2015-05-13T17:46:12-05:00 2014-06-30 861065772 Deloitte Tax LLP 111 Monument Circle Suite 2000 Indianapolis IN 462045108 990 2013-07-01 352099320 StVincent Frankfort Hospital Inc STVI 7656563542 1300 South Jackson Street Frankfort IN 460410669 Thomas Crawford Administrator 7656563133 2015-05-13 1 Shawna M Jimenez P01222873 3174648600 2015-05-01 2013 2016-02-25 16:41:14Z Thomas Crawford 1300 South Jackson Street Frankfort IN 460410669 31509272 0 X www.stvincent.org X 2000 IN We are a nonprofit hospital dedicated to providing healthcare that leaves no one behind. 7 4 165 70 0 0 59576 32197 30422243 29457747 1578352 1770850 263775 248478 32323946 31509272 203 2967735 0 0 10581507 9888691 0 0 0 16206691 12630966 26788401 25487392 5535545 6021880 46405212 55300473 7803270 7613137 38601942 47687336 X St.Vincent Frankfort Hospital is dedicated to providing spiritually-centered, holistic healthcare that sustains and improves the health of those served, with special attention to the poor and vulnerable. Both inpatient and outpatient health services are provided without regard to patient race, creed, national origin, economic status, insurance status or ability to pay. This mission extends well beyond the provision of core medical services to encompass medical and scientific research programs, the training and educating of health care professionals and active support of community-based partnerships and programs to improve health and quality of life. 0 0 22175732 2967735 29457747 St.Vincent Frankfort Hospital (SVFH) is a 25-bed, critical access hospital serving rural Clinton and contiguous counties and providing services without regard to patient race, creed, national origin, economic status, or ability to pay. During fiscal year 2014, SVFH treated 837 adults and children for a total of 3,460 inpatient days of service. The hospital also provided services for 35,193 outpatient visits, including 741 outpatient surgeries and 11,249 emergency room and minor care visits. See Schedule H for a non-exhaustive list of community benefit programs and descriptions. St.Vincent Frankfort Hospital (SVFH) provides a substantial portion of its core health services to the poor, uninsured or underinsured and has proactively taken steps to address the accessibility, financing, and delivery of healthcare to the underserved. In addition to core medical services, SVFH partners with its community to assess community assets and needs, with special emphasis on the poor and vunerable. During the fiscal year ending June 30, 2014, SVFH's total community benefit was ($147,941), which included $3,654,311 of DSH money related to fiscal year 2012 and 2013. If the DSH money were not paid in fiscal year 2014, SVFH's total community benefit would have been $3,506,370. See Schedule H for a non-exhaustive list of community benefit programs and descriptions. 22175732 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 35 0 1 165 1 0 0 0 0 0 0 0 0 0 0 X 7 4 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 1 0 IN X Wayne Knight CFO 7656563452 1300 S Jackson Street Frankfort IN 460410669 Gloria Ponton Chair 0.20 0.00 X X 0 0 0 R Mark Ellison Thru 42014 Secretary/Treasurer 0.20 40.00 X X 0 203381 39934 Joseph D Dominik MD Director 40.00 0.00 X 0 152913 27771 Brett Eaton MD Director 0.20 0.00 X 0 0 0 Randy Ridgway Director 0.20 0.00 X 0 0 0 Ronald L Mead Director 0.20 40.00 X 0 292204 49777 Don Rusk Director 0.20 0.00 X 0 0 0 Thomas D Crawford Administrator 40.00 0.40 X X 179257 0 38716 Wayne R Knight CFO 15.00 45.20 X 0 156694 25355 Jerrell K Marks Thru 92013 CFO 40.00 0.20 X 114813 0 11530 Stephen D Tharp CMO 40.00 0.00 X 0 172604 28545 Kristi L Bledsoe CNO 40.00 0.00 X 116691 0 20682 Melissa M Roche Physician 40.00 0.00 X 217888 0 23078 Donald H Jacoby Manager Pharmacy 40.00 0.00 X 140619 0 12535 Krista K Wright Director of HR 40.00 0.20 X 108932 0 25231 878200 977796 303154 6 0 1 0 TX Team Rehab Inc 8777 Purdue Rd Ste 330 Indianapolis IN 46268 PT/OT services 811101 Emcare 1717 Main Street Ste 5200 Dallas TX 75201 Medical services 755276 Mid America Clinical Labs 6704 Reliable Parkway Chicago IL 60686 Lab services 396090 Ameripath Indianapolis LLC 2560 N Shadeland Ave Ste A Indianapolis IN 46219 Pathology services 142802 4 32197 32197 Net Medicare/Medicaid 621990 17940018 17940018 Net patient revenue 621990 11517729 11517729 29457747 1770850 1770850 129420 0 129420 129420 129420 Cafeteria revenue 722210 113953 113953 Pharmacy revenue 446110 5105 5105 119058 31509272 29457747 0 2019328 X 2967735 2967735 481691 481691 7374882 6426553 948329 1588170 1383949 204221 443948 386861 57087 911943 794677 117266 9566 8336 1230 15 13 2 530005 461852 68153 2312017 2014717 297300 32836 28614 4222 15873 13832 2041 418574 364750 53824 30107 30107 Purchased services 3068467 2673896 394571 Supplies 1436407 1251701 184706 Corporate expense 1331806 1160550 171256 Provider tax expense 1168414 1018169 150245 1364936 1189420 175516 25487392 22175732 3311660 0 161282 118241 2912343 5898952 422974 495978 22365 163500 8230111 5862174 2612958 2367937 40273290 46255865 46405212 55300473 3630008 3194128 4173262 4419009 7803270 7613137 X 38567700 47633643 34242 53693 38601942 47687336 46405212 55300473 X 6021880 2973706 89808 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 1568 1568 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.Vincent Frankfort 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. 160146 160146 2646735 1277020 1369715 66241 39582 26659 5340076 4545572 794504 16913 16913 2367937 Interest in investments held by Ascension Health Alliance 45353668 Other receivables and notes receivable 208767 Restricted by donor or grantor 53693 Receivables from third party payors 400249 Pension plan 239488 46255865 Due to St.Vincent Hospital and Health Care Center, Inc. (EIN: 35-0869066) 2073141 Other 375123 Payable to third party programs 1477980 Intercompany debt with Ascension Health Alliance 492765 4419009 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. 1 1 X 1 X 1 X 1 1 1 0 1 1 1588914 1588914 0.06230 5497616 7290128 -1792512 0.00000 7086530 7290128 -203598 0.06230 113 32467 390 32077 0.00130 13 23580 23580 0.00090 126 56047 390 55657 0.00220 126 7142577 7290518 -147941 0.06450 2 80 80 0.00000 2 80 80 0 807183 242155 8413865 8330559 83306 X 1 1 1 1 StVincent Frankfort Hospital Inc 1300 S Jackson Street Frankfort IN 460410669 http://www.stvincent.org/St-Vincent-Fr 14-005039-1 X X X X StVincent Frankfort Hospital Inc 1 1 X X X X X X X X X 12 1 0 1 X www.stvincent.org/CHNA/ X X X X X X X X 0 0 1 1 200.000000000000 1 400.000000000000 1 X X 1 1 X X X 1 0 X X X X 1 X 0 0 St.Vincent Frankfort Hospital, Inc. Part V, Section B, Line 3: In conducting its CHNA, the hospital facility took into account input from representatives of the community as well as those with special knowledge or expertise in public health. The hospital formed a CHNA Task Force, which was the group primarily responsible for overseeing the CHNA process, consisting of internal St.Vincent Frankfort Hospital staff. However, due to her expertise in public health and epidemiology, the effort was led by Pauline Shen, an Indiana-based epidemiologist and consultant with extensive experience in public health. Throughout this process, the task force met monthly to discuss strategy and the progress made toward the completion of the comprehensive community health needs assessment. Other organizations who participated in the CHNA included Wesley Manor, Purdue Extension, Head Start, YMCA, Learning Network, Frankfort Public Schools, Clinton County Health Department, Community Counseling Center, WIC, Clinton County Tobacco Prevention & Cessation Program, Chamber of Commerce, government officials, and more. St.Vincent Frankfort Hospital, Inc. Part V, Section B, Line 7: Dental Addressing this issue is not a direct priority of St.Vincent Frankfort; however, the hospital supports the efforts of organizations focused on dental issues. Educational Attainment - Addressing this issue is not a direct priority of St.Vincent Frankfort; however, the hospital provides a clinic site for the certified nursing assistant program in Clinton County. Teen Pregnancy - Addressing this issue is not a direct priority of St.Vincent Frankfort; however, the hospital does support efforts of the PEERS Program that focuses on abstinence for high school students. St.Vincent Frankfort Hospital, Inc. 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. 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 minimum, patients with incomes above 200% of the FPL but not exceeding 400% 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 II, Community Building Activities: St.Vincent Frankfort Hospital promotes the health of its communities by striving to improve the quality of life within the community. Research has established that factors such as economic status, employment, housing, education level, and built environment can all be powerful social determinants of health. Additionally, helping to create greater capacity within the community to address a broad range of quality of life issues also impacts health. St.Vincent Frankfort Hospital meets regularly with local organizations in the community to learn what resources are available and plan community health improvement efforts. In fiscal year 2014, these organizations included: the Chamber of Commerce, Paul Phillippe Senior Resource Center, Frankfort Main Street Board, the Clinton County Economic Advancement Foundation and United Way. 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 $2,445,773 at charges, ($807,183 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 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 its related health ministries follow the Catholic Health Association ("CHA") guidelines for determining community benefit. CHA community benefit reporting guidelines suggest that Medicare shortfall is not treated as community benefit. Part III, Line 9b: The organization has a written debt collection policy that also includes a provision on the collection practices to be followed for patients who are known to qualify for charity care or financial assistance. If a patient qualifies for charity or financial assistance certain collection practices do not apply. Part VI, Line 2: Communities are dynamic systems in which multiple factors interact to impact quality of life and health status. In addition to the formal CHNA conducted every 3 years, St.Vincent Frankfort Hospital helps to lead a community roundtable called Healthy Communities of Clinton County Coalition whose purpose is to assess needs within the community, prioritize action and work in partnership to address identified challenges. The coalition works closely with its member organizations which come from multiple sectors of the community, including local government, business, education, faith communities, public health, health care providers and other social and human service organizations. In addition, the coalition works closely with other coalitions as well as the local and state health departments to stay abreast of changing needs within the community by identifying evidence-based and promising practices to address these needs. Part VI, Line 3: St.Vincent Frankfort Hospital communicates with patients in multiple ways to ensure that those who are billed for services are aware of the hospital's charity care program as well as their potential eligibility for local, state or federal programs. Signs are prominently posted in each service area, and bills contain a formal notice explaining the hospital's charity care program. In addition, the hospital employs financial counselors, health access workers, and enrollment specialists who consult with patients about their eligibility for financial assistance programs and help patients in applying for any public programs for which they may qualify. Part VI, Line 4: St.Vincent Frankfort Hospital (SVFH) is located in Frankfort, Indiana and serves rural Clinton and contiguous counties, in northwest Central Indiana. Clinton County has a population of 32,916. Per capita personal income is below state average while median household income is above state average. Clinton County's unemployment rate of 7.1% and poverty rate of 13.8% are below the state averages. Manufacturing is the county's leading industry, accounting for 34.6% of total employment. 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.Vincent Frankfort Hospital:- 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- trains and educates health care professionals- participates in government-sponsored programs such as Medicaid and Medicare to provide healthcare to the poor and elderly- is governed by a board in which independent persons who are representative of the community comprise a majority Part VI, Line 6: As part of the St.Vincent Health System, St.Vincent Frankfort Hospital is dedicated to improving the health status and quality of life for the communities it serves. While designated associates at St.Vincent Frankfort Hospital devote all or a significant portion of their time to leading and administering local community-based programs and partnerships, associates throughout the organization are active participants in community outreach. They are assisted and supported by designated St.Vincent Health Community Development associates and other support staff who work with each of its healthcare facilities to advocate for and provide technical assistance for community outreach, needs assessments and partnerships as well as to support regional and state-wide programs, community programs sponsored by St.Vincent Health in which St.Vincent Frankfort Hospital participates. Form 990, Part III, Line 4a, 4b and 4c: Community Benefit ReportSt.Vincent Frankfort Hospital also provides the following medical services: Cancer (Oncology), Diabetes Care, Gastroenterology, Emergency Medicine, Heart (Cardiovascular), Immediate Care, Laboratory, Maternity (Obstetrics), Mental Health (Psychiatry), Pastoral Care, Radiology, Rehabilitation Therapy, Respiratory Care, Surgery, and Women's Services. Some of these services operate at a loss in order to ensure that comprehensive services are available to the community.Such community-focused programs improve access to healthcare, advocate for the poor and vulnerable, promote health through free education and screenings and help build better communities by improving quality of life. Community Benefit Overview St.Vincent Frankfort Hospital is part of St.Vincent Health, a non-profit healthcare system consisting of 22 locally-sponsored ministries serving over 47 counties throughout Central Indiana. Sponsored by Ascension Health, the nation's largest Catholic healthcare system, St.Vincent Health is one of the largest healthcare employers in the state. As part of St.Vincent Health, the St.Vincent Frankfort vision is to deliver a continuum of holistic, high-quality health services and improve the lives and health of Indiana individuals and communities, with special attention to the poor and vulnerable. This is accomplished through strong partnerships with businesses, community organizations, local, state and federal government, physicians, St.Vincent Frankfort associates and others. Working with its partners, and utilizing the CHNA completed every three years, St.Vincent Frankfort Hospital is committed to addressing community health needs and developing and executing an implementation strategy to meet identified needs to improve health outcomes within the community. Community benefit is not the work of a single department or group within St.Vincent Frankfort, but is part of the St.Vincent mission and cultural fabric. The hospital leadership team provides direction and resources in developing and executing the Implementation Strategy in conjunction with the St.Vincent Health Community Development Department, but associates at all levels of the organization contribute to community benefit and health improvement. Charity Care and Certain Other Community Benefits at Cost Patient Services for Poor and Vulnerable Hospital and outpatient care is provided to patients that cannot pay for services, including hospitalizations, surgeries, prescription drugs, medical equipment and medical supplies. Patients with income less than 200% of the Federal Poverty level (FPL) are eligible for 100% charity care for services. Patients with incomes at or above 200% of the FPL, but not exceeding 400% of the FPL, receive discounted services based on an income-dependent sliding scale. Hospital financial counselors and health access workers assist patients in determining eligibility and in completing necessary documentation. St.Vincent Frankfort Hospital is committed to 100% access, and is proactive in providing healthcare that leaves no one behind. Public Program Participation St.Vincent Frankfort Hospital participates in government programs including Medicaid, SCHIP (Hoosier Healthwise), Healthy Indiana Plan (HIP), the Insurance Exchange and Medicare and assists patients in enrolling for programs for which they are eligible. Per Catholic Health Association guidelines and St.Vincent Health's conservative approach, Medicare shortfall is not included as community benefit. Community Health Needs Assessment True community benefit responds to the particular needs and challenges of the community, building on its unique strengths and assets. The hospital leads a community health needs assessment every 3 years. Using a variety of tools, including surveys, key person interviews, focus groups, secondary data, and data analysis professionals, the team identifies community issues and concerns. These are shared with the community at large, and a consensus is reached about priorities and available resources. To provide community input and a basis for collaboration within the community to address health needs, St.Vincent leads or participates in a community roundtable or forum. This group brings together individuals and organizations from throughout the community who share a common interest in improving health status and quality of life and provide expertise in a variety of community areas including public health. Tobacco use, obesity, drug use and abuse, and access to healthcare have all been identified as key community needs.Implementation Strategy Using the CHNA completed in fiscal year 2013, the hospital developed a 2014-2016 Implementation Strategy to address priority community health needs. These strategies include:1. Tobacco UseEducate children of the harms of smokeless tobacco, provide smoking cessation program, create new policy, systems, and environmental changes with new grant funding- Educate all Clinton County elementary schools about the harms of smokeless tobacco. - Continue providing smoking cessation classes.- Manage ITPC and ACHIEVE grant funds in partnership with Healthy Communities of Clinton County Coalition.2. ObesityInitiate a healthy foods policy/pledge and guidelines for the hospital - Work with Touch Point in creating policy/pledge and plan.- Create stoplight and healthy food percentages.- Present to administrator for approval.- Educate the associates.3. Drug Use & AbuseOrganize a "Get rid of your Prescription Drugs" Day and a Prescription Drug Seminar- Plan a Prescription Drug Drop Off Day.- Partner with Sheriff's Department at health fair.- Plan a prescription Drug Seminar.- Create pamphlet packet of drug abuse for physicians and emergency department.4. Access to HealthcareCoordinate access for vulnerable community members through a Health Access Worker (HAW)- Work with community based agencies, programs, services and providers to coordinate care for vulnerable community members.- Access referrals and assist clients based on Pathway indicators.- Document client intervention/assistance in eCAP.- Report completed Pathways on a quarterly basis and work on identified barriers to access with community stakeholders (goal of 300 completed Pathways a year).Rural and Urban Access to HealthAs part of its commitment to 100% access, St.Vincent Frankfort Hospital is one of eight St.Vincent Health ministries that participate in Rural and Urban Access to Health (RUAH), a community-based care coordination program. Effective care coordination provides a strategy for addressing certain social determinants of health by assuring barriers to care are addressed and individuals are connected to critical prevention and treatment services. Central to the program is a Health Access Worker whose role is to connect the hospital to the community by helping individuals address barriers to health care, and referring them to other local resources as needed. The Health Access Worker assists individuals with finding a medical home; applying for public programs such as Medicaid, food stamps and the Healthy Indiana Plan; and in assessing needs so that referrals can be made for other forms of community-based assistance. The Health Access Worker also advocates for clients with service providers and serves as a system navigator. RUAH outcomes are measured using the Pathways Model with 5 defined pathways/protocols (enrollment, medical home, pregnancy, medical referral and social services) as a means of tracking interventions and improving accountability towards positive, measurable changes in patients' lives. During fiscal year 2014, the Health Access Worker opened 1,026 pathways and completed 566 pathways.Medication AssistanceIn addition to care coordination, RUAH assists patients who meet income guidelines in obtaining free or reduced-cost prescription drugs. St.Vincent Frankfort Hospital provides a sophisticated and continually-updated database to track eligibility and requirements that vary by company and medication. In fiscal year 2014, the medication assistant helped patients obtain a total of 2,080 medications for which the average wholesale price totaled $880,003. Community Health Education St.Vincent Frankfort Hospital provides health education on a number of topics and issues facing the local community throughout the year. In fiscal year 2014, the following health education was provided: CPR, breastfeeding, diabetes care and smoking cessation. Approximately 593 people received health education in fiscal year 2014. Health Fairs and ScreeningsSt.Vincent Frankfort Hospital participates in several health fairs and screening events each year, including their annual health fair which is held at the Clinton County Fairgrounds. Participants can be tested for blood pressure, blood glucose, cholesterol, fitness testing, and more at low or no cost. Materials on health information and preventive services are a vital part of health fairs and screenings. During fiscal year 2014, St.Vincent Frankfort Hospital served over 1,000 people through its participation in these health fairs and screenings.Healthy Communities of Clinton County CoalitionHealthy Communities of Clinton County Coalition began 9 years ago as a partnership between St.Vincent Frankfort and Purdue Extension. Based on the results of the community health needs assessment, the coalition has focused on tobacco prevention and cessation, obesity prevention, and the elimination of minority health disparities. Partnering with local, state and national partners, the coalition has been instrumental in advocating policy, system and environmental changes that make the healthy choice the easy choice. In addition to the tobacco and obesity efforts described, the coalition has helped 2 school systems in the county attract federal/state dollars to encourage safe walking and riding to school. The coalition also received grant funding to reevaluate the change (community health assessment and group evaluation) tools that were performed 2 years ago from the ACHIEVE (Action Communities for Health Innovation and Environmental Change) grant. This grant will analyze what has been accomplished and help motivate the community to do more to improve the health of Clinton County.Immunizations and Flu ShotsVaccinations are one of the best ways to stop an epidemic and prevent the spread of diseases. St.Vincent Frankfort Hospital provided approximately 100 flu shots and over 3,000 immunizations, free of charge, to the elderly, college students, and children during fiscal year 2014. Tobacco Prevention and Cessation The Healthy Communities of Clinton County Coalition recognizes tobacco use as one of the leading causes of preventable death in Indiana. Representing the Healthy Communities of Clinton County Coalition and serving as its fiscal agent, St.Vincent Frankfort Hospital applied for, and was awarded, Indiana Tobacco Prevention & Cessation funds. These funds support a part-time tobacco prevention coordinator for Clinton County, whose efforts include the initiation of campus-wide smoke-free policies for schools and healthcare facilities; education at schools and workplace health fairs; and advocating to service organizations the positive impact of smoke-free policies. The hospital also, independently, provides Stop Smoking classes, free-of-charge, to anyone needing help with this addiction. During fiscal year 2014, 60 people participated in these classes.Community Benefit Cash and In-Kind ContributionsIn addition to the outreach programs operated by the hospital, the hospital makes cash and in-kind donations to a variety of community organizations focused on improving health status in the community. These take the form of cash donations to outside organizations, the donation of employee time/services to outside organizations and the representation of the hospital on community boards and committees working to improve health status and quality of life within the community. Community Building Activities Research shows that social determinants and quality of life play a major role in the health status of individuals and communities. Community building activities, which focus on improving the quality of life within a community, ultimately influence and improve health status. Partnering to Build a Better CommunityWith the support and leadership of county government, the Healthy Communities of Clinton County Coalition has also focused on infrastructure initiatives. The city of Frankfort passed a complete streets ordinance to encourage walking and biking paths in conjunction with streets. This creates a healthier environment and promotes other options of transportation. Also, a Health Action Plan was developed and adopted as part of the Clinton County Comprehensive Plan. Community Building Cash and In-Kind ContributionThe hospital makes cash and in-kind donations to a variety of community organizations focused on building the community and improving quality of life. These take the form of cash donations to outside organizations, the donation of employee time/services to outside organizations and the representation of the hospital on community boards and committees working to improve infrastructure for the community. 1 StVincent Health Inc 10330 N Meridian Street Ste 430N Indianapolis IN 46290 352052591 501 (c)(3) 2967735 Net cash transfer to parent company's centralized cash account 1 0 Part I, Line 2: The finance committee ensures that funds are distributed appropriately according to Ascension Health's strategic business plan and consistent with corporate policies and procedures. 0 0 0 0 0 0 0 0 0 R Mark Ellison Thru 42014 Secretary/Treasurer 0 193865 0 0 0 9516 0 18794 0 21140 0 243315 0 0 Joseph D Dominik MD Director 0 121406 0 30905 0 602 0 14493 0 13278 0 180684 0 0 Ronald L Mead Director 0 264039 0 0 0 28165 0 35511 0 14266 0 341981 0 0 Thomas D Crawford Administrator 178555 0 0 0 702 0 19064 0 19652 0 217973 0 0 0 Wayne R Knight CFO 0 153735 0 0 0 2959 0 9463 0 15892 0 182049 0 0 Stephen D Tharp CMO 0 171785 0 138 0 681 0 14974 0 13571 0 201149 0 0 Melissa M Roche Physician 198760 0 1069 0 18059 0 5106 0 17972 0 240966 0 0 0 Donald H Jacoby Manager Pharmacy 139898 0 0 0 721 0 10329 0 2206 0 153154 0 0 0 Part I, Line 3 St.Vincent Health, Inc., a related organization of St.Vincent Frankfort Hospital, Inc., uses the following to establish the compensation of the organization's CEO/Executive Director: - Compensation committee - Independent compensation consultant - Compensation survey or study - Approval by the board or compensation committee Form 990, Part VI, Section A, line 6 St.Vincent Frankfort Hospital, Inc. has a single corporate member, St.Vincent Health, Inc. Form 990, Part VI, Section A, line 7a St.Vincent Frankfort Hospital, Inc. has a single corporate member, St.Vincent Health, Inc. who has the ability to elect members to the governing body of St.Vincent Frankfort Hospital, Inc. Form 990, Part VI, Section A, line 7b All decisions that have a material impact to St.Vincent Frankfort Hospital, Inc.'s financial information or corporation as a whole are subject to approval by its sole corporate member, St.Vincent Health, Inc. Form 990, Part VI, Section B, line 11 Management, including certain officers, works diligently to complete the Form 990 and attached schedules in a thorough manner. Management presents the Form 990 to a designated committee of the Board to review and answer any questions. Prior to filing the returns, all Board members are provided the Form 990 and management team members are available to answer any Board member questions. Form 990, Part VI, 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 committee with governing board delegated powers considering the proposed transaction or arrangement. The remaining individuals on the governing board or committee will decide if conflicts of interest exist. Each director, principal officer and member of a committee with governing board delegated powers annually signs a statement which affirms such person has received a copy of the conflicts of interest policy, has read and understands the policy, has agreed to comply with the policy, and understands that the organization is charitable and in order to maintain its federal tax exemption it must engage primarily in activities which accomplish its tax exempt purpose. Form 990, Part VI, Section B, line 15b Compensation determinations of St.Vincent Frankfort Hospital, Inc.'s CEO, executive director, or top management official is made by St.Vincent Health, Inc.'s management. The process includes a review and approval by independent persons and comparability data. In review of the compensation, the CEO, executive director, and top management were compared to other hospitals in the area that hold the same position. Compensation determinations of St.Vincent Frankfort Hospital, Inc.'s other officers or key employees are made by St.Vincent Frankfort Hospital, Inc.'s management. In determining compensation of other officers or key employees of the organization, the process included a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision. In the review of the compensation, the other officers or key employees of the organization were compared to other hospitals' employees in the area that hold the same position. Form 990, Part VI, Section C, line 19 The organization will provide any documents open to public inspection upon request. Form 990, Part IX, Line 1: During the fiscal year, St.Vincent Frankfort Hospital, Inc.'s parent, St.Vincent Health, Inc., moved to a centralized bank account for all of their related organizations. Some of the amounts shown on Form 990, Part IX, Line 1 represent cash transfers to their parent organization's centralized bank account. Form 990, Part XI, line 9: FAS 158 pension liability 89,808. Part IV, Line 24A: Tax Exempt Bond Issuance St.Vincent Frankfort Hospital, Inc. is a health facility that is part of Ascension Health System. Ascension Health is the borrower for tax exempt hospital revenue bonds. St.Vincent Frankfort Hospital, Inc. holds an intercompany note payable with Ascension Health, and this information is reported on the balance sheet. 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 Ascension Health Alliance 0 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 StVincent Hospital & Health Care Center Inc 1 Rehabilitation Hospital of Indiana Inc 4141 Shore Drive Indianapolis IN 46254 351786005 Rehabilitation hospital IN 501(C)(3) 3 StVincent Health Inc 1 SVH Real Estate Inc 10330 N Meridian Street Ste 430N Indianapolis IN 46290 205002285 Real estate holding company IN 501(C)(3) 11A, I StVincent Health Inc 1 StJoseph Hospital & Health Center Inc 1907 W Sycamore Street Kokomo IN 46901 350992717 Hospital IN 501(C)(3) 3 StVincent Health Inc 1 StJoseph Foundation of Kokomo Indiana Inc 1907 W Sycamore Street Kokomo IN 46901 237313206 Supporting organization IN 501(C)(3) 11A, I StJoseph Hospital & Health Center Inc 1 StVincent Anderson Regional Hospital Inc 2015 Jackson Street Anderson IN 46016 460877261 Hospital IN 501(C)(3) 3 StVincent Health Inc 1 StVincent Anderson Regional Hospital Foundation Inc 2015 Jackson Street Anderson IN 46016 352053693 Supporting organization IN 501(C)(3) 11A, I StVincent Anderson Regional Hospital Inc 1 StVincent Carmel Hospital Inc 13500 N Meridian Street Carmel IN 46032 743107055 Hospital IN 501(C)(3) 3 StVincent Health Inc 1 StVincent Clay Hospital Inc 1206 E National Avenue Brazil IN 47834 352112529 Critical access hospital IN 501(C)(3) 3 StVincent Health Inc 1 StVincent Dunn Hospital Inc 1600 23rd Street Bedford IN 47421 272192831 Critical access hospital IN 501(C)(3) 3 StVincent Health Inc 1 StVincent Frankfort Hospital Inc 1300 S Jackson Frankfort IN 46041 352099320 Critical access hospital IN 501(C)(3) 3 StVincent Health Inc 1 StVincent Frankfort Hospital Foundation Inc 1300 S Jackson Frankfort IN 46041 351531734 Supporting organization IN 501(C)(3) 11A, I StVincent Frankfort Hospital Inc 1 StVincent Health Inc 10330 N Meridian Street Ste 430N Indianapolis IN 46290 352052591 Parent company IN 501(C)(3) 11C, III-FI Ascension Health 0 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 StVincent Health Inc 1 StVincent Hospital and Health Care Center Inc 2001 W 86th Street Indianapolis IN 46260 350869066 Hospital IN 501(C)(3) 3 StVincent Health Inc 1 StVincent Hospital Foundation Inc 10330 N Meridian Street Ste 430N Indianapolis IN 46290 356088862 Supporting organization IN 501(C)(3) 11A, I StVincent Hospital & Health Care Center Inc 1 StVincent Jennings Hospital Inc 301 Henry Street North Vernon IN 47265 351841606 Critical access hospital IN 501(C)(3) 3 StVincent Health Inc 1 StVincent Madison County Health System Inc 1331 South A Street Elwood IN 46036 350876389 Hospital IN 501(C)(3) 3 StVincent Health Inc 1 StVincent Medical Group Inc 8425 Harcourt Road Indianapolis IN 46260 272039417 Physician professional services IN 501(C)(3) 9 StVincent Health Inc 1 StVincent Mercy Hospital Foundation Inc 1331 South A Street Elwood IN 46036 311066871 Supporting organization IN 501(C)(3) 11A, I StVincent Madison County Health System Inc 1 StVincent New Hope Inc 8450 N Payne Road Indianapolis IN 46260 351733591 Intermediate care facility IN 501(C)(3) 9 StVincent Health Inc 1 StVincent Randolph Hospital Inc 473 Greenville Avenue Winchester IN 47394 352103153 Critical access hospital IN 501(C)(3) 3 StVincent Health Inc 1 StVincent Randolph Hospital Foundation Inc 473 Greenville Avenue Winchester IN 47394 352133006 Supporting organization IN 501(C)(3) 11A, I StVincent Randolph Hospital Inc 1 StVincent Salem Hospital Inc 911 N Shelby Street Salem IN 47167 270847538 Critical access hospital IN 501(C)(3) 3 StVincent Health Inc 1 StVincent Seton Specialty Hospital Inc 8050 Township Line Road Indianapolis IN 46260 351712001 Long term care hospital IN 501(C)(3) 3 StVincent Health Inc 1 StVincent Williamsport Hospital Inc 412 N Monroe Street Williamsport IN 47993 350784551 Critical access hospital IN 501(C)(3) 3 StVincent Health Inc 1 StVincent Williamsport Hospital Foundation Inc 412 N Monroe Street Williamsport IN 47993 743130159 Supporting organization IN 501(C)(3) 11A, I StVincent Williamsport Hospital Inc 1 SVSM Inc 2001 W 86th Street Indianapolis IN 46260 810607827 Holding company IN 501(C)(3) 11A, I StVincent Health Inc 1 St Mary's At Home Inc 3700 Washington Avenue Evansville IN 47750 351899560 DME/Home care IN 501(C)(3) 11A, I St Mary's Health Services Inc 1 St Mary's Building Corporation 3700 Washington Avenue Evansville IN 47750 237248362 Real estate holding company IN 501(C)(2) St Mary's Health Services Inc 1 St Mary's Warrick Emergency Medical Services Inc 3700 Washington Avenue Evansville IN 47750 205342518 Ambulance services IN 501(C)(4) St Mary's Health Services Inc 1 St Mary's Health Inc 3700 Washington Avenue Evansville IN 47750 352057801 Health ministry parent IN 501(C)(3) 11C, III-FI StVincent Health Inc 1 St Mary's Physician Network LLC 3700 Washington Avenue Evansville IN 47750 205023387 Physician professional services IN 501(C)(3) 9 St Mary's Health Inc 1 St Mary's Health Services Inc 3700 Washington Avenue Evansville IN 47750 351679526 Investment services IN 501(C)(3) 11C, III-FI St Mary's Health Inc 1 St Mary's CARE Partners Inc 3700 Washington Avenue Evansville IN 47750 351899562 Tax-exempt affiliate reimbursements IN 501(C)(3) 11A, I St Mary's Health Inc 1 St Mary's Medical Center Foundation of Evansville Inc 3700 Washington Avenue Evansville IN 47750 237045370 Supporting organization IN 501(C)(3) 11A, I St Mary's Medical Center of Evansville Inc 1 St Mary's Medical Center of Evansville Inc 3700 Washington Avenue Evansville IN 47750 350869065 Hospital IN 501(C)(3) 3 St Mary's Health Services Inc 1 St Mary's Warrick Hospital Foundation Inc 1116 Millis Avenue Boonville IN 47601 351961890 Supporting organization IN 501(C)(3) 11A, I St Mary's Warrick Hospital Inc 1 St Mary's Warrick Hospital Inc 1116 Millis Avenue Boonville IN 47601 351343019 Hospital IN 501(C)(3) 3 St Mary's Health Services Inc 1 St Mary's Ohio Valley Heartcare LLC 901 St Marys Drive Evansville IN 47714 273474697 Cardiology services IN 501(C)(3) 11A, I St Mary's Health Inc 1 St Mary's Medical Group LLC 3700 Washington Avenue Evansville IN 47750 261356310 Physician professional services IN 501(C)(3) 9 St Mary's Health Inc 1 Primary Physician Network LLC 3700 Washington Avenue Evansville IN 47750 208775914 Physician professional services IN 501(C)(3) 9 St Mary's Health Inc 1 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 235288 43117 0 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 3732048 1498768 0 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 158622 2278545 0 1 0.50000 Endoscopy Center LLC 13421 Old Meridian St Ste 150 Carmel IN 46032 320029881 Endoscopy center IN StVincent Carmel Hospital Inc Related 578601 314246 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 -3111767 2034584 0 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 -357761 1333459 0 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 3773781 0 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 3167357 1838718 0 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 396120 1386917 0 1 0.50000 StVincent HealthUSP LLC 15305 Dallas Pkwy Ste 1600 Addison TX 75001 203749962 Ambulatory surgery center IN StVincent Health Inc Related 84964 161818 0 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 24931443 79758894 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 -122846 45663 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 5266312 5068766 0 1 0.50000 Seton Health Services LLC 3700 Washington Avenue Evansville IN 47750 270451316 Equipment rental IN St Mary's Health Services Inc Related 45743 55336 0 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 465380 321989 0 1 0.75000 St Mary's Medical Group Inc 3700 Washington Avenue Evansville IN 47750 352076827 Investment IN St Mary's Health Services Inc C -1556561 257378 1.00000 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 StVincent Health Inc B 2967735 Fair market value