2016-05-10T13:31:48-05:00 2015-06-30 990 2014-07-01 510064326 ST FRANCIS HOSPITAL INC STFR 3024214100 PO BOX 2500 WILMINGTON DE 198050500 BRIAN E DIETZ CEO 3024214100 2016-05-10 2014 2016-08-17 19:52:53Z SAINT FRANCIS HEALTHCARE BRIAN E DIETZ PO BOX 2500 WILMINGTON DE 198050500 133682397 0 0928 X STFRANCISHEALTHCARE.ORG X 1923 DE TO PROVIDE HEALTHCARE AND HOSPITAL SERVICES 14 10 1198 130 174987 0 420647 702698 123383967 128241276 157012 617382 3971471 3861468 127933097 133422824 11195 44567 0 0 64115303 68264302 0 0 0 68542942 66514716 132669440 134823585 -4736343 -1400761 75604195 75546651 135509145 138870265 -59904950 -63323614 X WE, ST. FRANCIS HEALTHCARE AND TRINITY HEALTH, SERVE TOGETHER IN THE SPIRIT OF THE GOSPEL AS A COMPASSIONATE AND TRANSFORMING HEALING PRESENCE WITHIN OUR COMMUNITIES.ST. FRANCIS HOSPITAL IS A MEMBER OF ST. FRANCIS HEALTHCARE AND TRINITY HEALTH. 0 0 106222860 44567 128207989 ST. FRANCIS HOSPITAL IS A COMMUNITY HOSPITAL LOCATED IN WILMINGTON, DELAWARE, IN OPERATION SINCE 1923. THE HOSPITAL PROVIDES A FULL SPECTRUM OF GENERAL MEDICAL SERVICES, INCLUDING EMERGENCY, DIAGNOSTIC TESTING, AND WOMEN'S HEALTH. ST. FRANCIS ALSO OFFERS SPECIALIZED SURGICAL SERVICES, INCLUDING BARIATRIC SURGERY, AND IS THE ONLY HOSPITAL IN WILMINGTON TO OFFER PRECISION SURGERY VIA THE DA VINCI SURGICAL SYSTEM FOR MINIMALLY INVASIVE GYNECOLOGICAL, PROSTATE AND HEART SURGERIES. ST. FRANCIS HAS ALSO BEEN OPERATING A SLEEP CENTER SINCE 1997, AND IS ONE OF THE FEW SLEEP CENTERS IN DELAWARE THAT IS ACCREDITED BY THE ACADEMY OF SLEEP MEDICINE. IN FY15 THE HOSPITAL PROVIDED OVER 19,000 PATIENT DAYS OF HEALTHCARE SERVICES TO INPATIENTS, SERVED OVER 170,000 OUTPATIENTS, 31,000 EMERGENCY ROOM VISITS, AND 25,000 HOME HEALTH VISITS. PLEASE VISIT SCHEDULE H AND THE WEBSITE FOR ADDITIONAL INFORMATION ABOUT SERVICES, RECOGNITIONS AND AWARDS: WWW.STFANCISHEALTHCARE.ORG 106222860 1 1 0 1 0 0 0 0 0 0 1 1 0 1 1 0 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 1 0 0 0 0 0 1 1 1 1 0 0 1 236 0 1 1198 1 1 1 0 0 0 0 0 0 0 0 0 X 14 10 0 1 1 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 X BERNARD CITERONE 3025758316 701 N CLAYTON ST WILMINGTON DE 198050500 BRIAN E DIETZ DIRECTOR; PRESIDENT & CEO 52.00 3.00 X X 0 390335 31656 DENNIS SALTER DIRECTOR; CHAIR 1.00 1.00 X X 0 0 0 CINDY H MANN DIRECTOR; VICE CHAIR 1.00 1.00 X X 0 0 0 SR CHRISTA M THOMPSON DIRECTOR; SECRETARY 1.00 1.00 X X 0 0 0 RICHELLE A VIBLE DIRECTOR; TREASURER 1.00 1.00 X X 0 0 0 OSWALDO A NICASTRO MD DIRECTOR; PHYSICIAN 49.00 1.00 X 170613 0 28045 BRIAN P MCDONOUGH MD DIRECTOR; PHYSICIAN 49.00 1.00 X 349669 0 38965 REV LEONARD R KLEIN STM DIRECTOR 1.00 1.00 X 0 0 0 STEPHEN J MOTTOLA DIRECTOR 1.00 2.00 X 0 0 0 RICHARD J ANGIULLO DIRECTOR 1.00 1.00 X 0 0 0 WILLIAM S MONTGOMERY DIRECTOR THROUGH 12/14 1.00 1.00 X 0 0 0 ELIZABETH B LEE DIRECTOR 1.00 1.00 X 0 0 0 MARK BRUCKER DIRECTOR AS OF 1/15 1.00 1.00 X 0 0 0 JOSEPH DESANTIS DIRECTOR AS OF 1/15 1.00 1.00 X 0 0 0 KEVIN SHANNON DIRECTOR AS OF 1/15 1.00 1.00 X 0 0 0 BERNARD P CITERONE INTERIM CFO (PD BY MGMT CO) 47.00 3.00 X 0 0 0 MICHAEL POLNEROW DO VP MEDICAL AFFAIRS/ CMO 50.00 0.00 X 411068 0 13404 JENNIFER KIRBY VP PATIENT SERVICES/ CNO 50.00 0.00 X 239591 0 4826 NANCY PETIT MD PHYSICIAN 50.00 0.00 X 482840 0 34201 RICHARD W LEADER MD PHYSICIAN 50.00 0.00 X 444663 0 38278 JAMES COSGROVE DO PHYSICIAN 49.00 1.00 X 431756 0 34160 NANCY FAN MD PHYSICIAN 50.00 0.00 X 340858 0 18811 LASHAUNA MCINTOSH MD PHYSICIAN 50.00 0.00 X 322946 0 31426 JULIE HESTER FORMER OFFICER 0.00 0.00 X 0 204181 149311 DALE SZAFRAN FORMER OFFICER; DIRECTOR OF FINANCE 45.00 0.00 X 118836 0 8633 COY SMITH FORMER KEY EMPLOYEE 0.00 0.00 X 154973 0 14250 RICHARD W HENDERSON MD FORMER KEY EMPLOYEE 50.00 0.00 X 286893 0 31880 3754706 594516 477846 73 1 1 0 PREMIER ANESTHESIA OF PA PC 2655 NORTHWINDS PARKWAY ALPHARETTA GA 30009 ANESTHETISTS 1961513 IMA CONSULTING 3 CHRISTY DR STE 100 CHADDS FORD PA 19317 CONSULTANTS 1031067 COGENT HEALTHCARE PENNSYLVANIA PO BOX 645037 CINCINNATI OH 45264 ICU PHYSICIAN FEES 975525 VITAL SECURITY INVESTIGATIONS 1035 PRIMERA BLVD STE 1035 LAKE MARY FL 32746 SECURITY 951696 JANNX MEDICAL SYSTEMS INC 12166 OLD BIG BEND BLVD SUITE 300 ST LOUIS MO 63122 BIO MEDICAL ENGINEERS 914835 28 511449 176249 15000 702698 NET PATIENT SVC REV 622110 128130172 128130172 LABORATORY REVENUE 621500 111104 111104 128241276 527342 527342 3365421 259573 3105848 3105848 3105848 90040 0 90040 90040 90040 CAFETERIA REVENUE 722514 524284 524284 PARKING GARAGE REVENUE 812930 89636 89636 LAUNDRY REVENUE 812300 63883 63883 77817 77817 755620 133422824 128207989 174987 4337150 X 44567 44567 2257855 587292 1670563 1008077 46438 961639 54531686 41301362 13230324 1306373 996743 309630 5158772 3829197 1329575 4001539 2938239 1063300 304613 304613 89163 89163 21115811 17927576 3188235 375736 275894 99842 3880991 2849723 1031268 3722062 2733025 989037 3841275 2751586 1089689 194687 142954 51733 8812 6470 2342 4091742 4091742 5384249 3953531 1430718 1152209 846041 306168 MEDICAL SUPPLIES 16687624 16687624 INTERCO. PURCHASED SVCS 1924431 1413066 511365 CONTRACT LABOR 1003764 737041 266723 BAD DEBT 194210 194210 2543337 1868539 674798 134823585 106222860 28600725 0 3306 34146 11886749 15843911 3363130 3494876 805334 661100 71588429 45509514 28145481 26078915 11604678 12826681 10290941 12826681 9504576 3780341 75604195 75546651 12786710 17617375 3500102 4165715 119222333 117087175 135509145 138870265 X -60050865 -63350442 145915 26828 -59904950 -63323614 75604195 75546651 X -1400761 -704213 -1313690 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 3904 0 0 0 3904 0 PART II-B, LINE 1: ST. FRANCIS HOSPITAL HAS MADE GRANTS TO OTHER ORGANIZATIONS FOR LOBBYING PURPOSES. THESE GRANTS HAVE BEEN IN THE FORM OF MEMBERSHIP DUES PAID TO REGIONAL AND NATIONAL HEALTH CARE ORGANIZATIONS, WHERE THE ORGANIZATIONS HAVE PROVIDED ST. FRANCIS HOSPITAL WITH AN ESTIMATED PERCENTAGE OF DUES PAYMENTS WHICH ARE USED FOR LOBBYING ACTIVITIES. ST. FRANCIS HOSPITAL MADE NO CONTRIBUTIONS TO ANY LEGISLATORS OR CANDIDATES. 596699 596699 16874317 2051059 14823258 52622223 43458455 9163768 1495190 1495190 26078915 COMMINGLED FUNDS DIRECTLY HOLDING SECURITIES 3591471 F HEDGE FUNDS 4361071 F EQUITY METHOD INVESTMENTS 4874139 C 12826681 MISCELLANEOUS RECEIVABLES 2891931 OTHER LONG-TERM ASSETS 47475 INTERCOMPANY OTHER LT ASSETS 840935 3780341 INTERCOMPANY ACCOUNTS PAYABLE 829162 INTERCOMPANY OTHER LT LIABILITIES 1297337 INTERCOMPANY NOTES PAYABLE 109895377 OTHER CURRENT LIABILITIES 5039092 INTERCOMPANY OTHER LIABILITIES 26207 117087175 1 1 X 1 X 1 X 1 1 0 1 1 3924 2444379 2286504 157875 0.00120 21220 43018894 41146402 1872492 0.01390 0 0 0 25144 45463273 43432906 2030367 0.01510 5 11115 1785774 323013 1462761 0.01090 1 4599 3181402 1080000 2101402 0.01560 6 15714 4967176 1403013 3564163 0.02650 6 40858 50430449 44835919 5594530 0.04160 1 194210 0 27476621 33326144 -5849523 X 1 1 1 1 ST FRANCIS HOSPITAL INC 701 CLAYTON STREET WILMINGTON DE 198050500 STFRANCISHEALTHCARE.ORG STATE ID# HSPTL-004 X X X X ST FRANCIS HOSPITAL 1 0 0 1 X X X X X X X X X 13 1 0 0 1 X SEE PART V, SECTION C X 1 13 1 SEE PART V, SECTION C 0 0 1 X 200.000000000000 400.000000000000 X X X X X X 1 1 X X X 1 X SEE PART V, SECTION C X SEE PART V, SECTION C X SEE PART V, SECTION C X X X X X 1 X 0 X X X 1 X 0 0 ST. FRANCIS HOSPITAL PART V, SECTION B, LINE 5: ST. FRANCIS HOSPITAL, INC. A/K/A SAINT FRANCIS HEALTHCARE, ESTABLISHED AN INTERNAL COMMITTEE OF DOCTORS, NURSES, COMMUNITY HEALTH LEADERS, AND ADMINISTRATORS TO GUIDE AND PARTICIPATE IN THE DEVELOPMENT AND ASSESSMENT OF OUR COMMUNITY HEALTH NEEDS ASSESSMENT AND COMMUNITY HEALTH IMPROVEMENT PLAN. IN ADDITION TO THIS COMMITTEE, A VARIETY OF EXTERNAL GROUPS WERE CONSULTED, INCLUDING COMMUNITY AND NEIGHBORHOOD ASSOCIATIONS, OTHER NON-PROFIT ORGANIZATIONS SERVING THE COMMUNITY (ESPECIALLY THE POOR), PARISH AND FAITH-BASED GROUPS, CULTURAL, AND CIVIC AND POLITICAL LEADERS. TWO PUBLIC FORUMS WERE ALSO HELD AT THE HOSPITAL WHERE THE PUBLIC WAS INVITED TO COMMENT ON OUR ASSESSMENT AND PLAN.THE COMMUNITY HEALTH NEEDS ASSESSMENT AND THE COMMUNITY HEALTH IMPROVEMENT PLAN WERE PRESENTED AND APPROVED BY THE MISSION, MINISTRY AND ADVOCACY COMMITTEE OF THE BOARD OF DIRECTORS, AND BY THE FULL BOARD OF DIRECTORS. ST. FRANCIS HOSPITAL PART V, SECTION B, LINE 11: ALL OF THE COMMUNITY HEALTH NEEDS IDENTIFIED IN THE CHNA HAVE BEEN ADDRESSED BY ST. FRANCIS. BELOW IS A LIST OF THOSE NEEDS AND THE PROGRAMS ADDRESSING THEM: PRE-NATAL, MATERNAL, INFANT AND CHILD HEALTH, PARTICULARLY IN THE CITY OF WILMINGTON -PROGRAMS SUCH AS TINY STEPS, CENTER OF HOPE AND THE SAINT CLARE VAN HAVE PROVIDED EDUCATION, HEALTHCARE AND PRENATAL CARE TO INFANTS, CHILDREN AND MOTHERS, AND INSURED AND UNINSURED FAMILIES SMOKING CESSATION-SMOKING CESSATION EDUCATION IS PROVIDED AT EVERY INITIAL PRENATAL VISIT IN ADDITION TO OTHER SMOKING CESSATION EDUCATION PROGRAMS OFFERED AT ST. FRANCISSTROKE PREVENTION, HEART DISEASE AND CARE, PARTICULARLY EDUCATION REGARDING RISKS DUE TO HIGH BLOOD PRESSURE AND HIGH CHOLESTEROL RISKS -FREE BLOOD PRESSURE SCREENINGS ARE PROVIDED AT VARIOUS HEALTHCARE AND COMMUNITY EVENTS IN ADDITION TO EDUCATION ON THE RISKS AND PREVENTION OF STROKE AND HEART DISEASE-ST. FRANCIS CONTINUES STROKE PREVENTION AND EDUCATION PROGRAMS, PROVIDING SERVICES TO ALL ST. FRANCIS PROGRAMS AND TO THE COMMUNITY-MILLION HEARTS-STROKE AWARENESS DAY PEOPLE 65 AND OVER LIVING BELOW THE POVERTY LINE-ST. FRANCIS LIFE CENTER SUPPORTS THE NEEDS OF THE ELDERLY IN DELAWARE WHO ARE NURSING HOME ELIGIBLE -THE LIFE CENTER PROVIDES ONE LOCATION WHERE DOCTORS, NURSES AND OTHER HEALTHCARE PROFESSIONALS OFFER TREATMENT AND MONITOR CHANGES IN PARTICIPANTS' HEALTH-FINANCIAL ASSISTANCE IS AVAILABLE-REFERRAL PROGRAMS TO FOOD BANKS AND TRANSPORTATION ASSISTANCE-FAMILY PRACTICE RESIDENTS PROVIDE CARE TO THOSE WHO ARE IN NURSING HOMESCANCER PREVENTION AND SUPPORT-ST. FRANCIS OFFERS FREE SCREENINGS, SUPPORT PROGRAMS, REFERRAL AND CARE NAVIGATION, AND EDUCATION ON CANCER PREVENTIONDENTAL CARE-TINY STEPS, CENTER OF HOPE, AND THE SAINT CLARE VAN HAVE PARTNERED WITH HENRIETTA JOHNSON MEDICAL CENTER TO PROVIDE INFORMATION ON DENTAL SERVICES FOR INSURED AND UNINSURED FAMILIES WHO ARE IN NEED OF DENTAL CARECARE FOR THOSE IN TRANSITIONAL HOUSING OR PRECARIOUS HOUSING-ST. FRANCIS IS THE ONLY HOSPITAL CONTRACTED IN WILMINGTON WHERE WOMEN IN PRISON CAN HAVE THEIR BABIES DELIVERED-HEALTH EDUCATION AND PROFESSIONAL DEVELOPMENT EDUCATION IS PROVIDED TO THE WOMEN OF BAYARD HOUSE WHO ARE IN TRANSITION FROM PRECARIOUS SITUATIONS-PARTNERSHIP WITH ST. FRANCIS FROM PARISHES AND OTHER COMMUNITY CENTERS-ST. FRANCIS HAS DEVELOPED PARTNERSHIPS WITH CATHOLIC SCHOOLS (SAINT ANTHONY, SAINT ANN, AND SAINT JOHN THE BELOVED) AND COMMUNITY OUTREACH GROUPS (WILMINGTON CONSORTIUM, WILMINGTON HEALTH PLANNING COMMITTEE, AND LACC) TO ASSIST WITH HEALTHCARE INITIATIVES THROUGHOUT DELAWARECITY VIOLENCE INITIATIVE -ST. FRANCIS MET WITH CHIEF OF POLICE TO COORDINATE PROGRAMS WITH THE COMMUNITY TO STOP THE VIOLENCE-SUMMIT OF NON-VIOLENCE RALLY-ST. FRANCIS MET WITH PUBLIC DEFENDER OF YOUTH TO ASSIST WITH PROGRAMS FOR VIOLENCE PREVENTION-NEW BEGINNING NEXT STEPS SUPPORT GROUP FOR EX-OFFENDERS -PARDONS PROJECT (BAN THE BOX) -POLICE PRESENCE AROUND ST. FRANCIS-POLICE DEVICE TO PINPOINT SHOTS FIRED ON TOP OF ST. FRANCIS BUILDING -PARTICIPATION IN ANNUAL MARCH FOR PEACE AS A SPONSOR ST. FRANCIS HOSPITAL PART V, SECTION B, LINE 13H: THE HOSPITAL RECOGNIZES THAT NOT ALL PATIENTS ARE ABLE TO PROVIDE COMPLETE FINANCIAL AND/OR SOCIAL INFORMATION. THEREFORE, APPROVAL FOR FINANCIAL SUPPORT MAY BE DETERMINED BASED ON AVAILABLE INFORMATION. EXAMPLES OF PRESUMPTIVE CASES INCLUDE: DECEASED PATIENTS WITH NO KNOWN ESTATE, THE HOMELESS, UNEMPLOYED PATIENTS, NON-COVERED MEDICALLY NECESSARY SERVICES PROVIDED TO PATIENTS QUALIFYING FOR PUBLIC ASSISTANCE PROGRAMS, PATIENT BANKRUPTCIES, AND MEMBERS OF RELIGIOUS ORGANIZATIONS WHO HAVE TAKEN A VOW OF POVERTY AND HAVE NO RESOURCES INDIVIDUALLY OR THROUGH THE RELIGIOUS ORDER.FOR THE PURPOSE OF HELPING FINANCIALLY NEEDY PATIENTS, A THIRD PARTY IS UTILIZED TO CONDUCT A REVIEW OF PATIENT INFORMATION TO ASSESS FINANCIAL NEED. THIS REVIEW UTILIZES A HEALTHCARE INDUSTRY-RECOGNIZED, PREDICTIVE MODEL THAT IS BASED ON PUBLIC RECORD DATABASES. THESE PUBLIC RECORDS ENABLE THE HOSPITAL TO ASSESS WHETHER THE PATIENT IS CHARACTERISTIC OF OTHER PATIENTS WHO HAVE HISTORICALLY QUALIFIED FOR FINANCIAL ASSISTANCE UNDER THE TRADITIONAL APPLICATION PROCESS. IN CASES WHERE THERE IS AN ABSENCE OF INFORMATION PROVIDED DIRECTLY BY THE PATIENT, AND AFTER EFFORTS TO CONFIRM COVERAGE AVAILABILITY, THE PREDICTIVE MODEL PROVIDES A SYSTEMATIC METHOD TO GRANT PRESUMPTIVE ELIGIBILITY TO FINANCIALLY NEEDY PATIENTS. ST. FRANCIS HOSPITAL PART V, SECTION B, LINE 22D: PATIENTS WITH INCOME AT OR BELOW 200% OF THE FEDERAL POVERTY GUIDELINES (FPG) ARE ELIGIBLE FOR 100% CHARITY CARE WRITE OFF OF THE CHARGES FOR MEDICALLY NECESSARY SERVICES. ACUTE CARE PATIENTS WITH INCOME BETWEEN 201% AND 400% OF THE FPG RECEIVE A DISCOUNT OFF TOTAL CHARGES FOR MEDICALLY NECESSARY SERVICES EQUAL TO THE HOSPITAL'S AVERAGE ACUTE CARE CONTRACTUAL ADJUSTMENT FOR MEDICARE. AMBULATORY PATIENTS WITH INCOME BETWEEN 201% AND 400% OF THE FPG RECEIVE A DISCOUNT OFF TOTAL CHARGES FOR MEDICALLY NECESSARY SERVICES EQUAL TO THE HOSPITAL'S AVERAGE PHYSICIAN CONTRACTUAL ADJUSTMENT FOR MEDICARE. THE ACUTE AND PHYSICIAN AVERAGE CONTRACTUAL ADJUSTMENT AMOUNTS FOR MEDICARE ARE CALCULATED UTILIZING THE LOOK BACK METHODOLOGY OF CALCULATING THE SUM OF PAID CLAIMS DIVIDED BY THE TOTAL GROSS CHARGES FOR THOSE CLAIMS ANNUALLY USING TWELVE MONTHS OF PAID CLAIMS WITH A 30 DAY LAG FROM REPORT DATE TO THE MOST RECENT DISCHARGE DATE. PART V, SECTION B, LINE 7A: HTTP://WWW.STFRANCISHEALTHCARE.ORG/COMMUNITY/COMMUNITY-HEALTH-NEEDS-ASSESSMENT.ASPX PART V, SECTION B, LINE 10A: HTTP://WWW.STFRANCISHEALTHCARE.ORG/DOCUMENTS/CHIP-DECEMBER-17_03.PDF PART V, SECTION B, LINE 16A: HTTP://WWW.STFRANCISHEALTHCARE.ORG/PATIENTS-VISITORS/FINANCIAL-ASSISTANCE.ASPX PART V, SECTION B, LINE 16B: HTTP://WWW.STFRANCISHEALTHCARE.ORG/PATIENTS-VISITORS/FINANCIAL-ASSISTANCE.ASPX PART V, SECTION B, LINE 16C: HTTP://WWW.STFRANCISHEALTHCARE.ORG/PATIENTS-VISITORS/FINANCIAL-ASSISTANCE.ASPX PART V, SECTION B, LINE 16 FINANCIAL ASSISTANCE POLICY WEBSITE AVAILABILITY ST. FRANCIS HOSPITAL PART V, SECTION B, LINE 16A WEBSITE: SEE PART V, SECTION C ST. FRANCIS HOSPITAL PART V, SECTION B, LINE 16B WEBSITE: SEE PART V, SECTION C ST. FRANCIS HOSPITAL PART V, SECTION B, LINE 16C WEBSITE: SEE PART V, SECTION C 8 THE WOMEN'S PLACE 1100 NORTH GRANT AVENUE WILMINGTON DE 19805 EMPLOYED PHYSICIANS WOMEN TO WOMEN OBGYN 1806 N VAN BUREN STREET SUITE 210 WILMINGTON DE 19810 EMPLOYED PHYSICIANS NORTH WILMINGTON WOMEN'S CENTER 2002 FOULK ROAD SUITE A WILMINGTON DE 19810 EMPLOYED PHYSICIANS CENTER OF HOPETINY STEPS 5584 KIRKWOOD HIGHWAY WILMINGTON DE 19808 EMPLOYED PHYSICIANS DELAWARE FAMILY MEDICINE 2002 FOULK ROAD SUITE D WILMINGTON DE 19810 EMPLOYED PHYSICIANS BARIATRICS 537 STANTON-CHRISTIANA ROAD SUITE 103 NEWARK DE 19713 BARIATRIC CARE WOMEN TO WOMEN OBGYN E-64 OMEGA DRIVE NEWARK DE 19711 EMPLOYED PHYSICIANS SACRED HEART CENTER 915 N MADISON STREET WILMINGTON DE 19801 EMPLOYED PHYSICIANS PART I, LINE 3C: IN ADDITION TO LOOKING AT A MULTIPLE OF THE FEDERAL POVERTY GUIDELINES, OTHER FACTORS ARE CONSIDERED SUCH AS THE PATIENT'S FINANCIAL STATUS AND/OR ABILITY TO PAY AS DETERMINED THROUGH THE ASSESSMENT PROCESS. PART I, LINE 6A: ST. FRANCIS HOSPITAL PREPARES AN ANNUAL COMMUNITY BENEFIT REPORT, WHICH IT SUBMITS TO THE STATE OF DELAWARE. IN ADDITION, ST. FRANCIS HOSPITAL REPORTS ITS COMMUNITY BENEFIT INFORMATION AS PART OF THE CONSOLIDATED COMMUNITY BENEFIT INFORMATION REPORTED BY TRINITY HEALTH (EIN 35-1443425) IN ITS AUDITED FINANCIAL STATEMENTS, AVAILABLE AT WWW.TRINITY-HEALTH.ORG.IN ADDITION, ST. FRANCIS HOSPITAL INCLUDES A COPY OF ITS MOST RECENTLY FILED SCHEDULE H ON BOTH ITS OWN WEBSITE AND TRINITY HEALTH'S WEBSITE. PART I, LINE 7: THE BEST AVAILABLE DATA WAS USED TO CALCULATE THE COST AMOUNTS REPORTED IN ITEM 7. FOR CERTAIN CATEGORIES, PRIMARILY TOTAL CHARITY CARE AND MEANS-TESTED GOVERNMENT PROGRAMS, SPECIFIC COST-TO-CHARGE RATIOS WERE CALCULATED AND APPLIED TO THOSE CATEGORIES. THE COST-TO-CHARGE RATIO WAS DERIVED FROM WORKSHEET 2, RATIO OF PATIENT CARE COST-TO-CHARGES. IN OTHER CATEGORIES, THE BEST AVAILABLE DATA WAS DERIVED FROM THE HOSPITAL'S COST ACCOUNTING SYSTEM. PART I, LN 7 COL(F): THE FOLLOWING NUMBER, $194,210, REPRESENTS THE AMOUNT OF BAD DEBT EXPENSE INCLUDED IN TOTAL FUNCTIONAL EXPENSES IN FORM 990, PART IX, LINE 25. PER IRS INSTRUCTIONS, THIS AMOUNT WAS EXCLUDED FROM THE DENOMINATOR WHEN CALCULATING THE PERCENT OF TOTAL EXPENSE FOR SCHEDULE H, PART I, LINE 7, COLUMN (F). PART III, LINE 2: METHODOLOGY USED FOR LINE 2 - ANY DISCOUNTS PROVIDED OR PAYMENTS MADE TO A PARTICULAR PATIENT ACCOUNT ARE APPLIED TO THAT PATIENT ACCOUNT PRIOR TO ANY BAD DEBT WRITE-OFF AND ARE THUS NOT INCLUDED IN BAD DEBT EXPENSE. AS A RESULT OF THE PAYMENT AND ADJUSTMENT ACTIVITY BEING POSTED TO BAD DEBT ACCOUNTS, WE ARE ABLE TO REPORT BAD DEBT EXPENSE NET OF THESE TRANSACTIONS. PART III, LINE 3: ST. FRANCIS HOSPITAL USES A PREDICTIVE MODEL THAT INCORPORATES THREE DISTINCT VARIABLES IN COMBINATION TO PREDICT WHETHER A PATIENT QUALIFIES FOR CHARITY: (1) SOCIO-ECONOMIC SCORE, (2) ESTIMATED FEDERAL POVERTY LEVEL (FPL), AND (3) HOMEOWNERSHIP. BASED ON THE MODEL, CHARITY CARE CAN STILL BE EXTENDED TO PATIENTS EVEN IF THEY HAVE NOT RESPONDED TO FINANCIAL COUNSELING EFFORTS AND ALL OTHER FUNDING SOURCES HAVE BEEN EXHAUSTED. FOR FINANCIAL STATEMENT PURPOSES, ST. FRANCIS HOSPITAL IS RECORDING AMOUNTS AS CHARITY CARE (INSTEAD OF BAD DEBT EXPENSE) BASED ON THE RESULTS OF THE PREDICTIVE MODEL. THEREFORE, ST. FRANCIS HOSPITAL IS REPORTING ZERO ON LINE 3, SINCE THEORETICALLY ANY POTENTIAL CHARITY CARE SHOULD HAVE BEEN IDENTIFIED THROUGH THE PREDICTIVE MODEL. PART III, LINE 4: ST. FRANCIS HOSPITAL IS INCLUDED IN THE CONSOLIDATED FINANCIAL STATEMENTS OF TRINITY HEALTH. THE FOLLOWING IS THE TEXT OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS FOOTNOTE FROM PAGE 15 OF THOSE STATEMENTS: "THE CORPORATION RECOGNIZES A SIGNIFICANT AMOUNT OF PATIENT SERVICE REVENUE AT THE TIME THE SERVICES ARE RENDERED EVEN THOUGH THE CORPORATION DOES NOT ASSESS THE PATIENT'S ABILITY TO PAY AT THAT TIME. AS A RESULT, THE PROVISION FOR BAD DEBTS IS PRESENTED AS A DEDUCTION FROM PATIENT SERVICE REVENUE (NET OF CONTRACTUAL PROVISIONS AND DISCOUNTS). FOR UNINSURED AND UNDERINSURED PATIENTS THAT DO NOT QUALIFY FOR CHARITY CARE, THE CORPORATION ESTABLISHES AN ALLOWANCE TO REDUCE THE CARRYING VALUE OF SUCH RECEIVABLES TO THEIR ESTIMATED NET REALIZABLE VALUE. THIS ALLOWANCE IS ESTABLISHED BASED ON THE AGING OF ACCOUNTS RECEIVABLE AND THE HISTORICAL COLLECTION EXPERIENCE BY THE HEALTH MINISTRIES AND FOR EACH TYPE OF PAYOR. A SIGNIFICANT PORTION OF THE CORPORATION'S PROVISION FOR DOUBTFUL ACCOUNTS RELATES TO SELF-PAY PATIENTS, AS WELL AS CO-PAYMENTS AND DEDUCTIBLES OWED TO THE CORPORATION BY PATIENTS WITH INSURANCE." PART III, LINE 8: ST. FRANCIS HOSPITAL DOES NOT BELIEVE ANY MEDICARE SHORTFALL SHOULD BE TREATED AS COMMUNITY BENEFIT. THIS IS SIMILAR TO CATHOLIC HEALTH ASSOCIATION RECOMMENDATIONS, WHICH STATE THAT SERVING MEDICARE PATIENTS IS NOT A DIFFERENTIATING FEATURE OF TAX-EXEMPT HEALTHCARE ORGANIZATIONS AND THAT THE EXISTING COMMUNITY BENEFIT FRAMEWORK ALLOWS COMMUNITY BENEFIT PROGRAMS THAT SERVE THE MEDICARE POPULATION TO BE COUNTED IN OTHER COMMUNITY BENEFIT CATEGORIES.PART III, LINE 8: COSTING METHODOLOGY FOR LINE 6 - MEDICARE COSTS WERE OBTAINED FROM THE FILED MEDICARE COST REPORT. THE COSTS ARE BASED ON MEDICARE ALLOWABLE COSTS AS REPORTED ON WORKSHEET B, COLUMN 27, WHICH EXCLUDE DIRECT MEDICAL EDUCATION COSTS. INPATIENT MEDICARE COSTS ARE CALCULATED BASED ON A COMBINATION OF ALLOWABLE COST PER DAY TIMES MEDICARE DAYS FOR ROUTINE SERVICES AND COST TO CHARGE RATIO TIMES MEDICARE CHARGES FOR ANCILLARY SERVICES. OUTPATIENT MEDICARE COSTS ARE CALCULATED BASED ON COST TO CHARGE RATIO TIMES MEDICARE CHARGES BY ANCILLARY DEPARTMENT. PART III, LINE 9B: THE HOSPITAL'S COLLECTION POLICY CONTAINS PROVISIONS ON THE COLLECTION PRACTICES TO BE FOLLOWED FOR PATIENTS WHO ARE KNOWN TO QUALIFY FOR FINANCIAL ASSISTANCE. CHARITY DISCOUNTS ARE APPLIED TO THE AMOUNTS THAT QUALIFY FOR FINANCIAL ASSISTANCE. COLLECTION PRACTICES FOR THE REMAINING BALANCES ARE CLEARLY OUTLINED IN THE ORGANIZATION'S COLLECTION POLICY. THE HOSPITAL HAS IMPLEMENTED BILLING AND COLLECTION PRACTICES FOR PATIENT PAYMENT OBLIGATIONS THAT ARE FAIR, CONSISTENT AND COMPLIANT WITH STATE AND FEDERAL REGULATIONS. PART VI, LINE 2: NEEDS ASSESSMENT - SAINT FRANCIS HOSPITAL REGULARLY USES DATA FROM THE STATE OF DELAWARE, THE CENTER FOR DISEASE CONTROL, AND THE BUREAU OF VITAL STATISTICS TO BETTER UNDERSTAND HEALTH CHALLENGES AND NEEDS. IN ADDITION, SAINT FRANCIS PARTICIPATES IN THE DELAWARE HEALTHTRACKER, A SERVICE OFFERED THROUGH THE DELAWARE HEALTHCARE ASSOCIATION TO GATHER AND ANALYZE STATISTICS RELATING TO HEALTH NEEDS IN THE STATE. PART VI, LINE 3: PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE-ST. FRANCIS HOSPITAL IS COMMITTED TO:-PROVIDING ACCESS TO QUALITY HEALTHCARE SERVICES WITH COMPASSION, DIGNITY AND RESPECT FOR THOSE WE SERVE, PARTICULARLY THE POOR AND THE UNDERSERVED IN OUR COMMUNITIES-CARING FOR ALL PERSONS, REGARDLESS OF THEIR ABILITY TO PAY FOR SERVICES-ASSISTING PATIENTS WHO CANNOT PAY FOR PART OR ALL OF THE CARE THEY RECEIVE -BALANCING NEEDED FINANCIAL ASSISTANCE FOR SOME PATIENTS WITH BROADER FISCAL RESPONSIBILITIES IN ORDER TO SUSTAIN VIABILITY AND PROVIDE THE QUALITY AND QUANTITY OF SERVICES FOR ALL WHO MAY NEED CARE IN A COMMUNITYIN ACCORDANCE WITH AMERICAN HOSPITAL ASSOCIATION RECOMMENDATIONS, ST. FRANCIS HOSPITAL HAS ADOPTED THE FOLLOWING GUIDING PRINCIPLES WHEN HANDLING THE BILLING, COLLECTION AND FINANCIAL SUPPORT FUNCTIONS FOR OUR PATIENTS: -PROVIDE EFFECTIVE COMMUNICATIONS WITH PATIENTS REGARDING HOSPITAL BILLS-MAKE AFFIRMATIVE EFFORTS TO HELP PATIENTS APPLY FOR PUBLIC AND PRIVATE FINANCIAL SUPPORT PROGRAMS-OFFER FINANCIAL SUPPORT TO PATIENTS WITH LIMITED MEANS-IMPLEMENT POLICIES FOR ASSISTING LOW-INCOME PATIENTS IN A CONSISTENT MANNER-IMPLEMENT FAIR AND CONSISTENT BILLING AND COLLECTION PRACTICES FOR ALL PATIENTS WITH PATIENT PAYMENT OBLIGATIONSST. FRANCIS HOSPITAL COMMUNICATES EFFECTIVELY WITH PATIENTS REGARDING PATIENT PAYMENT OBLIGATIONS. FINANCIAL COUNSELING IS PROVIDED TO PATIENTS ABOUT THEIR PAYMENT OBLIGATIONS AND HOSPITAL BILLS. INFORMATION ON HOSPITAL-BASED FINANCIAL SUPPORT POLICIES AND EXTERNAL PROGRAMS THAT PROVIDE COVERAGE FOR SERVICES ARE MADE AVAILABLE TO PATIENTS DURING THE PRE-REGISTRATION AND REGISTRATION PROCESSES AND/OR THROUGH COMMUNICATIONS WITH PATIENTS SEEKING FINANCIAL ASSISTANCE. FINANCIAL COUNSELORS MAKE AFFIRMATIVE EFFORTS TO HELP PATIENTS APPLY FOR PUBLIC AND PRIVATE PROGRAMS FOR WHICH THEY MAY QUALIFY AND THAT MAY ASSIST THEM IN OBTAINING AND PAYING FOR HEALTHCARE SERVICES. EVERY EFFORT IS MADE TO DETERMINE A PATIENT'S ELIGIBILITY PRIOR TO OR AT THE TIME OF ADMISSION OR SERVICE. FINANCIAL ASSISTANCE APPLICATIONS WILL BE ACCEPTED UNTIL ONE YEAR AFTER THE FIRST BILLING STATEMENT TO THE PATIENT. ST. FRANCIS HOSPITAL OFFERS FINANCIAL SUPPORT TO PATIENTS WITH LIMITED MEANS. THIS SUPPORT IS AVAILABLE TO UNINSURED AND UNDERINSURED PATIENTS WHO DO NOT QUALIFY FOR PUBLIC PROGRAMS OR OTHER ASSISTANCE. NOTIFICATION ABOUT FINANCIAL ASSISTANCE, INCLUDING CONTACT INFORMATION, IS AVAILABLE THROUGH PATIENT BROCHURES, MESSAGES ON PATIENT BILLS, POSTED NOTICES IN PUBLIC REGISTRATION AREAS INCLUDING EMERGENCY ROOMS, ADMITTING AND REGISTRATION DEPARTMENTS, AND OTHER PATIENT FINANCIAL SERVICES OFFICES. SUMMARIES OF HOSPITAL PROGRAMS ARE MADE AVAILABLE TO APPROPRIATE COMMUNITY HEALTH AND HUMAN SERVICES AGENCIES AND OTHER ORGANIZATIONS THAT ASSIST PEOPLE IN NEED. INFORMATION REGARDING FINANCIAL ASSISTANCE PROGRAMS IS ALSO AVAILABLE ON HOSPITAL WEBSITES. IN ADDITION TO ENGLISH, THIS INFORMATION IS ALSO AVAILABLE IN SPANISH, REFLECTING ANOTHER PRIMARY LANGUAGE SPOKEN BY THE POPULATION SERVICED BY OUR HOSPITAL. ST. FRANCIS HOSPITAL HAS ESTABLISHED A WRITTEN POLICY FOR THE BILLING, COLLECTION AND SUPPORT FOR PATIENTS WITH PAYMENT OBLIGATIONS. ST. FRANCIS HOSPITAL MAKES EVERY EFFORT TO ADHERE TO THE POLICY AND IS COMMITTED TO IMPLEMENTING AND APPLYING THE POLICY FOR ASSISTING PATIENTS WITH LIMITED MEANS IN A PROFESSIONAL, CONSISTENT MANNER. PART VI, LINE 4: COMMUNITY INFORMATION- ST. FRANCIS HOSPITAL IS LOCATED IN THE CITY OF WILMINGTON. THE HOSPITAL'S SERVICE AREA WAS DEFINED AS THE COMMUNITY FOR THE PURPOSES OF THIS ASSESSMENT. THE SERVICE AREA INCLUDES THE FOLLOWING ZIP CODES IN WILMINGTON, DELAWARE: 19801, 19802, 19804, 19805, AND 19806. WITHIN NEW CASTLE COUNTY, THE FOLLOWING ZIP CODES ARE ALSO SERVED BY ST. FRANCIS: 19803 AND 19810 (TALLEYVILLE); 19809 (CLAYMONT); 19808 (PIKE CREEK); 19707 AND 19807 (HOCKESSIN); 19736 (YORKLYN); 19720 (NEW CASTLE); 19702, 19711, 19713, 19716 AND 19717 (NEWARK); AND 19701 (BEAR). IN KEEPING WITH NATIONAL TRENDS, DELAWARE'S POPULATION IS MORE DIVERSE THAN 10 YEARS AGO, WITH SIGNIFICANT INCREASES IN AFRICAN AMERICAN AND HISPANIC POPULATIONS. THE CNS COMPONENT WITH THE HIGHEST PERCENTAGE IN THE ST. FRANCIS HOSPITAL IMMEDIATE SERVICE AREA IS RACIAL AND ETHNIC MINORITIES AT 88%, FOLLOWED BY ADULTS AGE 65 AND OVER WHO ARE LIVING IN POVERTY AT 66.2%. TWO IN FIVE SINGLE FEMALE-HEADED HOUSEHOLDS WITH CHILDREN ARE LIVING IN POVERTY (44.4%). EIGHT PERCENT OF RESIDENTS IN THE PRIMARY SERVICE AREA DO NOT SPEAK ENGLISH AND 23.2% DO NOT HAVE HIGH SCHOOL DIPLOMAS.COMMUNITY MEMBERS WHO ARE SERVED AT ST. FRANCIS HOSPITAL INCLUDE AFRICAN AMERICAN, HISPANIC/LATINO AND WHITE WHO ARE AT OR BELOW THE POVERTY LEVEL, WITH LITTLE OR NO EDUCATION, DO NOT SPEAK OR SPEAK LITTLE ENGLISH OR ARE UNINSURED OR UNDERINSURED. THE PERCENTAGE OF FAMILIES WITH CHILDREN AND SINGLE FEMALES WITH CHILDREN LIVING IN POVERTY ARE HIGHER IN THE WILMINGTON AND NEWARK AREAS OF DELAWARE. CENTER OF HOPE IS THE MAIN SERVICE AREA FOR NEWARK, DELAWARE, SERVING A LARGE PERCENTAGE OF HISPANIC/LATINA WOMEN AND FAMILIES WITH CHILDREN. WITHIN THE STATE OF DELAWARE, A SIGNIFICANT NUMBER OF THE POOR WITHIN THE CITY AND THE SURROUNDING NEIGHBORHOODS PURSUE CARE AT ST. FRANCIS. ALMOST 90% OF ST. FRANCIS ADMISSIONS COME FROM THE EMERGENCY DEPARTMENT WHERE THOSE IN NEED OF URGENT OR IMMEDIATE CARE SEEK ASSISTANCE. WHILE HOMELESS RATES HAVE REMAINED RELATIVELY STABLE IN DELAWARE, THERE HAS BEEN INCREASING ATTENTION TO THE HEALTH CARE NEEDS OF THOSE IN SHELTERS AND THOSE WHO ARE IN TRANSITION (MOVING OUT OF PRISON, THE MILITARY OR STABLE RELATIONSHIPS). PART VI, LINE 5: OTHER INFORMATION- SERVICES PROVIDED THROUGH CENTER OF HOPE, TINY STEPS AND THE SAINT CLARE VAN, HAVE CONTINUED TO ADDRESS THE PRE-CONCEPTION, PRENATAL HEALTH, HEALTHCARE AND SERVICE NEEDS OF FAMILIES IN DELAWARE. NEW PROGRAMS WITHIN THOSE SERVICE AREAS, SUCH AS THE TINY STEPS BOOK DRIVE, HAVE HELPED ENCOURAGE FAMILY READING - TO BUILD STRONGER FAMILY RELATIONSHIPS AND PROMOTE EDUCATION. PARTNERING WITH HENRIETTA JOHNSON MEDICAL CENTER HAS ALLOWED CENTER OF HOPE, TINY STEPS, AND THE SAINT CLARE VAN TO DISTRIBUTE DENTAL INFORMATION AND REFER INSURED AND UNINSURED FAMILIES FOR DENTAL TREATMENT TO PROMOTE DENTAL HEALTH. OTHER RELATIONSHIPS BUILT WITH CATHOLIC SCHOOLS, COMMUNITY GROUPS, AND COMMUNITY PROGRAMS HAVE ALLOWED ST. FRANCIS TO PROVIDE EDUCATION, SUPPORT, AND RESOURCES TO THE BROADER COMMUNITY. FOR EXAMPLE, ST. FRANCIS HAS PARTNERED WITH THE LATIN AMERICAN COMMUNITY CENTER (LACC) TO PROVIDE SERVICES AND EDUCATION TO PROMOTE HEART HEALTH AND STROKE AWARENESS AND PREVENTION TO THE HISPANIC COMMUNITY. ST. FRANCIS ALSO CONDUCTS A HEALTH EDUCATION LECTURE SERIES AT BAYARD HOUSE, A HOME FOR PREGNANT WOMEN, WHICH PROVIDES EDUCATION ON PRENATAL HEALTH, NUTRITION, POSTPARTUM, LABOR AND DELIVERY, AND OTHER INFORMATION TO ASSIST IN A HEALTHY PREGNANCY. A LECTURE SERIES WAS INTRODUCED TO INCLUDE PROFESSIONAL DEVELOPMENT TO HELP THE WOMEN WITH RESUME WRITING, PROFESSIONAL DRESS AND CONDUCT, AND INTERVIEW SKILLS, AS WELL AS PROVIDE INFORMATION ON GED TESTING, ASSISTED LIVING INFORMATION, ETC. ADDITIONALLY, PARTNERING WITH THE WILMINGTON CONSORTIUM, HEALTH AMBASSADORS, AND OTHER COMMUNITY GROUPS HAS PROVIDED ST. FRANCIS WITH MORE OPPORTUNITIES TO REACH AND EDUCATE COMMUNITY MEMBERS THROUGH VARIOUS OUTLETS. FOR ADDITIONAL INFORMATION, PLEASE VISIT WWW.DEHA.ORG FOR THE 6TH ANNUAL DEHA COMMUNITY BENEFIT REPORT. PART VI, LINE 6: ST. FRANCIS HOSPITAL IS A MEMBER OF TRINITY HEALTH, ONE OF THE LARGEST CATHOLIC HEALTH CARE DELIVERY SYSTEMS IN THE COUNTRY. TRINITY HEALTH ANNUALLY REQUIRES THAT ALL REGIONAL HEALTH MINISTRIES DEFINE - AND ACHIEVE - COMMUNITY BENEFIT GOALS THAT INCLUDE IMPLEMENTING NEEDED SERVICES OR EXPANDING ACCESS TO SERVICES FOR LOW-INCOME INDIVIDUALS. AS A NOT-FOR-PROFIT HEALTH SYSTEM, TRINITY HEALTH REINVESTS ITS PROFITS BACK INTO THE COMMUNITY THROUGH PROGRAMS SERVING THOSE WHO ARE POOR AND UNINSURED, HELPING MANAGE CHRONIC CONDITIONS LIKE DIABETES, PROVIDING HEALTH EDUCATION, PROMOTING WELLNESS AND REACHING OUT TO UNDERSERVED POPULATIONS. ANNUALLY, THE ORGANIZATION INVESTS MORE THAN $800 MILLION IN SUCH COMMUNITY BENEFITS AND WORKS TO ENSURE THAT ITS MEMBER HOSPITALS AND OTHER ENTITIES/AFFILIATES ENHANCE THE OVERALL HEALTH OF THE COMMUNITIES THEY SERVE BY ADDRESSING EACH COMMUNITY'S SPECIFIC NEEDS. FOR MORE INFORMATION ABOUT TRINITY HEALTH, VISIT WWW.TRINITY-HEALTH.ORG. PART VI, LINE 7, REPORTS FILED WITH STATES DE 0 DELAWARE STATE CHAMBER OF COMMERCE PO BOX 671 WILMINGTON DE 19899 510007780 501(C)(6) 5000 PROGRAM SUPPORT DIAMOND STATE CLASSIC PO BOX 12104 WILMINGTON DE 19850 203217290 501(C)(3) 10000 PROGRAM SUPPORT AMERICAN HEART ASSOCIATION PO BOX 4002907 DES MOINES IA 503402907 135613797 501(C)(3) 10000 PROGRAM SUPPORT CATHOLIC CHARITIES 2601 W 4TH STREET WILMINGTON DE 19805 510065685 501(C)(3) 6000 PROGRAM SUPPORT 3 1 PART I, LINE 2: DONATIONS MADE BY ST. FRANCIS HOSPITAL TO CHARITABLE ORGANIZATIONS ARE MADE IN FURTHERANCE OF THE RECIPIENT ORGANIZATION'S EXEMPT PURPOSE. DONATIONS ARE INCLUDED IN COMMUNITY BENEFITS IN SCHEDULE H IF THE CONTRIBUTION HAS BEEN FORMALLY RESTRICTED TO A COMMUNITY BENEFIT ACTIVITY THAT MEETS THE CRITERIA TO BE REPORTED ON SCHEDULE H. 1 1 0 0 0 0 0 0 0 BRIAN E DIETZ DIRECTOR; PRESIDENT & CEO 0 310919 0 65951 0 13465 0 11700 0 19956 0 421991 0 0 OSWALDO A NICASTRO MD DIRECTOR; PHYSICIAN 169761 0 700 0 152 0 1766 0 26279 0 198658 0 0 0 BRIAN P MCDONOUGH MD DIRECTOR; PHYSICIAN 348962 0 0 0 707 0 14175 0 24790 0 388634 0 0 0 MICHAEL POLNEROW DO VP MEDICAL AFFAIRS/ CMO 408225 0 0 0 2843 0 12329 0 1075 0 424472 0 0 0 JENNIFER KIRBY VP PATIENT SERVICES/ CNO 111491 0 127497 0 603 0 1114 0 3712 0 244417 0 0 0 NANCY PETIT MD PHYSICIAN 449683 0 32500 0 657 0 12900 0 21301 0 517041 0 0 0 RICHARD W LEADER MD PHYSICIAN 411571 0 32500 0 592 0 12900 0 25378 0 482941 0 0 0 JAMES COSGROVE DO PHYSICIAN 402612 0 26325 0 2819 0 15450 0 18710 0 465916 0 0 0 NANCY FAN MD PHYSICIAN 322249 0 18303 0 306 0 7741 0 11070 0 359669 0 0 0 LASHAUNA MCINTOSH MD PHYSICIAN 317647 0 4993 0 306 0 7715 0 23711 0 354372 0 0 0 JULIE HESTER FORMER OFFICER 0 0 0 0 0 204181 0 143753 0 5558 0 353492 0 203507 DALE SZAFRAN FORMER OFFICER; DIRECTOR OF FINANCE 118467 0 0 0 369 0 1859 0 6774 0 127469 0 0 0 COY SMITH FORMER KEY EMPLOYEE 13427 0 0 0 141546 0 3756 0 10494 0 169223 0 0 0 RICHARD W HENDERSON MD FORMER KEY EMPLOYEE 285369 0 0 0 1524 0 13475 0 18405 0 318773 0 0 0 PART I, LINE 3 ST. FRANCIS HOSPITAL IS A SUBSIDIARY IN THE TRINITY HEALTH SYSTEM. ST. FRANCIS HOSPITAL'S CEO IS PAID DIRECTLY BY THE SYSTEM'S PARENT ENTITY, TRINITY HEALTH CORPORATION. TRINITY HEALTH CORPORATION USED THE FOLLOWING METHODS TO ESTABLISH THE COMPENSATION OF ST. FRANCIS HOSPITAL'S CEO: - COMPENSATION COMMITTEE - INDEPENDENT COMPENSATION CONSULTANT - FORM 990 OF OTHER ORGANIZATIONS - WRITTEN EMPLOYMENT CONTRACT - COMPENSATION SURVEY OR STUDY, AND - APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE PART I, LINES 4A-B THE FOLLOWING INDIVIDUALS RECEIVED SEVERANCE PAYMENTS IN CALENDAR 2014. THESE AMOUNTS ARE INCLUDED IN COLUMN B(III) OF SCHEDULE J, PART II: JULIE HESTER - $203,507 COY SMITH - $141,117 COLUMN F OF SCHEDULE J, PART II INCLUDES THE PORITON OF THESE AMOUNTS THAT WERE REPORTED AS DEFERRED COMPENSATION IN PRIOR YEARS. IN ADDITION, COLUMN C OF SCHEDULE J, PART II INCLUDES THE FOLLOWING SEVERANCE AMOUNTS, WHICH WERE UNPAID AS OF 12/31/14: JULIE HESTER - $136,103 (PAID IN 2015) COY SMITH - $2,294 (PAID IN 2015) THE FOLLOWING IS A PARTICIPANT IN THE NEW TRINITY HEALTH SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP) EFFECTIVE JANUARY 1, 2014. THE PLAN WILL PROVIDE RETIREMENT BENEFITS TO CERTAIN TRINITY HEALTH EXECUTIVES SUBJECT TO MEETING SPECIFIED VESTING AND EMPLOYMENT DATE REQUIREMENTS. THERE WERE NO PAYOUTS IN 2014. BRIAN DIETZ RACHAEL POLNEROW FAMILY MEMBER OF MICHAEL POLNEROW, KEY EMPLOYEE 46438 COMPENSATION 0 MAUREEN JEWELL FAMILY MEMBER OF SR. CHRISTA M. THOMPSON, DIRECTOR AND OFFICER 131079 COMPENSATION 0 FORM 990, PART VI, SECTION A, LINE 3 ST. FRANCIS HOSPITAL HAS CONTRACTED WITH IMA CONSULTING FOR THE PROVISION OF INTERIM CFO SERVICES. IN CALENDAR YEAR 2014 ST. FRANCIS HOSPITAL PAID $355,024 TO IMA CONSULTING FOR BERNARD P. CITERONE'S SERVICES AS INTERIM CFO OF ST. FRANCIS HOSPITAL. ST. FRANCIS HOSPITAL DOES NOT KNOW HOW MUCH BERNARD P. CITERONE RECEIVED AS WAGES FROM IMA CONSULTING IN CALENDAR 2014. ST. FRANCIS HOSPITAL HAS CONTRACTED WITH IMA CONSULTING FOR THE PROVISION OF INTERIM CNO SERVICES. IN CALENDAR YEAR 2014 ST. FRANCIS HOSPITAL PAID $224,659 TO IMA CONSULTING FOR DIANE TORRES' SERVICES AS INTERIM CNO OF ST. FRANCIS HOSPITAL. ST. FRANCIS HOSPITAL DOES NOT KNOW HOW MUCH DIANE TORRES RECEIVED AS WAGES FROM IMA CONSULTING IN CALENDAR 2014. FORM 990, PART VI, SECTION A, LINE 4 THE ARTICLES OF INCORPORATION AND BYLAWS OF ST. FRANCIS HOSPITAL WERE AMENDED AND RESTATED TO CHANGE THE SOLE MEMBER OF THE CORPORATION. EFFECTIVE JULY 1, 2014, THE SOLE MEMBER IS TRINITY HEALTH CORPORATION. FORM 990, PART VI, SECTION A, LINE 6 THE SOLE MEMBER OF ST. FRANCIS HOSPITAL IS TRINITY HEALTH CORPORATION. SEE LINE 7 FOR ADDITIONAL INFORMATION. FORM 990, PART VI, SECTION A, LINE 7A TRINITY HEALTH CORPORATION IS THE SOLE MEMBER OF ST. FRANCIS HOSPITAL. TRINITY HEALTH CORPORATION HAS THE RIGHT TO APPOINT ALL PERSONS TO THE BOARD OF DIRECTORS OF ST. FRANCIS HOSPITAL. FORM 990, PART VI, SECTION A, LINE 7B AS SOLE MEMBER, TRINITY HEALTH CORPORATION MUST APPROVE CERTAIN DECISIONS OF THE GOVERNING BODY, INCLUDING THE STRATEGIC PLAN, ANNUAL CAPITAL PLAN, AND ANNUAL OPERATING BUDGET. TRINITY HEALTH CORPORATION MUST ALSO APPROVE SIGNIFICANT CHANGES SUCH AS A MERGER, DISSOLUTION, SALE OF ASSETS IN EXCESS OF CERTAIN LIMITS, AND MODIFICATIONS TO GOVERNING DOCUMENTS. FORM 990, PART VI, SECTION B, LINE 11 PRIOR TO FILING, THE FORM 990 FOR ST. FRANCIS HOSPITAL IS REVIEWED BY SENIOR MANAGEMENT. IN ADDITION, CERTAIN KEY SECTIONS OF THE FORM ARE REVIEWED BY THE STEWARDSHIP COMMITTEE AND/OR GOVERNANCE COMMITTEE. THE BOARD RECEIVES A COPY OF THE RETURN IN ITS FINAL FORM BEFORE IT IS FILED WITH THE INTERNAL REVENUE SERVICE. FORM 990, PART VI, SECTION B, LINE 12C ST. FRANCIS HOSPITAL HAS ADOPTED TRINITY HEALTH'S GOVERNANCE POLICY NO. 1, WHICH SETS FORTH THE ORGANIZATION'S CONFLICT OF INTEREST POLICY AND PROCESSES. IT APPLIES TO ALL "INTERESTED PERSONS" OF ST. FRANCIS HOSPITAL, WHICH INCLUDES DIRECTORS, PRINCIPAL OFFICERS, KEY EMPLOYEES, AND MEMBERS OF COMMITTEES WITH BOARD-DELEGATED POWERS. INTERESTED PERSONS ARE EXPECTED TO DISCHARGE THEIR DUTIES IN A MANNER THE PERSON REASONABLY BELIEVES TO BE IN THE BEST INTERESTS OF ST. FRANCIS HOSPITAL AND TO AVOID SITUATIONS INVOLVING A CONFLICT OF INTEREST. ON AN ANNUAL BASIS, INTERESTED PERSONS ARE REQUIRED TO COMPLETE A CONFLICT OF INTEREST DISCLOSURE STATEMENT AND TO AFFIRM THEIR RECEIPT OF THE CONFLICT OF INTEREST POLICY, COMPLIANCE WITH ITS REQUIREMENTS, AND AGREE TO NOTIFY THE ORGANIZATION OF CHANGES IMPACTING THEIR ANNUAL DISCLOSURE IN ACCORDANCE WITH THE POLICY. THE ANNUAL DISCLOSURES ARE PROVIDED TO INTERNAL LEGAL COUNSEL AND THE INTEGRITY AND COMPLIANCE OFFICER, FROM WHICH LEGAL COUNSEL PREPARES A REPORT FOR THE BOARD CHAIR AND CEO. A SUMMARY OF POTENTIAL CONFLICTS IS REVIEWED WITH THE BOARD OF DIRECTORS OF ST. FRANCIS HOSPITAL (OR A DELEGATED COMMITTEE OF THE BOARD) ON A YEARLY BASIS. INTERESTED PERSONS ARE REQUIRED TO MAKE FULL DISCLOSURE TO ST. FRANCIS HOSPITAL OF ANY FINANCIAL OR BUSINESS INTERESTS THAT MIGHT RESULT IN OR HAVE THE APPEARANCE OF A CONFLICT OF INTEREST. THE BOARD OF DIRECTORS OF ST. FRANCIS HOSPITAL (OR A DELEGATED COMMITTEE OF THE BOARD) IS RESPONSIBLE FOR THE REVIEW OF TRANSACTIONS TO DETERMINE WHETHER AN ACTUAL CONFLICT OF INTEREST EXISTS. IN THE EVENT OF AN ACTUAL CONFLICT, THE BOARD (OR A DELEGATED COMMITTEE OF THE BOARD) WILL EITHER AVOID THE CONFLICT OR APPROPRIATELY SCRUTINIZE THE TRANSACTION TO ENSURE IT IS IN THE BEST INTERESTS OF ST. FRANCIS HOSPITAL. INTERESTED PERSONS ARE REQUIRED TO RECUSE THEMSELVES FROM DISCUSSION AND VOTING ON MATTERS INVOLVING A CONFLICT OF INTEREST. THE POLICY FURTHER ADDRESSES THE PROPER DOCUMENTATION OF THE PROCEEDINGS AND POTENTIAL DISCIPLINARY AND CORRECTIVE ACTION FOR VIOLATIONS OF THE POLICY. THE POLICY IS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART VI, SECTION B, LINE 15 QUESTION 15A IS ANSWERED "NO" BECAUSE THE COMPENSATION FOR ST. FRANCIS HOSPITAL'S CEO IS ESTABLISHED AND PAID BY TRINITY HEALTH, A RELATED ORGANIZATION. IN ESTABLISHING CEO COMPENSATION, TRINITY HEALTH FOLLOWS A PROCESS AND POLICY THAT IS INTENDED TO MIRROR THE IRC SECTION 4958 GUIDELINES FOR OBTAINING A "REBUTTABLE PRESUMPTION OF REASONABLENESS" WITH REGARD TO COMPENSATION AND BENEFITS. AS PART OF THAT PROCESS, THE COMPENSATION AND BENEFITS OF THE CEO OF ST. FRANCIS HOSPITAL ARE REVIEWED AT LEAST ANNUALLY BY THE TRINITY HEALTH BOARD OR THE TRINITY HEALTH HUMAN RESOURCES AND COMPENSATION COMMITTEE (HRCC) OF THE BOARD, AUTHORIZED TO ACT ON BEHALF OF THE BOARD WITH RESPECT TO CERTAIN COMPENSATION MATTERS. AS PART OF ITS REVIEW PROCESS, THE HRCC RETAINS AN INDEPENDENT FIRM EXPERIENCED IN COMPENSATION AND BENEFIT MATTERS FOR NOT-FOR-PROFIT HEALTHCARE ORGANIZATIONS TO ADVISE IT IN THE DETERMINATIONS IT MAKES ON THE REASONABLENESS OF PROPOSED COMPENSATION AND BENEFITS ARRANGEMENTS. FOR THE COMPENSATION OF OTHER EXECUTIVES, ST. FRANCIS HOSPITAL HAS A PROCESS FOR DETERMINING COMPENSATION WHICH INCLUDES THE FOLLOWING: THE BOARD HAS AN INDEPENDENT COMMITTEE REVIEW AND APPROVE ALL ELEMENTS OF REMUNERATION FOR ALL DISQUALIFIED PARTIES, AS WELL AS OTHER KEY MANAGEMENT. THE BOARD/COMMITTEE HAS AN ESTABLISHED COMPENSATION PHILOSOPHY WHICH DETAILS THE OBJECTIVES OF MARKET POSITIONING AND PAY ELEMENTS. THE COMMITTEE ENGAGES WITH EXTERNAL CONSULTANTS TO PROVIDE MARKET DATA COMPARING THE ORGANIZATION'S ROLES TO SIMILARLY SIZED HEALTH SYSTEMS UTILIZING BOTH TITLE AND JOB CONTENT COMPARISONS. THE COMMITTEE REVIEWS THE MARKET ANALYSIS, APPROVES ANY SALARY ADJUSTMENTS FOR THE EXECUTIVE POPULATION, CONSIDERS BOTH REASONABLENESS AND EFFECTIVENESS OF ALL REMUNERATIVE PROGRAMS AND ESTABLISHES THE DETAILED PERFORMANCE EXPECTATIONS WHICH ARE INCORPORATED INTO THE INCENTIVE PLAN. ALL OF THESE DISCUSSIONS AND DECISIONS ARE DOCUMENTED THROUGH THE PROVISION OF MEETING MINUTES. FORM 990, PART VI, SECTION C, LINE 19 ST. FRANCIS HOSPITAL IS A SUBSIDIARY ORGANIZATION IN THE TRINITY HEALTH SYSTEM. TRINITY HEALTH MAKES CERTAIN OF ITS KEY DOCUMENTS AVAILABLE TO THE PUBLIC ON ITS WEBSITE, WWW.TRINITY-HEALTH.ORG, IN THE "ABOUT US" SECTION. IN THIS SECTION, THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS ARE PUBLICLY AVAILABLE. IN ADDITION, ST. FRANCIS HOSPITAL INCLUDES A COPY OF ITS MOST RECENTLY FILED SCHEDULE H ON BOTH ITS OWN WEBSITE AND TRINITY HEALTH'S WEBSITE. ST. FRANCIS HOSPITAL'S GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE AVAILABLE UPON REQUEST. FORM 990, PART IX, LINE 11G MEDICAL SPECIALIST FEES: PROGRAM SERVICE EXPENSES 7,516,343. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 7,516,343. CONSULTING FEES: PROGRAM SERVICE EXPENSES 927,385. MANAGEMENT AND GENERAL EXPENSES 335,605. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,262,990. MISC. PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 9,358,355. MANAGEMENT AND GENERAL EXPENSES 2,807,217. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 12,165,572. RECRUITMENT: PROGRAM SERVICE EXPENSES 125,412. MANAGEMENT AND GENERAL EXPENSES 45,384. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 170,796. COLLECTION SERVICES: PROGRAM SERVICE EXPENSES 81. MANAGEMENT AND GENERAL EXPENSES 29. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 110. FORM 990, PART XI, LINE 9: EQUITY TRANSFERS FROM AFFILIATES 311,367. LOSS FROM DISCONTINUED OPERATIONS -1,625,057. FORM 990, PART XII, LINE 2: ST. FRANCIS HOSPITAL'S FINANCIAL STATEMENTS WERE INCLUDED IN THE FY15 CONSOLIDATED FINANCIAL STATEMENTS OF TRINITY HEALTH, WHICH WERE AUDITED BY AN INDEPENDENT PUBLIC ACCOUNTING FIRM. DELAWARE CARE COLLABORATION DCC LLC 701 N CLAYTON STREET WILMINGTON DE 19805 474069475 ACCOUNTABLE CARE ORGANIZATION DE -33333 0 ST FRANCIS HOSPITAL INC ADVANTAGE HEALTHSAINT MARY'S MEDICAL GROUP 245 STATE ST SE GRAND RAPIDS MI 49503 272491974 HEALTHCARE SERVICES MI 501(C)(3) LINE 9 TRINITY HEALTH-MICHIGAN 1 ALBANY MEMORIAL HOSPITAL 600 NORTHERN BLVD ALBANY NY 12204 141338457 HEALTHCARE AND HOSPITAL SERVICES NY 501(C)(3) LINE 3 NORTHEAST HEALTH INC 1 ALLEGANY FRANCISCAN MINISTRIES INC 33920 US HIGHWAY 19 NORTH SUITE 269 PALM HARBOR FL 34684 581492325 HEALTHCARE SYSTEM MANAGEMENT AND SUPPORT FL 501(C)(3) LINE 11A, I TRINITY HEALTH CORPORATION 1 AMICARE HOSPICE SERVICES INC 20555 VICTOR PARKWAY LIVONIA MI 48152 382949053 HOSPICE SERVICES MI 501(C)(3) LINE 9 TRINITY HOME HEALTH SERVICES INC 1 AUXILIARY OF HOLY ROSARY HOSPITAL 351 SW 9TH STREET ONTARIO OR 97914 943059469 VOLUNTEER SERVICE AUXILIARY OR 501(C)(3) LINE 9 SAINT ALPHONSUS MEDICAL CENTER-ONTARIO 1 BAUM HARMON MERCY HOSPITAL 255 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