2015-05-13T22:14:03-05:00 2014-06-30 861065772 DELOITTE TAX LLP 111 MONUMENT CIRCLE SUITE 2000 INDIANAPOLIS IN 462045108 990 2013-07-01 350869065 ST MARY'S MEDICAL CENTER OF EVANSVILLE INC STMA 8124854178 3700 WASHINGTON AVENUE EVANSVILLE IN 47750 JOHN L ZABROWSKI CHIEF FINANCIAL OFFICER 8124854178 2015-05-13 1 SHAWNA M JIMENEZ P01222873 3174648600 2015-05-01 2013 2016-02-25 16:41:14Z KEITH JEWELL 3700 WASHINGTON AVENUE EVANSVILLE IN 47750 472357590 0 0928 X WWW.STMARYS.ORG X 1941 IN DEDICATED TO SPIRITUALLY CENTERED CARE, WHICH IMPROVES THE HEALTH OF INDIVIDUALS AND COMMUNITIES. 13 7 3538 402 151529 -238257 1527361 10823280 438137652 434304866 17885356 17138110 10819915 9354204 468370284 471620460 21016801 64907190 0 0 156616340 147631788 0 0 715774 241877344 243888976 419510485 456427954 48859799 15192506 614660665 617201774 213767120 198479327 400893545 418722447 DEDICATED TO SPIRITUALLY CENTERED CARE, WHICH IMPROVES THE HEALTH OF INDIVIDUALS AND COMMUNITIES. 0 0 303531631 64907190 441278940 ST. MARY'S MEDICAL CENTER OF EVANSVILLE, INC. (SMMC) PROVIDES INPATIENT AND OUTPATIENT MEDICAL SERVICES SERVING VANDERBURGH AND CONTIGUOUS COUNTIES AND PROVIDING SERVICES WITHOUT REGARD TO PATIENT RACE, CREED, NATIONAL ORIGIN, ECONOMIC STATUS, OR ABILITY TO PAY. DURING FISCAL YEAR 2014, SMMC TREATED 16,123 INPATIENTS IN THE COMMUNITY FOR A TOTAL OF 78,171 PATIENT DAYS OF SERVICE. SMMC ALSO PROVIDED SERVICES TO 346,485 OUTPATIENTS, INCLUDING 4,433 INPATIENT SURGERY PATIENTS, 53,219 EMERGENCY ROOM VISITS, 1,615 PHYSICIAN OFFICE VISITS, AND 28,338 CLINIC VISITS. SEE SCHEDULE H FOR A NON-EXHAUSTIVE LIST OF COMMUNITY BENEFIT PROGRAMS AND DESCRIPTIONS. 42971751 SMMC 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 ARE DEEMED INDIGENT UNDER STATE, COUNTY, OR HOSPITAL GUIDELINES WAS $42,971,751, WHICH INCLUDED $17,952,308 OF TRADITIONAL FINANCIAL ASSISTANCE AND $25,019,443 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. 1424341 IN ADDITION TO CORE MEDICAL SERVICES, SMMC 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, SMMC PROVIDED $1,424,341 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, SMMC PROVIDED A TOTAL COMMUNITY BENEFIT OF $44,396,092 IN FISCAL YEAR 2014.) SMMC SERVES AND SUPPORTS ITS COMMUNITY THROUGH SUCH PROGRAMS AS SUPPORT GROUPS, PUBLIC HEALTH SCREENINGS, AND NUTRITION COUNSELING. SEE SCHEDULE H FOR A NON-EXHAUSTIVE LIST OF COMMUNITY BENEFIT PROGRAMS AND DESCRIPTIONS. 347927723 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 1 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 1 0 1 0 0 0 0 1 1 1 0 0 1 236 0 1 3538 1 1 1 0 0 0 0 0 0 0 0 0 X 13 7 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 1 1 IN X JOHN L ZABROWSKI 8124854178 3700 WASHINGTON AVENUE EVANSVILLE IN 47750 DARCY ELLISON SR VP/CNO 60.00 1.00 X 345276 0 84542 DORON FINN MD BOARD MEMBER 1.00 0.00 X 0 0 0 GWEN SANDEFUR EVP/COO 60.00 5.20 X 396534 0 25108 JOHN STANLEY BOARD MEMBER 1.00 2.00 X 0 0 0 KARL SASH MD BOARD MEMBER 1.00 56.00 X 0 653364 94682 KEITH JEWELL CEO/PRESIDENT 60.00 10.00 X X 0 10096 0 MARIA DEL-RIO MD BOARD MEMBER 55.00 0.00 X 402499 0 33899 MICHAEL HERRELL MD CHAIR 1.00 5.00 X X 0 0 0 NADINE COUDRET BOARD MEMBER 1.00 1.00 X 0 0 0 SHARON KAZEE BOARD MEMBER 1.00 1.00 X 0 0 0 SISTER SHARON RICHARDT BOARD MEMBER 1.00 1.00 X 0 0 0 SISTER XAVIER BALLANCE BOARD MEMBER 1.00 4.00 X 0 0 0 TIMOTHY FLESCH THRU 122013 CEO/PRESIDENT 60.00 11.20 X X 1661825 0 23492 TRICIA HENNING BOARD MEMBER 1.00 2.00 X 0 0 0 JOHN ZABROWSKI CFO 60.00 1.00 X 0 0 0 KIMBERLY HODGKINSON THRU 12014 CFO 60.00 3.00 X 361522 0 21294 JANICE ERNEST VP/CARDIOVASCULAR & SYSTEM SUPPORT SERVICES 55.00 2.00 X 223185 0 50258 JOHN GREANEY VP/STRATEGIC SERVICES 55.00 0.00 X 207438 0 24640 KATHY HALL VP/SMHS REGIONAL ADMINISTRATOR 55.00 3.00 X 213081 0 28541 MICHAEL KLUEH VP/CRO 55.00 0.00 X 198886 0 41593 MIKE WHITMORE VP/CLINICAL SUPPORT & ANCILLARY SERVICES 55.00 0.00 X 219899 0 20623 VERNON MAAS MD VP/MEDICAL AFFAIRS 55.00 0.00 X 255029 0 54974 ALIREZA KHAKBAZNEJAD MD PHYSICIAN 55.00 0.00 X 447020 0 46035 CHARLES LACKEY MD PHYSICIAN 55.00 0.00 X 502487 0 51154 JOHN GALLAGHER MD PHYSICIAN 55.00 0.00 X 445032 0 78982 KATHRYN BRYAN MD PHYSICIAN 55.00 0.00 X 483791 0 51852 MUREENA TURNQUEST-WELLS MD PHYSICIAN 55.00 1.00 X 616313 0 81210 THOMAS LILLY FORMER KEY EMPLOYEE 0.00 0.00 X 240841 0 15219 7220658 663460 828098 148 1 1 0 AMBULATORY CARE CENTER LLC 1125 PROFESSIONAL BLVD EVANSVILLE IN 47714 MEDICAL SERVICES 29165844 MID AMERICA CLINICAL LABS PO BOX 19163 INDIANAPOLIS IN 46219 MEDICAL SERVICES 4273890 TRIMEDX PO BOX 636129 CINCINNATI OH 45263 HEALTH CARE EQUIPMENT MANAGEMENT 2715798 EMERGENCY PROFESSIONAL SERVICE PO BOX 634850 CINCINNATI OH 45263 MEDICAL SERVICES 2375214 ST MARY'S PERIPHERAL VASCULAR SERVICES 3700 WASHINGTON AVENUE EVANSVILLE IN 47750 MEDICAL SERVICES 1734631 51 10522884 300396 54175 10823280 OUTPATIENT SERVICE REV 621110 223385583 223385583 INPATIENT SERVICE REV 621110 210919283 210919283 434304866 17298327 17298327 631151 555613 75538 75538 75538 21300 181517 -160217 -160217 -160217 APOTHECARY 446110 4740264 4740264 CAFETERIA/MISC. SERV 722320 1781494 93358 1688136 LAB SERVICES 621500 337571 32861 304710 2419337 2394027 25310 9278666 471620460 441278940 151529 19366711 64907190 64907190 4894138 402499 4491639 115696237 97872134 17562220 261883 19540106 15924130 3573541 42435 7501307 6113160 1371857 16290 754094 753594 500 2294 2294 17310425 13384009 3926416 155012 11484 129465 14063 2245620 1308858 922938 13824 170210 93675 76535 4254477 106904 4147573 239768 134951 82973 21844 187806 79027 108700 79 4191850 3423566 768284 12401752 11083963 1317789 1419559 1159026 260097 436 PURCHASED SERVICES 113884124 48518679 65363193 2252 MEDICAL SUPPLIES 51288876 51288876 PROVIDER TAX EXPENSE 19199872 19199872 COST OF GOODS SOLD 5778431 5778431 10404806 6383695 3678443 342668 456427954 347927723 107784457 715774 3446252 342125 54541611 61369645 854961 794299 6068368 7950756 2562612 575375 323174944 247039015 85224143 76135929 55798 64262 279255 7578268 461627665 462391115 614660665 617201774 37975128 29343427 175791992 169135900 213767120 198479327 X 400893545 418722447 400893545 418722447 614660665 617201774 X 15192506 31379119 -28742723 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 3147 3147 0 PART II-B, LINE 1: LOBBYING EXPENSES REPRESENT THE PORTION OF DUES PAID TO NATIONAL AND STATE HOSPITAL ASSOCIATIONS THAT IS SPECIFICALLY ALLOCABLE TO LOBBYING. ST. MARY'S MEDICAL CENTER OF EVANSVILLE, 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. 7736792 7736792 93655938 64571438 29084500 20212082 12132800 8079282 201570132 170334777 31235355 76135929 OTHER RECEIVABLES 4351049 DEFERRED COMPENSATION ASSET 5093422 ESTIMATED SETTLEMENTS FROM THIRD PARTIES 2756338 PHYSICIAN GUARANTEES ASSET 14269028 OTHER CURRENT ASSETS 1918010 INTEREST IN INVESTMENTS HELD BY ASCENSION HEALTH ALLIANCE 427200286 ADVANCES TO AFFILIATES 124239 DUE FROM ST. MARY'S AT HOME, INC. -157975 DUE FROM ST. MARY'S HEALTH SERVICES, INC. -70363 DUE FROM ST. MARY'S BUILDING CORPORATION 231512 DUE FROM ST. MARY'S MEDICAL CENTER FOUNDATION OF EVANSVILLE, INC. 370292 DUE FROM ST. MARY'S PERIPHERAL VASCULAR SERVICES MANAGEMENT CO., LLC 150042 DUE FROM ST. MARY'S MEDICAL GROUP, LLC 287126 DUE FROM ST. MARY'S WARRICK EMERGENCY SERVICES, INC. 1229644 DUE FROM ST. MARY'S WARRICK HOSPITAL, INC. 1191054 DUE FROM ST. MARY'S ACUTE DIALYSIS SERVICES, INC. 192796 DUE FROM ST. MARY'S CARE PARTNERS, INC. -12755 DUE FROM ST.VINCENT HEALTH, INC. 1 DUE FROM ST.VINCENT HOSPITAL AND HEALTH CARE CENTER, INC. 2780184 DUE FROM MEDEXCEL, LLC D/B/A TRIMEDIX 487185 462391115 DEFERRED COMPENSATION 5093422 SELF INSURANCE LIABILITY 1812228 ESTIMATED SETTLEMENT LIABILITY 5313181 AH SAVINGS LIABILITY 1923692 VALUATION ALLOWANCE 1950000 DEFERRED RENT PAYABLE 444580 PHYSICIAN GUARANTEE LIABILITY 14269028 INTERCOMPANY DEBT WITH ASCENSION HEALTH ALLIANCE 135459870 DUE TO ST. MARY'S AT HOME, INC. 5835 DUE TO ST. MARY'S HEALTH SERVICES, INC. 2035 DUE TO ST. MARY'S BUILDING CORPORATION 493039 DUE TO ST. MARY'S MEDICAL CENTER FOUNDATION OF EVANSVILLE, INC. 2348 DUE TO ST. MARY'S PERIPHERAL VASCULAR SERVICES MANAGEMENT CO., LLC 222157 DUE TO ST. MARY'S MEDICAL GROUP, LLC 16575 DUE TO ST. MARY'S WARRICK EMERGENCY SERVICES, INC. 7035 DUE TO ST. MARY'S WARRICK HOSPITAL, INC. 65854 DUE TO ST.VINCENT HEALTH, INC. 235846 DUE TO ST.VINCENT HOSPITAL AND HEALTH CARE CENTER, INC. 312432 DUE TO ASCENSION HEALTH MINISTRY SERVICE CENTER 1506743 169135900 X PART X, LINE 2: 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. NORTH AMERICA 0 0 PROGRAM SERVICES MEDICAL SUPPLIES 6630 NORTH AMERICA 0 0 PROGRAM SERVICES LICENSES, PERMITS 5478 NORTH AMERICA 0 0 PROGRAM SERVICES MINOR MEDICAL EQUIPMENT 25628 NORTH AMERICA 0 0 PROGRAM SERVICES EQUIPMENT 25760 0 0 0 0 0 0 63496 0 63496 0 0 0 0 0 0 1 1 X 1 X 1 X 1 1 0 1 1 17952308 17952308 0.03930 62605772 37586329 25019443 0.05480 80558080 37586329 42971751 0.09410 541747 849456 307709 541747 0.00120 383281 383281 0.00080 42807 499313 499313 0.00110 584554 1732050 307709 1424341 0.00310 584554 82290130 37894038 44396092 0.09720 0 4138370 413837 103917649 153275886 -49358237 X 1 1 1 ST MARY'S PERIPHERAL VASCULAR SERVICES MANAGEMENT COMPANY LLC MANAGEMENT 0.75000 0.00000 0.75000 1 1 ST MARY'S MEDICAL CENTER OF EVA INC 3700 WASHINGTON AVENUE EVANSVILLE IN 47750 WWW.STMARYS.ORG/SMLOCATION 14-005089-1 X X X X X ST MARY'S MEDICAL CENTER OF EVA INC 1 1 X X X X X X X X X 12 1 1 1 X HTTP://WWW.STMARYS.ORG/CHNA X X X X X X X X X 0 0 1 1 200.000000000000 1 300.000000000000 1 X X 1 1 X X X 1 0 X X X X 1 X 0 0 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 WARRICK HOSPITAL, INC., DEACONESS HOSPITAL, DEACONESS GATEWAY, DEACONESS CROSSPOINTE, AND THE WOMEN'S HOSPITAL. PART V, SECTION B, LINE 5C: THE HOSPITAL FACILITY PRESENTED ITS CHNA TO THE COMMUNITY AT A LOCAL FINANCIAL INSTITUTION. PART V, SECTION B, LINE 7: THE HOSPITAL FACILITY'S COMMUNITY NEEDS HEALTH ASSESSMENT IDENTIFIED ACCESS TO CARE, ORAL 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. 19 ST MARY'S SURGICARE 300 CIRCLE FRONT DRIVE EVANSVILLE IN 47715 GENERAL SURGICAL CENTER ST MARY'S SURGICARE 1125 PROFESSIONAL BLVD EVANSVILLE IN 47714 GENERAL SURGICAL CENTER ST MARY'S CONVENIENT CARE EAST 100 EPWORTH CROSSING SUITE B100 NEWBURGH IN 47630 MULTI SERVICE OUTPATIENT FACILITY ST MARY'S MATERNAL-FETAL MEDICINE 3700 WASHINGTON AVENUE SUITE 2100A EVANSVILLE IN 47750 OBSTETRICS/GYNECOLOGY ST MARY'S OUTPATIENT REHAB 1144 WASHINGTON SQUARE EVANSVILLE IN 47715 OUTPATIENT REHAB CLINIC ST MARY'S REHAB 3900 WASHINGTON AVENUE EVANSVILLE IN 47714 INPATIENT REHAB CENTER ST MARY'S NORTHBROOK 3838 N FIRST AVENUE EVANSVILLE IN 47710 PRIMARY CARE FACILITY ST MARY'S FOR CHILDREN 3900 WASHINGTON AVENUE EVANSVILLE IN 47714 CHILDREN'S HEALTH FACILITY ST MARY'S OCCMED 2330 LYNCH ROAD EVANSVILLE IN 47711 OCCUPATIONAL MEDICINE CLINIC ST MARY'S CONVENIENT CARE - WEST 5320 WESTON ROAD EVANSVILLE IN 47712 PRIMARY CARE FACILITY ST MARY'S NORTH POINTE REHAB 2300 LYNCH ROAD EVANSVILLE IN 47711 OUTPATIENT REHAB CLINIC ST MARY'S NORTHBROOK - DX RADIOLOGY 3838 N FIRST AVENUE EVANSVILLE IN 47710 IMAGING SERVICES/RADIOLOGY ST MARY'S IMAGING AND LAB 1138 WASHINGTON SQUARE EVANSVILLE IN 47715 IMAGING SERVICES/RADIOLOGY ST MARY'S NORTHBROOK - CT 3838 N FIRST AVENUE EVANSVILLE IN 47710 IMAGING SERVICES/RADIOLOGY ST MARY'S WEST SIDE X-RAY 2345 W FRANKLIN STREET EVANSVILLE IN 47712 IMAGING SERVICES/RADIOLOGY JOSLIN DIABETES CENTER 3801 BELLEMEADE AVENUE EVANSVILLE IN 47714 DIABETES SERVICE CENTER ST MARY'S WEIGHT MANAGEMENT CENTER 950 S KENMORE EVANSVILLE IN 47714 WEIGHT MANAGEMENT FACILITY ST MARY'S HEART INSTITUTE 3700 WASHINGTON AVENUE EVANSVILLE IN 47714 SPECIALITY CARE FACILITY ST MARY'S PRE-PROCEDURE CLINIC 1140 WASHINGTON AVENUE EVANSVILLE IN 47714 PRIMARY CARE FACILITY 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, WHICH MAY BE ADJUSTED FOR COST OF LIVING UTILIZING THE LOCAL WAGE INDEX COMPARED TO THE NATIONAL WAGE INDEX, WILL BE ELIGIBLE FOR 100% CHARITY CARE WRITE OFF OF CHARGES FOR SERVICES THAT HAVE BEEN PROVIDED TO THEM. ALSO, AT A MINUMUM, PATIENTS WITH INCOMES ABOVE 200% OF THE FPL BUT NOT EXCEEDING 300% OF THE FPL, SUBJECT TO ADJUSTMENTS FOR COST OF LIVING UTILIZING THE LOCAL WAGE INDEX COMPARED TO NATIONAL WAGE INDEX, WILL 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 A COST ACCOUNTING SYSTEM THAT ADDRESSES ALL PATIENT SEGMENTS (FOR EXAMPLE, INPATIENT, OUTPATIENT, EMERGENCY ROOM, PRIVATE INSURANCE, MEDICAID, MEDICARE, UNINSURED, OR SELF PAY). THE BEST AVAILABLE DATA WAS USED TO CALCULATE THE AMOUNTS REPORTED IN THE TABLE. FOR THE INFORMATION IN THE TABLE, A COST-TO-CHARGE RATIO WAS CALCULATED AND APPLIED. 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 $15,058,871 AT CHARGES ($4,138,370 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 COSTS REPORTED IN THE ORGANIZATION'S MEDICARE COST REPORT. ASCENSION HEALTH AND 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 SYSTEMS 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 MEDICAL CENTER OF EVANSVILLE, INC. IS TO WORK WITH ITS COMMUNITY TO CONDUCT AN ASSESSMENT AT LEAST EVERY THREE YEARS. ASSESSMENTS MAY INCLUDE PRIMARY SURVEY DATA, SECONDARY 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 MEDICAL CENTER OF EVANSVILLE, 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 MEDICAL CENTER OF EVANSVILLE, 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 MEDICAL CENTER OF EVANSVILLE, 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 EMPLOYS FINANCIAL COUNSELORS, HEALTH ACCESS WORKERS, AND ENROLLMENT SPECIALISTS WHO CONSULT WITH PATIENTS ABOUT THEIR ELIGIBILITY FOR FINANCIAL ASSISTANCE PROGRAMS AND HELP PATIENTS IN APPLYING FOR ANY PUBLIC PROGRAMS FOR WHICH THEY MAY QUALIFY. ALL SELF-PAY PATIENTS RECEIVE A 15% DISCOUNT OFF THE TOP ON ALL CHARGES BEFORE STATEMENTS ARE MAILED. PART VI, LINE 4: ST. MARY'S MEDICAL CENTER OF EVANSVILLE, INC. IS LOCATED IN EVANSVILLE, INDIANA AND SERVES VANDERBURGH AND CONTINGUOUS COUNTIES IN SOUTHERN INDIANA AND NORTH-CENTRAL KENTUCKY. THE PRIMARY SERVICE AREA IS DEFINED AS VANDERBURGH, WARRICK AND POSEY COUNTIES. THE POPULATION FOR THE PRIMARY SERVICE AREA WAS 287,757 IN 2014. ALSO THE MEDIAN INCOME FOR THE PRIMARY SERVICE AREA WAS $54,936 FOR 2014 WITH 16% OF CHILDREN BELOW POVERTY LEVEL. 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 MEDICAL CENTER OF EVANSVILLE, INC.:- DELIVERS PATIENT SERVICES, INCLUDING EMERGENCY DEPARTMENT SERVICES AND URGENT CARE SITES, 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- TRAINS AND EDUCATES HEALTH CARE PROFESSIONALS- PARTICIPATES IN GOVERNMENT-SPONSORED PROGRAMS SUCH AS MEDICAID AND MEDICARE TO PROVIDE TO THE POOR AND ELDERLY. APPLICATION EVENTS ARE HELD AS WELL AS FOLLOW UP ASSISTANCE FOR INSURANCE- HEALTH ACCESS ADVOCATES ("HAA") ARE COMMUNITY BASED STAFF WHOSE PRIMARY ROLE IS TO SIGN CHILDREN UP FOR HOOSIER HEALTHCARE INSURANCE. THEY CAN DO THIS BY ASSISTING FAMILIES IN APPLYING FOR HOOSIER HEALTHCARE INSURANCE HERE IN THE OFFICE, IN THE COMMUNITY, OR AT THE PATIENT'S HOME. DURING THIS PROCESS, THEY CAN ALSO ASSIST FAMILIES WITH BASIC NEEDS SUCH AS FOOD, SHELTER AND CLOTHING. THE ADVOCATES CAN ALSO ASSIST ADULTS WITH APPLYING FOR MEDICAID, HEALTHY INDIANA PLAN, AND OTHER RESOURCES SUCH AS PHARMACEUTICAL APPLICATIONS FOR THOSE WHO QUALIFY. HAA WILL AT TIMES TRANSPORT PATIENTS TO NECESSARY APPOINTMENTS. ADDITIONALLY, HAA PROVIDES ASSISTANCE TO THE LATINO POPULATION BY PROVIDING A BI-LINGUAL ASSOCIATE. THIS ASSOCIATE SPEARHEADS A CERTIFIED MEDICAL INTERPRETER TRAINING PROGRAM THROUGH THE BRIDGING THE GAP PROGRAM - IS GOVERNED BY A BOARD IN WHICH INDEPENDENT COMMUNITY MEMBERS COMPRISE A MAJORITY- CONDUCTS COMMUNITY HEALTH NEEDS ASSESSMENTS AND HOLDS MEMBERSHIP ON OTHER PUBLIC AGENCY BOARDS TO ENHANCE WELL BEING OF THE COMMUNITY IN PARTNERSHIP PROGRAMS- PROVIDES DENTAL SERVICES FOR PRIMARY SERVICE AREA WITH MOBILE DENTAL FOR KIDS CLINIC- NUTRITION COUNSELING IS PROVIDED TO THE COMMUNITY AND SPECIFICALLY AREA SCHOOLS AND YOUTH GROUPS, SUCH AS FOOD PYRAMID PROGRAMS, STAFF HEALTH FAIR, ETC- COMPLIMENTARY THERAPIES INCLUDING MASSAGES, YOGA CLASSES, STRESS REDUCTION CLASSES AT HOPE RESOURCE CENTER FOR CANCER PATIENTS AND SURVIVORS- MALL WALKING PROGRAMS AND MONTHLY BLOOD PRESSURE SCREENINGS AT LOCAL MALL- CHRISTMAS PROGRAMS FOR THE POOR: GREAT EXPECTATIONS. AREA FAMILIES ARE IDENTIFIED FROM LOCAL GROUPS SUCH AS UNITED WAY, CHURCHES, AND THE SCHOOL SYSTEMS, AS NEEDING ASSISTANCE WITH CHRISTMAS. ASSOCIATES OF ST. MARY'S GIVE MONIES, FOOD, CLOTHING, TOYS, ETC. TO FAMILIES IN NEED EACH YEAR. - AUTISM VISIT WITH SANTA- WNIN KIDS DAY - MOBILE DENTAL KARE LAB- CPR CLASSES GIVEN AT LOCAL DAYCARES AND SCHOOLS- JOSLIN AND DIABETIC FOOT CLINIC - LECTURES, CLASSES, EXERCISE INSERVICES- SAFESITTERS EDUCATION FOR TEENAGERS PREPARING TO TAKE CARE OF YOUNG CHILDREN, TODDLERS, AND INFANTS- ST. MARY'S NIGHTS AT CHILDREN'S MUSEUM OF EVANSVILLE- YOUTH FIRST RETREATS- AMERICAN RED CROSS BLOOD DRIVES- AMBULANCE, REHAB, AND MISC. BILLINGS PAID FOR PATIENTS- PATIENT CARE FOR NON-PROFIT ECHO CLINIC- TRANSPORTATION SERVICES FOR PATIENTS AND FAMILIES - MEAL TICKETS FOR PATIENT FAMILIES PART VI, LINE 6: AS A PART OF ST. MARY'S HEALTH, INC., ST. MARY'S MEDICAL CENTER OF EVANSVILLE, INC. IS DEDICATED TO IMPROVING THE HEALTH STATUS AND QUALITY OF LIFE FOR THE COMMUNITIES IT SERVES. WHILE DESIGNATED ASSOCIATES AT ST. MARY'S MEDICAL CENTER OF EVANSVILLE, INC. DEVOTE ALL OR SIGNIFICANT PORTIONS OF THEIR TIME TO LEADING AND ADMINISTERING LOCAL COMMUNITY-BASED PROGRAMS AND PARTNERSHIPS, ASSOCIATES THROUGHOUT THE ORGANIZATION ARE ACTIVE PARTICIPANTS IN COMMUNITY OUTREACH. THEY ARE ASSISTED AND SUPPORTED BY DESIGNATED ST. 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 MEDICAL CENTER OF EVANSVILLE, INC. PARTICIPATES.FORM 990, PART III, LINE 4A, 4B AND 4C:COMMUNITY BENEFIT REPORTAS A MEMBER OF ASCENSION HEALTH, THE NATION'S LARGEST CATHOLIC HEALTHCARE SYSTEM, ST. MARY'S MEDICAL CENTER OF EVANSVILLE, INC. CONTINUES TO BUILD AND STRENGTHEN SUSTAINABLE COLLABORATIVE EFFORTS THAT BENEFIT THE HEALTH OF INDIVIDUALS, FAMILIES, AND SOCIETY AS A WHOLE. THE GOAL OF ST. MARY'S MEDICAL CENTER OF EVANSVILLE, INC. IS TO PERPETUATE THE HEALING MISSION OF THE CHURCH. ST. MARY'S MEDICAL CENTER OF EVANSVILLE, INC. FURTHERS THIS GOAL THROUGH DELIVERY OF PATIENT SERVICES, CARE TO THE ELDERLY AND INDIGENT, PATIENT EDUCATION AND HEALTH AWARENESS PROGRAMS FOR THE COMMUNITY, AND MEDICAL RESEARCH. OUR CONCERN FOR ALL HUMAN LIFE AND DIGNITY OF EACH PERSON LEADS THE ORGANIZATION TO PROVIDE MEDICAL SERVICES TO ALL PEOPLE IN THE COMMUNITY WITHOUT REGARD TO THE PATIENT'S RACE, CREED, NATIONAL ORIGIN, ECONOMIC STATUS, OR ABILITY TO PAY. IN ORDER TO PORTRAY THE FULL BREADTH OF OUR CONTRIBUTION, OUR COMMUNITY BENEFIT INFORMATION IS DESCRIBED BELOW:ORGANIZATIONAL COMMITMENT TO PROVIDING COMMUNITY BENEFITST. MARY'S MEDICAL CENTER OF EVANSVILLE, INC. IS A 494-BED ACUTE CARE HOSPITAL. ST. MARY'S MEDICAL CENTER OF EVANSVILLE, INC. SERVICES THE TRI-STATE AREA AROUND SOUTHERN INDIANA, INCLUDING SOUTHEASTERN ILLINOIS, AND NORTHWESTERN KENTUCKY. ST. MARY'S MEDICAL CENTER OF EVANSVILLE, INC. SEEKS TO IMPROVE THE PHYSICAL, MENTAL, SOCIAL AND SPIRITUAL HEALTH STATUS OF ITS SURROUNDING COMMUNITY. ST. MARY'S MEDICAL CENTER OF EVANSVILLE, INC. PROVIDES SIGNIFICANT RESOURCES ONLINE FOR PUBLIC USE AND EDUCATION AT WWW.STMARYS.ORG. SUCH ITEMS INCLUDE INFORMATION ON ALLERGIES, ASTHMA, BACK PAIN, CANCER, DIABETES, HEART DISEASE, KIDNEY DISEASE, MEN'S HEALTH, ORTHOPEDIC HEALTH, MENTAL HEALTH, PARENTING, PATIENT SAFETY, PREGNANCY, SENIOR HEALTH, STRESS, STROKE, WEIGHT MANAGEMENT AND WOMEN'S HEALTH. PLEASE VISIT WWW.STMARYS.ORG FOR A FULL LIST OF SERVICES. 1 ST MARY'S OHIO VALLEY HEARTCARE LLC 3700 WASHINGTON AVENUE EVANSVILLE IN 47750 273474697 501(C)(3) 3700345 OPERATING GRANT ST MARY'S PHYSICIAN NETWORK LLC 3700 WASHINGTON AVENUE EVANSVILLE IN 47750 205023387 501(C)(3) 3365000 OPERATING GRANT ST MARY'S MEDICAL GROUP LLC 3700 WASHINGTON AVENUE EVANSVILLE IN 47750 261356310 501(C)(3) 10350000 OPERATING GRANT PRIMARY PHYSICIAN NETWORK LLC 3700 WASHINGTON AVENUE EVANSVILLE IN 47750 208775914 501(C)(3) 3770000 OPERATING GRANT ST MARY'S HEALTH INC 3700 WASHINGTON AVENUE EVANSVILLE IN 47750 352057801 501(C)(3) 40216424 OPERATING SUPPORT ST MARY'S MEDICAL GROUP INC 3700 WASHINGTON AVENUE EVANSVILLE IN 47750 352076827 2500000 OPERATING SUPPORT ST MARY'S CARE PARTNERS INC 3700 WASHINGTON AVENUE EVANSVILLE IN 47750 351899562 501(C)(3) 1000000 OPERATING SUPPORT ST MARY'S AT HOME INC 3700 WASHINGTON AVENUE EVANSVILLE IN 47750 351899560 501(C)(3) 5421 FMV EQUIPMENT OPERATING SUPPORT 7 1 PART I, LINE 2: 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. 1 1 0 0 0 0 0 0 0 DARCY ELLISON SR VP/CNO 301277 0 42181 0 1818 0 71759 0 12783 0 429818 0 0 0 GWEN SANDEFUR EVP/COO 344978 0 50551 0 1005 0 11903 0 13205 0 421642 0 0 0 KARL SASH MD BOARD MEMBER 0 327829 0 284404 0 41131 0 60223 0 34459 0 748046 0 39996 MARIA DEL-RIO MD BOARD MEMBER 310878 0 89633 0 1988 0 26092 0 7807 0 436398 0 0 0 TIMOTHY FLESCH THRU 122013 CEO/PRESIDENT 895586 0 742747 0 23492 0 5000 0 18492 0 1685317 0 2 0 KIMBERLY HODGKINSON THRU 12014 CFO 311293 0 45509 0 4720 0 5000 0 16294 0 382816 0 0 0 JANICE ERNEST VP/CARDIOVASCULAR & SYSTEM SUPPORT S 192567 0 28560 0 2058 0 30531 0 19727 0 273443 0 0 0 JOHN GREANEY VP/STRATEGIC SERVICES 179861 0 26736 0 841 0 5000 0 19640 0 232078 0 0 0 KATHY HALL VP/SMHS REGIONAL ADMINISTRATOR 184845 0 27817 0 419 0 13538 0 15003 0 241622 0 0 0 MICHAEL KLUEH VP/CRO 164168 0 25956 0 8762 0 20920 0 20673 0 240479 0 3983 0 MIKE WHITMORE VP/CLINICAL SUPPORT & ANCILLARY SERV 190720 0 27777 0 1402 0 18091 0 2532 0 240522 0 0 0 VERNON MAAS MD VP/MEDICAL AFFAIRS 218010 0 25394 0 11625 0 44396 0 10578 0 310003 0 0 0 ALIREZA KHAKBAZNEJAD MD PHYSICIAN 399507 0 33825 0 13688 0 39728 0 6307 0 493055 0 6057 0 CHARLES LACKEY MD PHYSICIAN 446547 0 0 0 55940 0 42139 0 9015 0 553641 0 37900 0 JOHN GALLAGHER MD PHYSICIAN 188045 0 81435 0 175552 0 66112 0 12870 0 524014 0 55791 0 KATHRYN BRYAN MD PHYSICIAN 427711 0 0 0 56080 0 40626 0 11226 0 535643 0 36382 0 MUREENA TURNQUEST-WELLS MD PHYSICIAN 537509 0 59296 0 19508 0 65253 0 15957 0 697523 0 0 0 THOMAS LILLY FORMER KEY EMPLOYEE 104387 0 32962 0 103492 0 11648 0 3571 0 256060 0 0 0 PART I, LINE 3: ASCENSION HEALTH, A RELATED ORGANIZATION OF ST. MARY'S MEDICAL CENTER OF EVANSVILLE, 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 HIGHEST COMPENSATED EMPLOYEE AND FORMER KEY EMPLOYEE RECEIVED SEVERANCE PAYMENTS FROM THE ORGANIZATION OR A RELATED ORGANIZATION DURING THE CALENDAR YEAR 2013: JOHN GALLAGHER, MD $105,715 THOMAS LILLY $99,920 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: ALIREZA KHAKBAZNEJAD, MD $6,057 CHARLES LACKEY, MD $37,900 JOHN GALLAGHER, MD $55,791 KATHRYN BRYAN, MD $36,382 MICHAEL KLUEH $3,983 TIMOTHY FLESCH $2 KARL SASH, MD $39,996 CAROL ACKERMAN - SEE PART V - 48709 SEE PART V 0 JENNIFER HERRELL MD - SEE PART V - 33615 SEE PART V 0 KIMBERLY WHITMORE - SEE PART V - 53624 SEE PART V 0 SCHEDULE L, PART IV: BUSINESS TRANSACTIONS INVOLVING INTERESTED PERSONS(A) NAME OF PERSON: CAROL ACKERMAN(B) RELATIONSHIP BETWEEN INTERESTED PERSON AND ORGANIZATION: SISTER-IN-LAW OF DARCY ELLISON(C) AMOUNT OF TRANSACTION: $48,709(D) DESCRIPTION OF TRANSACTION: CAROL ACKERMAN IS AN EMPLOYEE OF ST. MARY'S MEDICAL CENTER OF EVANSVILLE, INC. AND RECEIVES COMPENSATION FROM THE ORGANIZATION.(E) SHARING OF ORGANIZATION REVENUES: NO SCHEDULE L, PART IV: BUSINESS TRANSACTIONS INVOLVING INTERESTED PERSONS(A) NAME OF PERSON: JENNIFER HERRELL, MD(B) RELATIONSHIP BETWEEN INTERESTED PERSON AND ORGANIZATION: DAUGHTER OF MICHAEL HERRELL, MD(C) AMOUNT OF TRANSACTION: $33,615(D) DESCRIPTION OF TRANSACTION: JENNIFER HERRELL, MD IS AN EMPLOYEE OF ST. MARY'S MEDICAL CENTER OF EVANSVILLE, INC. AND RECEIVES COMPENSATION FROM THE ORGANIZATION.(E) SHARING OF ORGANIZATION REVENUES: NO SCHEDULE L, PART IV: BUSINESS TRANSACTIONS INVOLVING INTERESTED PERSONS(A) NAME OF PERSON: KIMBERLY WHITMORE(B) RELATIONSHIP BETWEEN INTERESTED PERSON AND ORGANIZATION: WIFE OF MIKE WHITMORE(C) AMOUNT OF TRANSACTION: $53,624(D) DESCRIPTION OF TRANSACTION: KIMBERLY WHITMORE IS AN EMPLOYEE OF ST. MARY'S MEDICAL CENTER OF EVANSVILLE, INC. AND RECEIVES COMPENSATION FROM THE ORGANIZATION.(E) SHARING OF ORGANIZATION REVENUES: NO X MEDICAL EQUIP 1 54175 FMV OF DONATED ASSET 0 0 0 0 PART I, COLUMN (B): THE NUMBERS IN COLUMN (B) REFER TO THE NUMBER OF CONTRIBUTIONS. FORM 990, PART IV, LINE 24A: ST. MARY'S MEDICAL CENTER OF EVANSVILLE, INC. IS A HEALTH FACILITY THAT IS PART OF THE ASCENSION HEALTH SYSTEM. ASCENSION HEALTH IS THE BORROWER FOR TAX-EXEMPT HOSPITAL REVENUE BONDS. ST. MARY'S MEDICAL CENTER OF EVANSVILLE, INC. HOLDS AN INTERCOMPANY NOTE PAYABLE WITH ASCENSION HEALTH, AND THIS INFORMATION IS REPORTED ON THE BALANCE SHEET. FORM 990, PART VI, SECTION A, LINE 6 ST. MARY'S MEDICAL CENTER OF EVANSVILLE, INC. HAS A SINGLE CORPORATE MEMBER, ST. MARY'S HEALTH SERVICES, INC. FORM 990, PART VI, SECTION A, LINE 7A ST. MARY'S MEDICAL CENTER OF EVANSVILLE, INC. HAS A SINGLE CORPORATE MEMBER, ST. MARY'S HEALTH SERVICES, INC. WHO HAS THE ABILITY TO ELECT MEMBERS TO THE GOVERNING BODY OF ST. MARY'S MEDICAL CENTER OF EVANSVILLE, INC. FORM 990, PART VI, SECTION A, LINE 7B ALL DECISIONS THAT HAVE A MATERIAL IMPACT TO ST. MARY'S MEDICAL CENTER OF EVANSVILLE, 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 REVIEW THE FORM 990 VIA A SECURE WEB-BASED PORTAL AND ASK ANY QUESTIONS REGARDING THE FORM 990. ANY QUESTIONS AND RESPONSES WILL BE POSTED TO THE WEB-BASED PORTAL 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 MEDICAL CENTER OF EVANSVILLE, 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 THEIR COMPENSATION WAS DECIDED. COMPENSATION DETERMINATIONS OF ST. MARY'S MEDICAL CENTER OF EVANSVILLE, 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 SUBSIDIARIES (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 -428,383. BOND REMIDIATION -13,523,000. NET ASSET TRANSFER WITH ST. MARY'S HEALTH SERVICES, INC. -1,588,575. NET ASSET TRANSFER WITH ST. MARY'S HEALTH, INC. -481,662. NET ASSET TRANSFER WITH ST. MARY'S BUILDING CORPORATION -12,721,103. 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