ST MARYS WARRICK HOSPITAL INC: Form 990, tax year 2013
View the entire original 990 at ProPublica ↗
- Organization
- ST MARYS WARRICK HOSPITAL INC (EIN 35-1343019)
- Tax period
- 2013-07-01 to 2014-06-30
- Filed
- 2015-05-13
- IRS object ID
- 201511339349306356
- Schema version
- 2013v4.0
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule H
- Schedule I
- Schedule J
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2015-05-13T22:28:21-05:00 | ReturnTs |
| Tax Period End | 2014-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 861065772 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DELOITTE TAX LLP | BusinessNameLine1 |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 111 MONUMENT CIRCLE SUITE 2000 | AddressLine1 |
| City | INDIANAPOLIS | City |
| State | IN | State |
| ZIP Code | 46204 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2013-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 351343019 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ST MARY'S WARRICK HOSPITAL INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | WARR | BusinessNameControlTxt |
| Phone | 8124854178 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1116 MILLIS AVENUE | AddressLine1 |
| City | BOONVILLE | City |
| State | IN | State |
| ZIP Code | 47601 | ZIPCode |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | JOHN L ZABROWSKI | PersonNm |
| Person Title | CHIEF FINANCIAL OFFICER | PersonTitleTxt |
| Phone | 8124854178 | PhoneNum |
| Signature | 2015-05-13 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | SHAWNA M JIMENEZ | PreparerPersonNm |
| PTIN | P01222873 | PTIN |
| Phone | 3174648600 | PhoneNum |
| Preparation | 2015-05-01 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2013 | TaxYr |
| Build TS | 2016-02-25 16:41:14Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | KEITH JEWELL | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1116 MILLIS AVENUE | AddressLine1 |
| City | BOONVILLE | City |
| State | IN | State |
| ZIP Code | 47601 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $17,640,432 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.STMARYS.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1971 | FormationYr |
| Legal Domicile State | IN | LegalDomicileStateCd |
| Activity Or Mission | ST. MARY'S WARRICK HOSPITAL, INC. IS A CRITICAL ACCESS HOSPITAL IN RURAL WARRICK COUNTY. THE HOSPITAL PROVIDES ACUTE CARE AND OUTPATIENT SERVICES TO PERSONS REGARDLESS OF ABILITY TO PAY. | ActivityOrMissionDesc |
| Voting Members Governing Body | 8 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 4 | VotingMembersIndependentCnt |
| Total Employee | 201 | TotalEmployeeCnt |
| Total Volunteers | 11 | TotalVolunteersCnt |
| Total Gross UBI | $9,486 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $0 | PYContributionsGrantsAmt |
| CY Contributions Grants | $2,448,222 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $13,889,155 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $14,406,338 | CYProgramServiceRevenueAmt |
| PY Investment Income | -$12,473 | PYInvestmentIncomeAmt |
| CY Investment Income | $10,617 | CYInvestmentIncomeAmt |
| PY Other Revenue | $434,182 | PYOtherRevenueAmt |
| CY Other Revenue | $775,255 | CYOtherRevenueAmt |
| PY Total Revenue | $14,310,864 | PYTotalRevenueAmt |
| CY Total Revenue | $17,640,432 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $472,671 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $7,557,463 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $6,680,899 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $8,520,311 | PYOtherExpensesAmt |
| CY Other Expenses | $7,791,974 | CYOtherExpensesAmt |
| PY Total Expenses | $16,077,774 | PYTotalExpensesAmt |
| CY Total Expenses | $14,945,544 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$1,766,910 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $2,694,888 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $8,761,028 | TotalAssetsBOYAmt |
| Total Assets EOY | $13,424,983 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $10,744,533 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $12,772,372 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | -$1,983,505 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $652,611 | NetAssetsOrFundBalancesEOYAmt |
| Mission | ST. MARY'S WARRICK HOSPITAL, INC. IS A CRITICAL ACCESS HOSPITAL IN RURAL WARRICK COUNTY. THE HOSPITAL PROVIDES ACUTE CARE AND OUTPATIENT SERVICES TO PERSONS REGARDLESS OF ABILITY TO PAY. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $8,183,022 | ExpenseAmt |
| Grant | $472,671 | GrantAmt |
| Revenue | $14,398,492 | RevenueAmt |
| Desc | ST. MARY'S WARRICK HOSPITAL, INC. (SMW) IS A NOT-FOR-PROFIT GENERAL SHORT-TERM CRITICAL ACCESS HOSPITAL SERVING WARRICK, POSEY, SPENCER, AND OTHER RURAL POPULATED COUNTIES SURROUNDING THE AREA WITHOUT REGARD TO PATIENT RACE, CREED, NATIONAL ORIGIN, ECONOMIC STATUS, OR ABILITY TO PAY. DURING THE FISCAL YEAR ENDING JUNE 30, 2014, THE HOSPITAL PROVIDED HEALTHCARE TO 740 PATIENTS IN THE COMMUNITY FOR A TOTAL OF 5,777 PATIENT DAYS OF SERVICE. ADDITIONALLY, THE HOSPITAL ALSO PROVIDED SERVICES TO 18,516 OUTPATIENTS, INCLUDING 225 OUTPATIENT SURGERY SERVICES AND 7,198 EMERGENCY ROOM VISITS. SEE SCHEDULE H FOR A NON-EXHAUSTIVE LIST OF COMMUNITY BENEFIT PROGRAMS AND DESCRIPTIONS. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $2,676,693 | ExpenseAmt |
| Desc | SMW PROVIDES A SUBSTANTIAL PORTION OF ITS CORE HEALTH SERVICES TO THE POOR, UNINSURED, OR UNDERINSURED AND HAS PROACTIVELY TAKEN STEPS TO ADDRESS ACCESSIBILITY, AND THE FINANCING, AND DELIVERY OF HEALTHCARE TO THE UNDERSERVED. DURING THE FISCAL YEAR ENDING JUNE 30, 2014, THE UNREIMBURSED COST OF FREE OR DISCOUNTED SERVICES PROVIDED TO PATIENTS WHO WERE DEEMED INDIGENT UNDER STATE, COUNTY, OR HOSPITAL GUIDELINES WAS $2,676,693 WHICH INCLUDED $259,098 OF TRADITIONAL FINANCIAL ASSISTANCE AND $2,417,595 IN UNPAID COSTS OF CARE FOR THOSE QUALIFYING FOR MEDICAID OR OTHER PUBLIC PROGRAMS FOR THE POOR. SEE SCHEDULE H FOR A NON-EXHAUSTIVE LIST OF COMMUNITY BENEFIT PROGRAMS AND DESCRIPTIONS. | Desc |
Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $23,514 | ExpenseAmt |
| Desc | IN ADDITION TO CORE MEDICAL SERVICES, SMW AND COMMUNITY PARTNERS ASSESS COMMUNITY ASSETS AND NEEDS AND WORK TOGETHER TO ADDRESS ISSUES IMPACTING HEALTH AND QUALITY OF LIFE, WITH SPECIAL EMPHASIS ON THE POOR AND VULNERABLE. IN FISCAL YEAR 2014, SMW PROVIDED $23,514 IN UNBILLED SERVICES TO THE POOR AND TO THE BROADER COMMUNITY. (WHEN COMBINED WITH THE COSTS OF FREE OR DISCOUNTED SERVICES FOR THE POOR LISTED IN LINE 4B, SMW PROVIDED A TOTAL COMMUNITY BENEFIT OF $2,700,207 IN FISCAL YEAR 2014.) SMW SERVES AND SUPPORTS ITS COMMUNITY THROUGH SUCH PROGRAMS AS HEALTH FAIRS AND SCREENINGS, TRANSPORTATION FOR PATIENT AT NO COST TO PATIENT, AS WELL AS VARIOUS COMMUNITY SUPPORT GROUPS. SEE SCHEDULE H FOR A NON-EXHAUSTIVE LIST OF COMMUNITY BENEFIT PROGRAMS AND DESCRIPTIONS. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expenses | $10,883,229 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (1) | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Temp Or Permanent Endowments | 0 | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (1) | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | Yes (1) | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | Yes (1) | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (1) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | Yes (1) | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 28 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 201 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | Yes (1) | UnrelatedBusIncmOverLimitInd |
| Form990 T Filed | Yes (1) | Form990TFiledInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 8 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 4 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | 0 | CompensationProcessCEOInd |
| Compensation Process Other | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | Yes (1) | InvestmentInJointVentureInd |
| Written Policy Or Procedure | Yes (1) | WrittenPolicyOrProcedureInd |
| States Where Copy Of Return Is Fld | IN | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | JOHN L ZABROWSKI | PersonNm |
| Phone | 8124854178 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3700 WASHINGTON AVENUE | AddressLine1 |
| City | EVANSVILLE | City |
| State | IN | State |
| ZIP Code | 47750 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionAGrp (17 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd | Former Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd |
|---|---|---|---|---|---|---|---|---|---|
| GWEN SANDEFUR | |||||||||
| BOARD MEMBER | 1.00 | 64.20 | Yes (X) | $0 | $396,534 | $25,108 | |||
| JAMES MOONEY MD | |||||||||
| BOARD MEMBER | 55.00 | 1.00 | Yes (X) | $120,479 | $0 | $12,483 | |||
| JERRY AIGNER | |||||||||
| BOARD MEMBER | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| KATHY HALL | |||||||||
| BOARD MEMBER | 1.00 | 57.00 | Yes (X) | $0 | $213,081 | $28,541 | |||
| LAURENCE STEENBERG THRU 112013 | |||||||||
| VICE CHAIR | 1.00 | 2.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | ||
| LLOYD MCGINNIS MD | |||||||||
| BOARD MEMBER | 1.00 | 57.00 | Yes (X) | $0 | $185,802 | $9,832 | |||
| MICHAEL HERRELL MD | |||||||||
| CHAIR | 1.00 | 5.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | ||
| SALLY RIDEOUT | |||||||||
| BOARD MEMBER | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| SISTER JANE BURGER THRU 72013 | |||||||||
| BOARD MEMBER | 1.00 | 2.00 | Yes (X) | $0 | $0 | $0 | |||
| TIMOTHY FLESCH THRU 122013 | |||||||||
| SECRETARY/TREASURER | 1.00 | 70.20 | Yes (X) | $0 | $1,661,825 | $23,492 | Yes (X) | ||
| JUDGE DONALD HENDRICKSON | |||||||||
| BOARD MEMBER | 1.00 | 2.00 | Yes (X) | $0 | $0 | $0 | |||
| JOSEL MIJARES MD | |||||||||
| PHYSICIAN | 55.00 | 0.00 | $141,576 | $0 | $0 | Yes (X) | |||
| DAVID VAUGHN MD | |||||||||
| PHYSICIAN | 55.00 | 0.00 | $289,772 | $0 | $28,386 | Yes (X) | |||
| PETER ROSARIO MD | |||||||||
| PHYSICIAN | 55.00 | 0.00 | $333,156 | $0 | $7,835 | Yes (X) | |||
| THOMAS MILLER MD | |||||||||
| PHYSICIAN | 55.00 | 0.00 | $235,585 | $0 | $10,674 | Yes (X) | |||
| TIMOTHY LABELLE MD | |||||||||
| PHYSICIAN | 55.00 | 0.00 | $215,207 | $0 | $12,084 | Yes (X) | |||
| CAROL GODSEY | |||||||||
| FORMER OFFICER | 0.00 | 0.00 | $199,803 | $0 | $5,000 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,535,578 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $2,457,242 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $163,435 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 7 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | Yes (1) | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1 | CityContractorAddress/USAddress/City | StateContractorAddress/USAddress/State | ZIP CodeContractorAddress/USAddress/ZIPCode | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| HORIZON HEALTH | |||||
| PO BOX 840839 | DALLAS | TX | 75284 | MANAGEMENT SERVICES | $441,988 |
| KENNETH PARKER MD | |||||
| PO BOX 129 | INGLEFIELD | IN | 47618 | MEDICAL SERVICE | $214,000 |
| CYBERACOUSTIC LABS LTD | |||||
| 14019 ECHO HILL TRAIL | LOUISVILLE | KY | 40299 | MEDICAL SERVICE | $157,472 |
| MEDICAL STAFFING SOLUTIONS | |||||
| 8601 N KENTUCKY AVE SUITE A | EVANSVILLE | IN | 47725 | MEDICAL SERVICE | $156,363 |
| CPSI | |||||
| 6600 WALL STREET | MOBILE | AL | 36695 | HEALTHCARE INFORMATION MANAGEMENT | $154,219 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 5 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $2,448,222 | RelatedOrganizationsAmt |
| Total Contributions | $2,448,222 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt | Unrelated Business RevenueUnrelatedBusinessRevenueAmt |
|---|---|---|---|---|
| INPATIENT REVENUE | 621990 | $10,114,747 | $10,114,747 | |
| OUTPATIENT REVENUE | 621990 | $4,282,105 | $4,282,105 | |
| REFERENCE LAB FEES | 541380 | $9,486 | $9,486 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $14,406,338 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $10,617 | TotalRevenueColumnAmt |
| Exclusion | $10,617 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $96,275 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $96,275 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $96,275 | TotalRevenueColumnAmt |
| Exclusion | $96,275 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | ExclusionExclusionAmt |
|---|---|---|---|
| JAIL CLINIC | 621990 | $81,547 | $81,547 |
| VENDING MACHINE/CAFETERIA | 900099 | $35,107 | $35,107 |
| EXERCISE PROGRAM/GYM MEMBERSHIP | 713940 | $21,171 | $21,171 |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $541,155 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $1,640 | RelatedOrExemptFuncIncomeAmt |
| Exclusion | $539,515 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $678,980 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $17,640,432 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $14,398,492 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $9,486 | UnrelatedBusinessRevenueAmt |
| Exclusion | $784,232 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $472,671 | TotalAmt |
| Program Services | $472,671 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $132,962 | TotalAmt |
| Management And General | $132,962 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,499,410 | TotalAmt |
| Program Services | $4,866,049 | ProgramServicesAmt |
| Management And General | $633,361 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $679,301 | TotalAmt |
| Program Services | $586,877 | ProgramServicesAmt |
| Management And General | $92,424 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $369,226 | TotalAmt |
| Program Services | $318,990 | ProgramServicesAmt |
| Management And General | $50,236 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $113,947 | TotalAmt |
| Program Services | $108,147 | ProgramServicesAmt |
| Management And General | $5,800 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,942 | TotalAmt |
| Management And General | $2,942 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $147,329 | TotalAmt |
| Program Services | $63,506 | ProgramServicesAmt |
| Management And General | $83,823 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $180,520 | TotalAmt |
| Program Services | $3,616 | ProgramServicesAmt |
| Management And General | $176,904 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $405,982 | TotalAmt |
| Program Services | $350,745 | ProgramServicesAmt |
| Management And General | $55,237 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,177 | TotalAmt |
| Program Services | $3,613 | ProgramServicesAmt |
| Management And General | $1,564 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,860 | TotalAmt |
| Program Services | $6,249 | ProgramServicesAmt |
| Management And General | $1,611 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $156,279 | TotalAmt |
| Management And General | $156,279 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $703,440 | TotalAmt |
| Management And General | $703,440 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $9,312 | TotalAmt |
| Management And General | $9,312 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| PURCHASED SERVICES | $2,511,752 | $863,858 | $1,647,894 |
| PROVIDER TAX EXPENSE | $1,276,768 | $1,276,768 | |
| MEDICAL FEES | $1,205,657 | $1,205,657 | |
| MEDICAL SUPPLIES | $608,680 | $608,680 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $456,329 | TotalAmt |
| Program Services | $147,803 | ProgramServicesAmt |
| Management And General | $308,526 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $14,945,544 | TotalAmt |
| Program Services | $10,883,229 | ProgramServicesAmt |
| Management And General | $4,062,315 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $226,008 | BOYAmt |
| EOY | $311,403 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,990,633 | BOYAmt |
| EOY | $1,660,876 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $155,851 | BOYAmt |
| EOY | $159,226 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $51,404 | BOYAmt |
| EOY | $14,341 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $19,558,870 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $14,424,603 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,532,755 | BOYAmt |
| EOY | $5,134,267 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $13,470 | BOYAmt |
| EOY | $12,825 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $377,153 | BOYAmt |
| EOY | $308,580 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $413,754 | BOYAmt |
| EOY | $5,823,465 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,761,028 | BOYAmt |
| EOY | $13,424,983 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,131,338 | BOYAmt |
| EOY | $3,601,115 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,613,195 | BOYAmt |
| EOY | $9,171,257 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,744,533 | BOYAmt |
| EOY | $12,772,372 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -$1,983,505 | BOYAmt |
| EOY | $652,611 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -$1,983,505 | BOYAmt |
| EOY | $652,611 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,761,028 | BOYAmt |
| EOY | $13,424,983 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $2,694,888 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $8,463 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | -$67,235 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | VolunteersInd |
| Paid Staff Or Management | 0 | PaidStaffOrManagementInd |
| Media Advertisements | 0 | MediaAdvertisementsInd |
| Mailings Members | 0 | MailingsMembersInd |
| Publications Or Broadcast | 0 | PublicationsOrBroadcastInd |
| Grants Other Organizations | 0 | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | 0 | DirectContactLegislatorsInd |
| Rallies Demonstrations | 0 | RalliesDemonstrationsInd |
| Other Activities | Yes (1) | OtherActivitiesInd |
| Other Activities | $256 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $256 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | 0 | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART II-B, LINE 1: | FormAndLineReferenceDesc |
| Explanation | LOBBYING EXPENSES REPRESENT THE PORTION OF DUES PAID TO NATIONAL AND STATE HOSPITAL ASSOCIATIONS THAT IS SPECIFICALLY ALLOCABLE TO LOBBYING. ST. MARY'S WARRICK HOSPITAL, INC. DOES NOT PARTICIPATE IN OR INTERVENE IN (INCLUDING THE PUBLISHING OR DISTRIBUTING OR STATEMENTS) ANY POLITICAL CAMPAIGN ON BEHALF OF (OR IN OPPOSITION TO) ANY CANDIDATE FOR PUBLIC OFFICE. | ExplanationTxt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $181,810 | OtherCostOrOtherBasisAmt |
| Book Value | $181,810 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $11,599,858 | OtherCostOrOtherBasisAmt |
| Depreciation | $7,882,139 | DepreciationAmt |
| Book Value | $3,717,719 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $14,267 | OtherCostOrOtherBasisAmt |
| Depreciation | $14,267 | DepreciationAmt |
| Book Value | $0 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $7,499,503 | OtherCostOrOtherBasisAmt |
| Depreciation | $6,266,171 | DepreciationAmt |
| Book Value | $1,233,332 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $263,432 | OtherCostOrOtherBasisAmt |
| Depreciation | $262,026 | DepreciationAmt |
| Book Value | $1,406 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $5,134,267 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp (9 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| RECEIVABLE FROM 3RD PARTY PROGRAM | $595,915 |
| AH DEFERRED COMPENSATION | $11,189 |
| OTHER CURRENT ASSETS | $250,275 |
| DUE FROM ST. MARY'S MEDICAL CENTER FOUNDATION OF EVANSVILLE, INC. | $150 |
| INTEREST IN INVESTMENTS HELD BY ASCENSION HEALTH ALLIANCE | $752,403 |
| PHYSICIAN GUARANTEE | $4,134,775 |
| DUE FROM ST. MARY'S MEDICAL CENTER OF EVANSVILLE, INC. | $65,854 |
| ST. MARY'S MEDICAL GROUP, LLC | $10,114 |
| ST. MARY'S WARRICK EMERGENCY MEDICAL SERVICES, INC. | $2,790 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $5,823,465 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (5 entries)
| DescDesc | AmtAmt |
|---|---|
| INTERCOMPANY DEBT WITH ASCENSION HEALTH ALLIANCE | $3,649,635 |
| PENSION LIABILITY | $659,579 |
| INTERCOMPANY TO ST. MARY'S MEDICAL CENTER | $716,079 |
| DEFERRED COMPENSATION | $11,189 |
| PHYSICIAN GUARANTEE | $4,134,775 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $9,171,257 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART X, LINE 2: | FormAndLineReferenceDesc |
| Explanation | 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, 2014. | ExplanationTxt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent200 | Yes (X) | Percent200Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
| Percent300 | Yes (X) | Percent300Ind |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | 0 | ExpensesExceedBudgetInd |
| Annual Community Bnft Report | Yes (1) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (1) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $259,098 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $259,098 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01730 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,256,915 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $839,320 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,417,595 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.16180 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,516,013 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $839,320 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,676,693 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.17910 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 2738 | PersonsServedCnt |
| Total Community Benefit Expns | $2,738 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $2,738 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00020 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 835 | PersonsServedCnt |
| Total Community Benefit Expns | $20,776 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $20,776 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00140 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 3573 | PersonsServedCnt |
| Total Community Benefit Expns | $23,514 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $23,514 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00160 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 3573 | PersonsServedCnt |
| Total Community Benefit Expns | $3,539,527 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $839,320 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,700,207 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.18070 | TotalExpensePct |
Community Support CommunitySupportGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 154 | PersonsServedCnt |
| Total Community Benefit Expns | $700 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $700 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Coalition Building CoalitionBuildingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 85 | PersonsServedCnt |
| Total Community Benefit Expns | $200 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $200 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 239 | PersonsServedCnt |
| Total Community Benefit Expns | $900 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $900 | NetCommunityBenefitExpnsAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReportedInd |
| Bad Debt Expense | $895,947 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $89,595 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $6,272,262 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $6,334,984 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$62,722 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ST MARY'S WARRICK HOSPITAL INC | BusinessNameLine1 |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1116 MILLIS AVENUE | AddressLine1 |
| City | BOONVILLE | City |
| State | IN | State |
| ZIP Code | 47601 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | WWW.STMARYS.ORG/WARRICK | WebsiteAddressTxt |
| State License | 15-005111-1 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ST MARY'S WARRICK HOSPITAL INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Information Gaps | Yes (X) | InformationGapsInd |
| CHNA Conducted | 12 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | Yes (1) | CHNAConductedWithOtherFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | HTTP://WWW.STMARYS.ORG/CHNA | OwnWebsiteURLTxt |
| Rpt Available Upon Request | Yes (X) | RptAvailableUponRequestInd |
| Adopt Implementation Strategy | Yes (X) | AdoptImplementationStrategyInd |
| Exec Implementation Strategy | Yes (X) | ExecImplementationStrategyInd |
| Develop Community Wide Plan | Yes (X) | DevelopCommunityWidePlanInd |
| Exec Community Wide Plan | Yes (X) | ExecCommunityWidePlanInd |
| Include Operational Plan | Yes (X) | IncludeOperationalPlanInd |
| Prioritize Health Needs | Yes (X) | PrioritizeHealthNeedsInd |
| Prioritize Services | Yes (X) | PrioritizeServicesInd |
| All Needs Addressed | 0 | AllNeedsAddressedInd |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Used Deter Elig Free Care | Yes (1) | FPGUsedDeterEligFreeCareInd |
| FPG Family Incm Lmt Free Care | 200.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Used Determ Elig Dscnt Care | Yes (1) | FPGUsedDetermEligDscntCareInd |
| FPG Family Incm Lmt Dscnt Care | 300.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| Income Level | Yes (X) | IncomeLevelInd |
| Asset Level | Yes (X) | AssetLevelInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| Attached To Invoice | Yes (X) | AttachedToInvoiceInd |
| Posted In Emergency Room | Yes (X) | PostedInEmergencyRoomInd |
| Posted In Admission Office | Yes (X) | PostedInAdmissionOfficeInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| FAP Notified Upon Admission | Yes (X) | FAPNotifiedUponAdmissionInd |
| FAP Notified Before Discharge | Yes (X) | FAPNotifiedBeforeDischargeInd |
| FAP Notified All Patients | Yes (X) | FAPNotifiedAllPatientsInd |
| Documented Elig Determination | Yes (X) | DocumentedEligDeterminationInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Other Method Used | Yes (X) | OtherMethodUsedInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART V, SECTION B, LINE 3: | IN CONDUCTING ITS CHNA, THE HOSPITAL FACILITY TOOK INTO ACCOUNT INPUT FROM PERSONS WHO REPRESENT THE BROAD INTERESTS OF THE COMMUNITY SERVED BY THE HOSPITAL FACILITY AS WELL AS PROFESSIONAL RESEARCH CONSULTANTS, INC., A CONSULTING COMPANY THAT HAS SPECIAL KNOWLEDGE AND EXPERTISE IN PUBLIC HEALTH.THE HOSPITAL FACILITY CONSULTED WITH THESE PERSONS THROUGH MEETINGS AND FOCUS GROUPS.ADDITIONALLY, THE HOSPITAL CONSULTED WITH THE FOLLOWING ORGANIZATIONS AND GROUPS IN CONDUCTING ITS MOST RECENT CHNA: ECHO, UNITED WAY, WELBORN BAPTIST FOUNDATION, SMOKE FREE COMMUNITIES, YMCA, DIEHL CONSULTING, THE CITY OF EVANSVILLE'S MAYOR'S OFFICE, SOUTHWEST MENTAL HEALTH, BRENTWOOD MEADOWS, CROSSPOINTE, EVANSVILLE-VANDERBURGH DRUG TASK FORCE, WARRICK CO. SHERIFF DEPARTMENT, VANDERBURGH CO. SHERIFF DEPARTMENT, YOUTH FIRST, EVANSVILLE STATE HOSPITAL, LAMPION CENTER, WARRICK PSYCHIATRIC CARE AND THE CHILDREN'S PSYCHIATRIC HOSPITAL. |
| PART V, SECTION B, LINE 4: | THE OTHER HOSPITAL FACILITIES WITH WHICH THE REPORTING HOSPITAL FACILITY CONDUCTED ITS CHNA INCLUDES ST. MARY'S MEDICAL CENTER OF EVANSVILLE, INC., DEACONESS HOSPITAL, DEACONESS GATEWAY, DEACONESS CROSSPOINTE, AND THE WOMEN'S HOSPITAL. |
| PART V, SECTION B, LINE 7: | THE HOSPITAL FACILITY'S COMMUNITY HEALTH NEEDS ASSESSMENT IDENTIFIED ACCESS TO CARE, ORAL HEALTH, MENTAL HEALTH AND EDUCATION TRAINING AS NEEDS OF THE COMMUNITY. THE HOSPITAL FACILITY DID NOT TAKE ACTION TO ADDRESS THESE NEEDS AS IT HAS LIMITED FINANCIAL AND OTHER RESOURCES. |
| PART V, SECTION B, LINE 20D: | 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. |
Supplemental Information Detail SupplementalInformationDetail (13 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 3C: | THE ORGANIZATION PROVIDES MEDICALLY NECESSARY CARE TO ALL PATIENTS, REGARDLESS OF RACE, COLOR, CREED, ETHNIC ORIGIN, GENDER, DISABILITY, OR ECONOMIC STATUS. THE HOSPITAL USES A PERCENTAGE OF FEDERAL POVERTY LEVEL (FPL) TO DETERMINE FREE AND DISCOUNTED CARE. AT A MINIMUM, PATIENTS WITH INCOME LESS THAN OR EQUAL TO 200% OF THE FPL, WILL BE ELIGIBLE FOR 100% CHARITY CARE WRITE OFF OF CHARGES FOR SERVICES THAT HAVE BEEN PROVIDED TO THEM. ALSO, AT A MINIMUM, PATIENTS WITH INCOMES ABOVE 200% OF THE FPL BUT NOT EXCEEDING 300% OF THE FPL, ARE ELIGIBLE TO RECEIVE A DISCOUNT ON THE SERVICES PROVIDED TO THEM. |
| 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 AN ACCOUNTING SYSTEM THAT ADDRESSES ALL PATIENT SEGMENTS (FOR EXAMPLE, INPATIENT, OUTPATIENT, EMERGENCY ROOM, PRIVATE INSURANCE, MEDICAID, MEDICARE, UNINSURED, OR SELF PAY). THE BEST AVAILABLE DATA WAS USED TO CALCULATE THE AMOUNTS REPORTED IN THE TABLE. FOR THE INFORMATION IN THE TABLE, A COST-TO-CHARGE RATIO WAS CALCULATED AND APPLIED. |
| PART II, COMMUNITY BUILDING ACTIVITIES: | WHILE MOST OF ST. MARY'S WARRICK HOSPITAL, INC.'S COMMUNITY BENEFIT ACTIVITIES DIRECTLY IMPACT THE HEALTH OF ITS COMMUNITIES, ST. MARY'S WARRICK HOSPITAL, INC. ALSO INVESTS IN COMMUNITY BUILDING ACTIVITIES THAT INDIRECTLY IMPROVE HEALTH BY IMPROVING QUALITY OF LIFE WITHIN THE COMMUNITY. RESEARCH HAS ESTABLISHED THAT FACTORS SUCH AS ECONOMIC STATUS, EMPLOYMENT, HOUSING, EDUCATION LEVEL, AND BUILT ENVIRONMENT CAN ALL BE POWERFUL SOCIAL DETERMINANTS OF HEALTH. ADDITIONALY, HELPING TO CREATE GREATER CAPACITY WITHIN THE COMMUNITY TO ADDRESS A BROAD RANGE OF QUALITY OF LIFE ISSUES ALSO IMPACTS HEALTH. |
| PART III, LINE 2: | 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 2014 WAS $2,638,504 AT CHARGES ($895,947 AT COST). |
| PART III, LINE 3: | 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. |
| PART III, LINE 4: | THE ORGANIZATION IS A PART OF THE ASCENSION HEALTH ALLIANCE'S CONSOLIDATED AUDIT IN WHICH THE FOOTNOTE THAT DISCUSSES THE BAD DEBT EXPENSE IS LOCATED ON PAGE 19. |
| PART III, LINE 8: | A COST TO CHARGE RATIO IS APPLIED TO THE ORGANIZATION'S MEDICARE EXPENSE TO DETERMINE THE MEDICARE ALLOWABLE COST REPORTED IN THE ORGANIZATION'S MEDICARE COST REPORT. ASCENSION HEALTH AND ITS RELATED HEALTH MINISTRIES FOLLOW THE CATHOLIC HEALTH ASSOCIATION ("CHA") GUIDELINES FOR DETERMINING COMMUNITY BENEFIT. CHA COMMUNITY BENEFIT REPORTING GUIDELINES SUGGEST THAT MEDICARE SHORTFALL IS NOT TREATED AS A COMMUNITY BENEFIT. |
| 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 AND THE FINANCIAL ASSISTANCE PROGRAM IS FOLLOWED. |
| PART VI, LINE 2: | COMMUNITIES ARE DYNAMIC IN WHICH MULTIPLE FACTORS INTERACT TO IMPACT QUALITY OF LIFE AND HEALTH STATUS. AS PART OF THE ST. MARY'S HEALTH SYSTEM, THE GOAL OF ST. MARY'S WARRICK HOSPITAL, INC. IS TO WORK WITH ITS COMMUNITY TO CONDUCT AN ASSESSMENT AT LEAST EVERY THREE YEARS IN PARTNERSHIP WITH ST. MARY'S MEDICAL CENTER OF EVANSVILLE, INC. ASSESSMENTS MAY INCLUDE PRIMARY SURVEY DATA, SECONDARY SURVEY DATA, FOCUS GROUP INPUT, COMMUNITY LEADERS' SURVEY AND OTHER DATA. RESULTS ARE MADE AVAILABLE TO ORGANIZATIONS AND INDIVIDUALS THROUGHOUT THE COMMUNITY. THESE NEEDS ASSESSMENTS ARE ALSO UTILIZED IN CREATING THE HOSPITAL'S INTEGRATED STRATEGIC FINANCIAL AND OPERATIONAL PLAN. TO THAT END, ST. MARY'S WARRICK HOSPITAL, INC. HAS BROUGHT TOGETHER A COMMUNITY ROUNDTABLE WITH THE PURPOSE OF DETERMINING THE RESOURCES AND NEEDS, PRIORITIZING ACTION AND WORKING IN PARTNERSHIP TO ADDRESS IDENTIFIED CHALLENGES WITHIN A DESIGNATED AREA SURROUNDING THE HOSPITAL. ST. MARY'S WARRICK HOSPITAL, INC. ALSO IDENTIFIES COMMUNITY HEALTH NEEDS BY EMPLOYING OTHER PUBLIC AGENCY NEEDS ASSESSMENTS SUCH AS WELBORN BAPTIST FOUNDATION AND THE UNITED WAY. |
| PART VI, LINE 3: | ST. MARY'S WARRICK HOSPITAL, INC. COMMUNICATES WITH PATIENTS IN MULTIPLE WAYS TO ENSURE THAT THOSE WHO ARE BILLED FOR SERVICES ARE AWARE OF THE HOSPITAL'S CHARITY CARE PROGRAM AS WELL AS THEIR POTENTIAL ELIGIBILITY FOR LOCAL, STATE OR FEDERAL PROGRAMS. SIGNS ARE PROMINENTLY POSTED IN EACH SERVICE AREA. IN ADDITION, THE HOSPITAL CONTRACTS HEALTH ACCESS WORKERS AND ENROLLMENT SPECIALISTS WHO CONSULT WITH PATIENTS ABOUT THEIR ELIGIBILITY FOR FINANCIAL ASSISTANCE PROGRAMS AND HELP PATIENTS IN APPLYING FOR ANY PUBLIC PROGRAMS FOR WHICH THEY MAY QUALIFY. |
| PART VI, LINE 4: | ST. MARY'S WARRICK HOSPITAL, INC. IS A CRITICAL ACCESS HOSPITAL LOCATED IN BOONVILLE, INDIANA SERVING WARRICK, POSEY, SPENCER, AND OTHER RURAL POPULATED COUNTIES SURROUNDING THE AREA. ACCORDING TO THE 2014 COUNTY AND HEALTH RANKINGS, WARRICK COUNTY HAS A POPULATION OF 60,463 AND 14% OF THE CHILDREN IN WARRICK COUNTY ARE DEEMED TO LIVE IN HOUSEHOLDS BELOW THE POVERTY GUIDELINES. IN ADDITION, 14% OF THE ADULTS AND 4% OF THE CHILDREN LIVING IN WARRICK COUNTY DO NOT HAVE HEALTH INSURANCE. CHILD AND ADULT OBESITY CONTINUES TO BE ONE OF THE HIGHEST COMMUNITY ISSUES FOR WARRICK COUNTY WITH 32% OF ADULTS WITH A BODY MASS GREATER THAN 30. OTHER COMMUNITY ISSUES INCLUDE:- FAMILIES' UNDERSTANDING OF FINANCES, BUDGETING, AND TAX CREDITS;- UNDERSTANDING THE CYCLE OF POVERTY THAT OCCURS IN SUCCESSIVE GENERATIONS;- COST OF PRESCRIPTION MEDICINE; AND- AFFORDABLE AND ACCESSIBLE HEALTH CARE FOR LOW- TO MODERATE-INCOME INDIVIDUALS |
| PART VI, LINE 5: | TO PROVIDE THE HIGHEST QUALITY HEALTHCARE TO ALL PERSONS IN THE COMMUNITY, AND IN KEEPING WITH ITS NOT-FOR-PROFIT STATUS, ST. MARY'S WARRICK HOSPITAL, INC.:- DELIVERS PATIENT SERVICES, INCLUDING EMERGENCY DEPARTMENT SERVICES TO ALL INDIVIDUALS REQUIRING HEALTHCARE, WITHOUT REGARD TO PATIENT RACE, ETHNICITY, ECONOMIC STATUS, INSURANCE STATUS OR ABILITY TO PAY.- MAINTAINS AN OPEN MEDICAL STAFF THAT ALLOWS CREDENTIALED PHYSICIANS TO PRACTICE AT ITS FACILITIES.- PARTICIPATES IN GOVERNMENT-SPONSORED PROGRAMS SUCH AS MEDICAID AND MEDICARE TO THE POOR AND ELDERLY.- HOLDS MEMBERSHIP ON OTHER PUBLIC AGENCY BOARDS TO ENHANCE WELL BEING OF THE COMMUNITY IN PARTNERSHIP PROGRAMS. |
| PART VI, LINE 6: | AS A PART OF ST. MARY'S HEALTH SYSTEM, ST. MARY'S WARRICK HOSPITAL, INC. IS DEDICATED TO IMPROVING THE HEALTH STATUS AND QUALITY OF LIFE FOR THE COMMUNITIES IT SERVES. WHILE DESIGNATED ASSOCIATES AT ST. MARY'S WARRICK HOSPITAL, INC. DEVOTE SIGNIFICANT PORTIONS OF TIME TO LEADING AND ADMINISTERING LOCAL COMMUNITY-BASED PROGRAMS AND PARTNERSHIPS, ASSOCIATES THROUGHOUT THE ORGANIZATION ARE ACTIVE PARTICIPANTS IN COMMUNITY OUTREACH. THEY ARE ASSISTED AND SUPPORTED BY DESIGNATED ST. MARY'S HEALTH COMMUNITY DEVELOPMENT AND SERVICE STAFF WHO WORK WITH EACH OF ITS HEALTHCARE FACILITIES TO ADVOCATE FOR AND PROVIDE TECHNICAL ASSISTANCE FOR COMMUNITY OUTREACH, NEEDS ASSESSMENTS AND PARTNERSHIPS AS WELL AS TO SUPPORT REGIONAL AND STATE-WIDE PROGRAMS, COMMUNITY PROGRAMS SPONSORED BY ST. MARY'S HEALTH IN WHICH ST. MARY'S WARRICK HOSPITAL, INC. PARTICIPATES. |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (1) | GrantRecordsMaintainedInd |
Recipient Table RecipientTable
Recipient Business Name RecipientBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ST MARY'S HEALTH INC | BusinessNameLine1 |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3700 WASHINGTON AVENUE | AddressLine1 |
| City | EVANSVILLE | City |
| State | IN | State |
| ZIP Code | 47750 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Recipient EIN | 352057801 | RecipientEIN |
| IRC Section | 501(C)(3) | IRCSectionDesc |
| Cash Grant | $472,671 | CashGrantAmt |
| Purpose Of Grant | OPERATING SUPPORT | PurposeOfGrantTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 1 | Total501c3OrgCnt |
| Total Other Org | 0 | TotalOtherOrgCnt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 2: | FormAndLineReferenceDesc |
| Explanation | ONE PERSON OF ST. MARY'S MEDICAL CENTER OF EVANSVILLE, INC., IS RESPONSIBLE FOR RESEARCHING AND COORDINATING GRANT PROPOSALS. THIS PERSON IS ALSO RESPONSIBLE FOR ENSURING THAT TIMELY REPORTS ARE SENT TO THE GRANTOR. THE CHIEF EXECUTIVE OF THE ENTITY OPERATIONS REVIEWS AND APPROVES ALL THE EXPENDITURES FROM THE GRANT FUNDS, ENSURING THEY ARE WITHIN THE GUIDELINES OF THE GRANT. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | Yes (1) | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (1) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (9 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| GWEN SANDEFUR | ||||||||||||||
| BOARD MEMBER | $0 | $344,978 | $0 | $50,551 | $0 | $1,005 | $0 | $11,903 | $0 | $13,205 | $0 | $421,642 | $0 | $0 |
| KATHY HALL | ||||||||||||||
| BOARD MEMBER | $0 | $184,845 | $0 | $27,817 | $0 | $419 | $0 | $13,538 | $0 | $15,003 | $0 | $241,622 | $0 | $0 |
| LLOYD MCGINNIS MD | ||||||||||||||
| BOARD MEMBER | $0 | $157,543 | $0 | $27,500 | $0 | $759 | $0 | $8,534 | $0 | $1,298 | $0 | $195,634 | $0 | $0 |
| TIMOTHY FLESCH THRU 122013 | ||||||||||||||
| SECRETARY/TREASURER | $0 | $895,586 | $0 | $742,747 | $0 | $23,492 | $0 | $5,000 | $0 | $18,492 | $0 | $1,685,317 | $0 | $2 |
| DAVID VAUGHN MD | ||||||||||||||
| PHYSICIAN | $288,988 | $0 | $439 | $0 | $345 | $0 | $20,289 | $0 | $8,097 | $0 | $318,158 | $0 | $0 | $0 |
| PETER ROSARIO MD | ||||||||||||||
| PHYSICIAN | $296,748 | $0 | $24,760 | $0 | $11,648 | $0 | $5,000 | $0 | $2,835 | $0 | $340,991 | $0 | $0 | $0 |
| THOMAS MILLER MD | ||||||||||||||
| PHYSICIAN | $234,557 | $0 | $0 | $0 | $1,028 | $0 | $2,837 | $0 | $7,837 | $0 | $246,259 | $0 | $0 | $0 |
| TIMOTHY LABELLE MD | ||||||||||||||
| PHYSICIAN | $199,617 | $0 | $0 | $0 | $15,590 | $0 | $5,000 | $0 | $7,084 | $0 | $227,291 | $0 | $0 | $0 |
| CAROL GODSEY | ||||||||||||||
| FORMER OFFICER | $78,900 | $0 | $27,430 | $0 | $93,473 | $0 | $5,000 | $0 | $0 | $0 | $204,803 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 3: | ASCENSION HEALTH, A RELATED ORGANIZATION OF ST. MARY'S WARRICK HOSPITAL, INC., USES THE FOLLOWING TO ESTABLISH THE COMPENSATION OF THE ORGANIZATION'S CEO/EXECUTIVE DIRECTOR: COMPENSATION COMMITTEE INDEPENDENT COMPENSATION CONSULTANT COMPENSATION SURVEY OR STUDY APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE |
| PART I, LINE 4A: | THE FOLLOWING OFFICERS RECEIVED SEVERANCE PAYMENTS FROM THE ORGANIZATION OR A RELATED ORGANIZATION DURING THE CALENDAR YEAR 2013: CAROL GODSEY $83,150 |
| PART I, LINE 4B: | ELIGIBLE EXECUTIVES PARTICIPATE IN VARIOUS NON-QUALIFIED DEFERRED COMPENSATION PLANS ORGANIZED UNDER CODE SECTION 457(F). THE EXACT PURPOSE OF EACH PLAN VARIES, BUT THEY INCLUDE: COMPENSATION LIMITATION MAKE-UP PLANS, VOLUNTARY DEFERRAL PLANS, DEFERRAL OF A PORTION OF INCENTIVE BONUS TYPE PLANS, ETC. ANY AMOUNT ULTIMATELY PAID UNDER THE PROGRAM TO THE EXECUTIVE IS REPORTED AS COMPENSATION ON FORM 990, SCHEDULE J, PART II, COLUMN B IN THE YEAR PAID. THE FOLLOWING INDIVIDUALS RECEIVED CURRENT YEAR DISTRIBUTIONS OF: TIMOTHY FLESCH $2 |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp
Name Of Interested NameOfInterested
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | STANLEY GROSSMAN | PersonNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship Description | - SEE PART V - | RelationshipDescriptionTxt |
| Transaction | $18,198 | TransactionAmt |
| Transaction | SEE PART V | TransactionDesc |
| Sharing Of Revenues | 0 | SharingOfRevenuesInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE L, PART IV: | FormAndLineReferenceDesc |
| Explanation | BUSINESS TRANSACTIONS INVOLVING INTERESTED PERSONS(A) NAME OF PERSON: STANLEY GROSSMAN(B) RELATIONSHIP BETWEEN INTERESTED PERSON AND ORGANIZATION: FATHER OF GWEN SANDEFUR(C) AMOUNT OF TRANSACTION: $18,198(D) DESCRIPTION OF TRANSACTION: STANLEY GROSSMAN IS AN EMPLOYEE OF ST. MARY'S WARRICK HOSPITAL, INC. AND RECEIVES COMPENSATION FROM THE ORGANIZATION.(E) SHARING OF ORGANIZATION REVENUES: NO | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (9 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 6 | ST. MARY'S WARRICK HOSPITAL, INC. HAS A SINGLE CORPORATE MEMBER, ST. MARY'S HEALTH SERVICES, INC. |
| FORM 990, PART VI, SECTION A, LINE 7A | ST. MARY'S WARRICK HOSPITAL, INC. HAS A SINGLE CORPORATE MEMBER, ST. MARY'S HEALTH SERVICES, INC., WHO HAS THE ABILITY TO ELECT MEMBERS TO THE GOVERNING BODY OF THE ST. MARY'S WARRICK HOSPITAL, INC. BOARD. |
| FORM 990, PART VI, SECTION A, LINE 7B | ALL DECISIONS THAT HAVE A MATERIAL IMPACT TO ST. MARY'S WARRICK HOSPITAL, INC.'S FINANCIAL INFORMATION OR CORPORATION AS A WHOLE ARE SUBJECT TO APPROVAL BY ITS SOLE CORPORATE MEMBER, ST. MARY'S HEALTH SERVICES, INC. |
| FORM 990, PART VI, SECTION B, LINE 11 | ST. MARY'S HEALTH, INC.'S FINANCE COMMITTEE REVIEWS THE FORM 990 IN MARCH UPON RECEIVING DIRECTION FROM ITS TAX PREPARER. THE FORM 990 IS THEN SENT TO THE GOVERNING BODY IN APRIL TO ALLOW FOR A THOROUGH REVIEW BY THE GOVERNING BODY PRIOR TO THE FILING DATE OF MAY 15TH. THE GOVERNING BODY WILL RECEIVE THE FORM 990 VIA EMAIL FOR REVIEW ELECTRONICALLY AND WILL SEND ANY QUESTIONS REGARDING THE FORM 990 VIA EMAIL. RESPONSES TO ANY QUESTIONS RECEIVED WILL BE PROVIDED ELECTRONICALLY TO THE BOARD MEMBERS BEFORE THE RETURN IS FILED. ALL QUESTIONS AND RESPONSES WILL BE REVIEWED AND DISCLOSED IN THE MEETING MINUTES OF THE NEXT BOARD MEETING FOLLOWING THE REVIEW OF THE FORM 990. |
| FORM 990, PART VI, 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 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, SECTION B, LINE 15 | IN DETERMINING THE COMPENSATION OF THE ORGANIZATION'S CEO, THE PROCESS, PERFORMED BY ASCENSION HEALTH, A RELATED ORGANIZATION OF ST. MARY'S WARRICK HOSPITAL, INC., INCLUDED A REVIEW AND APPROVAL BY INDEPENDENT PERSONS, COMPARABILITY DATA AND CONTEMPORANEOUS SUBSTANTIATION OF THE DELIBERATION AND DECISION. THE COMPENSATION COMMITTEE REVIEWED AND APPROVED THE COMPENSATION. IN THE REVIEW OF THE COMPENSATION, THE CEO WAS COMPARED TO INDIVIDUALS AT OTHER ORGANIZATIONS IN THE AREA WHO HOLD THE SAME TITLE. DURING THE REVIEW AND APPROVAL OF THE COMPENSATION, DOCUMENTATION OF THE DECISION WAS RECORDED IN THE COMMITTEE MINUTES. THE INDIVIDUAL WAS NOT PRESENT WHEN THIER COMPENSATION WAS DECIDED. COMPENSATION DETERMINATIONS OF ST. MARY'S WARRICK HOSPITAL, INC.'S OTHER OFFICERS OR KEY EMPLOYEES ARE MADE BY ST. MARY'S HEALTH, INC.'S MANAGEMENT. IN DETERMINING COMPENSATION OF OTHER OFFICERS OR KEY EMPLOYEES OF THE ORGANIZATION, THE PROCESS INCLUDED A REVIEW AND APPROVAL BY INDEPENDENT PERSONS, COMPARABILITY DATA, AND CONTEMPORANEOUS SUBSTANTIATION OF THE DELIBERATION AND DECISION. IN THE REVIEW OF THE COMPENSATION, THE OTHER OFFICERS OR KEY EMPLOYEES OF THE ORGANIZATION WERE COMPARED TO THE OTHER HOSPITALS' EMPLOYEES IN THE AREA THAT HOLD THE SAME POSITION. FORM 990, PART VI, SECTION B, LINE 16B: ST. MARY'S HEALTH, INC. AND SUBSIDIARES (ST. MARY'S) JOINT VENTURE OPERATING AGREEMENTS ARE NEGOTIATED WITH OTHER MEMBERS OF THE JOINT VENTURE TO ENSURE THAT ADEQUATE SAFEGUARDS ARE IN PLACE TO PROTECT ST. MARY'S EXEMPT STATUS. EACH AGREEMENT CONTAINS SPECIFIC LANGUAGE RELATED TO THE PROVISION OF HEALTH CARE SERVICES WITH A FOCUS ON COMMUNITY HEALTH BENEFIT AND MUST FOLLOW A FORMAL REVIEW PROCESS PRIOR TO CONTRACT EXECUTION. ST. MARY'S CONTINUALLY ENSURES THAT ITS EXEMPT STATUS IS PROTECTED BY ACTIVELY PARTICIPATING IN THE GOVERNANCE OF ALL ST. MARY'S JOINT VENTURES. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION WILL PROVIDE ANY DOCUMENTS OPEN TO PUBLIC INSPECTION UPON REQUEST. |
| FORM 990, PART XI, LINE 9: | FAS 158 PENSION LIABILITY -67,235. |
| FORM 990, PART IV, LINE 24A: | ST. MARY'S WARRICK HOSPITAL, INC. IS A HEALTH FACILITY THAT IS PART OF THE ASCENSION HEALTH SYSTEM. ASCENSION HEALTH SYSTEM IS THE HOLDER OF THE TAX EXEMPT HOSPITAL REVENUE BONDS. ST. MARY'S WARRICK HOSPITAL, INC. HOLDS AN INTERCOMPANY NOTE PAYABLE WITH ASCENSION HEALTH AND THIS INFORMATION IS REPORTED ON THE BALANCE SHEET. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (44 entries)
| Address Line1USAddress/AddressLine1 | CityUSAddress/City | StateUSAddress/State | ZIP CodeUSAddress/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Direct Controlling NADirectControllingNACd | Controlled OrganizationControlledOrganizationInd | Business Name Line1DirectControllingEntityName/BusinessNameLine1 |
|---|---|---|---|---|---|---|---|---|---|---|---|
| ASCENSION HEALTH ALLIANCE | |||||||||||
| PO BOX 45998 | ST LOUIS | MO | 631455998 | 453358926 | NATIONAL HEALTH SYSTEM | MO | 501(C)(3) | 11A, I | N/A | 0 | |
| ASCENSION HEALTH | |||||||||||
| PO BOX 45998 | ST LOUIS | MO | 63145 | 311662309 | NATIONAL HEALTH SYSTEM | MO | 501(C)(3) | 11A, I | 0 | ASCENSION HEALTH ALLIANCE | |
| CENTRAL INDIANA HEALTH SYSTEM CARDIAC SERVICES INC | |||||||||||
| 2001 W 86TH STREET | INDIANAPOLIS | IN | 46260 | 351869951 | FREESTANDING OUTPATIENT CENTER | IN | 501(C)(3) | 11C, III-FI | Yes (1) | STVINCENT HOSPITAL & HEALTH CARE CENTER INC | |
| REHABILITATION HOSPITAL OF INDIANA INC | |||||||||||
| 4141 SHORE DRIVE | INDIANAPOLIS | IN | 46254 | 351786005 | REHABILITATION HOSPITAL | IN | 501(C)(3) | 3 | Yes (1) | STVINCENT HEALTH INC | |
| SVH REAL ESTATE INC | |||||||||||
| 10330 N MERIDIAN STREET STE 430N | INDIANAPOLIS | IN | 46290 | 205002285 | REAL ESTATE HOLDING COMPANY | IN | 501(C)(3) | 11A, I | Yes (1) | STVINCENT HEALTH INC | |
| STJOSEPH HOSPITAL & HEALTH CENTER INC | |||||||||||
| 1907 W SYCAMORE STREET | KOKOMO | IN | 46901 | 350992717 | HOSPITAL | IN | 501(C)(3) | 3 | Yes (1) | STVINCENT HEALTH INC | |
| STJOSEPH FOUNDATION OF KOKOMO INDIANA INC | |||||||||||
| 1907 W SYCAMORE STREET | KOKOMO | IN | 46901 | 237313206 | SUPPORTING ORGANIZATION | IN | 501(C)(3) | 11A, I | Yes (1) | STJOSEPH HOSPITAL & HEALTH CENTER INC | |
| STVINCENT ANDERSON REGIONAL HOSPITAL INC | |||||||||||
| 2015 JACKSON STREET | ANDERSON | IN | 46016 | 460877261 | HOSPITAL | IN | 501(C)(3) | 3 | Yes (1) | STVINCENT HEALTH INC | |
| STVINCENT ANDERSON REGIONAL HOSPITAL FOUNDATION INC | |||||||||||
| 2015 JACKSON STREET | ANDERSON | IN | 46016 | 352053693 | SUPPORTING ORGANIZATION | IN | 501(C)(3) | 11A, I | Yes (1) | STVINCENT ANDERSON REGIONAL HOSPITAL INC | |
| STVINCENT CARMEL HOSPITAL INC | |||||||||||
| 13500 N MERIDIAN STREET | CARMEL | IN | 46032 | 743107055 | HOSPITAL | IN | 501(C)(3) | 3 | Yes (1) | STVINCENT HEALTH INC | |
| STVINCENT CLAY HOSPITAL INC | |||||||||||
| 1206 E NATIONAL AVENUE | BRAZIL | IN | 47834 | 352112529 | CRITICAL ACCESS HOSPITAL | IN | 501(C)(3) | 3 | Yes (1) | STVINCENT HEALTH INC | |
| STVINCENT DUNN HOSPITAL INC | |||||||||||
| 1600 23RD STREET | BEDFORD | IN | 47421 | 272192831 | CRITICAL ACCESS HOSPITAL | IN | 501(C)(3) | 3 | Yes (1) | STVINCENT HEALTH INC | |
| STVINCENT FISHERS HOSPITAL INC | |||||||||||
| 13861 OLIO ROAD | FISHERS | IN | 46037 | 454243702 | HOSPITAL | IN | 501(C)(3) | 3 | Yes (1) | STVINCENT HEALTH INC | |
| STVINCENT FRANKFORT HOSPITAL INC | |||||||||||
| 1300 S JACKSON | FRANKFORT | IN | 46041 | 352099320 | CRITICAL ACCESS HOSPITAL | IN | 501(C)(3) | 3 | Yes (1) | STVINCENT HEALTH INC | |
| STVINCENT FRANKFORT HOSPITAL FOUNDATION INC | |||||||||||
| 1300 S JACKSON | FRANKFORT | IN | 46041 | 351531734 | SUPPORTING ORGANIZATION | IN | 501(C)(3) | 11A, I | Yes (1) | STVINCENT FRANKFORT HOSPITAL INC | |
| STVINCENT HEALTH INC | |||||||||||
| 10330 N MERIDIAN STREET STE 430N | INDIANAPOLIS | IN | 46290 | 352052591 | PARENT COMPANY | IN | 501(C)(3) | 11C, III-FI | 0 | ASCENSION HEALTH | |
| STVINCENT HEALTH WELLNESS AND PREVENTIVE CARE INSTITUTE INC | |||||||||||
| 8333 NAAB ROAD STE 301 | INDIANAPOLIS | IN | 46260 | 461227327 | HEALTH AND WELLNESS SERVICES | IN | 501(C)(3) | 9 | Yes (1) | STVINCENT HEALTH INC | |
| STVINCENT HOSPITAL AND HEALTH CARE CENTER INC | |||||||||||
| 2001 W 86TH STREET | INDIANAPOLIS | IN | 46260 | 350869066 | HOSPITAL | IN | 501(C)(3) | 3 | Yes (1) | STVINCENT HEALTH INC | |
| STVINCENT HOSPITAL FOUNDATION INC | |||||||||||
| 10330 N MERIDIAN STREET STE 430N | INDIANAPOLIS | IN | 46290 | 356088862 | SUPPORTING ORGANIZATION | IN | 501(C)(3) | 11A, I | Yes (1) | STVINCENT HOSPITAL & HEALTH CARE CENTER INC | |
| STVINCENT JENNINGS HOSPITAL INC | |||||||||||
| 301 HENRY STREET | NORTH VERNON | IN | 47265 | 351841606 | CRITICAL ACCESS HOSPITAL | IN | 501(C)(3) | 3 | Yes (1) | STVINCENT HEALTH INC | |
| STVINCENT MADISON COUNTY HEALTH SYSTEM INC | |||||||||||
| 1331 SOUTH A STREET | ELWOOD | IN | 46036 | 350876389 | HOSPITAL | IN | 501(C)(3) | 3 | Yes (1) | STVINCENT HEALTH INC | |
| STVINCENT MEDICAL GROUP INC | |||||||||||
| 8425 HARCOURT ROAD | INDIANAPOLIS | IN | 46260 | 272039417 | PHYSICIAN PROFESSIONAL SERVICES | IN | 501(C)(3) | 9 | Yes (1) | STVINCENT HEALTH INC | |
| STVINCENT MERCY HOSPITAL FOUNDATION INC | |||||||||||
| 1331 SOUTH A STREET | ELWOOD | IN | 46036 | 311066871 | SUPPORTING ORGANIZATION | IN | 501(C)(3) | 11A, I | Yes (1) | STVINCENT MADISON COUNTY HEALTH SYSTEM INC | |
| STVINCENT NEW HOPE INC | |||||||||||
| 8450 N PAYNE ROAD | INDIANAPOLIS | IN | 46260 | 351733591 | INTERMEDIATE CARE FACILITY | IN | 501(C)(3) | 9 | Yes (1) | STVINCENT HEALTH INC | |
| STVINCENT RANDOLPH HOSPITAL INC | |||||||||||
| 473 GREENVILLE AVENUE | WINCHESTER | IN | 47394 | 352103153 | CRITICAL ACCESS HOSPITAL | IN | 501(C)(3) | 3 | Yes (1) | STVINCENT HEALTH INC | |
| STVINCENT RANDOLPH HOSPITAL FOUNDATION INC | |||||||||||
| 473 GREENVILLE AVENUE | WINCHESTER | IN | 47394 | 352133006 | SUPPORTING ORGANIZATION | IN | 501(C)(3) | 11A, I | Yes (1) | STVINCENT RANDOLPH HOSPITAL INC | |
| STVINCENT SALEM HOSPITAL INC | |||||||||||
| 911 N SHELBY STREET | SALEM | IN | 47167 | 270847538 | CRITICAL ACCESS HOSPITAL | IN | 501(C)(3) | 3 | Yes (1) | STVINCENT HEALTH INC | |
| STVINCENT SETON SPECIALTY HOSPITAL INC | |||||||||||
| 8050 TOWNSHIP LINE ROAD | INDIANAPOLIS | IN | 46260 | 351712001 | LONG TERM CARE HOSPITAL | IN | 501(C)(3) | 3 | Yes (1) | STVINCENT HEALTH INC | |
| STVINCENT WILLIAMSPORT HOSPITAL INC | |||||||||||
| 412 N MONROE STREET | WILLIAMSPORT | IN | 47993 | 350784551 | CRITICAL ACCESS HOSPITAL | IN | 501(C)(3) | 3 | Yes (1) | STVINCENT HEALTH INC | |
| STVINCENT WILLIAMSPORT HOSPITAL FOUNDATION INC | |||||||||||
| 412 N MONROE STREET | WILLIAMSPORT | IN | 47993 | 743130159 | SUPPORTING ORGANIZATION | IN | 501(C)(3) | 11A, I | Yes (1) | STVINCENT WILLIAMSPORT HOSPITAL INC | |
| SVSM INC | |||||||||||
| 2001 W 86TH STREET | INDIANAPOLIS | IN | 46260 | 810607827 | HOLDING COMPANY | IN | 501(C)(3) | 11A, I | Yes (1) | STVINCENT HEALTH INC | |
| ST MARY'S AT HOME INC | |||||||||||
| 3700 WASHINGTON AVENUE | EVANSVILLE | IN | 47750 | 351899560 | DME/HOME CARE | IN | 501(C)(3) | 11A, I | Yes (1) | ST MARY'S HEALTH SERVICES INC | |
| ST MARY'S BUILDING CORPORATION | |||||||||||
| 3700 WASHINGTON AVENUE | EVANSVILLE | IN | 47750 | 237248362 | REAL ESTATE HOLDING COMPANY | IN | 501(C)(2) | Yes (1) | ST MARY'S HEALTH SERVICES INC | ||
| ST MARY'S WARRICK EMERGENCY MEDICAL SERVICES INC | |||||||||||
| 3700 WASHINGTON AVENUE | EVANSVILLE | IN | 47750 | 205342518 | AMBULANCE SERVICES | IN | 501(C)(4) | Yes (1) | ST MARY'S HEALTH SERVICES INC | ||
| ST MARY'S HEALTH INC | |||||||||||
| 3700 WASHINGTON AVENUE | EVANSVILLE | IN | 47750 | 352057801 | HEALTH MINISTRY PARENT | IN | 501(C)(3) | 11C, III-FI | Yes (1) | STVINCENT HEALTH INC | |
| ST MARY'S PHYSICIAN NETWORK LLC | |||||||||||
| 3700 WASHINGTON AVENUE | EVANSVILLE | IN | 47750 | 205023387 | PHYSICIAN PROFESSIONAL SERVICES | IN | 501(C)(3) | 9 | Yes (1) | ST MARY'S HEALTH INC | |
| ST MARY'S HEALTH SERVICES INC | |||||||||||
| 3700 WASHINGTON AVENUE | EVANSVILLE | IN | 47750 | 351679526 | INVESTMENT SERVICES | IN | 501(C)(3) | 11C, III-FI | Yes (1) | ST MARY'S HEALTH INC | |
| ST MARY'S CARE PARTNERS INC | |||||||||||
| 3700 WASHINGTON AVENUE | EVANSVILLE | IN | 47750 | 351899562 | TAX-EXEMPT AFFILIATE REIMBURSEMENTS | IN | 501(C)(3) | 11A, I | Yes (1) | ST MARY'S HEALTH INC | |
| ST MARY'S MEDICAL CENTER FOUNDATION OF EVANSVILLE INC | |||||||||||
| 3700 WASHINGTON AVENUE | EVANSVILLE | IN | 47750 | 237045370 | SUPPORTING ORGANIZATION | IN | 501(C)(3) | 11A, I | Yes (1) | ST MARY'S MEDICAL CENTER OF EVANSVILLE INC | |
| ST MARY'S MEDICAL CENTER OF EVANSVILLE INC | |||||||||||
| 3700 WASHINGTON AVENUE | EVANSVILLE | IN | 47750 | 350869065 | HOSPITAL | IN | 501(C)(3) | 3 | Yes (1) | ST MARY'S HEALTH SERVICES INC | |
| ST MARY'S WARRICK HOSPITAL FOUNDATION INC | |||||||||||
| 1116 MILLIS AVENUE | BOONVILLE | IN | 47601 | 351961890 | SUPPORTING ORGANIZATION | IN | 501(C)(3) | 11A, I | Yes (1) | ST MARY'S WARRICK HOSPITAL INC | |
| ST MARY'S OHIO VALLEY HEARTCARE LLC | |||||||||||
| 901 ST MARYS DRIVE | EVANSVILLE | IN | 47714 | 273474697 | CARDIOLOGY SERVICES | IN | 501(C)(3) | 11A, I | Yes (1) | ST MARY'S HEALTH INC | |
| ST MARY'S MEDICAL GROUP LLC | |||||||||||
| 3700 WASHINGTON AVENUE | EVANSVILLE | IN | 47750 | 261356310 | PHYSICIAN PROFESSIONAL SERVICES | IN | 501(C)(3) | 9 | Yes (1) | ST MARY'S HEALTH INC | |
| PRIMARY PHYSICIAN NETWORK LLC | |||||||||||
| 3700 WASHINGTON AVENUE | EVANSVILLE | IN | 47750 | 208775914 | PHYSICIAN PROFESSIONAL SERVICES | IN | 501(C)(3) | 9 | Yes (1) | ST MARY'S HEALTH INC | |
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (15 entries)
| Address Line1USAddress/AddressLine1 | CityUSAddress/City | StateUSAddress/State | ZIP CodeUSAddress/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Predominant Income TypePredominantIncomeTypeTxt | Share Of Total IncomeShareOfTotalIncomeAmt | Share Of EOY AssetsShareOfEOYAssetsAmt | Disproportionate AllocationsDisproportionateAllocationsInd | General Or Managing PartnerGeneralOrManagingPartnerInd | OwnershipOwnershipPct |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| BREAST MRI LEASING COMPANY LLC | |||||||||||||
| 10330 N MERIDIAN ST STE 430N | INDIANAPOLIS | IN | 46290 | 426662493 | SALE AND RENTAL SERVICES | IN | STVINCENT HOSPITAL AND HEALTH CARE CENTER INC | RELATED | $235,288 | $43,117 | 0 | Yes (1) | 0.50000 |
| CARMEL AMBULATORY SURGERY CENTER LLC | |||||||||||||
| 13421 OLD MERIDIAN ST STE 150 | CARMEL | IN | 46032 | 320014795 | AMBULATORY SURGERY CENTER | IN | STVINCENT CARMEL HOSPITAL INC | RELATED | $3,732,048 | $1,498,768 | 0 | Yes (1) | 0.51000 |
| COOPERATIVE MANAGED CARE SERVICES LLC | |||||||||||||
| 9045 RIVER ROAD STE 250 | INDIANAPOLIS | IN | 46240 | 351999227 | CASE MANAGEMENT | IN | STVINCENT HOSPITAL AND HEALTH CARE CENTER INC | UNRELATED | $158,622 | $2,278,545 | 0 | Yes (1) | 0.50000 |
| ENDOSCOPY CENTER LLC | |||||||||||||
| 13421 OLD MERIDIAN ST STE 150 | CARMEL | IN | 46032 | 320029881 | ENDOSCOPY CENTER | IN | STVINCENT CARMEL HOSPITAL INC | RELATED | $578,601 | $314,246 | 0 | 0 | 0.51000 |
| HANCOCK PHYSICIAN NETWORK LLC | |||||||||||||
| 801 N STATE STREET | GREENFIELD | IN | 46140 | 352051598 | PRIMARY CARE PHYSICIAN PRACTICES | IN | STVINCENT HOSPITAL AND HEALTH CARE CENTER INC | RELATED | -$3,111,767 | $2,034,584 | 0 | Yes (1) | 0.50000 |
| HCH SVH CATH LAB SERVICES LLC | |||||||||||||
| 1000 N 16TH STREET | NEW CASTLE | IN | 47362 | 452087950 | CATH LAB SERVICES | IN | STVINCENT HOSPITAL AND HEALTH CARE CENTER INC | RELATED | -$357,761 | $1,333,459 | 0 | Yes (1) | 0.50000 |
| MERIDIAN HEIGHTS ASSOCIATES LLC | |||||||||||||
| 6100 W 96TH STREET STE 250 | INDIANAPOLIS | IN | 46278 | 264020296 | REAL ESTATE HOLDING | IN | STVINCENT CARMEL HOSPITAL INC | RELATED | $3,773,781 | 0 | Yes (1) | 0.50000 | |
| NAAB ROAD SURGERY CENTER LLC | |||||||||||||
| 8260 NAAB ROAD STE 100 | INDIANAPOLIS | IN | 46260 | 351991390 | AMBULATORY SURGERY CENTER | IN | STVINCENT HOSPITAL AND HEALTH CARE CENTER INC | RELATED | $3,167,357 | $1,838,718 | 0 | Yes (1) | 0.51000 |
| NEURO ONCOLOGY EQUIPMENT LLC | |||||||||||||
| 10330 N MERIDIAN ST STE 430N | INDIANAPOLIS | IN | 46290 | 743103803 | SALE AND RENTAL SERVICES | IN | STVINCENT HOSPITAL AND HEALTH CARE CENTER INC | RELATED | $396,120 | $1,386,917 | 0 | Yes (1) | 0.50000 |
| STVINCENT HEALTHUSP LLC | |||||||||||||
| 15305 DALLAS PKWY STE 1600 | ADDISON | TX | 75001 | 203749962 | AMBULATORY SURGERY CENTER | IN | STVINCENT HEALTH INC | RELATED | $84,964 | $161,818 | 0 | Yes (1) | 0.50000 |
| STVINCENT HEART CENTER OF INDIANA LLC | |||||||||||||
| 10580 N MERIDIAN STREET | INDIANAPOLIS | IN | 46290 | 364492612 | HEART HOSPITAL | IN | CENTRAL INDIANA HEALTH SYSTEM CARDIAC SERVICES INC | RELATED | $24,931,443 | $79,758,894 | 0 | 0 | 0.74080 |
| WOMEN'S PHYSICIAN SURGERY CENTER LLC | |||||||||||||
| 8081 TOWNSHIP LINE ROAD | INDIANAPOLIS | IN | 46260 | 352086841 | AMBULATORY SURGERY CENTER | IN | STVINCENT HOSPITAL AND HEALTH CARE CENTER INC | RELATED | -$122,846 | $45,663 | 0 | 0 | 0.58900 |
| AMBULATORY CARE CENTER LLC | |||||||||||||
| 1125 PROFESSIONAL BLVD | EVANSVILLE | IN | 47714 | 352006018 | OP SURGERY | IN | ST MARY'S HEALTH SERVICES INC | RELATED | $5,266,312 | $5,068,766 | 0 | Yes (1) | 0.50000 |
| SETON HEALTH SERVICES LLC | |||||||||||||
| 3700 WASHINGTON AVENUE | EVANSVILLE | IN | 47750 | 270451316 | EQUIPMENT RENTAL | IN | ST MARY'S HEALTH SERVICES INC | RELATED | $45,743 | $55,336 | 0 | Yes (1) | 0.50000 |
| ST MARY'S PERIPHERAL VASCULAR SERVICES MANAGEMENT CO LLC | |||||||||||||
| 3700 WASHINGTON AVENUE | EVANSVILLE | IN | 47750 | 205062635 | MANAGEMENT SERVICES | IN | ST MARY'S MEDICAL CENTER OF EVANSVILLE INC | RELATED | $465,380 | $321,989 | 0 | Yes (1) | 0.75000 |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp
Related Organization Name RelatedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ST MARY'S MEDICAL GROUP INC | BusinessNameLine1 |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3700 WASHINGTON AVENUE | AddressLine1 |
| City | EVANSVILLE | City |
| State | IN | State |
| ZIP Code | 47750 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 352076827 | EIN |
| Primary Activities | INVESTMENT | PrimaryActivitiesTxt |
| Legal Domicile State | IN | LegalDomicileStateCd |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ST MARY'S HEALTH SERVICES INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Entity Type | C | EntityTypeTxt |
| Share Of Total Income | -$1,556,561 | ShareOfTotalIncomeAmt |
| Share Of EOY Assets | $257,378 | ShareOfEOYAssetsAmt |
| Ownership | 1.00000 | OwnershipPct |
| Controlled Organization | Yes (1) | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | Yes (1) | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (1) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | Yes (1) | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | 0 | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (1) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (7 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| ASCENSION HEALTH | ||
| P | $279,957 | FMV OF SERVICES OR CASH |
| ST MARY'S HEALTH INC | ||
| P | $864,979 | FMV OF SERVICES OR CASH |
| ST MARY'S MEDICAL CENTER OF EVANSVILLE INC | ||
| E | $62,308 | FMV OF SERVICES OR CASH |
| ST MARY'S MEDICAL CENTER OF EVANSVILLE INC | ||
| P | $1,125,530 | FMV OF SERVICES OR CASH |
| ST MARY'S HEALTH INC | ||
| C | $2,446,720 | FMV OF SERVICES OR CASH |
| ST MARY'S HEALTH INC | ||
| B | $472,671 | FMV OF SERVICES OR CASH |
| PRIMARY PHYSICIAN NETWORK LLC | ||
| P | $57,590 | FMV OF SERVICES OR CASH |