2014-05-14T14:32:01-05:00 2013-06-30 861065772 DELOITTE TAX LLP 111 MONUMENT CIRCLE SUITE 2000 INDIANAPOLIS IN 462045108 990 2012-07-01 273474697 ST MARY'S OHIO VALLEY HEARTCARE LLC STMA 8124854178 3700 WASHINGTON AVENUE EVANSVILLE IN 47750 JOHN L ZABROWSKI 8124854178 2014-05-14 1 SHAWNA M JIMENEZ P01222873 3174648600 2014-05-12 2012 2015-11-30 17:44:51Z KEITH JEWELL 3700 WASHINGTON AVENUE EVANSVILLE IN 47750 11670237 0 X WWW.STMARYS.ORG X LLC 2011 IN ST. MARY'S OHIO VALLEY HEARTCARE, LLC IS DEDICATED TO PROVIDING CARDIAC PATIENTS AND THEIR FAMILIES WITH EXCELLENCE IN THE PREVENTION, TREATMENT, AND DIAGNOSIS OF HEART DISEASE. 12 0 90 0 0 0 2500000 4605000 7516141 6614248 10126 1587 2499725 449402 12525992 11670237 0 0 0 0 9558361 9399171 0 0 0 4463864 3147759 14022225 12546930 -1496233 -876693 1305250 845613 880424 1321474 424826 -475861 ST. MARY'S OHIO VALLEY HEARTCARE, LLC IS DEDICATED TO PROVIDING CARDIAC PATIENTS AND THEIR FAMILIES WITH EXCELLENCE IN THE PREVENTION, TREATMENT, AND DIAGNOSIS OF HEART DISEASE. 0 0 5980092 7063650 ST. MARY'S OHIO VALLEY HEARTCARE, LLC HAS ESTABLISHED A STRATEGIC RELATIONSHIP WITH ST. MARY'S MEDICAL CENTER OF EVANSVILLE, INC. TO OFFER CENTRALIZED DELIVERY OF OUTPATIENT CARDIAC CARE IN ADDITION TO INPATIENT SURGICAL PROCEDURES. ALSO, ST. MARY'S OHIO VALLEY HEARTCARE, LLC, CONTINUES TO TREAT BOTH ADULT AND PEDIATRIC CARDIAC PATIENTS WITH ON-SITE HIGH-TECH EQUIPMENT LOCATED ON THE ST. MARY'S MEDICAL CENTER OF EVANSVILLE, INC.'S CAMPUS. NO ONE IS REFUSED NEEDED MEDICAL ATTENTION DUE TO INABILITY TO PAY FOR SERVICES. ST. MARY'S OHIO VALLEY HEARTCARE, LLC IS PART OF ASCENSION HEALTH AND FOLLOWS THE CHARITY CARE POLICIES OF ST. MARY'S HEALTH, INC. 5980092 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 0 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 14 0 1 90 1 0 0 0 0 0 0 0 0 0 0 X 12 0 0 0 1 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 1 1 IN X JOHN L ZABROWSKI 8124854178 3700 WASHINGTON AVENUE EVANSVILLE IN 47750 PHILLIP BEHRENS MD 55.00 0.00 X 704931 0 86445 ELIZABETH BUTLER MD 55.00 0.00 X 649408 0 17401 PHILIP CASINO MD 55.00 0.00 X 699591 0 86954 DAVID CURTIS MD 55.00 0.00 X 463998 0 55344 JANICE ERNEST 1.00 61.00 X X 0 226052 99254 TIMOTHY FLESCH 1.00 65.20 X X 0 1704596 63161 SUZETTE HERSHMAN 1.00 63.00 X 0 105603 31175 DEEPA KUMBAR MD 55.00 0.00 X 202118 0 40679 WAJEEHUDDIN MOHAMMED MD 55.00 0.00 X 863494 0 82970 UMANG PATEL MD 55.00 0.00 X 741670 0 84099 ASIM REHMAN MD 55.00 0.00 X 866879 0 89527 ASEM RIMAWI MD 55.00 0.00 X 463920 0 62842 RITA FRANCE 40.00 0.00 X 113342 0 9338 CLAUDIA MERKLEY 40.00 0.00 X 114256 0 9193 5883607 2036251 818382 11 0 1 0 COMPHEALTH INC PO BOX 972651 DALLAS TX 75397 MEDICAL SERVICES 947608 DUKE REALTY 75 REMITTANCE DRIVE SUITE 3205 CHICAGO IL 60675 RENT 554597 WEATHERBY LOCUMS INC PO BOX 972633 DALLAS TX 75397 MEDICAL SERVICES 545285 MED-WRITE INC 515 AIRPORT RD 111 CHATTANOOGA TN 37421 BILLING SERVICES 357467 4 4605000 4605000 NET PATIENT REVENUES 621110 6614248 6614248 6614248 1587 1587 MEDICAL DIRECTOR FEES 561000 179750 179750 EHR INCENTIVE 900099 144000 144000 EKG READINGS 621500 107320 107320 18332 18332 449402 11670237 7063650 0 1587 X 6262270 6262270 2044004 2044004 750816 667944 82872 342081 304324 37757 242 215 27 1417175 1417175 4076 3626 450 100810 89781 11029 279465 248619 30846 940771 836933 103838 14835 13198 1637 15174 13499 1675 25503 22688 2815 25312 22518 2794 REPAIRS AND MAINTENENCE 81986 72937 9049 MEDICAL SUPPLIES 63211 63211 PURCHASED SERVICES 61499 54711 6788 EQUIPMENT RENTAL 40142 35711 4431 77558 68998 8560 12546930 5980092 6566838 0 326998 317591 642641 385095 188383 23637 24193 0 72948 59221 1029147 1001938 49951 27209 136 7875 0 24985 1305250 845613 819704 1055977 148553 60720 116944 880424 1321474 X 424826 -475861 424826 -475861 1305250 845613 X -876693 -389 -23605 X 0 1 X 1 0 X X X 0 0 0 ST MARY'S MEDICAL CENTER OF EVANSVILLE INC 350869065 3 1 0 1 0 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1029147 1001938 27209 27209 PENSION LIABILITY 4800 AH SAVINGS PLAN LIABILITY 112144 116944 0 1 0 0 0 0 0 0 0 PHILLIP BEHRENS MD 606995 0 87472 0 10464 0 61723 0 24722 0 791376 0 0 0 ELIZABETH BUTLER MD 554087 0 68698 0 26623 0 5000 0 12401 0 666809 0 0 0 PHILIP CASINO MD 510388 0 168931 0 20272 0 61301 0 25653 0 786545 0 0 0 DAVID CURTIS MD 278180 0 166705 0 19113 0 42096 0 13248 0 519342 0 0 0 JANICE ERNEST 0 196275 0 25756 0 4021 0 80214 0 19040 0 325306 0 0 TIMOTHY FLESCH 0 519605 0 1157134 0 27857 0 37143 0 26018 0 1767757 0 0 DEEPA KUMBAR MD 184036 0 0 0 18082 0 21959 0 18720 0 242797 0 0 0 WAJEEHUDDIN MOHAMMED MD 575314 0 269390 0 18790 0 73425 0 9545 0 946464 0 0 0 UMANG PATEL MD 503003 0 219877 0 18790 0 64397 0 19702 0 825769 0 0 0 ASIM REHMAN MD 616452 0 248067 0 2360 0 74065 0 15462 0 956406 0 0 0 ASEM RIMAWI MD 324222 0 138322 0 1376 0 42533 0 20309 0 526762 0 0 0 SUPPLEMENTAL INFORMATION PART III PART I, LINE 3: ST. MARY'S HEALTH, INC., A RELATED ORGANIZATION OF ST. MARY'S OHIO VALLEY HEARTCARE, LLC, USES THE FOLLOWING TO ESTABLISH THE COMPENSATION OF THE ORGANIZATION'S CEO/EXECUTIVE DIRECTOR: COMPENSATION COMMITTEE COMPENSATION SURVEY OR STUDY APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE SUPPLEMENTAL INFORMATION PART III PART I, LINE 4B: ALL EMPLOYEES AND AMOUNTS LISTED ARE VOLUNTARY DEFERRALS OR COMPANY CONTRIBUTIONS TO VARIOUS NON-QUALIFIED DEFERRED COMPENSATION PLANS ORGANIZED UNDER CODE SECTION 457(F). THE EXACT PURPOSE OF EACH PLAN VARIES, BUT THEY INCLUDE: COMPENSATION LIMITATION MAKE-UP PLANS, VOLUNTARY DEFERRAL PLANS, DEFERRAL OF A PORTION OF INCENTIVE BONUS TYPE PLANS, ETC. NO PAYMENTS WERE MADE TO LISTED PERSONS IN PART VII UNDER THE VARIOUS NON-QUALIFIED DEFERRED COMPENSATION PLANS DURING THE YEAR. FORM 990, PART VI, SECTION A, LINE 4 EFFECTIVE JULY 1, 2012, ST. MARY'S MEDICAL GROUP, LLC REPLACED ST. MARY'S HEALTH, INC. AS THE SOLE MEMBER OF ST. MARY'S OHIO VALLEY HEARTCARE, LLC. ST. MARY'S HEALTH, INC. IS THE SOLE MEMBER OF ST. MARY'S MEDICAL GROUP, LLC. FORM 990, PART VI, SECTION A, LINE 6 ST. MARY'S OHIO VALLEY HEARTCARE, LLC HAS A SINGLE CORPORATE MEMBER, ST. MARY'S MEDICAL GROUP, LLC, WHOSE SOLE MEMBER IS ST. MARY'S HEALTH, INC. FORM 990, PART VI, SECTION A, LINE 7A ST. MARY'S OHIO VALLEY HEARTCARE, LLC HAS A SINGLE CORPORATE MEMBER, ST. MARY'S MEDICAL GROUP, LLC, WHO HAS THE ABILITY TO ELECT MEMBERS TO THE GOVERNING BODY OF ST. MARY'S OHIO VALLEY HEARTCARE, LLC. FORM 990, PART VI, SECTION A, LINE 7B ALL DECISIONS THAT HAVE A MATERIAL IMPACT TO ST. MARY'S OHIO VALLEY HEARTCARE, LLC'S FINANCIAL INFORMATION OR COPORATION AS A WHOLE ARE SUBJECT TO APPROVAL BY ITS SOLE CORPORATE MEMBER, ST. MARY'S MEDICAL GROUP, LLC. FORM 990, PART VI, SECTION B, LINE 11 ST. MARY'S HEALTH, INC.'S FINANCE COMMITTEE REVIEWS THE FORM 990 IN MARCH UPON RECEIVING DIRECTION FROM ITS TAX PREPARER. THE FORM 990 IS THEN SENT TO THE GOVERNING BODY IN APRIL TO ALLOW FOR A THOROUGH REVIEW BY THE GOVERNING BODY PRIOR TO THE FILING DATE OF MAY 15TH. THE GOVERNING BODY WILL REVIEW THE FORM 990 VIA A SECURE WEB-BASED PORTAL AND ASK ANY QUESTIONS REGARDING THE FORM 990. ANY QUESTIONS AND RESPONSES WILL BE POSTED TO THE WEB-BASED PORTAL BEFORE THE RETURN IS FILED. ALL QUESTIONS AND RESPONSES WILL BE REVIEWED AND DISCLOSED IN THE MEETING MINUTES OF THE NEXT BOARD MEETING FOLLOWING THE REVIEW OF THE FORM 990. 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 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. COMPENSATION DETERMINATIONS OF ST. MARY'S OHIO VALLEY HEARTCARE, LLC'S CEO, EXECUTIVE DIRECTOR, OR TOP MANAGEMENT OFFICIAL ARE MADE BY A COMPENSATION COMMITTEE OF ST. MARY'S HEALTH, INC. IN DETERMINING COMPENSATION OF THE ORGANIZATION'S CEO, EXECUTIVE DIRECTOR, OR TOP MANAGEMENT OFFICIAL, THE PROCESS INCLUDED A REVIEW AND APPROVAL BY INDEPENDENT PERSONS, COMPARABILITY DATA, AND CONTEMPORANEOUS SUBSTANTIATION OF THE DELIBERATION AND DECISION. THE EXECUTIVE COMMITTEE OF THE ST. MARY'S HEALTH SYSTEM BOARD REVIEWED AND APPROVED THE COMPENSATION. IN THE 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. MARY'S OHIO VALLEY HEARTCARE, LLC'S OTHER OFFICERS OR KEY EMPLOYEES ARE MADE BY A COMPENSATION COMMITTEE OF ST. MARY'S 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 EXECUTIVE COMMITTEE OF THE ST. MARY'S HEALTH SYSTEM BOARD 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. OTHER FEES FORM 990, PART IX, LINE 11G MEDICAL FEES: PROGRAM SERVICE EXPENSES 1,417,175. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,417,175. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 9: FAS 158 PENSION LIABILITY 588. ASSET TRANSFER TO ST. MARY'S MEDICAL CENTER OF EVANSVILLE, INC. -24,193. 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