2014-05-14T09:42:07-05:00 2013-06-30 861065772 Deloitte Tax LLP 250 East Fifth Street Suite 1900 Cincinnati OH 45202 990 2012-07-01 431284526 St Mary's Medical Center STMA 8162285900 210 West RD Mize Road Blue Springs MO 64014 Steve Cleary 8166424400 2014-05-13 1 Rebecca Lyons P01487105 5137847100 2012 2015-11-30 17:44:51Z Steve Cleary 1000 Carondelet Dr Kansas City MO 64114 78260009 0 0928 X www.carondelethealth.org X 1983 MO 146-bed medical center offering a full array or acute care, outpatient and extended care services. 3 0 695 155 -351 -7705 83810 70425 87963860 75271542 607931 1141325 1226867 1000656 89882468 77483948 0 0 0 0 31567756 31859528 0 0 0 55327519 44716491 86895275 76576019 2987193 907929 71072573 69802289 29291604 28831878 41780969 40970411 X St. Mary's Medical Center (SMMC) is a Catholic organization dedicated to the healing ministry of Jesus Christ. Our commitment to human dignity compels us to provide compassionate, quality health care for the body, mind and spirit, with special concern for the poor. We are responsible stewards serving the needs of all people from conception to death. At St. Mary's Medical Center we are committed to providing our patients with the best care possible, in a safe & compassionate environment. 0 0 13895491 12870466 Medical inpatient services encompass 2,104 patient admissions and 8,480 patient days. St. Mary's Medical Center provides diagnostic services and high quality care to patients admitted with a wide range of diagnosis. Services includes radiology disciplines such as MRI, CT-Scans, and Ultrasound as well as laboratory tests, respiratory procedures, therapy treatments, pharmacy services and bedside nursing care. 19552891 17912137 Surgical services include 1,013 inpatient admissions, 4,860 patient days and 673 outpatient surgeries. St. Mary's Medical Center offers a wide range of both invasive and non-invasive surgical procedures and is equipped with the latest diagnostic and surgical equipment operated by our highly qualified nursing staff and physicians. Our Medical Center embraces major disciplines of care ranging from minimally invasive procedures to complex multi-disciplinary surgical interventions. We offer a wide range of outpatient and inpatient surgical interventions including vascular surgery, surgical management of breast disease, surgical oncology, orthopedic surgery, gynecological surgery, and ENT procedures. 7860225 8887314 Emergency services include 23,072 patient visits in the 24-hour emergency department. These patients are diagnosed, treated and discharged by our highly qualified clinicians and emergency physicians. 18616510 0 35601625 All other program services include: Cardiology, Orthopedics, Neurology, Oncology, Rehab Services, Women's Services, Radiology, Sleep Lab, Pain Center, Wound Care and other outpatient areas. These services represent 2,207 inpatient admissions with 7,470 patient days and 29,242 outpatient visits. 18616510 35601625 59925117 1 0 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 1 1 0 1 40 0 1 695 1 1 1 0 0 0 0 0 0 0 0 0 X 3 0 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X Steve Cleary 8169424400 1000 Carondelet Drive Kansas City MO 64114 Fleury Yelvington 2.00 46.00 X X 0 1385193 54882 Steve Cleary 2.00 46.00 X X 0 331260 56260 Annette Small 2.00 44.00 X X 0 215190 38526 Noel Graham MD 2.00 0.00 X 0 0 0 Daniel Dunker MD 2.00 0.00 X 0 0 0 Vicki Elmore 2.00 2.00 X 0 0 0 Edwin Hodges 40.00 0.00 X 141349 0 14211 Christopher Hughes 40.00 0.00 X 130603 0 32116 Carol Bailey 40.00 0.00 X 142189 0 33345 William Maxon 40.00 0.00 X 123632 0 29859 Thomas Mammen 40.00 0.00 X 140273 0 60643 678046 1931643 319842 8 0 1 0 Physicians Reference Lab LLC PO Box 802262 Kansas City MO 64180 Lab Services 2056982 Anesthesia Svcs of Blue Springs 1209-B NW N Ridge Dr Blue Springs MO 64015 Physician Services 1202287 TriMedx LLC 6325 Digital Way Suite 400 Indianapolis IN 46278 Bio-Med Services 987436 Children's Mercy Hospital 2401 Gillham Road Kansas City MO 64108 Physician Services 871699 Aramark PO Box 651009 Charlotte NC 28265 Food Services 732150 16 70425 70425 Medicare/Medicaid 621990 40788726 40788726 Patient Revenue 621990 34265860 34265860 St. Mary's Manor 621990 216956 216956 75271542 1110725 1110725 770714 711084 59630 59630 59630 30600 0 30600 30600 30600 129735 64977 64758 64758 Income from Subsidiary 621990 646710 646710 Unassigned Misc. Rev. 621990 128057 128057 Dietary Instruction 621990 73396 73396 28105 -351 28456 876268 77483948 75271542 -351 2142332 X 8000 8000 26499282 24177913 2321369 478303 436403 41900 2954377 2695570 258807 1919566 1749334 170232 9968 9968 7881099 7789339 91760 33725 33725 12272587 11961408 311179 12230 12230 2133240 1462037 671203 32993 30203 2790 100532 95921 4611 531055 531055 2498678 2231330 267348 204350 204350 Corporate Allocation 11546872 200771 11346101 MO State Assess Fee 5367054 5367054 Purchased Services 1777769 649987 1127782 Minor Equipment 198523 192901 5622 115816 115816 76576019 59925117 16650902 0 631018 405710 1769657 10354743 8822394 1129149 1312111 393813 380844 56067078 19771588 38429638 36295490 18364555 22585740 71072573 69802289 11802453 13084044 17489151 15747834 29291604 28831878 X 41780969 40970411 41780969 40970411 71072573 69802289 X 907929 -1718487 X 0 1 X 1 0 X 0 0 0 0 0 0 0 0 1 9968 9968 0 Explanation of Lobbying Activities: Part II-B, Line 1: Lobbying expenses represent the portions of dues paid to national and state hospitlal associations that are specifically allocable to lobbying. St. Mary's Medical Center does not participate in or intervene in (including the publishing or distributing of statements) any political campaign on behalf of (or in opposition to) any candidate for public office. 4400000 4400000 34865758 10787116 24078642 15975468 8256554 7718914 825852 727918 97934 36295490 Interest in Investments held by Ascension Health Alliance 18815344 Miscellaneous Long-Term Assets 3198171 Under Bond Indenture 439340 Estimated Third Party 108584 Other Receivables 24301 22585740 Intercompany Debt with Ascension Health Alliance 13173704 Other Long-Term Debt 2008710 Self Insurance Liability 565420 15747834 1 1 1 X 1 X 1 1 1 0 1 1 2170109 2170109 0.02830 11305248 8820674 2484574 0.03240 13475357 8820674 4654683 0.06070 34 2040 173849 22531 151318 0.00200 1 1363724 683124 680600 0.00890 3 886 3296972 2521763 775209 0.01010 9 138509 138509 0.00180 47 2926 4973054 3227418 1745636 0.02280 47 2926 18448411 12048092 6400319 0.08350 136 136 0.00000 2312 2312 0.00000 2448 2448 0 10914215 0 31968052 36851479 -4883427 X 1 1 1 1 St Mary's Medical Center

201 West RD Mize Rd Blue Springs MO 64014

www.carondelethealth.org X X X X St Mary's Medical Center 1 1 X X X X X X X X X 12 1 0 1 X X X X X 0 0 1 1 200.000000000000 1 300.000000000000 1 X X X X 1 1 X X X 1 0 1 X 0 0 Part I, Line 6a: The annual community benefit report is completed for Carondelet Health, the parent organization for St. Mary's Medical Center. 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 the Catholic Health Association ("CHA") guidelines. The organization uses a costing 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 were calculated and applied. Part I, Line 7g: St. Mary's Medical Center provides several clinical services that result in a financial loss. These services include Nursery Intensive Care Unit (NICU), Cardiac Rehab and the Obstetric/Newborn program. These services are hospital programs and do not include physician clinic services. Part II: Carondelet Health provided the following community building activities in Fiscal year 2012:- Support Groups at both St. Joseph & St. Mary's Medical Centers offer information and comfort in a supportive environment to people in the community. These include support for bereavement, Alzheimer's, stroke, breast cancer, cardiac rehab and diabetes. - Activities also included participation in community organizations such as local Chamber of Commerce to address health/safety issues. Part III, Line 4: From the consolidated audited financial statements of Ascension Health Alliance (which includes the activity of St. Mary's Medical Center):The provision for doubtful accounts is based upon management's assessment of expected net collections considering economic conditions, historical experience, trends in healthcare coverage, and other collection indicators. Periodically throughout the year, management assesses the adequacy of the allowance for doubtful accounts based upon historical write-off experience by payor category, including those amounts not covered by insurance. The results of this review are then used to make any modifications to the provision for doubtful accounts to establish an appropriate allowance for doubtful accounts. After satisfaction of amounts due from insurance and reasonable efforts to collect from the patient have been exhausted, the System follows established guidelines for placing certain past-due patient balances with collection agencies, subject to the terms of certain restrictions on collection efforts as determined by the System. Accounts receivable are written off after collection efforts have been followed in accordance with the System's policies. Part III, Line 8: Ascension Health and 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. Mary's Medical Center Part V, Section B, Line 3: Interviews with key stakeholders within Jackson County, MO were conducted between January and February 2013. Attachment A of CHNA lists the names, titles and organizations of those participating in the 30-minute interviews. In total, 50 interviews were completed. Physicians from the St. Mary's Medical Executive Committee and members of the St. Mary's Patient Advisory Committee also participated in this research by providing feedback on the consumer health needs in Jackson County.The individuals who participated in the community stakeholders' interviews represent the broad interests of the community served by St. Mary's Medical Center and included members of organizations serving low-income, minority populations and populations with chronic disease needs. Representatives from the three public health departments serving Jackson County, MO were also included in this research. These community leaders assisted our hospital in ranking the health needs that were determined to be a priority in the community. For a full list of organizations represented by the community stakeholders, reference Appendix A of CHNA. For a copy of the key stakeholder interview guide, including a ranking worksheet of top priorities in Jackson County, MO, reference Appendix B of CHNA. St. Mary's Medical Center Part V, Section B, Line 7: Needs Not Being Addressed as a Priority:- Access to Healthcare: This need will not be addressed as a priority. Our mission is to improve the health and lives of our patients and community. We take great pride in putting our patients first and that is the reason we have our charity and financial assistance programs available to offer assistance. St. Mary's also works with the Shared Free Clinic and several Stand Up! Blue Springs projects that provide dental care for children. However, due to resource restraints there are other organizations, some non-hospital settings, more equipped to deal with this issue. There are various community organizations and program addressing this need. - Addiction/Substance Abuse: This need will not be addressed as a priority. St. Mary's does not have a behavioral health program but collaborates with many organizations that focus on addiction and/or substance abuse to ensure our patients have continuity of care in the appropriate setting. This need is being addressed by a variety of organizations in Jackson County and throughout the Kansas City area. - Infectious Diseases: This need will not be addressed as a priority. Jackson County Health Department manages this issue.- Maternal, Infant and Child Health: This is a need we were addressing until the close of our Birthing Center in July of 2013. This is not a need we will be addressing going forward. Pregnant women in Jackson County are significantly more likely to receive no or inadequate prenatal care when compared to the statewide average; the percentage of low birth weight infants and infant mortality rates in Jackson county are also significantly higher. Teenage pregnancy is still very taboo and an issue in the community.St. Mary's Medical Center was awarded The Mader Family Foundation grant and created the St. Mary's Healthy Beginnings Program to address these issues. The St. Mary's Medical Center Foundation, with the support of local community agencies, made it possible to offer a unique prenatal program free of charge. Healthy Beginnings was for young mothers who were socially at risk. That included those who were on Medicaid, teens and those dealing with other social situations that could benefit from additional support. Members of this group received three to five individual visits with an RN for one-on-one education. Participants also receive a free car seat, childbirth classes, a breast pump, a breast-feeding class, prenatal education, referral to community resources (WIC, Healthy Families and Hope House), infant and maternity clothing, and much more. With the close of the Birthing Center, it was very important to keep the intent of the grant intact. The remaining $16,000 was given to Children's Mercy East, the Boy Scouts (obesity program) and the Rainbow Center to support children in Eastern Jackson County.- Mental Health and Mental Disorders: This need will not be addressed as a priority. St. Mary's does not have a behavioral health program and lacks the resources needed to combat this monumental problem. We do, however, collaborate with many organizations that focus on mental health to ensure our patients have continuity of care in the appropriate setting. This need is being addressed by a variety of organizations in Jackson County and throughout the Kansas City area.- Violence Prevention: This need will not be addressed as a priority. St. Mary's has an ongoing relationship with Hope House and helps promote awareness among our patients and employees to ensure they are receiving the care and support they need. However, there are other organizations in the community better served to address this need. St. Mary's Medical Center Part V, Section B, Line 20d: For cases that apply for our charity care program, upon receipt of a completed application, collection activity will cease until a determination has been made. For presumptive charity cases (cases where an application is not necessarily completed), collection activity may continue while the due diligence is being completed or until the patient's account is reviewed. Additionally, for all patients identified as full charity care patients, Carondelet Health:- Will not place a lien on a charity care patient's primary residence or include the primary residence in the asset calculation unless the value of the property clearly indicates an ability to assume the financial obligation and subject to senior management approval.- Will not execute a lien or force the sale or foreclosure of a charity care patient's primary residence/property to pay for an outstanding medical bill.- Will not use forced court appearance to require the charity care patient or responsible party to appear in court.- Will not garnish wages.Hospital charity policy has a yearly maximum to be charged for medical care for catastrophic medical cases where patient/guarantor medical bills exceed 20% of their gross income plus assets for the year.Uninsured Patient Discount Eligibility Criteria: An uninsured patient who does not qualify as financially or medically indigent shall receive a discount. Effective 7/1/10, the uninsured discount will be 30%.Prompt Pay: Prompt payment discounts are extended to all self-pay balances in return for immediate payment of patient/guarantor's. The prompt pay discount provides patients with balances due an alternative method of payment, as well as expedites the resolution of self-pay receivables. A prompt pay discount of 10% of charges is applicable for patients who meet the terms as stated in Carondelet Health Business Office Discretionary Discount Policy. Part VI, Line 2: The health care needs of our community are assessed every year by the Mid-America Regional Council. The assessment is based on data collected through surveys of safety net clinics and information provided by the Missouri and Kansas Hospital Associations and public health records. A committee comprised of representatives from many areas of the Medical Center was created to develop recommendations to improve access to health care in the community. Last fall, Carondelet Health implemented a new process that will comply with the Patient Protection and Affordable Care Act of 2010 requirement for a community health needs assessment including both qualitative and quantitative research. Part VI, Line 3: For uninsured patients, at time of service, we interview the patient looking for "found" insurance (Medicaid, Cobra, automobile insurance or local government programs). If no insurance coverage is discovered, we discuss payment arrangements and the hospital's financial assistance/charity programs. After time of service, when patients contact the business office regarding their patient care liability and the patients indicate a financial hardship in making payment, we discuss payment arrangements and the hospital's financial assistance/charity program. Part VI, Line 4: Carondelet Health is comprised of two acute care hospitals, St. Joseph Medical Center and St. Mary's Medical Center, along with Carondelet Home Care Services, a home health agency. Carondelet Health primarily serves the southern and eastern areas of metropolitan Kansas City, which comprise approximately two-thirds of the entire Kansas City population or 2.3 million people. 13.8 percent of households live at or below federal poverty guidelines, and uninsured and underinsured persons represent 25 percent of the population. 42.4 percent of the population are minority and 7 percent speak a language other than English, predominantly Spanish. Part VI, Line 5: Carondelet Health's board is comprised of individuals from throughout the community. Medical staff privileges are extended to all physicians who apply and meet qualifications.Carondelet Health provides a wide variety of resources to help improve the health of the community. Our Web site provides a free comprehensive health library with information on general wellness and specific health conditions, along with additional direct links to other health care support organizations. Meeting space is offered on the campuses of St. Joseph and St. Mary's Medical Centers for use by community groups. A wide range of support groups provide counseling for patients and their families coping with health concerns. In addition, Carondelet Health's community outreach efforts provide health and wellness resources that otherwise may be unavailable to many community members, including free health screenings and health educational materials. Part VI, Line 6: Carondelet Health is a member of Ascension Health.Ascension Health Alliance is a Missouri nonprofit corporation formed on September 13, 2011. Ascension Health Alliance is the sole corporate member and parent organization of Ascension Health, a Catholic national health system consisting primarily of nonprofit corporations that own and operate local healthcare facilities, or Health Ministries, located in 23 of the United States and the District of Columbia.Sponsorship:Ascension Health Alliance is sponsored by Ascension Health Ministries, a Public Juridic Person. The Participating Entities of Ascension Health Ministries are the Daughters of Charity of St. Vincent de Paul in the United States, St. Louise Province; the Congregation of St. Joseph; the Congregation of the Sisters of St. Joseph of Carondelet; the Congregation of Alexian Brothers of the Immaculate Conception Province, Inc. American Province; and the Sisters of the Sorrowful Mother of the Third Order of St. Francis of Assisi US/Caribbean Province. As more fully described in the Organizational Changes note, Marian Health System, which was previously sponsored by the Sisters of the Sorrowful Mother of the Third Order of St. Francis of Assisi US/Caribbean Province, became part of Ascension Health on April 1, 2013. In addition, Alexian Brothers Health System, which was previously sponsored by the Congregation of Alexian Brothers of the Immaculate Conception Province, Inc. American Province, became part of Ascension Health on January 1, 2012.Mission:The System directs its governance and management activities toward strong, vibrant, Catholic Health Ministries united in service and healing, and dedicates its resources to spiritually centered care which sustains and improves the health of the individuals and communities it serves. In accordance with the System's mission of service to those persons living in poverty and other vulnerable persons, each Health Ministry accepts patients regardless of their ability to pay. The System uses four categories to identify the resources utilized for the care of persons living in poverty and community benefit programs:- Traditional charity care includes the cost of services provided to persons who cannot afford health care because of inadequate resources and/or who are uninsured or underinsured.- Unpaid cost of public programs, excluding Medicare, represents the unpaid cost of services provided to persons covered by public programs for the persons living in poverty and other vulnerable persons.- Cost of other programs for persons living in poverty and other vulnerable persons includes unreimbursed costs of programs intentionally designed to serve the persons living in poverty and other vulnerable persons of the community, including substance abusers, the homeless, victims of child abuse, and persons with acquired immune deficiency syndrome.- Community benefit consists of the unreimbursed costs of community benefit programs and services for the general community, not solely for the poor, including health promotion and education, health clinics and screenings, and medical research.Discounts are provided to all uninsured patients, including those with the means to pay. Discounts provided to those patients who did not qualify for assistance under charity care guidelines are not included in the cost of providing care of persons living in poverty and community benefit programs. The cost of providing care to persons living in poverty and community benefit programs is estimated by reducing charges forgone by a factor derived from the ratio of each entity's total operating expenses to the entity's billed charges for patient care.Community Benefit ReportCarondelet HealthFor the year ended June 30, 2013Ever since the Sisters of St. Joseph of Carondelet began treating patients in a three-story house in downtown Kansas City, the emphasis has been compassion--compassionate care that encompasses the body, mind and spirit, with a special concern for the poor.It comes in the form of a smile and gentle touch behind the technology that reaches the lives of so many patients who grace our doors. It comes also in the form of financial assistance to uninsured patients at both St. Joseph and St. Mary's Medical Centers, regardless of their employment or credit history. Whether our patients need help applying for Medicaid assistance or just more time to settle their bills with an interest-free, extended-term payment plan, Carondelet Health will be that helping hand.Our mission inspires us to be a united community where we exceed the expectations of every individual with every interaction through unwavering advocacy. Educating the public about the challenges of those lacking health insurance include joining other organizations in Cover the Uninsured Week, along with outreach resource guides in English and Spanish.Our MissionCarondelet Health consists of Catholic organizations dedicated to the healing ministry of Jesus Christ. Our commitment to human dignity compels us to provide compassionate, quality healthcare for body, mind and spirit, with a special concern for the poor. We are responsible stewards serving the needs of all people from conception to death.We are united in this mission. Upholding the commitment of our founding Sisters of St. Joseph of Carondelet and the Sisters of St. Mary, we turn away no one in need. Compassionate, quality care remains the standard at all our facilities.Caring for Our CommunityCompassion goes beyond those financially challenged. It encompasses those who are vulnerable due to age and circumstance. Carondelet Health's facilities actively commit its resources to the communities they serve, through a wide variety of programs and services for the physical, mental, social and spiritual care of area residents:Healthy BeginningsThe St. Joseph and St. Mary's Medical Center Foundations, with the support of local community agencies, make it possible to offer a unique prenatal program free of charge for patients who are on Medicaid, teens, or for others socially at risk, that could benefit from additional support. Members of this group receive three to five individual visits with a RN for one-on-one education. Participants also receive a free car seat, childbirth and breastfeeding classes, a breast pump and much more.HealthWise SeniorsAt St. Joseph Medical Center, we recognize the special health needs of our seniors. We are committed to help the aging population in our community remain as active and independent as long as possible through a variety of programs.St. Joseph's Seniors Clinic addresses health needs of homebound seniors and residents of long-term care and assisted living facilities. The clinic provides a comfortable, convenient and ost-effective setting where seniors' needs can be assessed, diagnosed and treated by physicians. The clinic also provides free transportation for many patients. Seniors can now also take health assessments online and receive information on coping with:- Sleep disorders - Emotional health - Cognitive health- Nutritional health - Urinary incontinence - Skin issues- Fall risk.Free Wellness Services. Carondelet Health provides wellness services to nine churches in our service area and to designated low-income patients.Support Groups. Both medical centers offer groups for Alzheimer's, battered women, bereavement, breast cancer survivors, breastfeeding, diabetes, infant loss, Lyme disease, stroke and other areas of need.Classroom Space. Space is provided for alternative high school classes offered by the Kansas City School District. Other not-for-profit agencies are invited to host meetings and seminars in the medical centers for a nominal fee.Involvement with Community Events. In addition to free blood pressure, blood sugar and prostate cancer screenings, St. Joseph and St. Mary's participate in numerous health fairs, including the annual Fall Family Health Celebration at St. Joseph and the annual community event at St. Mary's which kicks off Eastern Jackson County Family Week activities. Together the medical centers sponsor a domestic violence rally to raise awareness and support area victims. St. Joseph also coordinates a free informational seminar with the American Diabetes Association.Contributions to Community Groups. Carondelet Health contributes to many worthwhile organizations, including Cristo Rey High School, the American Cancer Society, the American Heart Association and Catholic Charities of Kansas City. It supports the Seton Center Family and Health Services by providing human resources, maintenance and wellness services; and funds after school programs for at-risk children at YMCAs in Kansas City and Blue Springs.CarondeletHealth.org offers the latest in health information and direct links to more than 50 health-related organizations and support groups, including Reports Filed With States Part VI, Line 7 MO 0 1 0 0 0 0 0 0 0 Fleury Yelvington 0 500922 0 768420 0 115851 0 41549 0 13333 0 1440075 0 0 Steve Cleary 0 263746 0 31651 0 35863 0 43822 0 12438 0 387520 0 0 Annette Small 0 170075 0 21943 0 23172 0 15206 0 23320 0 253716 0 0 Edwin Hodges 140092 0 0 0 1257 0 1131 0 13080 0 155560 0 0 0 Christopher Hughes 123192 0 1184 0 6227 0 12782 0 19334 0 162719 0 0 0 Carol Bailey 141579 0 0 0 610 0 24337 0 9008 0 175534 0 0 0 William Maxon 117774 0 0 0 5858 0 11398 0 18461 0 153491 0 0 0 Thomas Mammen 128672 0 0 0 11601 0 55165 0 5478 0 200916 0 0 0 Part I, Line 3 Carondelet Health, a related organization of St. Mary's Medical Center, uses the following to establish the compensation of the organization's CEO (Annette Small): - Compensation Committee - Independent Compensation Consultant - Form 990 of Other Organizations - Written Employment Contract - Compensation Survey or Study - Approval by the Board or Compensation Committee. 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 executive is reported as compensation on Form 990, Schedule J, Part II, Column B in the year paid. A related organization that paid the salaries of the individuals listed in Schedule J, Part II, contributed to the supplemental nonqualified retirement plan in the amount as noted: - Steve Cleary - $31,651 - Fleury Yelvington - $76,825 - Annette Small - $21,944 Form 990, Part VI, Section A, line 2 Many of the persons listed on Part VII have a "business relationship" with each other by virtue of sitting on related Carondelet Health entity boards. Form 990, Part VI, Section A, line 6 St. Mary's Medical Center has a single corporate member, Carondelet Health. Form 990, Part VI, Section A, line 7a St. Mary's Medical Center has a single corporate member, Carondelet Health, who has the ability to elect members to the governing body of the St. Mary's Medical Center. Form 990, Part VI, Section A, line 7b All decisions that have a material impact to St. Mary's Medical Center financial information or corporation as a whole are subject to approval by its sole corporate member, Carondelet Health. 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. Prior to filing the return, all Board Members are provided the Form 990 and management team members are available to answer any Board Members questions. Form 990, Part VI, Section B, line 12c The organization regularly and consistently monitors and enforces compliance with the conflict of interest policy in that any director, principal officer, or member of a committee with governing board delegated powers, who has a direct or indirect financial interest, must disclose the existence of the financial interest and be given the opportunity to disclose all material facts to the directors and members of the committees with governing board delegated powers considering the proposed transaction or arrangement. The remaining individuals on the governing board or committee 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 conflict of interest policy, has read and understands the policy, has agreed to comply with the policy, and understands that the organization is charitable and in order to maintain its federal tax exemption it must engage primarily in activities which accomplish its tax-exempt purpose. Form 990, Part VI, Section B, line 15 In determining compensation of the organization's CEO (Annette Small), the process performed by Carondelet Health (a related organization) included a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision. The Audit Committee reviewed and approved the compensation. In the review of the compensation, the CEO was compared to individuals at other organizations in the area who hold the same title. During the review and approval of the compensation, documentation of the decision was recorded in the board minutes. Individual was not present when her compensation was decided. In determining compensation of other officers of the organization, the process included a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision. The Audit Committee reviewed and approved the compensation. In the review of the compensation, the other officers of the organization were compared to individuals at other organizations employees 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. Other Fees Form 990, Part IX, line 11g Medical Services: Program service expenses 3,231,800. Management and general expenses 0. Fundraising expenses 0. Total expenses 3,231,800. Purchased Medical Services: Program service expenses 2,409,799. Management and general expenses 0. Fundraising expenses 0. Total expenses 2,409,799. All other expenses: Program service expenses 2,147,740. Management and general expenses 91,760. Fundraising expenses 0. Total expenses 2,239,500. Changes in Net Assets or Fund Balances: Form 990, Part XI, line 9: Transfers to Affiliates -1,971,222. Transfers to Sponsors -150,000. Restricted Contributions Used for Property 397,811. Medical Staff Adjustment 4,924. 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 Carondelet Health 1000 Carondelet Drive Kansas City MO 641144673 431276738 System Parent MO Section 501(c)(3) Schedule A, Line 11c Ascension Health 0 Carondelet Health Corp & Affil Emp Health & Dental Care 1000 Carondelet Drive Kansas City MO 641144673 431116849 VEBA MO Section 501(c)(9) N/A Carondelet Health 1 Carondelet Home Care Services Inc 11050 Roe Suite 120 Overland Park MO 66211 431379352 Home Health Care Services MO Section 501(c)(3) Schedule A, Line 3 Carondelet Health 1 Carondelet Cardiology Services Inc 1000 Carondelet Drive Kansas City MO 641144673 271322670 Health Care MO Section 501(c)(3) Schedule A, Line 9 Carondelet Health 1 St Joseph Medical Center 1000 Carondelet Drive Kansas City MO 641144673 440546292 Health Care MO Section 501(c)(3) Schedule A, Line 3 Carondelet Health 1 St Mary's Medical Center Foundation 1000 Carondelet Drive Kansas City MO 641144673 431918107 Fundraising MO Section 501(c)(3) Schedule A, Line 11c Carondelet Health 1 St Joseph Medical Center Foundation 1000 Carondelet Drive Kansas City MO 641144673 431388461 Fundraising MO Section 501(c)(3) Schedule A, Line 11c Carondelet Health 1 South Kansas City Surgical Center LLC 10730 Nall Suite 100 Overland Park KS 66211 202181884 Health Care KS N/A Indian Creek Center Inc 1000 Carondelet Drive Kansas City MO 641144673 480956627 Management MO N/A C 0 Carondelet Management Company Inc 11050 Roe Suite 110 Overland Park KS 66211 431352545 Health Management KS N/A C 0 Carondelet Pharmacy 1000 Carondelet Drive Kansas City MO 641144673 431699329 Pharmacy MO N/A C 0 Carondelet Primary Care Network Inc 1000 Carondelet Drive Kansas City MO 641144673 431596702 Health Care MO N/A C 0 Saint Joseph Ambulatory Surgical Center LLC 1000 Carondelet Drive Kansas City MO 641144673 251905706 Health Care MO N/A C 0 Caronelet Occupational Health Wellness & Edu Serv Inc 1000 Carondelet Drive Kansas City MO 641144673 861144194 Health Care MO N/A C 0 Carondelet Physician Services 1000 Carondelet Drive Kansas City MO 64114 562661263 Health Care MO N/A C 0 Carondelet Medical Enterprises 1000 Carondelet Drive Kansas City MO 641144673 562661165 Office Admin. Services MO N/A C 0 0 0 1 0 0 0 0 0 0 1 0 0 0 0 1 0 1 1 0 Carondelet Health Corp & Affil Emp Health & Dental Care R 3544841 Journal Entry St Joseph Medical Center Q 16159351 Journal Entry Carondelet Health Q 7724865 Journal Entry Carondelet Cardiology Services Inc J 74410 Journal Entry Carondelet Health R 870000 Journal Entry Carondelet Health O 5288396 Journal Entry St Mary's Medical Center Foundation C 398351 Journal Entry