2014-05-14T09:43:51-05:00 2013-06-30 861065772 Deloitte Tax LLP 250 East Fifth Street Suite 1900 Cincinnati OH 45202 990 2012-07-01 591878316 St Catherine's Laboure Manor Inc STCA 9043087300 4205 Belfort Road No 4015 Jacksonville FL 32216 Kimberly Hodgkinson 9043087300 2014-05-12 1 Rebecca Lyons P01487105 5137847100 2014-05-05 2012 2015-11-30 17:44:51Z Moody L Chisholm 1 Shircliff Way Jacksonville FL 32204 25510694 0 0928 X www.jaxhealth.com X 1979 FL Short-term respite care & long-term 24-hour nursing care or hospice care. 11 9 360 14 0 0 34294 119170 24874054 24932628 438878 422274 44803 36622 25392029 25510694 0 0 0 0 11448710 11670982 0 0 0 10337000 11203767 21785710 22874749 3606319 2635945 24024694 22954807 18591394 18161935 5433300 4792872 X Rooted in the loving ministry of Jesus as Healer, we commit ourselves to serving all persons with special attention to those who are poor and vulnerable. Our Catholic Health Ministry is dedicated to spiritually centered, holistic care which sustains and improves the health of individuals and communities. We are advocates for a compassionate and just society through our actions and our words. 0 0 21312976 24932628 St. Catherine's Laboure Manor, Inc. provides quality skilled nursing services to the elderly and infirm, regardless of race, religion, national origin, or ability to pay. St. Catherine's Laboure Manor, Inc. has taken proactive steps to address those issues that will affect the accessibility, the financing, and the delivery of healthcare to all persons, especially the uninsured and the underserved. Approximately 40% of the value of services rendered were to elderly patients under the Medicare program and approximately 37% were under the Medicaid program. See Schedule O for complete Community Benefit Report. 21312976 1 1 0 0 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 19 0 1 360 1 0 0 0 0 0 0 0 0 0 0 0 X 11 9 0 0 0 0 1 1 1 1 0 0 0 1 1 1 1 1 1 1 1 0 X Herb Kaminsky 9043087300 4205 Belfort Road Suite 4030 Jacksonville FL 32216 C Daniel Rice 3.00 3.00 X X 0 0 0 Sidney S Simmons II 1.00 1.00 X X 0 0 0 Richard Mullaney 1.00 1.00 X X 0 0 0 Paul J Chappano MD 1.00 1.00 X 0 0 0 Gary R Chartrand 1.00 1.00 X 0 0 0 Dudley Greenhut 1.00 1.00 X 0 0 0 David G Kulik 1.00 1.00 X 0 0 0 Ricardo Morales Jr 1.00 1.00 X 0 0 0 Sr Nancy Murphy DC 1.00 1.00 X 0 0 0 Sr Elyse Staab DC 1.00 1.00 X 0 0 0 Moody Chisholm 40.00 40.00 X X 0 1158135 55827 Mark Doyle 40.00 40.00 X 0 477538 82397 Maureen F Gartland 40.00 0.00 X 183823 0 24178 Phil C Perry 40.00 40.00 X 0 458819 36260 Karen F Darnell 40.00 40.00 X 0 323407 37679 Janice G Lipsky 40.00 40.00 X 0 287156 52598 John Meyer 40.00 40.00 X 0 262692 45614 Jeffery Middlebrooks 40.00 40.00 X 0 172941 4865 Donnie Romine Jr 40.00 40.00 X 0 372395 106497 Teresa Butts 40.00 0.00 X 102577 0 11012 Gene K Miyamoto 0.00 0.00 X 0 396767 19103 286400 3909850 476030 3 1 1 0 Touchpoint Support Services PO Box 102289 Atlanta GA 303682289 Food Services 2400541 Rehabcare Group - SRS Division PO Box 503534 St Louis MO 631503534 Rehabiliation Services 1980950 ABM 355 Hopping Brook Rd Holliston MA 01746 Maintenance Services 298729 Arbor Medical Staffing 2727 Mayhan Drive MS14 Palm Coast FL 32135 Temporary Staffing 138264 4 102875 16295 119170 Medicare/Medicaid 621990 19198123 19198123 Net Patient Services 621990 5734505 5734505 24932628 422274 422274 Beauty/Barber Shop 812900 31194 31194 Cafeteria Revenue 722210 5428 5428 36622 25510694 24932628 0 458896 208001 195521 12480 8892080 8375330 516750 61144 58209 2935 1751742 1743612 8130 758015 700027 57988 115057 115057 7551 7551 2591310 2573271 18039 848152 746750 101402 15147 3685 11462 513176 487517 25659 670465 636942 33523 88431 82059 6372 Prof. Medical Fees 2075537 2059578 15959 Cost Containment Assess 1520699 1520699 Corporate Services 528260 105652 422608 Maintenance Service 178000 160200 17800 2051982 1856373 195609 22874749 21312976 1561773 0 850 850 10149549 219011 2274622 2210974 4340 25490 5998 22838462 13633723 9807980 9204739 1787353 11287745 24024694 22954807 1986632 1875412 16604762 16286523 18591394 18161935 X 5266954 4703257 166346 89615 0 5433300 4792872 24024694 22954807 X 2635945 325964 -3602337 X 0 1 X 1 0 X Schedule A, Part IV, Supplemental Information: Schedule A, Part I: Reason for Public Charity Status: St. Catherine's Laboure Manor, Inc. is exempt as a hospital under Internal Revenue Code Section 170(b)(1)(A)(iii); however it is not a hospital as defined by Form 990, Schedule H Instructions. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 4799652 4799652 5838154 4361743 1476411 2889814 2534110 355704 9310842 6737870 2572972 9204739 Estimated Third-Party Payor Settlements 287313 Investment of Net Assets of Related Foundation 89615 Recievable from Related Foundation 1336141 Other Miscellaneous Long Term Assets 66418 Patient Trust Accounts 42738 Interest in Investments Held by Ascension Health Alliance 9465520 11287745 AR Credit Balances 119237 Estimated Settlements to Third Party Payors 320888 AH Savings Plan Liability 54800 AP Intercompany between Health Ministries 776922 Resident or Patient Trust Fund ST 36244 Intercompany Debt to Ascension Health Alliance 14761278 SITF System Sponsored 103617 Pension Plan Liability 113537 16286523 X Description of Uncertain Tax Positions Under FIN 48: Part X, Line 2: From the consolidated financial statements of St. Vincent's Health System, Inc. (which include the activity of St. Catherine's Laboure Manor, Inc.): The Health Ministry 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. 1 1 0 0 0 0 0 0 0 Moody Chisholm 0 610753 0 417376 0 130006 0 39022 0 16805 0 1213962 0 0 Mark Doyle 0 390112 0 83118 0 4308 0 78085 0 4312 0 559935 0 0 Maureen F Gartland 149344 0 24586 0 9893 0 8982 0 15196 0 208001 0 0 0 Phil C Perry 0 351820 0 76093 0 30906 0 23500 0 12760 0 495079 0 0 Karen F Darnell 0 252976 0 51510 0 18921 0 22000 0 15679 0 361086 0 0 Janice G Lipsky 0 216316 0 53204 0 17636 0 36000 0 16598 0 339754 0 0 John Meyer 0 213014 0 47103 0 2575 0 40114 0 5500 0 308306 0 0 Jeffery Middlebrooks 0 142869 0 28839 0 1233 0 0 0 4865 0 177806 0 0 Donnie Romine Jr 0 217439 0 151448 0 3508 0 89987 0 16510 0 478892 0 0 Gene K Miyamoto 0 198230 0 0 0 198537 0 19103 0 0 0 415870 0 0 Part I, Line 3 St. Vincent's Health System, Inc., a related organization of St. Catherine's Laboure Manor, Inc., uses the following to establish the compensation of the organization's CEO: - Compensation Committee, - Independent Compensation Consultant, - Compensation Survey or Study, and - Approval by the Board or Compensation Committee Supplemental Information Part III Part I, Line 4a, Severance Payments: Gene K. Miyamoto - $194,741 Supplemental Information Part III Part I, Line 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 executives is reported as compensation on Form 990 Schedule J, Part II, Column B in the year paid. The related organizations (St. Vincent's Health System, Inc. and St. Vincent's Medical Center, Inc.) contributed to the nonqualified supplemental retirement plan as follows: Mark Doyle - $44,575 John Meyer - $17,032 Donnie L. Romine - $51,455 Gene K. Miyamoto - $8,092 Form 990, Part VI, Section A, line 6 St. Catherine's Laboure Manor, Inc. has a single corporate member, St. Vincent's Health System, Inc. Form 990, Part VI, Section A, line 7a St. Catherine's Laboure Manor, Inc. has a single corporate member, St. Vincent's Health System, Inc., who has the ability to elect members to the governing body of St. Catherine's Laboure Manor, Inc. Form 990, Part VI, Section A, line 7b All decisions that have a material impact to St. Catherine's Laboure Manor, Inc. financial information or corporation as a whole are subject to approval by its sole corporate member, St. Vincent's Health System, Inc. Form 990, Part VI, Section A, line 8b There are no separate committees that have the authority to act on behalf of the governing body for St. Catherine's Laboure Manor, 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 to the Board, or a designated committee, to review and answer any questions. 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 Officers, directors or trustees, and key employees are required to complete a Conflict of Interest Attestation Statement at the time of hiring or when their service begins. Annually, the Corporate Responsibility Officer sends the Conflict of Interest Policy and Attestation Statement to all officers, directors or trustees, and key employees for completion and return within two weeks. Three separate mailings are sent out with two week deadlines to receive a maximum response. The responses from the returned Attestation Statement are organized in a spreadsheet and are carefully reviewed by the Corporate Responsibility Officer, the Chief Legal Officer, and the Chief Executive Officer. A full report is presented to the Audit Committee and any potential conflicts of interest are handled by the committee in an appropriate manner. Form 990, Part VI, Section B, line 15 In determining the compensation of the organization's CEO, the process, performed by St. Vincent's Health System, Inc. (a related organization who paid the CEO), 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 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. 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 St. Vincent's Health System, Inc. (a related organization who paid the other officers or key employees), 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 other officers and key employees were 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 board minutes. Form 990, Part VI, Section C, line 19 The organization will provide any documents open to public inspection upon request. Changes in Net Assets or Fund Balances: Form 990, Part XI, line 9: Transfer to Affiliates -3,544,787. Temporary Restricted Released for Operations -93,026. Unrestricted Defined Pension Cost -56,319. Transfer Restricted Contributions used Property 91,795. Community Benefit Report: Form 990, Part III, Line 4a: This report illustrates the significant degree to which St. Catherine's Laboure Manor, Inc. contributes to the positive health status of the residents of Jacksonville, Florida and surrounding communities. St. Catherine's Laboure Manor, Inc. ("SCLM") is a subsidiary of St. Vincent's HealthCare, a multi entity health care network that provides essential health services to its community. As a member of Ascension Health, the nation's largest not-for-profit Catholic healthcare system, St. Vincent's HealthCare continues to build and strengthen sustainable collaborative efforts that benefit the health of individuals, families, and society as a whole. The goal of St. Vincent's HealthCare is to perpetuate the healing mission of the Catholic Church. St. Vincent's HealthCare furthers this goal through delivery of patient services that includes, care to the elderly and indigent. Our concern for all human life and dignity of each person leads the organization to provide medical services to all people in the community without regard to the patient's race, creed, national origin, economic status, or ability to pay. In order to portray the full breadth of our contribution, our community benefit information is described below: Organizational Commitment to Providing Community Benefit SCLM is a 240 bed nursing home serving the residents of Northeast Florida and Southeast Georgia. One of the largest long-term nursing facilities in Jacksonville, SCLM's offers many of the services residents need in a home-like atmosphere. Services include a 60-bed Special Care Unit for Alzheimer's and Dementia residents, dental and pharmacy services, a library, a beauty/barber shop, and chapel services. Supporting St. Vincent's HealthCare's mission of service to all persons with special attention to those who are poor and vulnerable, SCLM's is uniquely suited to care for those in need of short-term respite care, long-term care, 24-hour care or hospice care. Staff is prepared to meet the physical, emotional, and spiritual needs of residents through SCLM's wide range of services. Operations and Governance - SCLM has a governing body composed of community representatives and officials of St. Vincent's HealthCare. - SCLM is subject to all federal and state regulations including CMS, OBRA and OSHA. - SCLM participates in Medicaid, Medicare, CHAMPUS, Tricare, and/or other government-based health care sponsored health care programs. Unreimbursed Services Provided to the Elderly and the Poor In the spirit of the principles adopted by Ascension Health, SCLM has taken proactive steps to address those issues that will affect accessibility, the financing, and the delivery of nursing home services to all persons, especially the uninsured and the underserved. During the fiscal year ending June 30, 2013, approximately 40% of the values of services rendered were to elderly patients under the Medicare program, and approximately 37% of the services were provided to patients under the Medicaid program. Patient Services SCLM operates an Alzheimer/Dementia unit designed to meet the specialized needs of these residents. The combination of interior design and specialized training of its staff enables SCLM's to provide a responsive and secure living environment for up to 60 residents with memory impairments. The Alzheimer/Dementia unit offers a secure and private garden to provide patients access to safe outdoor activities, as well as specialized activity programs and a family support group. The facility and staff have been recognized by CMS for the skilled and caring ministry of its residents and was awarded recognition as a Four Star nursing home care facility in the state of Florida. During the fiscal year ended June 30, 2013, SCLM provided over 84,000 days of residential care. SCLM activities program is designed to meet residents' needs and abilities. Staff members schedule many special events throughout the year including several family nights and programs featuring special guests to entertain our patients and residents. The patients and residents especially enjoy visits from Body & Soul: The Art of Healing. This unique group of professional performers and artists from Jacksonville promotes the arts and healing to diminish the stresses that occur in the healthcare and extended care environment experience. Monthly group and room performances held at SCLM feature instrumental, vocal and theatrical performances that enhance the quality of life for patients, residents, family, friends, and healthcare providers while expanding the arts within the Jacksonville community. SCLM also has a charitable relationship with the Sisters of St. Francis Xavier, an order of Catholic Nuns from Myanmar. The Sister's work daily at SCLM is to provide clinical care with special focus on reverence for the spirit and dignity of each resident. Their presence alone has a calming effect for residents that are often vulnerable, allowing them to build a trusting relationship with residents in various stages of health care needs. Summary SCLM furthers its charitable purposes by providing a broad array of services to meet the healthcare and residential needs of those unable to care for themselves. We provide essential services to the community and provide appropriate charity services to those residents who are not able to pay for their own needs, and present education information classes and activities to the community in order to improve the overall status of the elderly. The care of this vulnerable population is the founding mission of the Daughters of Charity. 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 St Vincent's Health System Inc 4205 Belfort Road Suite 4030 Jacksonville FL 32216 593650609 Parent Entity FL Section 501(c)(3) Schedule A, Line 11b Ascension Health 0 St Vincent's Medical Center Inc 4205 Belfort Road Suite 4030 Jacksonville FL 32216 590624449 Hospital FL Section 501(c)(3) Schedule A, Line 3 St Vincent's Health System Inc 1 St Luke's-St Vincent's Healthcare Inc 4205 Belfort Road Suite 4030 Jacksonville FL 32216 260479484 Hospital FL Section 501(c)(3) Schedule A, Line 3 St Vincent's Health System Inc 1 St Vincent's Ambulatory Care Inc 4205 Belfort Road Suite 4030 Jacksonville FL 32216 592292041 Physician Practice FL Section 501(c)(3) Schedule A, Line 9 St Vincent's Health System Inc 1 St Vincent's Foundation Inc 4205 Belfort Road Suite 4030 Jacksonville FL 32216 592219923 Fund Raising FL Section 501(c)(3) Schedule A, Line 7 St Vincent's Health System Inc 1 St Vincent's Medical Center Clay County Inc 1580 Branan Field Road Middleburg FL 32068 461523194 Hospital FL Section 501(c)(3) Schedule A, Line 3 St Vincent's Health System Inc 1 Consolidated Pharmacy Services Inc 4205 Belfort Road Suite 4030 Jacksonville FL 32216 593398033 Retail Pharmacy & Patient Transport FL N/A C 0 First Coast Primary Care 4205 Belfort Road Suite 4030 Jacksonville FL 32216 205746243 Primary Care FL N/A C 0 St Vincent's Physician Enterprise Inc 4205 Belfort Road Suite 4030 Jacksonville FL 32216 271927603 Primary Care FL N/A C 0 Family Medicine Condominium Association Inc 1 Shircliff Way Jacksonville FL 32204 261983355 Condominium Association FL N/A C 0 0 0 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 St Vincent's Foundation Inc C 102875 FMV St Vincent's Health System Inc M 321133 FMV