2015-05-13T13:15:29-05:00 2014-06-30 861065772 Deloitte Tax LLP 250 East Fifth Suite 1900 Cincinnati OH 45202 990 2013-07-01 621284994 Saint Thomas Network SAIN 6152846826 4220 Harding Rd Nashville TN 37205 Craig Polkow CFO-Saint Thomas Health 6152846826 2015-05-13 1 Alicia Janisch P00741382 5137847100 2013 2016-02-25 16:41:14Z Michael Schatzlein 4220 Harding Rd Nashville TN 37205 11203468 0 0928 X www.sths.com X 1986 TN To promote and support all programs and activities for the benefit of Saint Thomas Hospital. 21 18 65 18 0 0 0 3744891 6418921 6538634 -73 -36256 1334028 209244 7752876 10456513 1169403 985954 0 0 944960 3215716 0 0 0 2003359 1968338 4117722 6170008 3635154 4286505 97601492 39120473 63165647 1360433 34435845 37760040 X To promote and support all programs and other activities in the interest of and for the exempt purposes of Ascension Health and Saint Thomas West Hospital including the provision of lodging for the families of critically ill patients and same-day surgery patients, operating family health centers and investing in equity partnerships with other health care organizations. 0 1 4717721 1319700 Saint Thomas Network operates a network of family health centers to serve the community by providing health care to all ages regardless of insurance or financial resources. The centers are staffed by licensed medical professionals. For those who do not have insurance, fees are based on a sliding scale using federal poverty guidelines. In addition, private insurance, Medicare and TennCare are accepted. 985954 4832408 Saint Thomas Network is partnered with other healthcare organizations to further the mission of providing spiritually centered, holistic care that sustains and improves the health of the communities it serves. These partnerships provide an outpatient neurosurgical center and several ambulatory surgery centers in the central Tennessee area. 391144 577752 Saint Thomas Network operates Seton Lodge and the Inn at Saint Thomas. Seton Lodge is a 50 room motel on the grounds of Saint Thomas Hospital that provides low cost accommodations for family members residing outside Davidson County whose relatives are in critical care or special care. The Inn at Saint Thomas is a similar 50 room motel providing pre-surgical accommodations for patients traveling to Saint Thomas from long distances. 5108865 1 1 0 0 0 0 0 0 0 0 1 0 1 1 1 1 0 1 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0 1 0 0 65 0 0 0 0 0 0 0 0 0 0 0 0 X 21 18 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 1 1 X Craig Polkow 6152846826 4220 Harding Rd Nashville TN 37205 X James Bearden Chairman 1.00 7.00 X 0 0 0 Clark Baker Vice Chairman 1.00 7.00 X 0 0 0 Mary Falls Esq Secretary 1.00 7.00 X 0 0 0 Anthony Heard Treasurer 1.00 7.00 X 0 0 0 Samar Ali Board Member (start 7/13) 1.00 7.00 X 0 0 0 William Anderson Board Member 1.00 7.00 X 0 0 0 Robert Dray MD Board Member 1.00 7.00 X 0 0 0 Robert Hutton MD Board Member (end 12/13) 1.00 7.00 X 0 0 0 Randy Laszewski Board Member 1.00 7.00 X 0 0 0 Mark Marsden MD Board Member (end 11/13) 1.00 7.00 X 0 0 0 Lee Moss Board Member 1.00 7.00 X 0 0 0 Mark Peacock MD Board Member (start 1/14) 1.00 6.00 X 0 0 0 Mark Peters MD Board Member (start 11/13) 1.00 6.00 X 0 0 0 Thom Rainer PhD Board Member 1.00 7.00 X 0 0 0 Steve Schwab MD Board Member (start 7/13) 1.00 7.00 X 0 0 0 Patrick R Sheperd Board Member 1.00 8.00 X 0 0 0 Scott Standard MD Board Member 1.00 8.00 X 0 0 0 Sister Dinah White DC Board Member 1.00 8.00 X 0 0 0 Brian Wilcox MD Board Member 1.00 8.00 X 0 0 0 John A Williams MD Board Member 1.00 8.00 X 0 0 0 Mike Schatzlein MD President/CEO 1.00 40.00 X X 0 1888568 39912 Craig Polkow EVP & CFO STH 1.00 40.00 X 0 439568 30536 Karen Springer EVP/COO 40.00 40.00 X 0 576074 12507 Wesley Littrell Former Sec/Treas (end 12/12) 0.00 0.00 X 0 562188 8078 Alan Strauss Former EVP & CFO STH 0.00 45.00 X 0 703190 50287 0 4169588 141320 0 1 1 0 0 3744891 3744891 Ancillary Revenue 621400 4671942 4671942 Net Patient Revenue 621400 1288940 1288940 Lodging Revenue 624200 577752 577752 6538634 -14 -14 728731 710713 18018 18018 18018 36242 -36242 -36242 -36242 Other Revenue 621990 191226 191226 191226 10456513 6729860 0 -18238 985954 985954 2905458 2324366 581092 -334619 -267695 -66924 420843 336674 84169 224034 179227 44807 536923 483231 53692 36025 32422 3603 875 831 44 342338 308104 34234 6322 5690 632 2813 281 2532 10894 9805 1089 229987 206988 22999 13177 11859 1318 Overhead Allocation 331245 264996 66249 0 Demolition Costs 202374 202374 0 Medical Supplies 109203 109203 0 0 Personal Property Tax 27053 21642 5411 0 119109 95287 23822 6170008 5108865 1061143 0 296 750 265823 269055 4730 4563 28588910 14663935 10109150 13924975 18209278 21620359 1214949 1126572 67797266 2174199 97601492 39120473 397260 593860 124336 80062 343569 338624 62300482 347887 63165647 1360433 X 34435845 37760040 0 0 34435845 37760040 97601492 39120473 X 4286505 -1378136 415826 X 0 1 X 1 0 X 278825 35744 3744891 4059460 6332915 3597683 5937305 6418921 6538634 28825458 6611740 3597683 5973049 6418921 10283525 32884918 0 0 0 32884918 2769378 2372572 723276 728707 728731 7322664 2769378 2372572 723276 728707 728731 7322664 9381118 5970255 6696325 7147628 11012256 40207582 0.81790 0.75950 0.18210 0.24050 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 3091881 5162703 8254584 10558381 7972140 13129090 5401431 10014 1023689 900538 133165 377781 330713 47068 392321 303594 88727 13924975 Saint Thomas Outpatient Neurosurgical Center, LLC 858726 C Saint Thomas/USP Surgery Centers, LLC 19326542 C Saint Thomas/USP Surgery Centers II, LLC 970777 C Saint Thomas Campus Surgicare LP 429936 C Northridge Surgery Center LP 34378 C 21620359 Intercompany Receivables 863647 Miscellaneous Receivables 176674 Prepaid Pension Asset 1098726 Construction in Progress 35152 2174199 Intercompany Payables 62418 Miscellaneous 109952 Real Estate Taxes payable 132510 Self Insurance Liability 43007 347887 X Part X, Line 2: From the consolidated audited financial statements of Ascension Health Alliance and its member organizations ("The System") which include the activity of St. Thomas Network: The System accounts for uncertainty in income tax provisions by applying a recognition threshold and measurement attribute for financial statement recognition and measurement of a tax position taken or expected to be taken in a tax return. The System has determined that no material unrecognized tax benefits or liabilities exist as of June 30, 2014. 1 Saint Thomas Health Foundations 4220 Harding Rd Nashville TN 37205 581663055 Section 501(c)(3) 985954 General Support 1 0 Part I, Line 2: Organizations requesting grants are asked to submit a request in writing which identifies the community health need the grant will be addressing, along with goals and objectives. Requests are reviewed by the Saint Thomas Health Community Health & Benefit Committee prior to approval. Awarded grantees are asked to submit a report of program/event activities. It is requested the report include demographic summary of population benefited and achieved objectives and impact on health. The reports are reviewed by the Community Health & Benefit Team in a broad manner upon receipt, but will be more thoroughly scrutinized if the grant recipient comes back to ask for a renewal or another grant. 1 1 0 0 0 0 0 0 0 Mike Schatzlein MD President/CEO 0 857096 0 830248 0 201224 0 7650 0 32262 0 1928480 0 0 Craig Polkow EVP & CFO STH 0 434821 0 0 0 4747 0 7650 0 22886 0 470104 0 0 Karen Springer EVP/COO 0 570000 0 0 0 6074 0 7650 0 4857 0 588581 0 0 Wesley Littrell Former Sec/Treas (end 12/12) 0 10094 0 0 0 552094 0 0 0 8078 0 570266 0 0 Alan Strauss Former EVP & CFO STH 0 474049 0 58000 0 171141 0 21675 0 28612 0 753477 0 0 Part I, Line 3 Ascension Health, a related organization of Saint Thomas Network, uses the following to establish the compensation of the organization's CEO: - Compensation Committee - Independent Compensation Consultant - Compensation Survey or Study - Approval by the Board or Compensation Committee Part I, Line 4a-4b: Eligible executives participate in a program that provides for supplemental retirement benefits. The payment of benefits under the program, if any, is entirely dependent upon the facts and circumstances under which the executive terminates employment with the organization. Benefits under the program are unfunded and non-vested. Due to the substantial risk of forfeiture provision, there is no guarantee that these executives will ever receive any benefit under the program. Any amount ultimately paid under the program to the executive is reported as compensation on Form 990, Schedule J, Part II, Column B in the year paid. The following individuals received severance payments in the amount noted: Wesley Littrell $480,256. The following individuals received payments from the supplemental nonqualified retirement plan in the amount noted: Wesley Littrell - $71,292 Michael Schatzlein - $179,379 Alan Strauss - $8,236 Schedule J, Part II The 2013 compensation amounts shown for Alan Strauss were paid by a related organization. $8,236 of the compensation was paid for Mr. Strauss's services as the CFO of Saint Thomas Health. His remaining compensation was paid for services as the CFO of the related organization. Form 990, Part III, line 3 On July 1, 2013 the activity of West End Medical Group was transferred to Baptist Healthcare Group and the activity of Saint Thomas Research Institute was transferred to Saint Thomas Health. Form 990, Part VI, Section A, line 2 Many of the persons listed on Part VII have a "business relationship" with each other by virtue of sitting on related Saint Thomas Health entity boards. Form 990, Part VI, Section A, line 6 Saint Thomas Network has a single corporate member, Saint Thomas Health. Form 990, Part VI, Section A, line 7a Saint Thomas Network has a single corporate member, Saint Thomas Health, who has the ability to elect members to the governing body of the Saint Thomas Network. Form 990, Part VI, Section A, line 7b All decisions that have a material impact to Saint Thomas Network financial information or corporation as a whole are subject to approval by its sole corporate member, Saint Thomas Health. Ascension Health, the sole corporation member of Saint Thomas Health, has designed a system authority matrix which assigns authority for key decisions that are necessary in the operation of the system. Specific areas that are identified in the authority matrix are: new organizations & major transactions; governing documents; appointments/removals; evaluation; debt limits; strategic & financial plans; assets; system policies & procedures. These areas are subject to certain levels of approval by Ascension per the system authority matrix. Form 990, Part VI, Section B, line 11 Management, including certain officers, works diligently to complete the Form 990 and attached schedules in a thorough manner. Management presents the Form to the Board, or a designated committee, to review. Prior to filing the return, all Board Members are provided the Form 990 and management team members are available to answer any Board Members' questions. Form 990, Part VI, Section B, line 12c The organization regularly and consistently monitors and enforces compliance with the conflict of interest policy in that any director, principal officer, or member of a committee with governing board delegated powers, who has a direct or indirect financial interest, must disclose the existence of the financial interest and be given the opportunity to disclose all material facts to the directors and members of the committees with governing board delegated powers considering the proposed transaction or arrangement. The remaining individuals on the governing board or committee will decide if conflicts of interest exist. Each director, principal officer and member of a committee with governing board delegated powers annually signs a statement which affirms such person has received a copy of the conflict of interest policy, 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 Saint Thomas Network, included a review and approval by independent persons, comparability data and contemporaneous substantiation of the deliberation and decision. The Compensation Committee reviewed and approved the compensation. In the review of the compensation, the CEO was compared to individuals at other organizations in the area who hold the same title. During the review and approval of the compensation, documentation of the decision was recorded in the committee minutes. The individual was not present when his compensation was decided. In determining the compensation of other officers or key employees of the organization, the process performed by Saint Thomas Health, a related organization, included a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision. The audit committee reviewed and approved the compensation. In the review of the compensation, the other officers or key employees of the organization were compared to individuals at other hospitals in the area who hold the same title. During the review and approval of the compensation, documentation of the decision was recorded in the board minutes. Form 990, Part VI, Section C, line 19 The organization will provide any documents open to public inspection upon request. Part VII, Section B: Independent Contractor Reporting Compensation of independent contractors is paid by and reported on the Form 1096, Annual Summary and Transmittal of U.S. Information Returns, of Ascension Health EIN 31-1662309. Expenses are allocated to and reimbursed by the filing organization to Ascension Health. As such, the organization has not reported independent contractors paid on Form 990, Part VII, Section B. Form 990, Part XI, line 9: Transfer to/from Ascension for Pension 362,442. Intercompany Write-Downs 353,134. Non-Controlling Interest activity -299,750. Richland Internal Medicine LLC 4220 Harding Road Nashville TN 37205 621868762 Physician Practice TN 0 0 Saint Thomas Network Saint Thomas NP LLC 4220 Harding Road Nashville TN 37205 261614782 Inactive TN 0 0 Saint Thomas Network Bellvue Medical Group LLC 4220 Harding Road Nashville TN 37205 621868848 Physician Practice TN 4717722 2690818 Saint Thomas Network Saint Thomas Emergency Medical Services LLC 4220 Harding Road Nashville TN 37205 208957092 Ambulance Services TN 0 0 Saint Thomas Network Premier IPA LLC 4220 Harding Road Nashville TN 37205 Inactive TN 0 0 Saint Thomas Network Children and Adults Medical Group LLC 4220 Harding Road Nashville TN 37205 621868855 Physician Practice TN 0 0 Saint Thomas Network Saint Thomas Outpatient Cardiac Catheterization Center LLC 4220 Harding Road Nashville TN 37205 321775306 Outpatient Services TN 0 0 Saint Thomas Network Ascension Health Alliance PO Box 45998 St Louis MO 631455998 453358926 National Health System MO Section 501(c)(3) Schedule A, Line 11a N/A 0 Ascension Health PO Box 45998 St Louis MO 63145 311662309 National Health System MO Section 501(c)(3) Schedule A, Line 11a Ascension Health Alliance 0 Saint Thomas Health 4220 Harding Road Nashville TN 37205 581716804 System Parent TN Section 501(c)(3) Schedule A, Line 11c Ascension Health 0 Saint Thomas West Hospital 4220 Harding Road Nashville TN 37205 620347580 Hospital TN Section 501(c)(3) Schedule A, Line 3 Saint Thomas Health 1 Saint Thomas Health Foundations PO Box 380 Nashville TN 37202 581663055 Operates Foundation TN Section 501(c)(3) Schedule A, Line 7 Saint Thomas Network 1 Covenant Care Inc 102 Woodmont Blvd Suite 800 Nashville TN 37205 621695737 Inactive TN Section 501(c)(3) Schedule A, Line 11a Saint Thomas Network 1 Saint Thomas Rutherford Hospital 1700 Medical Center Parkway Murfreesboro TN 37219 620475842 Hospital TN Section 501(c)(3) Schedule A, Line 3 Saint Thomas Health 1 Saint Thomas Rutherford Foundation (fka Middle Tennessee Medical Center Fo 1700 Medical Center Parkway Murfreesboro TN 37219 621167917 Foundation TN Section 501(c)(3) Schedule A, Line 11a Saint Thomas Rutherford Hospital 1 Saint Thomas Midtown Hospital 4220 Harding Road Nashville TN 37205 621869474 Acute Care Hospital TN Section 501(c)(3) Schedule A, Line 3 Saint Thomas Health 1 Baptist Hospital Foundation of Nashville Inc 2000 Church Street Nashville TN 37236 581861378 Inactive TN Section 501(c)(3) Schedule A, Line 11a Saint Thomas Midtown Hospital 1 Baptist Health Care Affiliates Inc 2000 Church Street Nashville TN 37236 581509251 Community Health Promotion TN Section 501(c)(3) Schedule A, Line 11a Saint Thomas Network 1 Baptist Health Care Group 2000 Church Street Nashville TN 37236 621529858 Healthcare Provider TN Section 501(c)(3) Schedule A, Line 3 Saint Thomas Network 1 Saint Thomas Hickman Hospital 135 East Swan Street Centerville TN 37033 581737573 Hospital TN Section 501(c)(3) Schedule A, Line 3 Baptist Health Care Affiliates Inc 1 Saint Thomas Home Care 135 East Swan Street Centerville TN 37033 621836937 Home Health Care TN Section 501(c)(3) Schedule A, Line 9 Saint Thomas Hickman Hospital 1 Baptist Womens Health Center LLC 1900 Church Street Suite 300 Nashville TN 37203 621772195 Owns and Operates Specialty Hospital TN N/A Middle Tennessee Ambulatory Surgery Center LP 500 N Highland Ave Murfreesboro TN 37130 Operates Outpatient Surgery Center TN N/A STHS Sleep Center LLC 102 Woodmont Boulevard Suite 800 Nashville TN 37205 203664894 Operates a Sleep Center TN Saint Thomas Network Related 1030437 758677 0 0 0.72500 Baptist Surgery Center LP 1900 Church Street Suite 300 Nashville TN 37203 Operates Outpatient Surgery Center TN N/A Middle Tennessee Imaging LLC 400 N Highland Avenue Murfreesboro TN 37219 010570490 Diagnostic Imaging Center TN N/A RADS of America LLC PO Box 249 Goodlettsville TN 370700249 203664894 Ambulatory Surgery Center TN N/A Murfreesboro Diagnostic Imaging LLC 400 N Highland Avenue Murfreesboro TN 37219 Diagnostic Imaging Center TN N/A Sova Inc 102 Woodmont Boulevard Suite 700 Nashville TN 37205 261319638 Health Services TN N/A C 0 Baptist Health Care Ventures Inc 2000 Church Street Nashville TN 37236 620469214 Holding Company TN N/A C 0 MissionPoint Health Partners 102 Woodmont Boulevard Suite 700 Nashville TN 37205 452958482 Accountable Care Organization TN N/A C 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 Saint Thomas Health Foundations B 985954 Actual Amount Paid Saint Thomas Rutherford Foundation C 679525 Actual Amount Paid Saint Thomas West Hospital C 1066725 Actual Amount Paid Saint Thomas Midtown Hospital C 709655 Actual Amount Paid Saint Thomas Rutherford Hospital C 1288986 Actual Amount Paid Saint Thomas Health Foundations R 320422 Actual Amount Paid Saint Thomas Rutherford Foundation R 573700 Actual Amount Paid