2014-05-13T17:24:44-05:00 2013-06-30 ERNST & YOUNG US LLP 111 MONUMENT CIRCLE SUITE 4000 INDIANAPOLIS IN 46204 990 2012-07-01 351738708 ST CATHERINE HOSPITALINC % MARY ANN SHACKLETT STCA 2193921700 4321 FIR STREET Suite EAST CHICAGO IN 46312 MARY ANN SHACKLETT 2193921700 2014-05-13 3176817000 2012 2015-11-30 17:44:51Z MARY ANN SHACKLETT 10010 DONALD S POWERS DR 201 MUNSTER IN 46321 175910514 false X www.comhs.org X 1928 IN St. Catherine Hospital is committed to providing the highest quality care in the most cost-efficient manner, respecting the dignity of the individual, providing for the (continued on note on mission statement) 18 14 1439 40 766259 -65627 1199357 3926414 159322493 165228391 -93943 47414 5292786 6273724 165720693 175475943 0 33945 0 0 72891515 67311415 0 0 0 95280849 92742801 168172364 160088161 -2451671 15387782 66165015 61439634 32133975 28409183 34031040 33030451 X ST. CATHERINE HOSPITAL IS COMMITTED TO PROVIDING THE HIGHEST QUALITY CARE IN THE MOST COST-EFFICIENT MANNER, RESPECTING THE DIGNITY OF THE INDIVIDUAL, PROVIDING FOR THE WELL-BEING OF THE COMMUNITY AND SERVING THE NEEDS OF ALL PEOPLE, INCLUDING THE POOR AND DISADVANTAGED. false false 53985532 62881139 NURSING - ST. CATHERINE HOSPITAL STAFFS 189 BEDS. Nursing staff work to ensure the delivery of optimal patient care and excellent patient care services in population and acuity specific areas ranging from ICU, IMCU, telemetry, medical, surgical, pediatrics, labor and delivery to behavioral health. 16992714 47127714 SURGERY - ST. CATHERINE HOSPITAL performed 5,314 surgeries. St. CATHERINE HOSPITAL offers a wide range of surgical services, including gastroenterology, orthopedics, general surgery, urology, cardiovascular and gynecology. OP areas include ophthalmology, pain management, ENT, plastics, and cosmetic. 8945412 36539952 CARDIOLOGY - Achieved 100% compliance for Door to Balloon time for all Stemi cases (Heart Attacks). Achieved the 98th percentile for Patient Satisfaction. Re accreditation of the Chest Pain Center. Blue Distinguished award in Cardiac Care. Acquired the angiojet system. This is a state of the art device to assist with blood clot removal. OCT/FFR light source used to visualize stenosis in coronary vessels. 7513751 32845580 PHARMACY - 2,492,832 DOSES ADMINISTERED 6612945 58288783 LAB - 554,131 SPECIMENS COLLECTED 6332269 12370588 IMCU - 10,539 PATIENT DAYS 5009334 38090130 ER - 27,645 VISITS 4838976 15556632 PT OT SPEECH - 115,768 PROCEDURES 4835106 4168772 OCC HEALTH - 7,223 VISITS 4610640 HIM 4381023 54394027 RADIOLOGY - 62,320 PROCEDURES 3994465 1379 DIETARY - 149,349 IP MEALS 3343804 4695339 ICU - 2,621 PATIENT DAYS 3026974 PATIENT SERVICES - 43,330 VISITS 2278133 2564733 HOME HEALTH - 27,492 VISITS 1882137 10307471 RESPIRATORY THERAPY - 64,907 PROCEDURES 1597635 SECURITY 1398211 ADMITTING - 9,220 IP ADMISSIONS 900410 5927845 NUCLEAR MED - 1,994 PROCEDURES 880116 3402276 CYBERKNIFE - 209 CLICKS 666735 1833501 OUTPATIENT SERVICES 608003 MEDICAL STAFF 525131 CENTRAL SUPPLY 524654 PHYSICIANS 460984 PUBLIC RELATIONS 397336 CENTRAL STERILIZATION - PROVIDE STERILE INSTRUMENT 143012 3231748 EEG - 4,758 PROCEDURES 103855 POB 39045 LTAC 6725 CANCER RESEARCH 231 PSYCH 118415 HOSPITALIST -186939578 CONTRACTUALS -20753874 CHARITY -13148064 BAD DEBT -2927030 INTERCOMPANY ELIMINATION 66911640 24028673 146835298 true true false false false false false false false false true false false true true false false true false false false false false false false false true true true false true false false false false false false false false false false false false false true true true false false true 80 0 true 1439 true true true false false false false false false false false false X 18 14 false false false false true true true true true false false true true true true true true true true false IN X MARY ANN SHACKLETT 2199348250 10010 DONALD S POWERS DR 201 MUNSTER IN 46321 LORENZO ARREDONDO 1.0 X 0 0 0 JOHN ARTIS 1.0 X 0 0 0 MARIA LUZ CORONA MAGISTRATE 1.0 X 0 0 0 R LOUIS GONZALEZ 1.0 X 0 0 0 JUDITH GRESKO 1.0 X 0 0 0 HENRY HADIDIAN MD 1.0 X 74700 0 0 DAVID HERBSTMAN MD 1.0 X 0 120 0 SR ANNEMARIE KAMPWERTH PHJC 1.0 X 0 0 0 THOMAS P KEILMAN 1.0 X 0 0 0 JOSEPH SEMANCIK MONSIGNOR 1.0 2.0 X 450 24400 0 JAIME RUIZ-MONTERO MD 1.0 40.0 X 0 352934 1533 GEORGE RYAN 1.0 X 0 0 0 EDWARD WILLIAMS PHD 1.0 2.0 X 0 32639 0 JOSEPH COSTANZA 1.0 2.0 X X 0 20900 0 PEGGY GERARD RN DNSC 1.0 0.0 X X 0 0 0 KIMBERLY ARTHUR MD 1.0 X X 0 0 0 JOHN CABAN 1.0 X X 0 0 0 JOANN BIRDZELL 40.0 1.0 X X 591781 0 55965 MARY ANN SHACKLETT 1.0 48.0 X 0 713202 52044 PAULA SWENSON 40.0 X 254158 0 11061 CRAIG BOLDA 1.0 40.0 X 0 248451 51718 SAMER ABBAS MD 40.0 X 487784 0 8817 DANIEL SAAH MD 40.0 X 480578 0 17649 ASIM MOHIUDDIN DO 40.0 X 431736 0 15810 SUBHASH JOSHI MD 40.0 X 394175 0 14950 PAUL HERTZ MD 40.0 X 247270 0 8942 2962632 1392646 238489 54 false true false REHAB CARE GROUP INC PO BOX 502096 ST LOUIS MO 63150 REHAB SERVICES 2700278 COOPERATIVE MANAGED CARE SERVICES L ST FRANCIS HOSPITAL DEPT 9010 BEECH GROVE IN 46107 CLAIMS PROCESSING 1723032 ACCURAY INC 1310 CHESAPEAKE TERRACE SUNNYVALE CA 94089 SERVICE CONTRACTS 498500 SECURITAS SECURITY SERVICES USA 100 W 78TH AVE MERRILLVILLE IN 46410 SECURITY 454538 ISM SECURITY MANAGEMENT LLC 905 W GLEN PARK AVE GRIFFITH IN 46319 SECURITY 410289 29 3723433 202981 3926414 NET PATIENT SERVICE REVENUE 900099 138829542 138063283 766259 CAPITATION REVENUE 900099 26398849 26398849 165228391 71687 71687 0 0 1030880 321798 709082 0 709082 709082 88500 112773 -24273 -24273 -24273 0 0 0 OCC HEALTH OFFSITE STAFFING 900099 2826873 2826873 PHARMACY 340B 900099 967249 967249 CAFETERIA 900099 652709 652709 1117811 845883 271928 5564642 175475943 169811219 766259 972051 33945 33945 0 0 0 988115 0 988115 0 52548617 48073600 4475017 2773279 2497300 275979 7018143 6380099 638044 3983261 3586873 396388 0 157485 157485 50598 50598 0 0 0 14233785 12221178 2012607 490065 443988 46077 1701974 1175399 526575 50490 36203 14287 0 1724845 1670983 53862 113237 105754 7483 0 64944 49924 15020 1568 1568 67080 67080 4487203 4040666 446537 1418413 1277262 141151 CAPITATION EXPENSE 20496356 20496356 MEDICAL SUPPLIES 19029621 19029621 CORPORATE ALLOCATION 15184096 13673074 1511022 HAF 4476895 4476895 8994146 7499098 1495048 160088161 146835298 13252863 0 5401715 6431740 134364 154274 0 0 20091682 15206408 0 0 0 0 0 0 4990493 4785636 799277 792850 69631668 43192577 25191611 26439091 0 0 0 0 0 0 0 0 9555873 7629635 66165015 61439634 28078959 17620821 0 0 282589 347553 0 0 0 0 0 0 0 0 0 0 3772427 10440809 32133975 28409183 X 33792070 32754828 238969 275623 0 0 34031039 33030451 66165015 61439634 X 15387782 -16388370 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 5316 5316 28576711 17463326 11113385 408103 29108 378995 35903983 24510357 11393626 4737555 1189768 3547769 26439091 ESTIMATED 3RD PARTY SETTLEMENT 3394161 MISCELLANEOUS RCVBL 1489702 LT LEGAL CLAIMS RCVBL 803247 MDWISE RCVBL 776809 US STEEL RCVBL - OCC HEALTH 630829 ST LEGAL CLAIMS RCVBL 308255 HEALTH ASSESSMENT FEE RCVBL 226632 7629635 0 DUE TO AFFILIATES 7983077 LT LEGAL CLAIMS LIABILITY 1081808 3RD PARTY SETTLEMENTS 701169 ASSET RETIREMENT OBLIGATION 607436 CONSTRUCTION RETAINAGE 50915 CAPITAL LEASES - CURRENT PORTION 16404 10440809 true true X true X true X true true true false true true 3637 6899605 6899605 0.04300 29027 39894468 33992908 5901560 0.03680 32664 46794073 33992908 12801165 0.07980 146 16583 398626 589 398037 0.00250 11 291 268337 268337 0.00170 44 33664 33664 0.00020 201 16874 700627 589 700038 0.00440 201 49538 47494700 33993497 13501203 0.08420 1 26418 11631 14787 0.00010 6 10979 10979 0.00010 9 16926 16926 0.00010 16 54323 11631 42692 0.00030 true 4371061 43711 54548240 60941244 -6393004 X true true 1 1 ST CATHERINE HOSPITAL

4321 FIR STREET EAST CHICAGO IN 46312

X X X ST CATHERINE HOSPITAL 1 X X X X X X X X X 13 true true true X X X X X X X X X X false false true true 200. true 300. true X X X X X X true true X X X X X X true false X X X X true X false false 2 HOME HEALTH OF ST CATHERINE HOSPITAL

4321 FIR ST EAST CHICAGO IN 46312

HOME HEALTH OCCUPATIONAL HEALTH

4320 FIR ST STE 313 EAST CHICAGO IN 46312

OUTPATIENT CENTER REQUIRED DESCRIPTIONS PART I, LINE 3C N/A REQUIRED DESCRIPTIONS PART I, LINE 6A THE STATE OF INDIANA ACCEPTS FORM 990 SCHEDULE H IN LIEU OF COMMUNITY BENEFITS REPORT. REQUIRED DESCRIPTIONS PART I, LINE 7A BAD DEBT OF $13,148,064 IS EXCLUDED FROM THE CALCULATION. THE METHODOLOGY USED WAS THE COST TO CHARGE RATIO. IT IS FOR INPATIENT ONLY AND EXCLUDES MEDICAID, CHARITY AND BAD DEBT. PART I, LINE 7B DIRECT OFFSETTING REVENUE EXCLUDES PRIOR YEAR(S) MEDICAID DSH RECEIPTS 2012 6,206,000 2011 1,142,000 2010 1,374,000 TOTAL 8,722,000 PART III, LINE 2 COST TO CHARGE RATIO REQUIRED DESCRIPTIONS PART III, LINE 4 ST. CATHERINE HOSPITAL EVALUATES THE COLLECTIBILITY OF ITS ACCOUNTS RECEVIABLE BASED ON THE LENGTH OF TIME THE RECEIVABLE IS OUTSTANDING AND THE ANTICIPATED FUTURE UNCOLLECTIBLE AMOUNTS BASED ON HISTORICAL EXPERIENCE. ACOUNTS RECEIVABLE ARE CHARGED TO THE ALLOWANCE FOR DOUBTFUL ACCOUNTS WHEN THEY ARE DEEMED UNCOLLECTIBLE. ST. CATHERINE'S DOES NOT REQUIRE COLLATERAL. THE COST TO CHARGE RATIO WAS USED TO CALCULATE THE ESTIMATED COST OF BAD DEBT ATTRIBUTABLE TO PATIENT ACCOUNTS THAT ARE REPORTED ON LINE 2. DISCOUNTS AND PAYMENTS ON PATIENT ACCOUNTS ARE RECORDED AS AN ADJUSTMENT TO REVENUE, NOT BAD DEBT EXPENSE. AS A TAX-EXEMPT HOSPITAL, WE MUST PROVIDE NECESSARY SERVICES REGARDLESS OF THE PATIENT'S ABILITY TO PAY FOR THE SERVICE PROVIDED. WE ESTIMATED A PERCENTAGE OF BAD DEBTS BASED UPON THE PORTION OF UNINSURED INDIVIDUALS THAT WOULD BE ELIGIBLE FOR THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY. THIS AMOUNT ENTERED ON PART III, LINE 3 SHOULD BE COUNTED AS A COMMUNITY BENEFIT. REQUIRED DESCRIPTIONS PART III - LINE 8 THE TOTAL REVENUE RECEIVED FROM MEDICARE WAS CALCULATED BY USING INFORMATION FROM THE COST ACCOUNTING SYSTEM. WE PROVIDE NECESSARY SERVICES REGARDLESS OF THE PATIENT'S ABILITY TO PAY FOR THE SERVICE PROVIDED OR THE REIMBUSEMENT RECEIVED FROM MEDICARE, QUALIFYING THE $6,393,004 OF MEDICARE SHORTFALL AS A COMMUNITY BENEFIT. REQUIRED DESCRIPTIONS PART III, LINE 9B COLLECTION POLICIES ARE THE SAME FOR ALL PATIENTS. PATIENTS ARE SCREENED FOR ELIGIBILITY FOR FINANCIAL ASSISTANCE BEFORE COLLECTION PROCEDURES BEGIN. IF AT ANY POINT IN THE COLLECTION PROCESS, DOCUMENTATION IS RECEIVED THAT INDICATES THE PATIENT IS POTENTIALLY ELIGIBLE FOR FINANCIAL ASSISTANCE BUT HAS NOT APPLIED FOR IT, THE ACCOUNT IS REFERRED BACK FOR A FINANCIAL ASSISTANCE REVIEW. REQUIRED DESCRIPTIONS PART V SECTION B LINE 1J - N/A LINE 3 - FOCUS GROUPS WITH COMMUNITY AND BUSINESS LEADERS LINE 4 - FRANCISCAN ALLIANCE AND THE METHODIST HOSPITALS LINE 5C - N/A LINE 6I - N/A LINE 7 - Community Health Needs: Areas Not Addressed The Community Health Needs assessment conducted by the hospitals of the Community Healthcare System identified areas of concern not identified in the hospital's implementation plan. These areas include: St. Catherine Hospital Service Areas: " Access to Health Services " Cancer " Chronic Kidney Disease " Family Planning " Injury & Violence Prevention " Oral Health Many of these areas are being addressed by the hospitals of the Community Healthcare System as well as by other community organizations. For example, Community Healthcare System supports a large cancer program with a separate research foundation focused on improving access to clinical trials for area residents as well as providing free support and mind-body services through its Cancer Resource Centre. All hospitals provide routine low-cost and free screening programs for a variety of cancers. One of the three hospitals in the Community Healthcare System has a behavior health program and has recently expanded its outpatient services to improve access to mental health services. As the hospital focuses on lifestyle, education, prevention and access to care issues surrounding its four focused areas, positive outcomes will likely have positive effects on the health needs not addressed. To have the greatest impact, however, the hospital has chosen to focus on three of the most serious diseases and the related lifestyle issues facing our community as well investing in the health of the most vulnerable residents - our newborns. LINE 10 - N/A LINE 11 - N/A LINE 12H - N/A LINE 14G - N/A LINE 16E - N/A LINE 17E - N/A LINE 18E - N/A LINE 19C - N/A LINE 19D - N/A LINE 20D - SEE PART V, LINE 20D IN SUPPLEMENTAL INFORMATION LINE 21 - N/A LINE 22 - N/A NEEDS ASSESSMENT IN COLLABORATION WITH FRANCISCAN ALLIANCE AND THE METHODIST HOSPITALS, ST. CATHERINE HOSPITAL CONTRACTED WITH A THIRD PARTY TO PERFORM OUR COMMUNITY HEALTH NEEDS ASSESSMENT AS PER REGULATION 501(R). PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE PATIENTS WHO ARE ADMITTED WITHOUT INSURANCE ARE DIRECTED TO THE HOSPITAL'S FINANCIAL COUNSELORS. THE FINANCIAL COUNSELORS PERFORM AN INTERVIEW WITH THE PATIENTS TO EXPLAIN TO THEM THE PROCESS NECESSARY TO RECEIVE FINANCIAL ASSISTANCE. THIS PROCESS INCLUDES APPLYING FOR MEDICAID OR OTHER GOVERNMENT AID. THE APPLICANT THEN MUST FILL OUT A FINANCIAL INFORMATION WORKSHEET AND SUBMIT VARIOUS INFORMATION TO DETERMINE IF THEY QUALIFY FOR FINANCIAL ASSISTANCE IN ACCORDANCE WITH THE FINANCIAL ASSISTANCE POLICY. THE POLICY IS POSTED IN THE EMERGENCY ROOM AREA AS WELL AS AT EACH INPATIENT WAITING DESK. THE INFORMATION IS ALSO AVAILABLE ON OUR WEBSITE. COMMUNITY INFORMATION THE COMMUNTIY SERVED INCLUDES NORTHWEST INDIANA. OUR MARKET SHARE FOR THE PRIMARY SERVICE AREA IS 69%. THE POPULATION IS AMONG THE YOUNGEST WITH THE LOWEST MEDIAN INCOME WHEN COMPARED TO OTHER MARKETS IN NORTHWEST INDIANA. OUR MEDIAN INCOME IS $28,386. WE ALSO HAVE THE LEAST INSURANCE COVERAGE - 62% UNINSURED OR MEDICAID. PROMOTION OF COMMUNITY HEALTH Alzheimer's Support Group - Alzheimer's Support Group meets the third Tuesday of each month at St. Catherine Hospital. This group is for patients, family and friends dealing with Alzheimer's. Participants in support groups receive emotional support, practical assistance in coping with the issues they face and the latest information about research. Alzheimer's Symposium - Support and resources are provided to help caregivers and those in very early stages of Alzheimer's learn about and navigate the medical and legal issues of this diagnosis. Speakers range from physicians to attorneys and participants may also browse a consortium of vendors providing information about everything from assisted living to home monitoring. Blood Profile Screening - These screenings offer a way for those concerned about heart health to monitor cholesterol, HDL, triglycerides or glucose. No physician order is necessary for the screening. The Cancer Resource Centre and St. Catherine Hospital provide a local celebration of Cancer Survivors Day - a national event, honoring the strength and courage of those who have lived - and continue to live - with cancer. Prizes are raffled and each attendee receives a gift. Food and entertainment are also provided. Cardiac Rehab - Informational sessions are held that give patients an opportunity to ask a pharmacist questions regarding their cardiac medications. Handouts are provided to patients comparing certain blood pressure medications. Consoling Hearts Grief Support - This support group is offered to those suffering from the loss of a loved one. Participants include family members, friends, or those who are having a difficulty dealing with the loss of a loved one. Coronary Health Appraisal-This appraisal helps to determine risk for heart disease and other related medical conditions. Screening includes: cholesterol (total, HDL, LDL, triglycerides), blood sugar, metabolic syndrome, blood pressure, body mass index and a Heart Health Profile. Hope Network Cancer Support Group - The last Wednesday of each month this group meets for informative sessions where they can share thoughts and feelings in a comfortable and confidential atmosphere. Keeping Baby Safe and Healthy-Pediatrician, Dr. Iyer, discusses when to call the doctor, child-proofing the house, what to do in an emergency and nutritional needs of babies. Information on child seat safety is also available. Lamaze - Six educational classes are offered each session for those in their last trimester of pregnancy. Classes include informative lectures about comfort measures and medication available for pain. The last session focuses on management of breast-feeding and newborn behavior patterns. Look Good Feel Better - A program for women undergoing radiation and/or chemotherapy. Beauty techniques are taught to help restore appearances and self-image during the course of treatment. Moving Forward - Stroke Education - This five part series helps Stroke survivors and caregivers learn to prevent future strokes through risk detection and management. Nutrition Counseling - Dietary evaluation and counseling is provided by a registered dietitian. PAD - What's It All About? - The Cardiac Rehabilitation Medical Director discusses peripheral arterial disease (PAD). Attendees learn the signs, symptoms, causes and treatment of this serious disease. Skin Cancer Screenings - Physician examines any questionable areas of the body to look for indications of cancer or pre-cancerous conditions. This screening takes place at a participating St. Catherine Hospital physician's office on a monthly basis. Transplant Support Group-A program committed to providing and distributing educational information and maintaining contact with donor families, transplant recipients, patients waiting a dialysis patients. Silver Sneakers is a senior exercise program offered free to those who qualify. This program is offered through the hospital's Cardiac Rehab Department. AFFILIATED HEALTH CARE SYSTEM ST. CATHERINE HOSPITAL IS PART OF AN AFFILIATED SYSTEM. EACH HOSPITAL IN THE SYSTEM PROVIDES MEDICAL SERVICES TO THEIR COMMUNITIES AND ADJOINING COMMUNITIES. EACH ENTITY'S PURPOSE IS TO PROVIDE HEALTH CARE TO THOSE WHO NEED IT, INCLUDING THE UNINSURED OR UNDERINSURED. STATE FILING OF COMMUNITY BENEFIT REPORT INDIANA FACILITY REPORTING GROUPS SEE REQUIRED DESCRIPTIONS PART III, LINE 8 Cost Report 591,037 Medicare Managed Care (620,442) Fee-based Outpatient charges (2,577,512) Disallowed Medicare expenses (3,786,087) Total (Shortfall) (6,393,087) PART V, LINE 20D Our maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care are based on a sliding scale. Up to 200% of federal poverty guidelines (FPG) is 100% free care. 201% -250% is discounted 80%. 251%-300% is discounted 60%. Patients may also be eligible for self-pay/prompt pay discounts regardless of the federal poverty level. We offer 30% discount to true self-pay accounts and a 10% discount to prompt pay accounts. false GRANTS PAID REQUESTS FOR DONATIONS FROM QUALIFIED 501(C)(3) CHARITIES AND UNIVERSITIES ARE EVALUATED AS TO WHETHER THE POTENTIAL DONEE ORGANIZATION WILL USE THE FUNDS IN A MANNER CONSISTENT WITH OUR CHARITABLE MISSION AND THE INTENTION OF THE CONTRIBUTION. OUR DONATIONS/CONTRIBUTIONS ARE PRIMARILY MADE TO LOCAL ORGANIZATIONS. SINCE THESE ARE NOT GRANTS, THERE IS NO NEED TO MONITOR. ST. CATHERINE HOSPITAL, INC. DID NOT CONTRIBUTE MORE THAN $5,000 TO ANY INDIVIDUAL ORGANIZATION. X true true X X X X X false false false false false false false true false JAIME RUIZ-MONTERO MD 0 352416 0 0 0 518 0 0 0 1533 0 354467 0 0 JOANN BIRDZELL 388616 0 195196 0 7969 0 52750 0 3215 0 647746 0 0 0 MARY ANN SHACKLETT 0 412061 0 274998 0 26143 0 27800 0 24244 0 765246 0 0 PAULA SWENSON 170990 0 82388 0 780 0 8163 0 2898 0 265219 0 0 0 CRAIG BOLDA 0 173923 0 74158 0 370 0 27800 0 23918 0 300169 0 0 SAMER ABBAS MD 487339 0 0 0 445 0 7350 0 1467 0 496601 0 0 0 DANIEL SAAH MD 478256 0 0 0 2322 0 11100 0 6549 0 498227 0 0 0 ASIM MOHIUDDIN DO 430926 0 0 0 810 0 11100 0 4710 0 447546 0 0 0 SUBHASH JOSHI MD 390611 0 0 0 3564 0 11100 0 3850 0 409125 0 0 0 PAUL HERTZ MD 245000 0 0 0 2270 0 7350 0 1592 0 256212 0 0 0 SUPPLEMENTAL INFORMATION PART I, LINE 1A THE ORGANIZATION PAYS HEALTH/SOCIAL CLUB DUES ON BEHALF OF CERTAIN OFFICERS, KEY EMPLOYEES AND THE FIVE HIGHEST PAID EMPLOYEES WHICH IS THEN TAXED AS A FRINGE BENEFIT TO THE INDIVIDUAL. PART 1, LINE 7 DESCRETIONARY BONUS IS PAID BASED ON FINANCIAL PERFORMANCE AND QUALITY INDICATORS TO CERTAIN EXECUTIVES. SUPPLEMENTAL INFORMATION PROGRAM SERVICES In 1928, St. Catherine Hospital, East Chicago, Indiana was opened to fill a need for health service to the communities of East Chicago, Whiting, Hammond and Gary. Today the hospital continues to provide a full range of medical services for inpatients and outpatients. St. Catherine Hospital is a non-profit hospital operating as a part of the Community Healthcare System, which includes Community Hospital in Munster, Indiana and St. Mary Medical Center in Hobart, Indiana. The hospitals are committed to providing the highest quality healthcare in the most cost-efficient manner, respecting the dignity of the individual, providing for the well-being of the community and serving the needs of all people, including the poor and disadvantaged. Community Healthcare System is the leading medical provider in Northwest Indiana, operating three non-profit hospitals, several outpatient clinics and physician offices. Together, the three operate the largest cardiovascular and cancer programs in the area. In the spirit of Katherine Kasper's founding charisma, St. Catherine Hospital continues to minister to our neighbors within the community; providing compassionate care of body and spirit. St. Catherine Hospital focuses on designing and providing services that meet the needs of its diverse community in East Chicago and the surrounding communities of Northwest Indiana. The hospital regularly surveys its patients to ascertain their satisfaction with its facilities and the programs that are offered and to identify the community's outstanding needs. The hospital was the first in the area to implement a Patient Advisory Council to allow our patients to provide us with feedback and suggestions that will help assure that the patients are at the center of all we do. By working in conjunction with our medical staff and associates, we ensure that programs and services not only address the patient's medical needs, but consider the patient's cultural and social needs as well. At St. Catherine Hospital, our mission and values guide us to provide quality, compassionate care for our patients and comfort for our visitors. Our philosophy is to care for all guests as if they were members of our own family. We have been recognized locally and nationally for various programs, proving our commitment to excellent service. Evidence based practice guidelines are followed and clinical outcomes are measured throughout the organization. The Chest Pain Center is accredited by the Society of Cardiovascular Care and rigorously maintains standards to enhance care of the cardiac patient. St. Catherine Hospital was recently recognized with the Cardiac Care Excellence award by Healthgrades. The Stroke Program is accredited by the Joint Commission. Joint Commission has awarded St. Catherine Hospital at Top Performer Award for 2012. St. Catherine Hospital takes pride in being responsive to the needs of our community. Over the last several years, focused efforts have been made to develop outreach education programs and offer health screenings that address challenges unique in our neighborhoods. STOP Diabetes in East Chicago, Lupus education, a support group for those dealing with the aftermath of a violent incident, the Well Walkers' Club, and free car seats provided to all families who deliver at St. Catherine Hospital are just a few of these programs. When possible, our community outreach team embraces innovative programs out of the hospital and into local churches, community centers, libraries and the workplace. This approach allows us to serve more people in settings they find comfortable and convenient. Collection Policy Schedule H Part III Line 9B Collection policies are the same for all patients. Patients are screened for eligibility for financial assistance before collection procedures begin. If at any point in the collection process, documentation is received that indicates the patient is potentially eligible for financial assistance but has not applied for it, the account is referred back for a financial assistance review. PART VI Line 7a Community Foundation of Northwest Indiana Inc is the parent company of St Catherine Hospital Inc and has control to elect members of their governing body. PART VI Line 7b Community Foundation of Northwest Indiana Inc is the parent of St Catherine Hospital Inc and has the rights to approve decisions made by St Catherine Hospital Inc. PART VI Line 11a THE 990 IS SUBMITTED TO THE SENIOR VP AND CFO FOR REVIEW. ONCE THIS REVIEW IS COMPLETE THE RETURNS ARE THEN PRESENTED TO SENIOR LEADERSHIP FOR REVIEW. THE 990 IS ALSO REVIEWED BY AN INDEPENDENT PUBLIC ACCOUNTING FIRM BEFORE IT IS POSTED TO A SECURE WEBSITE TO ALLOW THE BOARD OF DIRECTORS TO REVIEW PRIOR TO FILING. PART VI Line 12c AS PART OF THE ORGANIZATION'S ANNUAL MONITORING AND ENFORCEMENT PROCEDURES RELATING TO ITS CONFLICT OF INTEREST POLICY, ALL CONFLICT OF INTEREST QUESTIONNAIRES ARE REVIEWED AND THOSE OFFICERS, DIRECTORS, OR KEY EMPLOYEES WHO DO NOT RETURN OR FULLY COMPLETE THE QUESTIONNAIRE ARE CONTACTED TO RECONCILE THE OMISSION. OFFICERS & POSITIONS FOR WHICH PROCESS WAS USED, & YEAR PROCESS WAS BEGUN PART VI-B, LINE 15 IN 2003, THE PARENT COMPANY (CFNI) BOARD ADOPTED EXECUTIVE AND BOARD OF DIRECTORS COMPENSATION PHILOSOPHY AND REASONABLENESS STANDARDS. THIS IS TO ASCERTAIN THAT THESE STANDARDS ARE ADHERED TO. THEIR PROCESS FOR COLLECTING AND ASSEMBLING MARKET DATA IS CONSISTENT WITH THE REBUTTABLE PRESUMPTION CHECKLIST AND GUIDELINES ALONG WITH FAIR MARKET VALUE USED BY THE IRS IN CONDUCTING EXECUTIVE COMPENSATION REVIEWS AS WELL AS CONTEMPORARY COMPENSATION PRACTICES. ALL MARKET DATA IS ASSEMBLED FROM REPUTABLE COMMERCIALLY AVAILABLE SURVEYS. PART VI Line 19 ST CATHERINE HOSPITAL INC DOES NOT MAKE ITS GOVERNING DOCUMENTS OR CONFLICT OF INTEREST POLICY AVAILABLE TO THE PUBLIC. IN ACCORDANCE WITH BOND COVENANTS, ST CATHERINE HOSPITAL INC THROUGH COMMUNITY FOUNDATION OF NORTHWEST INDIANA MAKES ITS FINANCIAL STATEMENTS AND DISCLOSURES AVAILABLE TO THE PUBLIC THROUGH THE EMMA DATABASE. Part XI Line 5 Other Changes in Net Assets AMOUNT TRANSFERRED TO CFNI (PARENT) ($14,478,724) AMOUNT TRANSFERRED TO CCN ($1,909,646) TOTAL ($16,388,370) COMMUNITY FOUNDATION OF NW INDIANA INC 10010 DONALD POWERS DR MUNSTER IN 46321 311128781 SUPPORTNG ORG IN 501(C)(3) 11(C) NA false MUNSTER MEDICAL RESEARCH FOUNDATION INC 800 MACARTHUR BLVD MUNSTER IN 46321 351107009 HOSPITAL IN 501(C)(3) 3 CFNI true ST MARY MEDICAL CENTER 1500 SOUTH LAKE PARK AVE HOBART IN 46342 352007327 HOSPITAL IN 501(C)(3) 3 CFNI true COMMUNITY CANCER RESEARCH FOUNDATION 901 MACARTHUR BLVD MUNSTER IN 46321 352146374 CANCER FUNDRA IN 501(C)(3) 7 MMRF true COMMUNITY VILLAGE INC 10000 COLUMBIA AVE MUNSTER IN 46321 351956395 RETIREMT HOME IN 501(C)(3) 9 CFNI true THEATRE AT THE CENTER 1040 RIDGE RD MUNSTER IN 46321 351939427 CONCERTS IN 501(C)(3) 9 CFNI true CVPA HOLDING COMPANY 1040 RIDGE RD MUNSTER IN 46321 351938136 TITLE HLDG CO IN 501(C)(2) N/A CFNI true COMMUNITY RESOURCES INC 907 RIDGE RD MUNSTER IN 46321 351727711 MGMT SERVICES IN NA C CORP false true false false false false false false false false false false false true true true false false COMMUNITY CARE NETWORK B 1909646 FMV COMMUNITY CARE NETWORK O 2140630 FMV MUNSTER MEDICAL RESEARCH FOUNDATION INC O 1016011 FMV ST MARY MEDICAL CENTER O 591027 FMV COMMUNITY CARE NETWORK P 2355041 FMV MUNSTER MEDICAL RESEARCH FOUNDATION INC P 977247 FMV ST MARY MEDICAL CENTER P 671036 FMV COMMUNITY CARE NETWORK Q 364390 FMV MUNSTER MEDICAL RESEARCH FOUNDATION INC Q 2942364 FMV ST MARY MEDICAL CENTER Q 69003 FMV