2014-05-14T17:32:59-05:00 2013-06-30 861065772 Deloitte Tax LLP 111 Monument Circle Suite 2000 Indianapolis IN 462045108 990 2012-07-01 352099320 StVincent Frankfort Hospital Inc STVI 7656563542 1300 South Jackson Street Frankfort IN 460410669 Thomas Crawford 7656563133 2014-05-14 1 Shawna M Jimenez P01222873 3174648600 2014-04-30 2012 2015-11-30 17:44:51Z Thomas Crawford 1300 South Jackson Street Frankfort IN 460410669 32323946 0 X www.stvincent.org X 2000 IN We are a nonprofit hospital dedicated to providing healthcare that leaves no one behind. 8 4 209 80 0 0 123106 59576 28882328 30422243 1493784 1578352 291073 263775 30790291 32323946 0 203 0 0 11521469 10581507 0 0 0 15189626 16206691 26711095 26788401 4079196 5535545 38882858 46405212 7001725 7803270 31881133 38601942 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 19854404 203 30422243 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 2013, SVFH treated 858 adults and children for a total of 3,398 inpatient days of service. The hospital also provided services for 38,240 outpatient visits, including 793 outpatient surgeries and 11,377 emergency room and minor care visits. See Schedule H for a non-exhaustive list of community benefit programs and descriptions. 3155528 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. During the fiscal year ending June 30, 2013, the unreimbursed cost of free or discounted services provided to patients who were deemed indigent under state, county, or hospital guidelines was $3,155,528, which included $1,832,575 of traditional charity care and $1,322,953 in unpaid cost of care for those qualifying for Medicaid or other public programs for the poor. See Schedule H for a non-exhaustive list of community benefit programs and descriptions. 66087 In addition to core medical services, St.Vincent Frankfort Hospital (SVFH) partners with its community to assess community assets and needs and to work together to address issues impacting health and quality of life, with special emphasis on the poor and vulnerable. In fiscal year 2013, SVFH provided $66,087 in unbilled services to the poor and to the broader community. (When combined with the costs of free or discounted services for the poor listed in Line 4b, SVFH provided a total community benefit of $3,221,615 in fiscal year 2013.) SVFH serves and supports its community by providing such programs as health fairs and screenings, smoking cessation and other health education classes, and an immunization clinic. See Schedule H for a non-exhaustive list of community benefit programs and descriptions. 23076019 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 28 0 1 209 1 0 0 0 0 0 0 0 0 0 0 X 8 4 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 IN X Jerry Marks CFO 7656563542 1300 S Jackson Street Frankfort IN 460410669 Don Rusk 0.20 0.00 X X 0 0 0 Gloria Ponton 0.20 0.00 X X 0 0 0 R Mark Ellison 0.20 40.00 X X 0 236358 58154 Joseph Dominik MD 40.00 0.00 X 0 169885 47285 Brett Eaton MD 0.20 0.00 X 0 0 0 Randy Ridgway 0.20 0.00 X 0 0 0 Ronald L Mead 0.20 40.20 X 0 380496 75922 Thomas D Crawford 40.00 0.40 X X 0 244633 73531 Jerrell K Marks 40.00 0.20 X 165335 0 29029 Kristi L Bledsoe 40.00 0.00 X 139757 0 28943 Donald H Jacoby 40.00 0.00 X 143119 0 35934 Krista K Wright 40.00 0.20 X 132410 0 36815 580621 1031372 385613 4 0 1 0 TX Team Rehab Inc 4625 East Stop 11 Ste B Indianapolis IN 46237 PT/OT services 829481 Emcare 1717 Main Street Ste 5200 Dallas TX 75201 Medical services 520044 Mid America Clinical Labs 6704 Reliable Parkway Chicago IL 60686 Lab services 484532 3 176 59400 59576 Net patient revenue 621990 15994379 15994379 Net Medicare/Medicaid 621990 14427864 14427864 30422243 1560062 1560062 152676 0 152676 152676 152676 18290 0 18290 18290 18290 Cafeteria revenue 722210 106031 106031 Pharmacy revenue 446110 5068 5068 111099 32323946 30422243 0 1842127 203 203 363063 363063 8030930 6870533 1160397 5052 4322 730 1699255 1453728 245527 483207 413388 69819 1780713 1523416 257297 26341 22535 3806 15400 13175 2225 496054 424379 71675 1614181 1380946 233235 77373 66193 11180 17483 14957 2526 498670 426617 72053 23402 23402 Purchased services 3320240 2840495 479745 Community benefit 3221615 3221615 Supplies 1643509 1406037 237472 Provider tax expense 1001274 856599 144675 2470436 2113479 356957 26788401 23076019 3712382 0 1490817 161282 1917124 2912343 381280 422974 36178 22365 9051708 6438750 2992097 2612958 32065362 40273290 38882858 46405212 3602835 3630008 3398890 4173262 7001725 7803270 X 31836885 38567700 44248 34242 31881133 38601942 38882858 46405212 X 5535545 1107165 78099 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 991 991 0 Explanation of Lobbying Activities: 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 1906409 700128 1206281 66241 31464 34777 6903226 5707158 1196068 15686 15686 2612958 Interest in investments held by Ascension Health Alliance 39724239 Other receivables and notes receivable 299977 Restricted by donor or grantor 34242 Receivables from third party payors 214832 40273290 Due to St.Vincent Hospital and Health Care Center, Inc. (EIN: 35-0869066) 1274720 Pension liability 47814 Other 115730 Payable to third party programs 2235036 Intercompany debt with Ascension Health Alliance 499962 4173262 1 1 X 1 X 1 X 1 1 1 0 1 1 1832575 1832575 0.06840 4961075 3638122 1322953 0.04940 6793650 3638122 3155528 0.11780 1159 55831 55831 0.00210 200 10256 10256 0.00040 1359 66087 66087 0.00250 1359 6859737 3638122 3221615 0.12030 3500 2488 2488 0.00010 278 7429 7429 0.00030 250 3275 3275 0.00010 4028 13192 13192 0.00050 0 106073 31822 9017909 8928623 89286 X 1 1 1 1 StVincent Frankfort Hospital Inc

1300 S Jackson Street Frankfort IN 460410669

http://www.stvincent.org/St-Vincent-Fr X X X X StVincent Frankfort Hospital Inc 1 1 X X X X X X X X X 12 1 0 1 X 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 1 X 0 0 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: 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 2013, 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. Schedule H, 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 2013 was $312,254 at charges, ($106,073 at cost). Schedule H, 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 health care 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 St.Vincent Health System's consolidated audit in which the footnote that discusses the bad debt expense is located on page 22. 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. 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. St.Vincent Frankfort Hospital, Inc. Part V, Section B, Line 21: The following steps were followed and considered reasonable efforts followed for purposes of identifying patients eligible for assistance under the facility's FAP:- Notified each individual of the Hospital's Financial Assistance Policy (FAP). This notification began on the date care was provided and ended on the 120th day after the first billing statement was provided to the individual. - Individuals were notified of the FAP as noted in Question 14. This includes, but is not limited to, the following:- Brief description of eligibility requirements and assistance provided- Direct individuals to our website and physical location of application forms- Provided instructions to obtain free copy of FAP and application by mail- Provided contact information for an individual/nonprofit organization to assist if the individual has questions- Provided statement of translations of FAP as well as plain language summaries- Provided statement that no FAP-eligible individual will be charged more for emergency/medically necessary care than AGB- For individuals who submitted an incomplete FAP, we provided that individual with information relevant to assist them with completion of the FAP. - For individuals who submitted a complete FAP, we made and documented a determination as to whether that person was eligible under the facility's FAP. - We determined eligibility based on other means such as establishing that the individual is eligible under one or more means tested programs (as noted in Question 12). St.Vincent Frankfort Hospital, Inc. Part V, Section B, Line 22: The following steps were followed and considered reasonable efforts followed for purposes of identifying patients eligible for assistance under the facility's FAP:- Notified each individual of the Hospital's Financial Assistance Policy (FAP) as noted in Question 14. This includes, but is not limited to, the following:- Brief description of eligibility requirements and assistance provided- Direct individuals to our website and physical location of application forms- Provided instructions to obtain free copy of FAP and application by mail- Provided contact information for an individual/nonprofit organization to assist if the individual has questions- Provided statement of translations of FAP as well as plain language summaries- Provided statement that no FAP-eligible individual will be charged more for emergency/medically necessary care than AGB- This notification began on the date care was provided and ended on the 120th day after the first billing statement was provided to the individual.- For individuals who submitted an incomplete FAP, we provided that individual with information relevant to assist them with completion of the FAP. - For individuals who submitted a complete FAP, we made and documented a determination as to whether that person was eligible under the facility's FAP. - We determined eligibility based on other means such as establishing that the individual is eligible under one or more means tested programs (as noted in Question 12). Part V, Section B, Line 5: St.Vincent Frankfort Hospital, Inc.: The Community Health Needs Assessment ("CHNA") of the hospital facility can be located at the following web address: http://www.stvincent.org/Frankfort/. Part V, Section B, Line 16: St.Vincent Frankfort Hospital, Inc.: The following steps were followed and considered reasonable efforts for purposes of Question 16:- Notified each individual of the facility's Financial Assistance Policy (FAP). This notification began on the date care was provided and ended on the 120th day after the first billing statement was provided to the individual. - Individuals were notified of the FAP by methods as noted in Question 14. This includes, but is not limited to, providing the following:- A brief description of eligibility requirements and assistance provided- Directions on how to access the FAP and application on our website and physical location of application forms- Instructions to obtain free copy of FAP and application by mail- Contact information for an individual/nonprofit organization to assist if the individual has questions- Statement of translations of FAP as well as plain language summaries- Statement that no FAP-eligible individual will be charged more for emergency/medically necessary care than AGB- For individuals who submitted an incomplete FAP, we provided that individual with information relevant to assist them with completion of the FAP. - For individuals who submitted a complete FAP, we made and documented a determination as to whether that person was eligible under the facility's FAP. - We determined eligibility based on other means such as establishing that the individual is eligible under one or more means tested programs (as noted in Question 12). Part V, Section B, Line 17: St.Vincent Frankfort Hospital, Inc.: The following steps were followed and considered reasonable efforts for purposes of Question 17:- Notified each individual of the Hospital's Financial Assistance Policy (FAP). This notification began on the date care was provided and ended on the 120th day after the first billing statement was provided to the individual. - Individuals were notified of the FAP as noted in Question 14. This includes, but is not limited to, the following:- Brief description of eligibility requirements and assistance provided- Direct individuals to our website and physical location of application forms- Provided instructions to obtain free copy of FAP and application by mail- Provided contact information for an individual/nonprofit organization to assist if the individual has questions- Provided statement of translations of FAP as well as plain language summaries- Provided statement that no FAP-eligible individual will be charged more for emergency/medically necessary care than AGB- For individuals who submitted an incomplete FAP, we provided that individual with information relevant to assist them with completion of the FAP. - For individuals who submitted a complete FAP, we made and documented a determination as to whether that person was eligible under the facility's FAP. - We determined eligibility based on other means such as establishing that the individual is eligible under one or more means tested programs (as noted in Question 12). Part V, Section B, Line 18: St.Vincent Frankfort Hospital, Inc.: Question 18 is more appropriately answered as not applicable as the Billing and Collections Policy of St.Vincent Frankfort Hospital, Inc. does not allow a hospital to engage in extraordinary collection actions before the organization made reasonable efforts to determine whether the individual is eligible for assistance under the financial assistance policy. Reasonable efforts taken include but are not limited to:- Notifying individuals of the financial assistance policy on admission- Notifying individuals of the financial assistance policy prior to discharge- Notifying individuals of the financial assistance policy in communications with the patients regarding the patients' bills- Documenting its determination of whether patients were eligible for financial assistance under the hospital facility's financial assistance policy 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 33,104, whose rapidly growing Hispanic population comprises almost 14% of the area population, over twice the state average. Per capita personal income is below state average while median household income is above state average. Manufacturing is the county's leading industry, accounting for 34.7% 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. Reports Filed With States Part VI, Line 7 IN Community Benefit Report Form 990, Part III, Line 4a, 4b and 4c: St.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, 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) 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 results of the CHNA completed in fiscal year 2013, the hospital developed a 2014-2016 Implementation Strategy to address priority 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 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 2013, the Health Access Worker opened 640 pathways and completed 419 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. St.Vincent Frankfort Hospital partners with the Open Door Clinic who provides a medication assistant to help patients by accessing the database. In 2013, the medication assistant helped patients obtain a total of 2,060 medications, for which the average wholesale price totaled $765,517. 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 2013, the following health education was provided: CPR, breastfeeding, diabetes care and smoking cessation. Approximately 593 people received health education in fiscal year 2013. Get Fit Clinton County During fiscal year 2013, the Healthy Communities of Clinton County Coalition, of which St.Vincent Frankfort Hospital is a primary partner, updated the 2010 Clinton County Walkways Brochure from 11 walkways to 20 walkways, including a walkway in every town in Clinton County. With the help of a monetary donation and time from the Rotary of Clinton County, 11 of the walkways now have a trail head to mark the starting point. 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 2013, 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 100 flu shots and 3,787 immunizations, free of charge, to the elderly, college students, and children during fiscal year 2013.Kindergarten ToursA hospital visit can be especially traumatic for a child who has no previous experience with the hospital. At St.Vincent Frankfort Hospital, educational tours are given to kindergarteners each year to help children develop healthy attitudes about health care. The tour offers children an up-close and personal look at lab, radiology, emergency department, and dietary. In the laboratory, the children get to see cultures under a microscope. The tour ensures that children will feel more at ease in the hospital environment, whether as a visitor or a patient, and avoid the anxiety and fear that can interfere with healing and recovery. Tobacco Prevention and CessationThe Healthy Communities of Clinton County Coalition recognizes tobacco use as one of the leading cause 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 2013, 75 people participated in these classes.Open Door ClinicSt.Vincent Frankfort Hospital partners with the Open Door Clinic. The Open Door Clinic is a volunteer-based, community-sponsored clinic that provides free medical services for uninsured and underinsured, low-income residents of Clinton County. St.Vincent Frankfort Hospital provides all of the lab services for the patients at Open Door Clinic for free. Community Benefit Cash and In-Kind Contributions In 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 and 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. Local HeroesSt.Vincent Frankfort Hospital is a partner in the Local Heroes program sponsored by Coach Kids of Clinton County, an organization dedicated to enriching the lives of families through mentoring relationships supported by educational and faith-based services. Local Heroes is a school-based mentoring program that matches elementary-aged children with an adult mentor/coach who commits to meeting with the child one hour per week at their school. St.Vincent Frankfort Hospital invests in the future of Clinton County by providing trained mentors for the program. 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. Paul Phillippe Resource CenterThe Paul Phillippe Resource Center provides counseling, advocacy, information and referral, social activities, recreation, and transportation to the elderly. The center also provides meals and home delivered meals for the aging population in Clinton County. The senior population in Clinton County is growing and wants to be self reliant. St.Vincent Frankfort Hospital and the Paul Phillippe Resource Center serve to cultivate a new and positive image of the aging process through education and health awareness. Community Building Cash and In-Kind ContributionsThe hospital makes cash and in-kind donations to a variety of community organizations focused on building 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 infrastructure for the community. X 1 1 X X X X 0 0 0 0 0 0 0 0 0 R Mark Ellison 0 192914 0 34251 0 9193 0 40455 0 17699 0 294512 0 0 Joseph Dominik MD 0 122272 0 47011 0 602 0 35963 0 11322 0 217170 0 0 Ronald L Mead 0 259003 0 85197 0 36296 0 59414 0 16508 0 456418 0 0 Thomas D Crawford 0 176401 0 61992 0 6240 0 54858 0 18673 0 318164 0 0 Jerrell K Marks 124980 0 26708 0 13647 0 19480 0 9549 0 194364 0 0 0 Kristi L Bledsoe 114911 0 24694 0 152 0 18636 0 10307 0 168700 0 0 0 Donald H Jacoby 135020 0 2960 0 5139 0 33573 0 2361 0 179053 0 0 0 Krista K Wright 100439 0 22224 0 9747 0 19303 0 17512 0 169225 0 0 0 Part I, Line 1a St.Vincent Frankfort Hospital paid for cell phone usage for four of the officers and highest compensated employees listed in Part VII. St.Vincent Frankfort Hospital will only reimburse a business expense when all three (3) of the following IRS requirements are met: 1. The expense must have a business connection (i.e., the expenses must be incurred while performing services on behalf of a SVH Entity); 2. The expense must be adequately substantiated by the Associate within a reasonable period of time; and 3. The Associate must return any excess reimbursement or allowance within a reasonable period of time. St.Vincent Frankfort Hospital "grossed up" the above applicable non-business expenses and included in the employees' W-2 as additional taxable compensation. 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 meeting will decide if conflicts of interest exist. Each director, principal officer and member of a committee with governing board delegated powers annually signs a statement which affirms such person has received a copy of the conflicts of interest policy, has read and understands the policy, has agreed to comply with the policy, and understands that the organization is charitable and in order to maintain its federal tax exemption it must engage primarily in activities which accomplish its tax exempt purpose. Form 990, Part VI, Section B, line 15 Compensation determinations of St.Vincent Frankfort Hospital's CEO, executive director, or top management officials are made by a compensation committee of St.Vincent Frankfort Hospital, Inc. and/or St.Vincent Health, Inc. In determining compensation of the organization's CEO, executive director, or top management officials, the process included a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision. The board, in executive session, reviewed and approved the compensation. 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. During the review and approval of the compensation, documentation of the decision was recorded in the board minutes. Individuals were not present when their compensation was decided. Compensation determinations of St.Vincent Frankfort Hospital's other officers or key employees are made by a compensation committee of St.Vincent Frankfort Hospital, Inc. and/or St.Vincent Health, Inc. 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. The board, in executive session, reviewed and approved the compensation. 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. 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: FAS 158 pension liability 78,099. Tax Exempt Bond Issuance Part IV, Line 24A: 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 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 Jubilee Partnerships Inc 2301 N Park Avenue Indianapolis IN 46205 352060765 Outreach activities IN 501(C)(3) 1 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 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 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 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 Fishers Hospital Inc 13861 Olio Road Fishers IN 46037 454243702 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 8425 Harcourt Road Indianapolis IN 46260 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 Pediatric Rehab Center Inc 1707 W 86th Street Indianapolis IN 46260 352048898 Specialty hospital IN 501(C)(3) 3 StVincent Hospital & Health Care Center 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 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