2015-05-13T13:15:29-05:00 2014-06-30 861065772 Deloitte Tax LLP 250 East Fifth Street Suite 1900 Cincinnati OH 45202 990 2013-07-01 621869474 Saint Thomas Midtown Hospital SAIN 6152845555 4220 Harding Road Nashville TN 37205 Craig Polkow CFO-Saint Thomas Health 6152845555 2015-05-13 1 Alicia Janisch P00741382 5137847100 2013 2016-02-25 16:41:14Z Michael Schatzlein 4220 Harding Road Nashville TN 37205 420476803 0 0928 X www.sths.com/midtown X 1941 TN Our Catholic Ministry is dedicated to spiritually centered, holistic care. 19 18 2290 176 0 0 4020588 868322 398456859 391044216 111894 -8938 18589528 15909262 421178869 407812862 0 897755 0 0 127495835 115568898 0 0 0 255155198 251671854 382651033 368138507 38527836 39674355 384570936 184862653 278175542 293943633 106395394 -109080980 X Rooted in the loving ministry of Jesus as healer, we commit ourselves to serving all persons with special attention to those who are poor and vulnerable. Our Catholic health ministry is dedicated to spiritually centered, holistic care, which sustains and improves the health of individuals and communities. We are advocates for a compassionate and just society through our actions and our words. 0 0 338736939 897755 407220400 Saint Thomas Midtown Hospital provides a substantial portion of its services to the elderly and poor. During the fiscal year ending June 30, 2014, 41% of the value of services rendered was to elderly patients under the Medicare program, and approximately 12% of the value of the services was provided to patients who were deemed indigent under state, county, or Saint Thomas Midtown Hospital guidelines. See Schedule H for supplemental information on community benefit. 338736939 1 1 0 1 0 0 0 0 0 1 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 1 0 0 1 0 0 2290 1 1 1 0 0 0 0 0 0 0 0 0 0 X 19 18 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 1 1 X Pam Hess 6152844479 2000 Church Street Nashville TN 37236 X James Bearden Chairman 1.00 7.00 X 0 0 0 Clark Baker Vice-Chairman 1.00 7.00 X 0 0 0 Mary Falls Esq Secretary STH Board 1.00 7.00 X 0 0 0 Anthony Heard Treasurer STH Board 1.00 7.00 X 0 0 0 Samar Ali Board Member (beg 7/13) 1.00 7.00 X 0 0 0 William Anderson Board Member 1.00 7.00 X 0 0 0 Robert Dray MD Board Member 1.00 7.00 X 0 0 0 Robert Hutton MD Board Member (end 12/13) 1.00 7.00 X 0 0 0 Randy Laszewski Board Member 1.00 7.00 X 0 0 0 Mark Marsden MD Board Member (end 11/13) 1.00 7.00 X 0 0 0 Lee Moss Board Member 1.00 8.00 X 0 0 0 Mark Peacock MD Board Member (beg 1/14) 1.00 6.00 X 0 0 0 Mark Peters MD Board Member (beg 11/13) 1.00 6.00 X 0 0 0 Thom Rainer MD Board Member 1.00 7.00 X 0 0 0 Steve Schwab MD Board Member (beg 7/13) 1.00 7.00 X 0 0 0 Patrick R Shepherd Board Member 1.00 8.00 X 0 0 0 Scott Standard MD Board Member 1.00 8.00 X 0 0 0 Sister Dinah White DC Board Member 1.00 8.00 X 0 0 0 Brian Wilcox MD Board Member 1.00 8.00 X 0 0 0 John Jay Williams MD Board Member 1.00 8.00 X 0 0 0 Michael Schatzlein MD President/CEO STHe 1.00 40.00 X X 0 1888568 39912 Craig Polkow Vice-Chairman & CFO STHe 1.00 40.00 X X 0 439568 30536 Karen Springer Sec/Treasurer 1.00 40.00 X X 0 576074 12507 Bernard Sherry President/CEO 40.00 40.00 X 0 506352 28091 Jennifer Elliot CNO/VP Clinical Opert.(beg 6/14) 40.00 40.00 X 190177 0 21384 Pam Hess CFO (beg 6/14) 40.00 40.00 X 0 270015 23577 Renee Kessler COO (end 6/14) 40.00 0.00 X 338931 0 26461 Don King COO (beg 6/14) 40.00 40.00 X 0 274800 27071 Retty Thomas-Mattu MD Physician 40.00 0.00 X 433306 0 27612 Daniel Carmody MD Physician 40.00 0.00 X 354059 0 26394 Dana Bannerman MD Physician 40.00 0.00 X 352929 0 24685 Naved Mohyuddin Jr MD Physician 40.00 0.00 X 350121 0 26813 Geoffrey Smallwood MD Physician 40.00 0.00 X 354984 0 30327 Wesley Littrell Former Sec/Treasurer 0.00 0.00 X 0 562188 8078 Alan Strauss Former EVP/CFO 0.00 0.00 X 0 703190 50287 2374507 5220755 403735 81 1 1 0 0 868322 868322 868322 Net Patient Revenue 621990 387721772 387721772 Ancillary Revenue 621300 1787067 1787067 Rental Income 900099 1535377 1535377 391044216 10192573 12539802 -2347229 -2347229 -2347229 115201 124139 -8938 -8938 -8938 TN Care Coverage Assmn 621990 14837456 14837456 Cafeteria/Vending Reve 722320 2080307 2080307 Medicaid Meaningful Us 900099 828223 828223 510505 510505 18256491 407812862 407220400 0 -275860 X 897755 897755 641766 577589 64177 92021487 82819338 9202149 2003558 1803202 200356 14155328 12739795 1415533 6746759 6072083 674676 64455656 54787308 9668348 359 359 -53019 -53019 9382 8444 938 42474640 38227176 4247464 28323 25491 2832 840024 756022 84002 228983 206085 22898 5608915 5048023 560892 56117 50505 5612 61231 55108 6123 7786522 7007870 778652 16588858 14929972 1658886 382648 344383 38265 Medical Supplies 76560079 76560079 0 0 TN Care Coverage Assmnt 28418877 28418877 0 0 Minor Equipment 1336685 1203017 133668 0 Maintenance & Repair 1067178 960460 106718 0 5820396 5238357 582039 368138507 338736939 29401568 0 2127 2326 39429571 46026800 4557436 5336567 351561 1402204 417760766 300883559 121605415 116877207 980399 938221 7302697 6497112 210341730 7782216 384570936 184862653 26819092 22353031 1126685 2719715 250229765 268870887 278175542 293943633 X 106395394 -109080980 0 0 106395394 -109080980 384570936 184862653 X 39674355 -255150729 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 9382 9382 0 Part II-B, Line 1: Lobbying expenses represent the portion of dues paid to national and state hospital associates that is specifically allocable to lobbying. Saint Thomas Midtown Hospital does not participate in or intervene in (including the publishing or distributing of statements) any political campaign on behalf of (or in opposition to) any candidate for public office. 457351 542 94297 4642 547548 258652 150943 58940 11184 457351 278117 260 -10597 9128 258652 255655 275 42030 19843 278117 242858 1597 34124 22924 255655 0.00000 0.57000 0.43000 0 1 1 10147749 10147749 71712382 50944448 20767934 509145 306854 202291 55236760 49281228 5955532 280154730 200351029 79803701 116877207 Est Settlements to Third Party Payors 6591067 Self-Insurance Liability 4009115 AH Savings Plan Liablity 1149813 Physician Guarantee Liability 591932 Intercompany Payables 10837161 Intercompany Debt to Ascension Health 241719652 Pension and Other Post Retirement Liab 1571837 Misc. Noncurrent Liabilities 2386686 Deferred Rent Liability 13624 268870887 X Part X, Line 2: From the consolidated audited financial statements of Ascension Health Alliance and its member organizations ("The System") which include the activity of Saint Thomas Midtown Hospital: The System accounts for uncertainty in income tax provisions 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, 2014. 1 1 X 1 X 1 X 1 1 1 0 1 1 12275049 12275049 0.03330 69473286 59974299 9498987 0.02580 81748335 59974299 21774036 0.05910 842421 431648 410773 0.00110 3601583 578203 3023380 0.00820 1043575 1043575 0.00280 5487579 1009851 4477728 0.01210 87235914 60984150 26251764 0.07120 20802 20802 0.00010 898 898 0.00000 21700 21700 0.00010 0 9069349 980397 80740588 87930614 -7190026 X 1 1 1 1 Saint Thomas Midtown Hospital 2000 Church Street Nashville TN 37203 https://www.sths.com/midtown 0000000032 X X X Saint Thomas Midtown Hospital 1 1 X X X X X X X X X 12 1 1 1 X Included in Section C, Line 5d X X X X X X X 1 0 1 1 200.000000000000 1 300.000000000000 1 X X X X X X 1 1 X X 1 0 X X X X 1 X 0 0 Saint Thomas Midtown Hospital Part V, Section B, Line 3: Input was received from individuals and groups who represented broad interests of the community through a community phone survey, interviews with community representatives and leaders, and a review of findings at a community health working summit. The CHNA process received input from those with special knowledge of or expertise in public health. The CHNA workgroup included those with experience in health policy advocacy, care of the un- and underinsured and public health training. The workgroup consulted with the local health department and social services departments, who provided input and resources for the CHNA. Stratasan was contracted as a consultant to provide coordination and analysis of a random community survey and facilitated a working community health summit to identify and prioritize health needs. For complete description of CHNA methodology and listing of individuals and organizations that provided input, please review the Hospital's CHNA online at: https://www.sths.com/SiteAssets/Pages/Community-Health-Needs-Assessment/2013_Davidson_CHNA.pdf Saint Thomas Midtown Hospital Part V, Section B, Line 4: The 2012 CHNA was conducted jointly with Saint Thomas Midtown Hospital, Saint Thomas Hospital for Spinal Surgery, Saint Thomas West Hospital, and Saint Thomas Health system representatives. Saint Thomas Midtown Hospital Part V, Section B, Line 5d: https://www.sths.com/SiteAssets/Pages/Community-Health-Needs-Assessment/2013_Davidson_CHNA.pdf Saint Thomas Midtown Hospital Part V, Section B, Line 6i: The implementation strategy may be found at: https://www.sths.com/Pages/Community/Community-Health-Needs-Assessment.aspx ST Midtown Hospital provided the following programs and donations during the tax year to address the CHNA priority needs identified:Need: Access to CarePrograms: Medical Mission at Home; Charity Care Post DischargeDonation: STH Safety Net Primary Care Clinics; Faith Family Medical Center; Room in the Inn; Linen Svc for Ronald McDonald House & Room in the InnNeed: Health Education & Practical ApplicationPrograms: Health Professions Education; Faith Community NursingDonation: Catholic CharitiesNeed: Mental & Dental HealthPrograms: Middle TN Oral Health CoalitionDonation: Hope Clinic for Women; Hope Smiles; Interfaith Dental ClinicNeed: Wellness/Obesity/FoodDonation: Nurses for NewbornsNeed: Exercise & SafetyDonation: Bicycle ProgramNeed: Economy/PovertyPrograms: Jobs in Healthcare; Maplewood Academies; MNPS-Workforce DevelopmentDonation: Charity BurialsSaint Thomas Health provided the following programs and donations during the tax year to address the CHNA priority needs identified:Need: Access to CarePrograms: Dispensary of Hope - Distribution Center; Dispensary of Hope Charitable Pharmacy - West; Medical Missions at Home; Safety Net Primary Care Clinics; Mobile MammographyNeed: Health Education & Practical ApplicationPrograms: Health Professions Education - CME Conferences; Health Professions Education - GME; Medical LibraryDonation: United WayNeed: Mental & Dental HealthDonation: Tennessee Suicide Prevention Network; Hope SmilesNeed: Wellness/Obesity/FoodDonation: The Governor's Foundation for Health and Wellness Saint Thomas Midtown Hospital Part V, Section B, Line 12i: We use presumptive scoring to identify charity accounts. Saint Thomas Midtown Hospital Part V, Section B, Line 14g: Signs are posted in waiting rooms and at the admissions offices to notify patients that the hospital has a financial assistance policy. In addition, every billing statement, the Hospital's website, and admission packets include information regarding the financial assistance policy. The policy is provided at the request of the patient. Saint Thomas Midtown Hospital Part V, Section B, Line 20d: The State of Tennessee legislates that billings cannot exceed 175% cost to charge on most recent Joint Annual Report. Other: For the hospital's complete Implementation Strategy, please review online at:https://www.sths.com/SiteAssets/Pages/Community-Health-Needs-Assessment/2013_Davidson_Implementation_Strategy.pdf Part I, Line 7: 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. Part II, Community Building Activities: Social determinates are the conditions of communities within which people live that effect their health and well-being and include housing, crime, poverty, education, discrimination, and others. Addressing the social determinates of health through community building is an important component in improving the contributing factors that determine the health of the community. Saint Thomas Midtown supports a variety of efforts and continues to work in collaboration with other community agencies to address the health and well-being of our community, especially the poor and vulnerable, including representation on community/non-profit boards and committees which work to improve the health and address its social determinates. Part III, Line 4: 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. After satisfaction of amounts due from insurance and reasonable efforts to collect from the patient have been exhausted, the System follows established guidelines for placing certain past-due patient balances with collection agencies, subject to the terms of certain restrictions on collection efforts as determined by the System. Accounts receivable are written off after collection efforts have been followed in accordance with the System's policies. Part III, Line 8: Saint Thomas Midtown Hospital follows 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. Part III, Line 9b: 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. Part VI, Line 2: Community Health Needs Assessment (CHNA) is conducted every three years, with the most recent conducted in fiscal year 2013. The CHNA was conducted jointly as noted above. The objectives of the CHNA and subsequent hospital specific implementation strategies were: 1. Provide an unbiased comprehensive assessment of Davidson County's health needs and assets; 2. Use the CHNA to prioritize the Saint Thomas Health Community Benefit Program strategy and 3. Fulfill Internal Revenue Service regulations related to 501(c)(3) non-profit hospital status for federal income taxes.For complete description of CHNA methodology, identification of priority needs, and findings, please review the Hospital's CHNA online at: https://www.sths.com/SiteAssets/Pages/Community-Health-Needs-Assessment/2013_Davidson_CHNA.pdfIn addition to the reported CHNA, the organization, Saint Thomas Health (STH), assesses the health needs of the communities it serves through representation on local health councils and non-profits addressing the needs of the underserved. Part VI, Line 3: Education of eligibility for assistance at Saint Thomas Midtown Hospital ("ST Midtown") begins at registration with signage displayed at all registration points notifying patients that we have a Financial Assistance Program, as well as contact information for the patient to use should they need assistance. Brochures containing this information are also available for patients at all registration points. ST Midtown registration associates discuss the estimated balance that will be due with both insured and self-pay patients. Should the associate identify that the patient may need assistance with that balance he/she will provide the patient with a Financial Assistance Application and help them complete it, if needed. All self-pay and underinsured patients are screened by ST Midtown for alternative coverage including Medicaid, SSI/SSD, COBRA, student coverage, and crime victims' compensation. If no alternative is identified, an associate will work with the patient to complete a Financial Assistance Application. Also, contact information is listed on ST Midtown billing statements for the patient to use in the event they need assistance with their balances, and collections associates have been trained to offer patients a Financial Assistance Application if needed by the patient. ST Midtown works with third party collection vendors who are required to follow the hospital's Financial Assistance Policy. Third party vendors are also used to perform "charity scoring," a process that screens incomplete Financial Assistance Applications to qualify patients for presumptive charity. Part VI, Line 4: Located in Nashville, Tennessee, Saint Thomas Midtown Hospital (ST Midtown), primarily serves residents of Davidson County and adjacent surrounding counties in Middle Tennessee. In calendar year 2013, over 80% of emergency room cases and over half of Tennessee inpatients originated within the county. ST Midtown served over 28,000 inpatients, including over 6,000 newborns.Davidson County is one of 95 counties within the state of Tennessee and is located in the Middle Tennessee region. Tennessee is located in the Southeastern region of the United States. Davidson County has urban, suburban and rural areas and encompasses 504 square miles, having a population density of 1,243.3 persons per square mile. United States Census Quick Facts for 2013 indicates an estimated population of 658,602. Community Demographic highlights include: 51.7% Female; 65.8% White; 28.1% African American; 7.0% Persons under 5 years; 10.9% Persons 65 years and over; 85.9% High school graduate or higher (% persons age 25+, 2008-2012); 23.1 minutes, mean travel time to work (2008-2012); $28,519 per capita money income in the past 12 months (2008-2012); $46,676 median household income (2008-2012); and 18.5% persons below poverty level (2008-2012). American Fact Finder, American Community Survey (2010-2012, 3 year estimate) notes, 17.2% of residents and 7.5% of children (ages 0-17), 22.8% ages 18-64, 1.5% 65 years and older, and 25.9% ages 19-25 in Davidson County were uninsured.According to the Tennessee Department of Health's Joint Annual Report of Hospitals, 2012, Davidson County has 15 hospitals: 10 General and Specialty Hospitals with a combined 3,129 staffed beds (3,754 licensed beds); One Mental Health Hospital with 195 staffed beds out of 300 licensed beds; and 4 Long Term hospitals with 183 staffed beds out of 187 licensed beds.There are areas designated as medically underserved within Davidson County. For a complete description of the community demographics and selection for CHNA purposes, please review the Hospital's CHNA online at: https://www.sths.com/SiteAssets/Pages/Community-Health-Needs-Assessment/2013_Davidson_CHNA.pdf Part VI, Line 5: The Saint Thomas Health's governing body is comprised of persons representing diverse aspects and interests of the community. The majority members of the Saint Thomas Health governing body reside in the organization's primary service who are neither employees nor independent contractors of the organization, nor family members thereof.-Medical Staff: The organization extends medical staff privileges to all qualified physicians in its community for some or all of its departments or specialties. -Patient care: ST Midtown operates an emergency room open to all persons, regardless of ability to pay. The hospital participates in Medicaid, Medicare, TennCare, CHAMPUS, Tricare, and other government sponsored health care programs. ST Midtown provides financial assistance and sliding scale discounts to those not covered by health insurance. -Saint Thomas Health Foundation: Patients and families also have access to the Irene and Melvin Lewis Fund which assists patients who are financially unable to provide for needed medical-related expenditures. There is also a fund available to employees of Saint Thomas Health who are experiencing hardship. This fund, the Sister Juliana Beurlein Employee Financial Assistance Fund offered system-wide over $90,000 in assistance in FY2014. STH Senior Leaders and associates participate as active board members of non-profit organizations whose mission aligns with community health improvement and addresses social determinates of health.-Medical Library: Medical Libraries are located on the campuses of Saint Thomas Midtown Hospital and Saint Thomas West Hospital. Librarians offer assistance in researching health information. Assistance is available to the broader community regardless of where medical care is obtained. In fiscal year 2014, Librarians assisted over 178 individuals, researching over 183 topics. (Community Health Need: Health Education)-Middle Tennessee Oral Health Coalition: A coalition of oral health stakeholders, formed to address the current oral health system and work towards a sustainable system of care for vulnerable populations in Middle TN. The coalition began in 2014, with the financial support of STH. STH advocacy and community health leaders participate in the coalition. (Community Health Need: Oral Health)-Health Professions Education: ST Midtown serves as a clinical site for students attending many of the area nursing and allied health schools. An average of 57 students per month had clinical training at the hospital in fiscal year 2014, with more than 21,000 hours of clinical instruction on the hospital campus during the year. (Community Health Need: Health Education and Access to Care)-Community Benefit Cash and In-Kind Contributions: ST Midtown supports a variety of efforts and continues to work in collaboration with other community agencies to address the health and well-being of our community, especially the poor and vulnerable, including: The hospital has provided access to its conference rooms at no charge to some community organizations whose programs align with its mission. -American Red Cross: ST Midtown hosts frequent blood drives in conjunction with the local American Red Cross. (Community Health Need: Access to Care)-Catholic Charities: Both ST West and ST Midtown Hospitals provide funds to support its work as the lead agency at the United Ways' South Nashville Family Resource Center to provide health education, access to healthy food and mental health services. This center is located next to one of STH safety net clinics. (Community Health Need: Wellness, Mental Health, Health Education and Access to Care)-Faith Family Medical Center: ST Midtown provides a building located on the hospital campus at no cost, for a primary care medical clinic which addresses the holistic health needs of the uninsured working poor. (Community Health Need: Access to Care and Health Education)-Hope Smiles: ST Midtown provides funds to support its mission to provide a safety net for dental care in the West Nashville area and to support its participation in the health systems three Medical Missions at Home events. (Community Health Need: Oral Health)-Interfaith Dental Clinic: ST Midtown provides funds to support its mission to provide oral health care and oral health education for uninsured, low-income working people, their families and the elderly. (Community Health Need: Oral Health and Health Education)-Hope Clinic for Women: ST Midtown provides funds to support its mission to equip women, men and families to make healthy choices with unplanned pregnancies, prevention, pregnancy loss and postpartum depression. (Community Health Need: Mental Health)-Nurses for Newborns: ST Midtown provides funds to support its mission to provide a safety net for families most at-risk, to help prevent infant mortality, child abuse and neglect through in-home nursing visits (up to 2 years) which provide healthcare, education and positive parenting skills. Additionally, ST Midtown works closely with Nurses for Newborns to promote a visit with a Nurses for Newborn representative for families prior to going home so that a relationship may be developed to ensure an easy transition. Various members of the hospital staff serve and have served on the Nurses for Newborns board. (Community Health Need: Wellness, Health Education, and Mental Health)-Room In The Inn: Both ST West and ST Midtown Hospitals provide funds to support its mission of support for persons experiencing homelessness. The funds are restricted to holistic support of homeless individuals who have experienced a recent hospitalization and who would benefit from a transitional supportive living environment, including navigation of the health care system and obtaining necessary mental health services. (Community Health Need: Access to Care)-Shared Linen services for Ronald McDonald House and Room In The Inn - Both ST Midtown and ST West Hospitals participate in cost sharing of linen expenses for two area non-profits, one which addresses needs of the homeless and one addressing temporary housing for families of hospitalized families. (Community Health Need: Access to Care) Part VI, Line 6: Ascension Health Alliance, d/b/a Ascension (Ascension), is a Missouri nonprofit corporation formed on September 13, 2011. Ascension is the sole corporate member and parent organization of Ascension Health, a Catholic national health system consisting primarily of nonprofit corporation that own and operate local healthcare facilities, or Health Ministries, located in 23 of the United States and the District of Columbia.Ascension is sponsored by Ascension Sponsor, a Public Juridic Person. The Participating Entities of Ascension Sponsor are the Daughters of Charity of St. Vincent de Paul, St. Louise Province; the Congregation of St. Joseph; the Congregation of the Sisters of St. Joseph of Carondelet; the Congregation of Alexian Brothers of the Immaculate Conception Province, Inc. American Province; and the Sisters of the Sorrowful Mother of the Third Order of St. Francis of Assisi US/Caribbean Province. As more fully described in the Organizational Changes note, Marian Health System, which was previously sponsored by the Sisters of the Sorrowful Mother of the Third Order of St. Francis of Assisi US/Caribbean Province, became part of Ascension Healthon April 1, 2013.Mission:The System directs its governance and management activities toward strong, vibrant, Catholic Health Ministries united in service and healing, and dedicates its resources to spiritually centered care which sustains and improves the health of the individuals and communities it serves. In accordance with the System's mission of service to those persons living in poverty and other vulnerable persons, each Health Ministry accepts patients regardless of their ability to pay. The System uses four categories to identify the resources utilized for the care of persons living in poverty and community benefit programs:-Traditional charity care includes the cost of services provided to persons who cannot afford healthcare because of inadequate resources and/or who are uninsured or underinsured. -Unpaid cost of public programs, excluding Medicare, represents the unpaid cost of services provided to persons covered by public programs for persons living in poverty and other vulnerable persons.-Cost of other programs for persons living in poverty and other vulnerable persons includes unreimbursed costs of programs intentionally designed to serve the persons living in poverty and other vulnerable persons of the community, including substance abusers, the homeless, victims of child abuse, and persons with acquired immune deficiency syndrome.-Community benefit consists of the unreimbursed costs of community benefit programs and services for the general community, not solely for the persons living in poverty, including health promotion and education, health clinics and screenings, and medical research.Discounts are provided to all uninsured patients, including those with the means to pay. Discounts provided to those patients who did not qualify for assistance under charity care guidelines are not included in the cost of providing care of persons living in poverty and other community benefit programs. The cost of providing care to persons living in poverty and other community benefit programs is estimated by reducing charges forgone by a factor derived from the ratio of each entity's total operating expenses to the entity's billed charges for patient care.Certain costs such as graduate medical education and certain other activities are excluded from total operating expenses for purposes of this computation. 1 Catholic Charities 1 Kimball Street Amsterdam NY 12010 350867980 501(c)(3) 8000 Provide funds to the United Ways' South Nashville Family Resource Center. Hope Clinic for Women 1810 Hayes Street Nashville TN 37203 621164825 501(c)(3) 10000 Provide funds to help women and families make health choices regarding pregnancies. Hope Smiles 115 Penn Warren Drive Suite 300-301 300-301 Brentwood TN 37027 260829468 501(c)(3) 31000 Provide funds for dental care and support for the Medical Missions at Home events in West Nashville. Interfaith Dental Clinic 1721 Patterson Street Nashville TN 37203 621567615 501(c)(3) 21600 Provide funds for oral health care and oral health education for underprivileged. Nurses for Newborns Foundation 50 Vantage Way Suite 101 Nashville TN 37228 431601329 501(c)(3) 55000 Provide funds to help prevent infant mortality, child abuse and neglect. Saint Thomas Network 4220 Harding Road Nashville TN 37205 621284994 501(c)(3) 709655 Donation to Clinic. Room in the Inn 705 Drexel Street Nashville TN 37203 620811413 501(c)(3) 62500 Provide funds to support persons experiencing homelessness. 7 0 Part I, Line 2: Organizations requesting grants are asked to submit a request in writing which identifies the community health need the grant will be addressing, along with goals and objectives. Requests are reviewed by the Saint Thomas Health Community Health & Benefit Committee prior to approval. Awarded grantees are asked to submit a report of program/even activities. It is requested the report include demographic summary of population benefited and achieved objectives and impact on health. The reports are reviewed by the Community Health & Benefit Team in a broad manner upon receipt, but will be more thoroughly scrutinized if the grant recipient comes back to ask for a renewal or another grant. 1 1 1 0 0 0 0 0 0 0 Michael Schatzlein MD President/CEO STHe 0 857096 0 830248 0 201224 0 7650 0 32262 0 1928480 0 0 Craig Polkow Vice-Chairman & CFO STHe 0 434821 0 0 0 4747 0 7650 0 22886 0 470104 0 0 Karen Springer Sec/Treasurer 0 570000 0 0 0 6074 0 7650 0 4857 0 588581 0 0 Bernard Sherry President/CEO 0 467815 0 0 0 38537 0 7650 0 20441 0 534443 0 0 Jennifer Elliot CNO/VP Clinical Opert.(beg 6/14) 189626 0 0 0 551 0 0 0 21384 0 211561 0 0 0 Pam Hess CFO (beg 6/14) 0 268755 0 0 0 1260 0 7317 0 16260 0 293592 0 0 Renee Kessler COO (end 6/14) 287397 0 0 0 51534 0 7650 0 18811 0 365392 0 0 0 Don King COO (beg 6/14) 0 273525 0 0 0 1275 0 7587 0 19484 0 301871 0 0 Retty Thomas-Mattu MD Physician 377322 0 55744 0 240 0 7650 0 19962 0 460918 0 0 0 Daniel Carmody MD Physician 339571 0 14288 0 200 0 7464 0 18930 0 380453 0 0 0 Dana Bannerman MD Physician 339523 0 13188 0 218 0 7271 0 17414 0 377614 0 0 0 Naved Mohyuddin Jr MD Physician 334088 0 15788 0 245 0 7311 0 19502 0 376934 0 0 0 Geoffrey Smallwood MD Physician 347894 0 0 0 7090 0 7650 0 22677 0 385311 0 0 0 Wesley Littrell Former Sec/Treasurer 0 10094 0 0 0 552094 0 0 0 8078 0 570266 0 0 Alan Strauss Former EVP/CFO 0 474049 0 58000 0 171141 0 21675 0 28612 0 753477 0 0 Part I, Line 3 Ascension Health, a related organization of Saint Thomas Midtown Hospital uses the following to establish the compensation of the organization's CEO: - Compensation Committee - Independent Compensation Consultant - Compensation Survey or Study - Approval by the Board or Compensation Committee Part I, Lines 4a-b Eligible executives participate in a program that provides for supplemental retirement benefits. The payment of benefits under the program, if any, is entirely dependent upon the facts and circumstances under which the executive terminates employment with the organization. Benefits under the program are unfunded and non-vested. Due to the substantial risk of forfeiture provision, there is no guarantee that these executives will ever receive any benefit under the program. Any amount ultimately paid under the program to the executive is reported as compensation on Form 990, Schedule J, Part II, Column B in the year paid. The following individuals received severance payments in the amount noted: Renee Kessler $45,729 Wesley Littrell $480,256 The following individuals received payments from the supplemental nonqualified retirement plan in the amount noted: Wesley Littrell $71,292 Michael Schatzlein $179,379 Bernard Sherry $32,256 Alan Strauss $8,236 Schedule J, Part II The 2013 compensation amounts shown for Alan Strauss were paid by a related organization. $8,236 of the compensation was paid for Mr. Strauss's services as the CFO of Saint Thomas Health. His remaining compensation was paid for services as the CFO of the related organization. X Fixed Assets 1 868322 Cost/Selling Price 0 0 0 0 Part I, Column (b): The number reported on Schedule M, Part I, Column b represents the number of contributors. Form 990, Part VI, Section A, line 2 Many of the persons listed on Part VII have a "business relationship" with each other by virtue of sitting on related Saint Thomas Health entity boards. Form 990, Part VI, Section A, line 6 Saint Thomas Midtown Hospital has a single corporate member, Saint Thomas Health. Form 990, Part VI, Section A, line 7a Saint Thomas Midtown Hospital has a single corporate member, Saint Thomas Health, who has the ability to elect members to the governing body of the Saint Thomas Midtown Hospital. Form 990, Part VI, Section A, line 7b All decisions that have a material impact to Saint Thomas Midtown Hospital financial information or corporation as a whole are subject to approval by its sole corporate member, Saint Thomas Health. Ascension Health, the sole corporate member of Saint Thomas Health, has designated a system authority matrix which assigns authority for key decisions that are necessary in the operation of the system. Specific areas that are identified in the authority matrix are: new organizations & major transactions; governing documents; appointments/removals; evaluation; debt limits; strategic & financial plans; assets; system policies & procedures. These areas are subject to certain levels of approval by Ascension per the system authority matrix. Form 990, Part VI, Section B, line 11 Management, including certain officers, works diligently to complete the Form 990 and attached schedules in a thorough manner. Prior to filing the return, all Board Members are provided the Form 990 and management team members are available to answer any Board Members' questions. Form 990, Part VI, Section B, line 12c The organization regularly and consistently monitors and enforces compliance with the conflict of interest policy in that any director, principal officer, or member of a committee with governing board delegated powers, who has a direct or indirect financial interest, must disclose the existence of the financial interest and be given the opportunity to disclose all material facts to the directors and members of the committees with governing board delegated powers considering the proposed transaction or arrangement. The remaining individuals on the governing board or committee will decide if conflicts of interest exist. Each director, principal officer and member of a committee with governing board delegated powers annually signs a statement which affirms such person has received a copy of the conflict of interest 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, Section B, line 15 In determining the compensation of the organization's CEO, the process, performed by Ascension Health, a related organization of Saint Thomas Midtown Hospital, included a review and approval by independent persons, comparability data and contemporaneous substantiation of the deliberation and decision. The Compensation Committee reviewed and approved the compensation. In the review of the compensation, the CEO was compared to individuals at other organizations in the area who hold the same title. During the review and approval of the compensation, documentation of the decision was recorded in the committee minutes. The individual was not present when his compensation was decided. In determining the compensation of other officers or key employees of the organization, the process, performed by Saint Thomas Health, a related organization, included a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision. The audit committee reviewed and approved the compensation. In the review of the compensation, the other officers or key employees of the organization were compared to other hospitals' employees in the area that hold the same title. During the review and approval of the compensation, documentation of the decision was recorded in the board minutes. Form 990, Part VI, Section C, line 19 The organization will provide any documents open to public inspection upon request. Form 990, Part VII, Section B Independent Contractor Reporting 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 IX, line 11g Dietary Purchase Services - Labor, Supplies, Other: Program service expenses 9,357,970. Management and general expenses 1,039,774. Fundraising expenses 0. Total expenses 10,397,744. Laundry Purchase Services - Labor, Supplies, Other: Program service expenses 1,189,740. Management and general expenses 132,193. Fundraising expenses 0. Total expenses 1,321,933. Medical Purchased Services - Labor, Equipment Rent, Other: Program service expenses 12,829,169. Management and general expenses 1,425,463. Fundraising expenses 0. Total expenses 14,254,632. TriMedx Purchased Services - Labor and Other: Program service expenses 6,659,195. Management and general expenses 739,911. Fundraising expenses 0. Total expenses 7,399,106. Other Purchase Services - Accounting/Billing/HR/Info Systems/Printing Copy: Program service expenses 1,125,978. Management and general expenses 125,109. Fundraising expenses 0. Total expenses 1,251,087. Physician Contracted Services: Program service expenses 7,065,124. Management and general expenses 785,014. Fundraising expenses 0. Total expenses 7,850,138. Form 990, Part XI, line 9: Deferred Pension Cost -99,313. Transfer to/from Affiliates -255,051,416. Ascension Health Alliance 4600 Edmunson Road St Louis MO 63134 453358926 National Health System MO section 501(c)(3) Schedule A, Line 11a N/A 0 Ascension Health PO Box 45998 St Louis MO 63134 311662309 National Health System MO Section 501(c)(3) Schedule A, Line 11a Ascension Health Alliance 0 Saint Thomas Health 4220 Harding Road Nashville TN 37205 581716804 System Parent TN Section 501(c)(3) Schedule A, Line 11c Ascension Health 0 Saint Thomas West Hospital 4220 Harding Road Nashville TN 37205 620347580 Hospital TN Section 501(c)(3) Schedule A, Line 3 Saint Thomas Health 1 Saint Thomas Network 4220 Harding Road Nashville TN 37205 621284994 Health Investment Entity TN Section 501(c)(3) Schedule A, Line 9 Saint Thomas Health 1 Saint Thomas Health Foundations PO Box 380 Nashville TN 37202 581663055 Operates Foundation TN Section 501(c)(3) Schedule A, Line 7 Saint Thomas Network 1 Covenant Care Inc 102 Woodmont Blvd Suite 800 Nashville TN 37205 621695737 Inactive TN Section 501(c)(3) Schedule A, Line 11a Saint Thomas Network 1 Saint Thomas Rutherford Hospital 1700 Medical Center Parkway Murfreesboro TN 37219 620475842 Hospital TN Section 501(c)(3) Schedule A, Line 3 Saint Thomas Health 1 Saint Thomas Rutherford Foundation fka Middle Tennessee Medical Center Fou 1700 Medical Center Parkway Murfreesboro TN 37219 621167917 Foundation TN Section 501(c)(3) Schedule A, Line 11a Saint Thomas Rutherford Hospital 1 Baptist Hospital Foundation of Nashville Inc 2000 Church Street Nashville TN 37236 581861378 Inactive TN Section 501(c)(3) Schedule A, Line 11a Saint Thomas Midtown Hospital 1 Baptist Health Care Affiliates Inc 2000 Church Street Nashville TN 37236 581509251 Community Health Promotion TN Section 501(c)(3) Schedule A, Line 11a Saint Thomas Network 1 Baptist Health Care Group 2000 Church Street Nashville TN 37236 621529858 Healthcare Provider TN Section 501(c)(3) Schedule A, Line 3 Saint Thomas Network 1 Saint Thomas Hickman Hospital 135 East Swan Street Centerville TN 37033 581737573 Hospital TN Section 501(c)(3) Schedule A, Line 3 Baptist Healthcare Affiliates Inc 1 Saint Thomas Home Care 135 East Swan Street Centerville TN 37033 621836937 Home Health Care TN Section 501(c)(3) Schedule A, Line 9 Saint Thomas Hickman Hospital 1 Baptist Womens Health Center LLC 1900 Church Street Suite 300 Nashville TN 37203 621772195 Owns and Operates Specialty Hospital TN N/A Middle Tennessee Ambulatory Surgery Center LP 500 N Highland Ave Murfreesboro TN 37130 Operates Outpatient Surgery Center TN N/A St Thomas Research Institute LLC Cardiology Series 102 Woodmont Boulevard Nashville TN 37205 264591782 Cardiology Research TN N/A STHS Sleep Center LLC 102 Woodmont Suite 800 Nashville TN 37205 203664894 Operates a Sleep Center TN N/A Baptist Surgery Center LP 1900 Church Street Suite 300 Nashville TN 37203 Operates Outpatient Surgery Center TN N/A Middle Tennessee Imaging LLC 400 N Highland Avenue Murfreesboro TN 37219 010570490 Diagnostic Imaging Center TN N/A RADS of America PO Box 249 Goodlettsville TN 37070 Ambulatory Surgery Center TN N/A Murfreedboro Diagnostic Imaging LLC 400 N Highland Avenue Murfreesboro TN 37219 200291952 Diagnostic Imaging Center TN N/A Sova Inc 102 Woodmont Boulevard Suite 700 Nashville TN 37205 261319638 Health Services TN N/A C 0 Baptist Health Care Ventures Inc 2000 Church Street Nashville TN 37236 620469214 Holding Company TN Saint Thomas Midtown Hospital C 952000 1.00000 1 MissionPoint Health Partners 102 Woodmont Boulevard Suite 700 Nashville TN 37205 452958482 Accountable Care Organization TN N/A C 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 Saint Thomas Network B 709655 Actual Amount Transferred Saint Thomas Health Foundations C 868322 Actual Amount Transferred Baptist Health Care Affiliates Inc R 3818168 Actual Amount Transferred Baptist Health Care Ventures Inc S 578904 Actual Amount Transferred Baptist Health Care Group R 39315483 Actual Amount Transferred Baptist Health Care Affiliates Inc S 155381 Actual Amount Transferred Saint Thomas Network S 12325 Actual Amount Transferred Saint Thomas Hickman Hospital S 14679045 Actual Amount Transferred Saint Thomas Rutherford Hospital S 1834890 Actual Amount Transferred Saint Thomas Network S 12965039 Actual Amount Transferred Saint Thomas Research Institute LLC Cardiology Series S 54576 Actual Amount Transferred Saint Thomas Health R 536127997 Actual Amount Transferred Saint Thomas Health Foundations S 263282 Actual Amount Transferred Saint Thomas West Hospital S 825203772 Actual Amount Transferred Saint Thomas Health R 1390678 Actual Amount Transferred MissionPoint Health Partners R 118397 Actual Amount Transferred Ascension Health Alliance S 163644 Actual Amount Transferred Ascension Health S 319964 Actual Amount Transferred