization contribute to community benefit and health improvement. Schedule H, Part I, Line 7 CHARITY CARE AND CERTAIN OTHER COMMUNITY BENEFITS AT COST Patient Services for Poor and Vulnerable Hospital and outpatient care is provided to patients that cannot pay for services, including hospitalizations, surgeries, prescription drugs, medical equipment and medical supplies. Patients with income less than 200% of the Federal Poverty level (FPL) are eligible for 100% charity care for services. Patients with incomes at or above 200% of the FPL, but not exceeding 400% of the FPL, receive discounted services based on an income-dependent sliding scale. Hospital financial counselors and health access workers assist patients in determining eligibility and in completing necessary documentation. St. Vincent Frankfort Hospital is committed to 100% access, and is proactive in providing healthcare that leaves no one behind. Public Program Participation St. Vincent Frankfort Hospital participates in government programs including Medicaid, SCHIP (Hoosier Healthwise), Healthy Indiana Plan (HIP), the Health Insurance Marketplace and Medicare and assists patients in enrolling for programs for which they are eligible. Per Catholic Health Association guidelines and St. Vincent Health's conservative approach, Medicare shortfall is not included as community benefit. Community Health Needs Assessment True community benefit responds to the particular needs and challenges of the community, building on its unique strengths and assets. The hospital leads a community health needs assessment every 3 years. Using a variety of tools, including surveys, key person interviews, focus groups, secondary data, and data analysis professionals, the team identifies community issues and concerns. These are shared with the community at large, and a consensus is reached about priorities and available resources. To provide community input and a basis for collaboration within the community to address health needs, St. Vincent leads or participates in a community round table or forum. This group brings together individuals and organizations from throughout the community who share a common interest in improving health status and quality of life and provide expertise in a variety of community areas including public health. Tobacco use, obesity, drug use and abuse, and access to healthcare have all been identified as key community needs. Rural and Urban Access to Health As part of its commitment to 100% access, St. Vincent Frankfort is one of nine St. Vincent Health ministries that participate in Rural and Urban Access to Health (RUAH), a community-based care coordination program. Effective care coordination provides a strategy for addressing certain social determinants of health by assuring barriers to care are addressed and individuals are connected to critical prevention and treatment services. Central to the program is a Health Access Worker whose role is to connect the hospital to the community by helping individuals address barriers to health care, and referring them to other local resources as needed. The Health Access Worker assists individuals with finding a medical home; applying for public programs such as Medicaid, food stamps and the Healthy Indiana Plan; and in assessing needs so that referrals can be made for other forms of community-based assistance. The Health Access Worker also advocates for clients with service providers and serves as a system navigator. RUAH outcomes are measured using the Pathways Model with 5 defined pathways/protocols (enrollment, medical home, pregnancy, medical referral and social services) as a means of tracking interventions and improving accountability towards positive, measurable changes in patients' lives. During fiscal year 2015, the Health Access Worker completed 537 pathways. Medication Assistance In addition to care coordination, RUAH assists patients who meet income guidelines in obtaining free or reduced-cost prescription drugs. St. Vincent Frankfort Hospital provides a sophisticated and continually-updated database to track eligibility and requirements that vary by company and medication. In fiscal year 2015, the medication assistant helped patients obtain a total of 906 medications for which the average wholesale price totaled $565,932. Health Fairs and Screenings St. Vincent Frankfort Hospital participates in several health fairs and screening events each year, including their annual health fair which is held at the Clinton County Fairgrounds. Participants can be tested for blood pressure, blood glucose, cholesterol, fitness testing, and more at low or no cost. Materials on health information and preventive services are a vital part of health fairs and screenings. During fiscal year 2015, St. Vincent Frankfort Hospital served over 1,168 people through its participation in these health fairs and screenings. Healthy Communities of Clinton County Coalition Healthy Communities of Clinton County Coalition began 10 years ago as a partnership between St. Vincent Frankfort and Purdue Extension. Based on the results of the community health needs assessment, the coalition has focused on tobacco prevention and cessation, obesity prevention, and the elimination of minority health disparities. Partnering with local, state and national partners, the coalition has been instrumental in advocating policy, system and environmental changes that make the healthy choice the easy choice. The coalition has received 2 grants for tobacco prevention/cessation and tobacco free baby and me. A focus has also been on healthy babies in which the coalition has received an infant mortality grant. In addition, the coalition has helped 2 school systems in the county attract federal/state dollars to encourage safe walking and riding to school. The city of Frankfort also passed a Complete Streets ordinance that will make walking a safer way to travel. These initial grants have led to many other grants to which the county has received over $1 million. Tobacco Prevention and Cessation The Healthy Communities of Clinton County Coalition recognizes tobacco use as one of the leading cause of preventable death in Indiana. Representing the Healthy Communities of Clinton County Coalition and serving as its fiscal agent, St. Vincent Frankfort Hospital applied for, and was awarded, Indiana Tobacco Prevention & Cessation funds. These funds support a part-time tobacco prevention coordinator for Clinton County, whose efforts include the initiation of campus-wide smoke-free policies for schools and healthcare facilities; education at schools and workplace health fairs; and advocating to service organizations the positive impact of smoke-free policies. The hospital also, independently, provides Stop Smoking classes, free-of-charge, to anyone needing help with this addiction. During fiscal year 2015, 66 people participated in these classes. Community Benefit Cash and In-Kind Contributions In addition to the outreach programs operated by the hospital, the hospital makes cash and in-kind donations to a variety of community organizations focused on improving health status in the community. These take the form of cash donations to outside organizations, the donation of employee time/services to outside organizations and the representation of the hospital on community boards and committees working to improve health status and quality of life within the community. Schedule H, Part II COMMUNITY BUILDING ACTIVITIES Research shows that social determinants and quality of life play a major role in the health status of individuals and communities. Community building activities, which focus on improving the quality of life within a community, ultimately influence and improve health status. Partnering to Build a Better Community With the support and leadership of county government, the Healthy Communities of Clinton County Coalition has also focused on infrastructure initiatives. The city of Frankfort passed a complete streets ordinance to encourage walking and biking paths in conjunction with streets. This creates a healthier environment and promotes other options of transportation. Also, a Health Action Plan was developed and adopted as part of the Clinton County Comprehensive Plan. Community Building Cash and In-Kind Contribution The hospital makes cash and in-kind donations to a variety of community organizations focused on building the community and improving quality of life. These take the form of cash donations to outside organizations, the donation of employee time/services to outside organizations and the representation of the hospital on community boards and committees working to improve infrastructure for the community. Schedule H, Part I, Line 7 Costing Methodology used to calculate financial assistance The cost of providing charity care, means tested government programs, and community benefit programs is estimated using internal cost data, and is calculated in compliance with Catholic Health Association ("CHA") guidelines. The organization uses a cost accounting system that addresses all patient segments (for example, inpatient, outpatient, emergency room, private insurance, Medicaid, Medicare, uninsured, or self pay). The best available data was used to calculate the amounts reported in the table. For the information in the table, a cost-to-charge ratio was calculated and applied. 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 the bad debt expense in fiscal year 2015 was $2,033,453 at charges, ($621,329 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 economic conditions, historical experience, 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 part of the Ascension Health Alliance's consolidated audit in which the footnote that 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 costs 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 community benefit. Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance The organization has a written debt collection policy that also includes a provision on the collection practices to be followed for patients who are known to qualify for charity care or financial assistance. If a patient qualifies for charity or financial assistance certain collection practices do not apply. Schedule H, Part VI, Line 2 Needs assessment Communities are dynamic systems in which multiple factors interact to impact quality of life and health status. In addition to the formal CHNA conducted every 3 years, St. Vincent Frankfort Hospital helps to lead a community round table called Healthy Communities of Clinton County Coalition whose purpose is to assess needs within the community, prioritize action and work in partnership to address identified challenges. The coalition works closely with its member organizations which come from multiple sectors of the community, including local government, business, education, faith communities, public health, health care providers and other social and human service organizations. In addition, the coalition works closely with other coalitions as well as the local and state health departments to stay abreast of changing needs within the community by identifying evidence-based and promising practices to address these needs. Schedule H, Part VI, Line 3 Patient education of eligibility for assistance St. Vincent Frankfort Hospital communicates with patients in multiple ways to ensure that those who are billed for services are aware of the hospital's financial assistance program as well as their potential eligibility for local, state or federal programs. Signs are prominently posted in each service area, and bills contain a formal notice explaining the hospital's charity care program. In addition, the hospital employs financial counselors, 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. Vincent Frankfort Hospital (SVFH) is located in Frankfort, Indiana and serves rural Clinton and contiguous counties, in northwest Central Indiana. Clinton County has a population of 32,776. Per capita personal income is below state average while median household income is above state average. Clinton County's poverty rate is 17.1%. Clinton County has one of the largest proportions of Hispanic people in the state (14.1%). The median age is 37.3 years old. Schedule H, Part VI, Line 5 Promotion of community health St. Vincent Frankfort Hospital promotes the health of its communities by striving to improve the 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. St. Vincent Frankfort Hospital meets regularly with local organizations in the community to learn what resources are available and plan community health improvement efforts. In fiscal year 2015, these organizations included: the Chamber of Commerce, Paul Phillippe Senior Resource Center, Frankfort Main Street Board, the Clinton County Economic Advancement Foundation and United Way. Schedule H, Part VI, Line 6 Affiliated health care system As part of St. Vincent Health, St. Vincent Frankfort Hospital is dedicated to improving the health status and quality of life for the communities it serves. While designated associates at St. Vincent Frankfort Hospital devote all or a significant portion of their time to leading and administering local community-based programs and partnerships, associates throughout the organization are active participants in community outreach. They are assisted and supported by designated St. Vincent Health Community Development & Health Improvement associates and other support staff who work with each of its healthcare facilities to advocate for and provide technical assistance for community outreach, needs assessments and partnerships as well as to support regional and state-wide programs, community programs sponsored by St. Vincent Health in which St. Vincent Frankfort Hospital participates. false false false false false false false false false STEPHEN D THARP CMO 0 151963 0 0 0 15494 0 5156 0 17656 0 190269 0 0 THOMAS D CRAWFORD ADMINISTRATOR 179323 0 0 0 25390 0 5581 0 24682 0 234976 0 0 0 WAYNE R KNIGHT REGIONAL CFO 0 169281 0 0 0 25065 0 4392 0 19391 0 218129 0 0 JOSEPH D DOMINIK MD DIRECTOR 0 121196 0 10000 0 602 0 3750 0 16442 0 151990 0 0 DONALD H JACOBY MANAGER-PHARMACY 140871 0 0 0 22394 0 3900 0 2265 0 169430 0 0 0 Schedule J, Part I, Line 3 Arrangement used to establish the top management official's compensation St. Vincent Health, Inc., a related organization of St. Vincent Frankfort 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 Tax Exempt Bond Issuance St. Vincent Frankfort Hospital, Inc. is a health facility that is part of Ascension Health System. Ascension Health is the borrower for tax exempt hospital revenue bonds. St. Vincent Frankfort Hospital, Inc. holds an intercompany note payable with Ascension Health, and this information is reported on the balance sheet. NUMBER OF 1099'S REPORTED IN BOX 3 OF FORM 1096 COMPENSATION OF INDEPENDENT CONTRACTORS IS PAID BY AND REPORTED ON THE FORM 1096, ANNUAL SUMMARY AND TRANSMITTAL OF U.S. INFORMATION RETURNS, OF ASCENSION HEALTH EIN 31-1662309. EXPENSES ARE ALLOCATED TO AND REIMBURSED BY THE FILING ORGANIZATION TO ASCENSION HEALTH. AS SUCH, THE ORGANIZATION HAS NOT REPORTED INDEPENDENT CONTRACTORS PAID ON FORM 990, PART VII, SECTION B. Form 990, Part VI, Line 6 Classes of members or stockholders St. Vincent Frankfort Hospital, Inc. has a single corporate member, St. Vincent Health, Inc. Form 990, Part VI, Line 7a Members or stockholders electing members of governing body St.Vincent Frankfort Hospital, Inc. has a single corporate member, St.Vincent Health, Inc. who has the ability to elect members to the governing body of St.Vincent Frankfort Hospital, Inc. Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders All decisions that have a material impact to St. Vincent Frankfort Hospital, Inc.'s financial information or corporation as a whole are subject to approval by its sole corporate member, St. Vincent Health, Inc. Form 990, Part VI, Line 11b Review of form 990 by governing body Management, including certain officers, works diligently to complete the Form 990 and attached schedules in a thorough manner. Management presents the Form 990 to a designated committee of the Board to review and answer any questions. Prior to filing the returns, all Board members are provided the Form 990 and management team members are available to answer any Board member questions. 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 committee 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 15b Process to establish compensation of other employees Compensation determinations of St. Vincent Frankfort Hospital, Inc.'s CEO, executive director, or top management official are made by St. Vincent Health, Inc.'s management. The process includes a review and approval by independent persons and comparability data. In review of the compensation, the CEO, executive director, and top management were compared to other hospitals in the area that hold the same position. Compensation determinations of St. Vincent Frankfort Hospital, Inc.'s other officers or key employees are made by St. Vincent Frankfort Hospital, 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 other hospitals' employees in the area that hold the same position. Form 990, Part VI, Line 19 Required documents available to the public The organization will provide any documents open to public inspection upon request. 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