2014-05-14T13:44:02-05:00 2013-06-30 861065772 DELOITTE TAX LLP 111 MONUMENT CIRCLE SUITE 2000 INDIANAPOLIS IN 462045108 990 2012-07-01 351899560 ST MARY'S AT HOME INC 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 6323886 0 X WWW.STMARYS.ORG X 1993 IN PROVIDES HOME HEALTH CARE SERVICES AND DURABLE MEDICAL EQUIPMENT FOR PATIENTS IN THE COMMUNITY. 7 0 0 0 0 0 0 0 6433221 6279652 53978 10176 66 184 6487265 6290012 0 700000 0 0 3993760 4064031 0 0 0 2243294 2278554 6237054 7042585 250211 -752573 3054070 2098586 1168729 935198 1885341 1163388 PROVIDES HOME HEALTH CARE SERVICES AND DURABLE MEDICAL EQUIPMENT FOR PATIENTS IN THE COMMUNITY. 0 0 5928872 700000 6279836 PROGRAM SERVICES ARE DEVOTED TO SUPPORTING ST. MARY'S MEDICAL CENTER OF EVANSVILLE, INC. BY PROVIDING HOME HEALTH CARE SERVICES AND DURABLE MEDICAL EQUIPMENT TO PERSONS IN THE EVANSVILLE AREA. NO INDIVIDUALS ARE REFUSED NEEDED MEDICAL CARE AT HOME DUE TO INABILITY TO PAY FOR SERVICES. ST. MARY'S AT HOME IS PART OF ASCENSION HEALTH AND FOLLOWS THE CHARITY CARE POLICIES OF ST. MARY'S HEALTH, INC. SEE SCHEDULE O FOR ADDITIONAL DETAILS. 5928872 1 0 0 0 0 0 0 0 0 0 1 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 2 0 1 0 0 0 0 0 0 0 0 0 0 0 X 7 0 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 IN X JOHN L ZABROWSKI 8124854178 3700 WASHINGTON AVENUE EVANSVILLE IN 47750 DARCY ELLISON 1.00 60.00 X 0 293768 127565 JANICE ERNEST 1.00 61.00 X 0 226052 99254 DOUG KNIES 1.00 60.00 X 0 170531 57171 MARK MARCHINO 1.00 60.00 X 0 141770 27341 JANET RAISOR 1.00 60.00 X 0 149171 53944 JOHN RODRIGUES MD 1.00 55.00 X 0 360639 23706 GWEN SANDEFUR 1.00 65.20 X X 0 381454 42467 0 1723385 431448 0 0 1 0 BKD LLP 910 E ST LOUIS STREET SUITE 200 SPRINGFIELD MO 658011190 PATIENT BILLING RECOVERY 128143 1 NET PATIENT REVENUE 621610 6279652 6279652 6279652 44050 44050 33874 -33874 -33874 -33874 PURCHASE DISCOUNTS 900099 184 184 184 6290012 6279836 0 10176 700000 700000 3150360 2416582 733778 677026 519334 157692 236645 181526 55119 11135 8541 2594 100090 76777 23313 3635 2788 847 67780 51993 15787 10483 8041 2442 208060 159599 48461 174449 133817 40632 1423 1092 331 4668 3581 1087 16191 12420 3771 28651 21978 6673 COST OF GOODS SOLD 1346130 1346130 MEDICAL SUPPLIES 214905 214905 GASOLINE 19423 14899 4524 REPAIRS AND MAINTENANCE 18808 14427 4381 52723 40442 12281 7042585 5928872 1113713 0 87834 146110 1118185 1015988 468311 463553 22879 247774 247774 50064 0 1329676 450056 3054070 2098586 892552 657195 141911 145616 134266 132387 1168729 935198 X 1885341 1163388 1885341 1163388 3054070 2098586 X -752573 30675 -55 X 0 1 X 1 0 X X X X 0 0 0 ST MARY'S MEDICAL CENTER OF EVANSVILLE 350869065 3 1 0 1 0 61257 61257 0 186517 186517 0 0 INTEREST IN INVESTMENTS HELD BY ASCENSION HEALTH ALLIANCE 437313 PREPAID VENDOR ACCOUNTS PAYABLE 12743 450056 INTERCOMPANY DEBT WITH ASCENSION HEALTH ALLIANCE 132387 132387 1 ST MARY'S HEALTH SERVICES INC 3700 WASHINGTON AVE EVANSVILLE IN 47750 351679526 501(C)(3) 700000 OPERATING SUPPORT 1 0 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: ONE PERSON OF ST. MARY'S MEDICAL CENTER OF EVANSVILLE, INC., IS RESPONSIBLE FOR RESEARCHING AND COORDINATING GRANT PROPOSALS. THIS PERSON IS ALSO RESPONSIBLE FOR ENSURING THAT TIMELY REPORTS ARE SENT TO THE GRANTOR. THE CHIEF EXECUTIVE OF THE ENTITY OPERATIONS REVIEWS AND APPROVES ALL THE EXPENDITURES FROM THE GRANT FUNDS, ENSURING THEY ARE WITHIN THE GUIDELINES OF THE GRANT. 0 1 0 0 0 0 0 0 0 DARCY ELLISON 0 253347 0 36611 0 3810 0 109928 0 17637 0 421333 0 0 JANICE ERNEST 0 196275 0 25756 0 4021 0 80214 0 19040 0 325306 0 0 DOUG KNIES 0 157038 0 11648 0 1845 0 56332 0 839 0 227702 0 0 MARK MARCHINO 0 130407 0 10311 0 1052 0 3218 0 24123 0 169111 0 0 JANET RAISOR 0 137414 0 10489 0 1268 0 36325 0 17619 0 203115 0 0 JOHN RODRIGUES MD 0 349967 0 0 0 10672 0 5000 0 18706 0 384345 0 0 GWEN SANDEFUR 0 336657 0 43368 0 1429 0 21708 0 20759 0 423921 0 0 SUPPLEMENTAL INFORMATION PART III PART I, LINE 3: ST. MARY'S HEALTH, INC. A RELATED ORGANIZATION OF ST. MARY'S AT HOME, INC., 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 6 ST. MARY'S AT HOME, INC. HAS A SINGLE CORPORATE MEMBER, ST. MARY'S HEALTH SERVICES, INC. FORM 990, PART VI, SECTION A, LINE 7A ST. MARY'S AT HOME, INC. HAS A SINGLE CORPORATE MEMBER, ST. MARY'S HEALTH SERVICES, INC., WHO HAS THE ABILITY TO ELECT MEMBERS TO THE GOVERNING BODY OF ST. MARY'S AT HOME, INC. FORM 990, PART VI, SECTION A, LINE 7B ALL DECISIONS THAT HAVE A MATERIAL IMPACT TO ST. MARY'S AT HOME, INC.'S FINANCIAL INFORMATION OR CORPORATION AS A WHOLE ARE SUBJECT TO APPROVAL BY ITS SOLE CORPORATE MEMBER, ST. MARY'S HEALTH SERVICES, INC. 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 AT HOME, INC.'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 AT HOME, INC.'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. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 9: NY DEBT OBLIGATION -55. FORM 990, PART IV, LINE 24A: ST. MARY'S AT HOME, INC. IS A HEALTH FACILITY THAT IS PART OF THE ASCENSION HEALTH SYSTEM. ASCENSION HEALTH IS THE BORROWER FOR TAX-EXEMPT HOSPITAL REVENUE BONDS. ST. MARY'S AT HOME, INC. HOLDS AN INTERCOMPANY NOTE PAYABLE WITH ASCENSION HEALTH, AND THIS INFORMATION IS REPORTED ON THE BALANCE SHEET. CHARITY CARE SUMMARY FOR FISCAL PERIOD JULY 1, 2012 TO JUNE 30, 2013 FORM 990, PART III, LINE 4A: CATEGORY 1 CARE OF THE POOR CHARITY - $125,415 CATEGORY 2 CARE OF THE POOR MEDICAID - $37,225 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 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