ST MARYS WARRICK HOSPITAL INC: Form 990, tax year 2012
View the entire original 990 at ProPublica ↗
- Organization
- ST MARYS WARRICK HOSPITAL INC (EIN 35-1343019)
- Tax period
- 2012-07-01 to 2013-06-30
- Filed
- 2014-05-14
- IRS object ID
- 201441349349307224
- Schema version
- 2012v2.1
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule C
- Schedule D
- Schedule H
- Schedule J
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2014-05-14T16:21:27-05:00 | Timestamp |
| Tax Period End Date | 2013-06-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 861065772 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DELOITTE TAX LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 111 MONUMENT CIRCLE SUITE 2000 | AddressLine1 |
| City | INDIANAPOLIS | City |
| State | IN | State |
| ZIP Code | 46204 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2012-07-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 351343019 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ST MARY'S WARRICK HOSPITAL INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | WARR | NameControl |
| Phone | 8124854178 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1116 MILLIS AVENUE | AddressLine1 |
| City | BOONVILLE | City |
| State | IN | State |
| ZIP Code | 47601 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | JOHN L ZABROWSKI | Name |
| Title | CHIEF FINANCIAL OFFICER | Title |
| Phone | 8124854178 | Phone |
| Date Signed | 2014-05-14 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | SHAWNA M JIMENEZ | Name |
| PTIN | P01222873 | PTIN |
| Phone | 3174648600 | Phone |
| Date Prepared | 2014-05-12 | DatePrepared |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2012 | TaxYear |
| Build TS | 2015-11-30 17:44:51Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | KEITH JEWELL | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1116 MILLIS AVENUE | AddressLine1 |
| City | BOONVILLE | City |
| State | IN | State |
| ZIP Code | 47601 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 14325102 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.STMARYS.ORG | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1971 | YearFormation |
| State Legal Domicile | IN | StateLegalDomicile |
| Activity Or Mission Description | ST. MARY'S WARRICK HOSPITAL, INC. IS A CRITICAL ACCESS HOSPITAL IN RURAL WARRICK COUNTY. THE HOSPITAL PROVIDES ACUTE CARE AND OUTPATIENT SERVICES TO PERSONS REGARDLESS OF ABILITY TO PAY. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 10 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 5 | NbrIndependentVotingMembers |
| Total Nbr Employees | 219 | TotalNbrEmployees |
| Total Nbr Volunteers | 21 | TotalNbrVolunteers |
| Total Gross UBI | 54489 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 430 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 0 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 14679999 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 13889155 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 10205 | InvestmentIncomePriorYear |
| Investment Income Current Year | -12473 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 284381 | OtherRevenuePriorYear |
| Other Revenue Current Year | 434182 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 14975015 | TotalRevenuePriorYear |
| Total Revenue Current Year | 14310864 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 0 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 7944564 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 7557463 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 7383193 | OtherExpensePriorYear |
| Other Expenses Current Year | 8520311 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 15327757 | TotalExpensesPriorYear |
| Total Expenses Current Year | 16077774 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | -352742 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | -1766910 | RevenuesLessExpensesCY |
| Total Assets BOY | 9850454 | TotalAssetsBOY |
| Total Assets EOY | 8761028 | TotalAssetsEOY |
| Total Liabilities BOY | 10137297 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 10744533 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | -286843 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | -1983505 | NetAssetsOrFundBalancesEOY |
| Mission Description | ST. MARY'S WARRICK HOSPITAL, INC. IS A CRITICAL ACCESS HOSPITAL IN RURAL WARRICK COUNTY. THE HOSPITAL PROVIDES ACUTE CARE AND OUTPATIENT SERVICES TO PERSONS REGARDLESS OF ABILITY TO PAY. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 8654093 | Expense |
| Revenue | 13821851 | Revenue |
| Description | ST. MARY'S WARRICK HOSPITAL, INC. (SMW) IS A NOT-FOR-PROFIT GENERAL SHORT-TERM CRITICAL ACCESS HOSPITAL SERVING WARRICK, POSEY, SPENCER, AND OTHER RURAL POPULATED COUNTIES SURROUNDING THE AREA WITHOUT REGARD TO PATIENT RACE, CREED, NATIONAL ORIGIN, ECONOMIC STATUS, OR ABILITY TO PAY. DURING THE FISCAL YEAR ENDING JUNE 30, 2013, THE HOSPITAL PROVIDED HEALTHCARE TO 919 PATIENTS IN THE COMMUNITY FOR A TOTAL OF 6,281 PATIENT DAYS OF SERVICE. ADDITIONALLY, THE HOSPITAL ALSO PROVIDED SERVICES TO 21,526 OUTPATIENTS, INCLUDING 288 OUTPATIENT SURGERY SERVICES AND 7,707 EMERGENCY ROOM VISITS. SEE SCHEDULE H FOR A NON-EXHAUSTIVE LIST OF COMMUNITY BENEFIT PROGRAMS AND DESCRIPTIONS. | Description |
Activity2 Activity2
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 2866142 | Expense |
| Description | SMW PROVIDES A SUBSTANTIAL PORTION OF ITS CORE HEALTH SERVICES TO THE POOR, UNINSURED, OR UNDERINSURED AND HAS PROACTIVELY TAKEN STEPS TO ADDRESS ACCESSIBILITY, AND THE 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 $2,866,142 WHICH INCLUDED $327,495 OF TRADITIONAL FINANCIAL ASSISTANCE AND $2,538,647 IN UNPAID COSTS 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. | Description |
Activity3 Activity3
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 77148 | Expense |
| Description | IN ADDITION TO CORE MEDICAL SERVICES, SMW AND COMMUNITY PARTNERS ASSESS COMMUNITY ASSETS AND NEEDS AND WORK TOGETHER TO ADDRESS ISSUES IMPACTING HEALTH AND QUALITY OF LIFE, WITH SPECIAL EMPHASIS ON THE POOR AND VULNERABLE. IN FISCAL YEAR 2013, SMW PROVIDED $77,148 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, SMW PROVIDED A TOTAL COMMUNITY BENEFIT OF $2,943,289 IN FISCAL YEAR 2013.) SMW SERVES AND SUPPORTS ITS COMMUNITY THROUGH SUCH PROGRAMS AS HEALTH FAIRS AND SCREENINGS, TRANSPORTATION FOR PATIENT AT NO COST TO PATIENT, AS WELL AS VARIOUS COMMUNITY SUPPORT GROUPS. SEE SCHEDULE H FOR A NON-EXHAUSTIVE LIST OF COMMUNITY BENEFIT PROGRAMS AND DESCRIPTIONS. | Description |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expense | 11597383 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 0 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 1 | LobbyingActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 0 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 0 | ReportOtherAssets |
| Report Other Liabilities | 1 | ReportOtherLiabilities |
| Report Fin48 Footnote | 0 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 0 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 1 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 1 | Hospital |
| Financial Stmt Attached | 1 | FinancialStmtAttached |
| Grants To Organizations | 0 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 1 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 1 | RelatedOrgControlledEntity |
| Transaction Related Entity | 1 | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 37 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 219 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 1 | UnrelatedBusinessIncome |
| Form990-T Filed | 1 | Form990-TFiled |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Premiums Paid | 0 | PremiumsPaid |
| Form8899 Filed | 0 | Form8899Filed |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 10 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 5 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 1 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 1 | MembersOrStockholders |
| Election Of Board Members | 1 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 1 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 1 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| States Where Copy Of Return Is Filed | IN | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | JOHN L ZABROWSKI | NamePerson |
| Telephone Number | 8124854178 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3700 WASHINGTON AVENUE | AddressLine1 |
| City | EVANSVILLE | City |
| State | IN | State |
| ZIP Code | 47750 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (16 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Average Hours Per Week RelatedAverageHoursPerWeekRelated | Individual Trustee Or DirectorIndividualTrusteeOrDirector | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | OfficerOfficer | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|---|
| JERRY AIGNER | ||||||||
| BOARD MEMBER | 1.00 | 1.00 | X | 0 | 0 | 0 | ||
| SISTER JANE BURGER | ||||||||
| BOARD MEMBER | 1.00 | 2.00 | X | 0 | 0 | 0 | ||
| TIMOTHY FLESCH | ||||||||
| SECRETARY/TREASURER | 1.00 | 65.20 | X | 0 | 1704596 | 63161 | X | |
| DONALD HENDRICKSON | ||||||||
| BOARD MEMBER | 1.00 | 1.00 | X | 0 | 0 | 0 | ||
| MICHAEL HERRELL MD | ||||||||
| CHAIR | 1.00 | 5.00 | X | 0 | 0 | 0 | X | |
| SALLY RIDEOUT LAMBERT | ||||||||
| BOARD MEMBER | 1.00 | 1.00 | X | 0 | 0 | 0 | ||
| LLOYD MCGINNIS MD | ||||||||
| BOARD MEMBER | 1.00 | 57.00 | X | 0 | 130863 | 3660 | ||
| JAMES MOONEY MD | ||||||||
| BOARD MEMBER | 55.00 | 1.00 | X | 110301 | 0 | 23174 | ||
| GWEN SANDEFUR | ||||||||
| BOARD MEMBER | 1.00 | 65.20 | X | 0 | 381454 | 42467 | ||
| LAURENCE STEENBERG | ||||||||
| VICE CHAIR | 1.00 | 1.00 | X | 0 | 0 | 0 | X | |
| CAROL GODSEY | ||||||||
| EXECUTIVE DIRECTOR | 1.00 | 62.00 | 0 | 192523 | 77562 | X | ||
| JOSEL MIJARES MD | ||||||||
| PHYSICIAN | 55.00 | 0.00 | 111345 | 0 | 0 | X | ||
| THOMAS MILLER MD | ||||||||
| PHYSICIAN | 55.00 | 0.00 | 235645 | 0 | 9296 | X | ||
| PETER ROSARIO MD | ||||||||
| PHYSICIAN | 55.00 | 0.00 | 330032 | 0 | 69631 | X | ||
| JOHN SCHELLHASE | ||||||||
| NURSE | 55.00 | 0.00 | 117436 | 0 | 33123 | X | ||
| DAVID VAUGHN MD | ||||||||
| PHYSICIAN | 55.00 | 0.00 | 293143 | 0 | 41898 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 1197902 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 2409436 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 363972 | TotalOtherCompensation |
| Number Individuals GT100 K | 6 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| HORIZON HEALTH | |||||
| PO BOX 840839 | DALLAS | TX | 75284 | MANAGEMENT SERVICES | 428984 |
| EMCARE | |||||
| 7032 COLLECTION CENTER DRIVE | CHICAGO | IL | 60693 | MEDICAL SERVICES/CODING | 356026 |
| KENNETH PARKER MD | |||||
| PO BOX 129 | INGLEFIELD | IN | 47618 | MEDICAL SERVICE | 215600 |
| CPSI | |||||
| 6600 WALL STREET | MOBILE | AL | 36695 | HEALTHCARE INFORMATION MANAGEMENT | 203586 |
| WEATHERBY LOCUMS | |||||
| PO BOX 972633 | DALLAS | TX | 75397 | MEDICAL SERVICE | 171867 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 7 | NumberOfContractorsGT100K |
Program Service Revenue ProgramServiceRevenue (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome | Unrelated Business RevenueUnrelatedBusinessRevenue |
|---|---|---|---|---|
| OUTPATIENT REVENUE | 621990 | 9881905 | 9881905 | |
| INPATIENT REVENUE | 621990 | 3952761 | 3952761 | |
| REFERENCE LAB FEES | 541380 | 54489 | 54489 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 13889155 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 1765 | TotalRevenueColumn |
| Exclusion | $1,765 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 88512 | Real |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 0 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 88512 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 88512 | TotalRevenueColumn |
| Exclusion | $88,512 | ExclusionAmount |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 14238 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | -14238 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -14238 | TotalRevenueColumn |
| Related Or Exempt Function Income | -14238 | RelatedOrExemptFunctionIncome |
Other Revenue Misc OtherRevenueMisc (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | ExclusionExclusionAmount |
|---|---|---|---|
| JAIL CLINIC | 621990 | 96435 | $96,435 |
| VENDING MACHINE/CAFETERIA | 900099 | 39805 | $39,805 |
| EXERCISE PROGRAM/GYM MEMBERSHIP | 713940 | 22048 | $22,048 |
Miscellaneous Revenue MiscellaneousRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 187382 | TotalRevenueColumn |
| Related Or Exempt Function Income | 1423 | RelatedOrExemptFunctionIncome |
| Exclusion | $185,959 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 345670 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 14310864 | TotalRevenueColumn |
| Related Or Exempt Function Income | 13821851 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 54489 | UnrelatedBusinessRevenue |
| Exclusion | $434,524 | ExclusionAmount |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 133475 | Total |
| Management And General | 133475 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 6157215 | Total |
| Program Services | 4464820 | ProgramServices |
| Management And General | 1692395 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 842652 | Total |
| Program Services | 580194 | ProgramServices |
| Management And General | 262458 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 424121 | Total |
| Program Services | 292021 | ProgramServices |
| Management And General | 132100 | ManagementAndGeneral |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1538482 | Total |
| Program Services | 1059295 | ProgramServices |
| Management And General | 479187 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 56052 | Total |
| Program Services | 38594 | ProgramServices |
| Management And General | 17458 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 600 | Total |
| Program Services | 413 | ProgramServices |
| Management And General | 187 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 60768 | Total |
| Program Services | 41841 | ProgramServices |
| Management And General | 18927 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4345 | Total |
| Program Services | 2991 | ProgramServices |
| Management And General | 1354 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 189166 | Total |
| Program Services | 130246 | ProgramServices |
| Management And General | 58920 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 189729 | Total |
| Program Services | 130635 | ProgramServices |
| Management And General | 59094 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 368663 | Total |
| Program Services | 253836 | ProgramServices |
| Management And General | 114827 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 27112 | Total |
| Program Services | 18667 | ProgramServices |
| Management And General | 8445 | ManagementAndGeneral |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 12854 | Total |
| Program Services | 8850 | ProgramServices |
| Management And General | 4004 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 169817 | Total |
| Management And General | 169817 | ManagementAndGeneral |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 722876 | Total |
| Management And General | 722876 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 32578 | Total |
| Management And General | 32578 | ManagementAndGeneral |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| MEDICAL FEES | 1427180 | 1427180 | |
| PROVIDER TAX EXPENSE | 1197582 | 1197582 | |
| MEDICAL SUPPLIES | 685115 | 685115 | |
| PURCHASED SERVICES | 626814 | 431581 | 195233 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1210578 | Total |
| Program Services | 833522 | ProgramServices |
| Management And General | 377056 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 16077774 | Total |
| Program Services | 11597383 | ProgramServices |
| Management And General | 4480391 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 240719 | BOY |
| EOY | 226008 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2312039 | BOY |
| EOY | 1990633 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 194086 | BOY |
| EOY | 155851 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 49870 | BOY |
| EOY | 51404 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 19324355 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 13791600 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5842092 | BOY |
| EOY | 5532755 | EOY |
Intangible Assets IntangibleAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 460534 | BOY |
| EOY | 377153 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 751114 | BOY |
| EOY | 427224 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 9850454 | BOY |
| EOY | 8761028 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4279124 | BOY |
| EOY | 5131338 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5858173 | BOY |
| EOY | 5613195 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 10137297 | BOY |
| EOY | 10744533 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -286843 | BOY |
| EOY | -1983505 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -286843 | BOY |
| EOY | -1983505 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 9850454 | BOY |
| EOY | 8761028 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | -1766910 | ReconcilationRevenueExpenses |
| Reconciliation Unrealized Invest | 3751 | ReconciliationUnrealizedInvest |
| Reconcilation Other Changes | 66497 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
FS Audited Basis FSAuditedBasis
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | 1 | AuditCommittee |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | Volunteers |
| Paid Staff Or Management | 0 | PaidStaffOrManagement |
| Media Advertisements | 0 | MediaAdvertisements |
| Mailings Members | 0 | MailingsMembers |
| Publications Or Broadcast | 0 | PublicationsOrBroadcast |
| Grants Other Organizations | 0 | GrantsOtherOrganizations |
| Direct Contact Legislators | 0 | DirectContactLegislators |
| Rallies Demonstrations | 0 | RalliesDemonstrations |
| Other Activities | 1 | OtherActivities |
| Other Activities | $489 | OtherActivitiesAmount |
| Total Lobbying Expenditures IIB | 489 | TotalLobbyingExpendituresIIB |
| Not Described In501c3 | 0 | NotDescribedIn501c3 |
Form990 Schedule C Part IV Form990ScheduleCPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | EXPLANATION OF LOBBYING ACTIVITIES: | Identifier |
| Return Reference | PART II-B, LINE 1: | ReturnReference |
| Explanation | LOBBYING EXPENSES REPRESENT THE PORTION OF DUES PAID TO NATIONAL AND STATE HOSPITAL ASSOCIATIONS THAT IS SPECIFICALLY ALLOCABLE TO LOBBYING. ST. MARY'S WARRICK 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. | Explanation |
Schedule D IRS990ScheduleD
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 181810 | OtherCostOrOtherBasis |
| Book Value | 181810 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 11579696 | OtherCostOrOtherBasis |
| Depreciation | 7494362 | Depreciation |
| Book Value | 4085334 | BookValue |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 14267 | OtherCostOrOtherBasis |
| Depreciation | 14267 | Depreciation |
| Book Value | 0 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 7285150 | OtherCostOrOtherBasis |
| Depreciation | 6029361 | Depreciation |
| Book Value | 1255789 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 263432 | OtherCostOrOtherBasis |
| Depreciation | 253610 | Depreciation |
| Book Value | 9822 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 5532755 | TotalOfBookValueLandBuildings |
Other Liabilities OtherLiabilities (4 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| INTERCOMPANY DEBT WITH ASCENSION HEALTH ALLIANCE | $3,702,939 |
| PENSION LIABILITY | $921,634 |
| INTERCOMPANY TO ST. MARY'S MEDICAL CENTER | $760,295 |
| DEFERRED COMPENSATION | $228,327 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 5613195 | TotalOfAmounts |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | 1 | CharityCarePolicy |
| Written Policy | 1 | WrittenPolicy |
| Policy Applied To All Hospitals | X | PolicyAppliedToAllHospitals |
| FPG Reference Free Care | 1 | FPGReferenceFreeCare |
| Pcent200 | X | Pcent200 |
| FPG Reference Discounted Care | 1 | FPGReferenceDiscountedCare |
| Pcent300 | X | Pcent300 |
| Free Disc Care Medically Indigent | 1 | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | 1 | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | 0 | ExpensesExceededBudget |
| Annual Community Benefit Report | 1 | AnnualCommunityBenefitReport |
| Report Publically Available | 1 | ReportPublicallyAvailable |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 327495 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 327495 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.02040 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 3381998 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 843351 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 2538647 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.15790 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 3709493 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 843351 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 2866142 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.17830 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 3610 | PersonsServed |
| Total Community Benefit Expense | 3610 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 3610 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00020 | PercentOfTotalExpense |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 1680 | PersonsServed |
| Total Community Benefit Expense | 41705 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 41705 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00260 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 5290 | PersonsServed |
| Total Community Benefit Expense | 45315 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 45315 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00280 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 5290 | PersonsServed |
| Total Community Benefit Expense | 3754808 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 843351 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 2911457 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.18110 | PercentOfTotalExpense |
Community Support CommunitySupport
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 130 | PersonsServed |
| Total Community Building Expense | 650 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 650 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00000 | PercentOfTotalExpense |
Coalition Building CoalitionBuilding
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 98 | PersonsServed |
| Total Community Building Expense | 322 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 322 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00000 | PercentOfTotalExpense |
Other Other
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 231 | PersonsServed |
| Total Community Building Expense | 30860 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 30860 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00190 | PercentOfTotalExpense |
Total Total
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 459 | PersonsServed |
| Total Community Building Expense | 31832 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 31832 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00190 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReported |
| Bad Debt Expense | $1,741,509 | BadDebtExpenseAmount |
| Amount Attributable To | 174151 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 6684030 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 6573938 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | 110092 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | X | CostToChargeRatio |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | 1 | WrittenDebtCollectionPolicy |
| Provision For Charity Care | 1 | ProvisionForCharityCare |
| Number Of Hospital Facilities | 1 | NumberOfHospitalFacilities |
Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Number | 1 | FacilityNumber |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ST MARY'S WARRICK HOSPITAL INC | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1116 MILLIS AVENUE | AddressLine1 |
| City | BOONVILLE | City |
| State | IN | State |
| ZIP Code | 47601 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | WWW.STMARYS.ORG/WARRICK | WebsiteAddress |
| Licensed Hospital | X | LicensedHospital |
| General Medical And Surgical | X | GeneralMedicalAndSurgical |
| Critical Access Hospital | X | CriticalAccessHospital |
| Er24 Hours | X | Er24Hours |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ST MARY'S WARRICK HOSPITAL INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
| CHNA Conducted | 1 | CHNAConducted |
| Community Definition | X | CommunityDefinition |
| Community Demographics | X | CommunityDemographics |
| Existing Resources | X | ExistingResources |
| How Data Obtained | X | HowDataObtained |
| Community Health Needs | X | CommunityHealthNeeds |
| Other Health Issues | X | OtherHealthIssues |
| Identifying Process | X | IdentifyingProcess |
| Consulting Process | X | ConsultingProcess |
| Information Gaps | X | InformationGaps |
| Needs Assessment Conducted | 12 | NeedsAssessmentConducted |
| Take Into Account | 1 | TakeIntoAccount |
| Other Facilities | 1 | OtherFacilities |
| CHNA Widely Available | 1 | CHNAWidelyAvailable |
| Own Website | X | OwnWebsite |
| On Request | X | OnRequest |
| Adopt Implement Strategy | X | AdoptImplementStrategy |
| Execute Implement Strategy | X | ExecuteImplementStrategy |
| Develop Community Plan | X | DevelopCommunityPlan |
| Participate Community Plan | X | ParticipateCommunityPlan |
| Include Operational Plans | X | IncludeOperationalPlans |
| Prioritize Health Needs | X | PrioritizeHealthNeeds |
| Prioritize Services | X | PrioritizeServices |
| All Needs Addressed | 0 | AllNeedsAddressed |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTax |
| Eligibility Criteria Explained | 1 | EligibilityCriteriaExplained |
| Uses FPG Free | 1 | UsesFPGFree |
| FPG Free Percent | 200.000000000000 | FPGFreePercent |
| Uses FPG Discounted | 1 | UsesFPGDiscounted |
| FPG Discount Percent | 300.000000000000 | FPGDiscountPercent |
| Explains Basis | 1 | ExplainsBasis |
| Income Level | X | IncomeLevel |
| Asset Level | X | AssetLevel |
| Explains Application Method | 1 | ExplainsApplicationMethod |
| Includes Publicity Measures | 1 | IncludesPublicityMeasures |
| Attached To Invoices | X | AttachedToInvoices |
| Posted In Emergency Room | X | PostedInEmergencyRoom |
| Posted In Admission Office | X | PostedInAdmissionOffice |
| Actions On Nonpayment | 1 | ActionsOnNonpayment |
| Collection Activities | 0 | CollectionActivities |
| Nondiscrim Emergency Care Policy | 1 | NondiscrimEmergencyCarePolicy |
| Used Other Method | X | UsedOtherMethod |
| Amounts Generally Billed | 0 | AmountsGenerallyBilled |
| Gross Charges | 0 | GrossCharges |
Form990 Schedule H Part VI Form990ScheduleHPartVI (25 entries)
| ExplanationExplanation | Return ReferenceReturnReference | IdentifierIdentifier |
|---|---|---|
| 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, 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 300% OF THE FPL, ARE ELIGIBLE TO 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 AN 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: WHILE MOST OF ST. MARY'S WARRICK HOSPITAL, INC.'S COMMUNITY BENEFIT ACTIVITIES DIRECTLY IMPACT THE HEALTH OF ITS COMMUNITIES, ST. MARY'S WARRICK HOSPITAL, INC. ALSO INVESTS IN COMMUNITY BUILDING ACTIVITIES THAT INDIRECTLY IMPROVE HEALTH BY IMPROVING 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. ADDITIONALY, HELPING TO CREATE GREATER CAPACITY WITHIN THE COMMUNITY TO ADDRESS A BROAD RANGE OF QUALITY OF LIFE ISSUES ALSO IMPACTS HEALTH. IN FISCAL YEAR 2013, ST. MARY'S WARRICK HOSPITAL, INC.'S COMMUNITY BUILDING ACTIVITIES INCLUDED: WORKING SOUP KITCHENS, PARTNERING WITH THE WARRICK CO. HEALTH COALITION, AND EMBRACING PROJECT SEARCH STUDENTS WITHIN THE HOSPITAL. | ||
| 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 $4,938,644 AT CHARGES ($1,741,509 AT COST). | PART III, LINE 2: | |
| 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 3: | |
| THE ORGANIZATION IS A 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 4: | |
| A COST TO CHARGE RATIO IS APPLIED TO THE ORGANIZATION'S MEDICARE EXPENSE TO DETERMINE THE MEDICARE ALLOWABLE COST 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 A COMMUNITY BENEFIT. | PART III, LINE 8: | |
| 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 AND THE FINANCIAL ASSISTANCE PROGRAM IS FOLLOWED. | PART III, LINE 9B: | |
| IN CONDUCTING ITS CHNA, THE HOSPITAL FACILITY TOOK INTO ACCOUNT INPUT FROM PERSONS WHO REPRESENT THE BROAD INTERESTS OF THE COMMUNITY SERVED BY THE HOSPITAL FACILITY AS WELL AS PROFESSIONAL RESEARCH CONSULTANTS, INC., A CONSULTING COMPANY THAT HAS SPECIAL KNOWLEDGE AND EXPERTISE IN PUBLIC HEALTH.THE HOSPITAL FACILITY CONSULTED WITH THESE PERSONS THROUGH MEETINGS AND FOCUS GROUPS.ADDITIONALLY, THE HOSPITAL CONSULTED WITH THE FOLLOWING ORGANIZATIONS AND GROUPS IN CONDUCTING ITS MOST RECENT CHNA: ECHO, UNITED WAY, WELBORN BAPTIST FOUNDATION, SMOKE FREE COMMUNITIES, YMCA, DIEHL CONSULTING, THE CITY OF EVANSVILLE'S MAYOR'S OFFICE, SOUTHWEST MENTAL HEALTH, BRENTWOOD MEADOWS, CROSSPOINTE, EVANSVILLE-VANDERBURGH DRUG TASK FORCE, WARRICK CO. SHERIFF DEPARTMENT, VANDERBURGH CO. SHERIFF DEPARTMENT, YOUTH FIRST, EVANSVILLE STATE HOSPITAL, LAMPION CENTER, WARRICK PSYCHIATRIC CARE AND THE CHILDREN'S PSYCHIATRIC HOSPITAL. | PART V, SECTION B, LINE 3: | |
| THE OTHER HOSPITAL FACILITIES WITH WHICH THE REPORTING HOSPITAL FACILITY CONDUCTED ITS CHNA INCLUDES ST. MARY'S MEDICAL CENTER OF EVANSVILLE, INC., DEACONESS HOSPITAL, DEACONESS GATEWAY, DEACONESS CROSSPOINTE, AND THE WOMEN'S HOSPITAL. | PART V, SECTION B, LINE 4: | |
| THE COMMUNITY HEALTH NEEDS ASSESSMENT ("CHNA") OF THE HOSPITAL FACILITY CAN BE LOCATED AT THE FOLLOWING WEB ADDRESS: HTTP://WWW.STMARYS.ORG/CHNA. | PART V, SECTION B, LINE 5: | |
| THE HOSPITAL FACILITY'S COMMUNITY HEALTH NEEDS ASSESSMENT IDENTIFIED ACCESS TO CARE, ORAL HEALTH, MENTAL HEALTH AND EDUCATION TRAINING AS NEEDS OF THE COMMUNITY. THE HOSPITAL FACILITY DID NOT TAKE ACTION TO ADDRESS THESE NEEDS AS IT HAS LIMITED FINANCIAL AND OTHER RESOURCES. | PART V, SECTION B, LINE 7: | |
| 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:- 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 16: | |
| 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 17: | |
| QUESTION 18 IS MORE APPROPRIATELY ANSWERED AS NOT APPLICABLE AS THE BILLING AND COLLECTIONS POLICY OF ST. MARY'S WARRICK 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 V, SECTION B, LINE 18: | |
| 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. | PART V, SECTION B, LINE 20D: | |
| 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). | 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) 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 22: | |
| PART VI, LINE 2: COMMUNITIES ARE DYNAMIC IN WHICH MULTIPLE FACTORS INTERACT TO IMPACT QUALITY OF LIFE AND HEALTH STATUS. AS PART OF THE ST. MARY'S HEALTH SYSTEM, THE GOAL OF ST. MARY'S WARRICK HOSPITAL, INC. IS TO WORK WITH ITS COMMUNITY TO CONDUCT AN ASSESSMENT AT LEAST EVERY THREE YEARS IN PARTNERSHIP WITH ST. MARY'S MEDICAL CENTER OF EVANSVILLE, INC. ASSESSMENTS MAY INCLUDE PRIMARY SURVEY DATA, SECONDARY SURVEY DATA, FOCUS GROUP INPUT, COMMUNITY LEADERS' SURVEY AND OTHER DATA. RESULTS ARE MADE AVAILABLE TO ORGANIZATIONS AND INDIVIDUALS THROUGHOUT THE COMMUNITY. THESE NEEDS ASSESSMENTS ARE ALSO UTILIZED IN CREATING THE HOSPITAL'S INTEGRATED STRATEGIC FINANCIAL AND OPERATIONAL PLAN. TO THAT END, ST. MARY'S WARRICK HOSPITAL, INC. HAS BROUGHT TOGETHER A COMMUNITY ROUNDTABLE WITH THE PURPOSE OF DETERMINING THE RESOURCES AND NEEDS, PRIORITIZING ACTION AND WORKING IN PARTNERSHIP TO ADDRESS IDENTIFIED CHALLENGES WITHIN A DESIGNATED AREA SURROUNDING THE HOSPITAL. ST. MARY'S WARRICK HOSPITAL, INC. ALSO IDENTIFIES COMMUNITY HEALTH NEEDS BY EMPLOYING OTHER PUBLIC AGENCY NEEDS ASSESSMENTS SUCH AS WELBORN BAPTIST FOUNDATION AND THE UNITED WAY. | ||
| PART VI, LINE 3: ST. MARY'S WARRICK HOSPITAL, INC. 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. IN ADDITION, THE HOSPITAL CONTRACTS 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. MARY'S WARRICK HOSPITAL, INC. IS A CRITICAL ACCESS HOSPITAL LOCATED IN BOONVILLE, INDIANA SERVING WARRICK, POSEY, SPENCER, AND OTHER RURAL POPULATED COUNTIES SURROUNDING THE AREA. ACCORDING TO THE 2013 COUNTY AND HEALTH RANKINGS, WARRICK COUNTY HAS A POPULATION OF 60,275 AND 12% OF THE CHILDREN IN WARRICK COUNTY ARE DEEMED TO LIVE IN HOUSEHOLDS BELOW THE POVERTY GUIDELINES. IN ADDITION, 15% OF THOSE LIVING IN WARRICK COUNTY UNDER THE AGE OF 65 DO NOT HAVE HEALTH INSURANCE. CHILD AND ADULT OBESITY CONTINUES TO BE ONE OF THE HIGHEST COMMUNITY ISSUES FOR WARRICK COUNTY WITH 32% OF ADULTS WITH A BODY MASS GREATER THAN 30. OTHER COMMUNITY ISSUES INCLUDE:- FAMILIES' UNDERSTANDING OF FINANCES, BUDGETING, AND TAX CREDITS;- UNDERSTANDING THE CYCLE OF POVERTY THAT OCCURS IN SUCCESSIVE GENERATIONS;- COST OF PRESCRIPTION MEDICINE; AND- AFFORDABLE AND ACCESSIBLE HEALTH CARE FOR LOW- TO MODERATE-INCOME INDIVIDUALS | ||
| 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. MARY'S WARRICK HOSPITAL, INC.:- 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.- PARTICIPATES IN GOVERNMENT-SPONSORED PROGRAMS SUCH AS MEDICAID AND MEDICARE TO THE POOR AND ELDERLY.- HOLDS MEMBERSHIP ON OTHER PUBLIC AGENCY BOARDS TO ENHANCE WELL BEING OF THE COMMUNITY IN PARTNERSHIP PROGRAMS. | ||
| PART VI, LINE 6: AS A PART OF ST. MARY'S HEALTH SYSTEM, ST. MARY'S WARRICK HOSPITAL, INC. IS DEDICATED TO IMPROVING THE HEALTH STATUS AND QUALITY OF LIFE FOR THE COMMUNITIES IT SERVES. WHILE DESIGNATED ASSOCIATES AT ST. MARY'S WARRICK HOSPITAL, INC. DEVOTE SIGNIFICANT PORTIONS OF 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. MARY'S HEALTH COMMUNITY DEVELOPMENT AND SERVICE 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. MARY'S HEALTH IN WHICH ST. MARY'S WARRICK HOSPITAL, INC. PARTICIPATES. | ||
| IN | PART VI, LINE 7 | REPORTS FILED WITH STATES |
| THE STATE OF INDIANA NO LONGER REQUIRES A SEPARATE COMMUNITY BENEFIT REPORT, BUT WILL REFERENCE THE FORM 990. ST. MARY'S WARRICK HOSPITAL, INC. AND ITS ITS RELATED ST. MARY'S HEALTH, INC. AFFILIATES PUBLISH A COMMUNITY BENEFIT REPORT WHICH IS AVAILABLE TO THE PUBLIC. A COPY OF THE FULL REPORT IS AVAILABLE AT HTTP://WWW.STMARYS.ORG/CHNA. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 1 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (7 entries)
| TitleTitle | Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| TIMOTHY FLESCH | ||||||||||||||
| SECRETARY/TREASURER | 0 | 519605 | 0 | 1157134 | 0 | 27857 | 0 | 37143 | 0 | 26018 | 0 | 1767757 | 0 | 0 |
| GWEN SANDEFUR | ||||||||||||||
| BOARD MEMBER | 0 | 336657 | 0 | 43368 | 0 | 1429 | 0 | 21708 | 0 | 20759 | 0 | 423921 | 0 | 0 |
| CAROL GODSEY | ||||||||||||||
| EXECUTIVE DIRECTOR | 0 | 151332 | 0 | 21806 | 0 | 19385 | 0 | 70406 | 0 | 7156 | 0 | 270085 | 0 | 0 |
| THOMAS MILLER MD | ||||||||||||||
| PHYSICIAN | 229245 | 0 | 1200 | 0 | 5200 | 0 | 2399 | 0 | 6897 | 0 | 244941 | 0 | 0 | 0 |
| PETER ROSARIO MD | ||||||||||||||
| PHYSICIAN | 293194 | 0 | 16499 | 0 | 20339 | 0 | 47885 | 0 | 21746 | 0 | 399663 | 0 | 0 | 0 |
| JOHN SCHELLHASE | ||||||||||||||
| NURSE | 115778 | 0 | 1632 | 0 | 26 | 0 | 29171 | 0 | 3952 | 0 | 150559 | 0 | 0 | 0 |
| DAVID VAUGHN MD | ||||||||||||||
| PHYSICIAN | 291198 | 0 | 1600 | 0 | 345 | 0 | 36966 | 0 | 4932 | 0 | 335041 | 0 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| SUPPLEMENTAL INFORMATION | PART III | PART I, LINE 3: ST. MARY'S HEALTH, INC., A RELATED ORGANIZATION OF ST. MARY'S WARRICK HOSPITAL, 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. |
Schedule L IRS990ScheduleL
Form990 Schedule L Part IV Form990ScheduleLPartIV
Name Of Interested Person NameOfInterestedPerson
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | STANLEY GROSSMAN | NamePerson |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship | - SEE PART V - | Relationship |
| Amount Of Transaction | 37197 | AmountOfTransaction |
| Description Of Transaction | SEE PART V | DescriptionOfTransaction |
| Sharing Of Revenues | 0 | SharingOfRevenues |
Form990 Schedule L Part V Form990ScheduleLPartV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | SCHEDULE L, PART IV: | Identifier |
| Return Reference | BUSINESS TRANSACTION INVOLVING INTERESTED PERSONS | ReturnReference |
| Explanation | (A) NAME OF PERSON: STANLEY GROSSMAN(B) RELATIONSHIP BETWEEN INTERESTED PERSON AND ORGANIZATION: FATHER OF GWEN SANDEFUR(C) AMOUNT OF TRANSACTION: $37,197(D) DESCRIPTION OF TRANSACTION: STANLEY GROSSMAN IS AN EMPLOYEE OF ST. MARY'S WARRICK HOSPITAL, INC. AND RECEIVES COMPENSATION FROM THE ORGANIZATION.(E) SHARING OF ORGANIZATION REVENUES: NO | Explanation |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (10 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| FORM 990, PART VI, SECTION A, LINE 4 | EFFECTIVE JULY 1, 2012, ST. MARY'S HEALTH SERVICES, INC. REPLACED ST. MARY'S HEALTH, INC. AS THE SOLE MEMBER OF ST. MARY'S WARRICK HOSPITAL, INC. | |
| FORM 990, PART VI, SECTION A, LINE 6 | ST. MARY'S WARRICK HOSPITAL, INC. HAS A SINGLE CORPORATE MEMBER, ST. MARY'S HEALTH SERVICES, INC. | |
| FORM 990, PART VI, SECTION A, LINE 7A | ST. MARY'S WARRICK HOSPITAL, INC. HAS A SINGLE CORPORATE MEMBER, ST. MARY'S HEALTH SERVICES, INC., WHO HAS THE ABILITY TO ELECT MEMBERS TO THE GOVERNING BODY OF THE ST. MARY'S WARRICK HOSPITAL, INC. BOARD. | |
| FORM 990, PART VI, SECTION A, LINE 7B | ALL DECISIONS THAT HAVE A MATERIAL IMPACT TO ST. MARY'S WARRICK HOSPITAL, 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 RECEIVE THE FORM 990 VIA EMAIL FOR REVIEW ELECTRONICALLY AND WILL SEND ANY QUESTIONS REGARDING THE FORM 990 VIA EMAIL. RESPONSES TO ANY QUESTIONS RECEIVED WILL BE PROVIDED ELECTRONICALLY TO THE BOARD MEMBERS 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. | |
| FORM 990, PART VI, SECTION B, LINE 15 | COMPENSATION DETERMINATIONS OF ST. MARY'S WARRICK HOSPITAL, INC.'S CEO, EXECUTIVE DIRECTOR, OR TOP MANAGEMENT OFFICIAL ARE MADE BY A COMPENSATION COMMITTEE OF ST. MARY'S WARRICK HOSPITAL, INC. AND/OR 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, INC. 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 WARRICK HOSPITAL, INC.'S OTHER OFFICERS OR KEY EMPLOYEES ARE MADE BY A COMPENSATION COMMITTEE OF ST. MARY'S WARRICK HOSPITAL, INC. AND/OR 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, INC. 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. | |
| FORM 990, PART XI, LINE 9: | FAS 158 PENSION LIABILITY 68,003. NY DEBT OBLIGATION -1,506. | CHANGES IN NET ASSETS OR FUND BALANCES: |
| FORM 990, PART IV, LINE 24A: | ST. MARY'S WARRICK HOSPITAL, INC. IS A HEALTH FACILITY THAT IS PART OF THE ASCENSION HEALTH SYSTEM. ASCENSION HEALTH SYSTEM IS THE HOLDER OF THE TAX EXEMPT HOSPITAL REVENUE BONDS. ST. MARY'S WARRICK HOSPITAL, INC. HOLDS AN INTERCOMPANY NOTE PAYABLE WITH ASCENSION HEALTH AND THIS INFORMATION IS REPORTED ON THE BALANCE SHEET. |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (44 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Controlled OrgControlledOrg |
|---|---|---|---|---|---|---|---|---|---|---|
| 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 INC | ||||||||||
| 1300 S JACKSON | FRANKFORT | IN | 46041 | 352099320 | CRITICAL ACCESS 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 SPECIALTY HOSPITAL INC | ||||||||||
| 8050 TOWNSHIP LINE ROAD | INDIANAPOLIS | IN | 46260 | 351712001 | LONG TERM CARE HOSPITAL | IN | 501(C)(3) | 3 | STVINCENT HEALTH INC | 1 |
| STVINCENT WILLIAMSPORT HOSPITAL INC | ||||||||||
| 412 N MONROE STREET | WILLIAMSPORT | IN | 47993 | 350784551 | CRITICAL ACCESS HOSPITAL | IN | 501(C)(3) | 3 | STVINCENT HEALTH INC | 1 |
| STVINCENT WILLIAMSPORT HOSPITAL FOUNDATION INC | ||||||||||
| 412 N MONROE STREET | WILLIAMSPORT | IN | 47993 | 743130159 | SUPPORTING ORGANIZATION | IN | 501(C)(3) | 11A, I | STVINCENT WILLIAMSPORT HOSPITAL INC | 1 |
| SVSM INC | ||||||||||
| 2001 W 86TH STREET | INDIANAPOLIS | IN | 46260 | 810607827 | HOLDING COMPANY | IN | 501(C)(3) | 11A, I | STVINCENT HEALTH INC | 1 |
| ST MARY'S AT HOME INC | ||||||||||
| 3700 WASHINGTON AVENUE | EVANSVILLE | IN | 47750 | 351899560 | DME/HOME CARE | IN | 501(C)(3) | 11A, I | ST MARY'S HEALTH SERVICES INC | 1 |
| ST MARY'S BUILDING CORPORATION | ||||||||||
| 3700 WASHINGTON AVENUE | EVANSVILLE | IN | 47750 | 237248362 | REAL ESTATE HOLDING COMPANY | IN | 501(C)(2) | ST MARY'S HEALTH SERVICES INC | 1 | |
| ST MARY'S WARRICK EMERGENCY MEDICAL SERVICES INC | ||||||||||
| 3700 WASHINGTON AVENUE | EVANSVILLE | IN | 47750 | 205342518 | AMBULANCE SERVICES | IN | 501(C)(4) | ST MARY'S HEALTH SERVICES INC | 1 | |
| ST MARY'S HEALTH INC | ||||||||||
| 3700 WASHINGTON AVENUE | EVANSVILLE | IN | 47750 | 352057801 | HEALTH MINISTRY PARENT | IN | 501(C)(3) | 11C, III-FI | STVINCENT HEALTH INC | 1 |
| ST MARY'S PHYSICIAN NETWORK LLC | ||||||||||
| 3700 WASHINGTON AVENUE | EVANSVILLE | IN | 47750 | 205023387 | PHYSICIAN PROFESSIONAL SERVICES | IN | 501(C)(3) | 9 | ST MARY'S MEDICAL GROUP LLC | 1 |
| ST MARY'S HEALTH SERVICES INC | ||||||||||
| 3700 WASHINGTON AVENUE | EVANSVILLE | IN | 47750 | 351679526 | INVESTMENT SERVICES | IN | 501(C)(3) | 11C, III-FI | ST MARY'S HEALTH INC | 1 |
| ST MARY'S CARE PARTNERS INC | ||||||||||
| 3700 WASHINGTON AVENUE | EVANSVILLE | IN | 47750 | 351899562 | TAX-EXEMPT AFFILIATE REIMBURSEMENTS | IN | 501(C)(3) | 11A, I | ST MARY'S HEALTH INC | 1 |
| ST MARY'S MEDICAL CENTER FOUNDATION OF EVANSVILLE INC | ||||||||||
| 3700 WASHINGTON AVENUE | EVANSVILLE | IN | 47750 | 237045370 | SUPPORTING ORGANIZATION | IN | 501(C)(3) | 11A, I | ST MARY'S MEDICAL CENTER OF EVANSVILLE INC | 1 |
| ST MARY'S MEDICAL CENTER OF EVANSVILLE INC | ||||||||||
| 3700 WASHINGTON AVENUE | EVANSVILLE | IN | 47750 | 350869065 | HOSPITAL | IN | 501(C)(3) | 3 | ST MARY'S HEALTH SERVICES INC | 1 |
| ST MARY'S WARRICK HOSPITAL FOUNDATION INC | ||||||||||
| 1116 MILLIS AVENUE | BOONVILLE | IN | 47601 | 351961890 | SUPPORTING ORGANIZATION | IN | 501(C)(3) | 11A, I | ST MARY'S WARRICK HOSPITAL INC | 1 |
| ST MARY'S OHIO VALLEY HEARTCARE LLC | ||||||||||
| 901 ST MARYS DRIVE | EVANSVILLE | IN | 47714 | 273474697 | CARDIOLOGY SERVICES | IN | 501(C)(3) | 11A, I | ST MARY'S MEDICAL GROUP LLC | 1 |
| ST MARY'S PHYSICIANS' HEALTH GROUP LLC | ||||||||||
| 3700 WASHINGTON AVENUE | EVANSVILLE | IN | 47750 | 261356310 | PHYSICIAN PROFESSIONAL SERVICES | IN | 501(C)(3) | 9 | ST MARY'S MEDICAL GROUP LLC | 1 |
| PRIMARY PHYSICIAN NETWORK LLC | ||||||||||
| 3700 WASHINGTON AVENUE | EVANSVILLE | IN | 47750 | 208775914 | PHYSICIAN PROFESSIONAL SERVICES | IN | 501(C)(3) | 9 | ST MARY'S MEDICAL GROUP LLC | 1 |
Form990 Schedule R Part III Form990ScheduleRPartIII (14 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivityPrimaryActivity | Legal Domicile StateLegalDomicileState | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Predominant Income TypePredominantIncomeType | Share Of Total IncomeShareOfTotalIncome | Share Of EOY AssetsShareOfEOYAssets | Disproportionate AllocationsDisproportionateAllocations | General Or Managing PartnerGeneralOrManagingPartner | Percentage OwnershipPercentageOwnership |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| BREAST MRI LEASING COMPANY LLC | |||||||||||||
| 10330 N MERIDIAN ST STE 430N | INDIANAPOLIS | IN | 46290 | 426662493 | SALE AND RENTAL SERVICES | IN | STVINCENT HOSPITAL AND HEALTH CARE CENTER INC | RELATED | 230642 | 43329 | 0 | 1 | 0.50000 |
| CARMEL AMBULATORY SURGERY CENTER LLC | |||||||||||||
| 13421 OLD MERIDIAN ST STE 150 | CARMEL | IN | 46032 | 320014795 | AMBULATORY SURGERY CENTER | IN | STVINCENT CARMEL HOSPITAL INC | RELATED | 5892459 | 1896555 | 0 | 1 | 0.45000 |
| COOPERATIVE MANAGED CARE SERVICES LLC | |||||||||||||
| 9045 RIVER ROAD STE 250 | INDIANAPOLIS | IN | 46240 | 351999227 | CASE MANAGEMENT | IN | STVINCENT HOSPITAL AND HEALTH CARE CENTER INC | UNRELATED | 212659 | 2119265 | 0 | 1 | 0.50000 |
| ENDOSCOPY CENTER LLC | |||||||||||||
| 13421 OLD MERIDIAN ST STE 150 | CARMEL | IN | 46032 | 320029881 | ENDOSCOPY CENTER | IN | STVINCENT CARMEL HOSPITAL INC | RELATED | 681952 | 357300 | 0 | 0 | 0.51000 |
| HANCOCK PHYSICIAN NETWORK LLC | |||||||||||||
| 801 N STATE STREET | GREENFIELD | IN | 46140 | 352051598 | PRIMARY CARE PHYSICIAN PRACTICES | IN | STVINCENT HOSPITAL AND HEALTH CARE CENTER INC | RELATED | -2692272 | 2094475 | 0 | 1 | 0.50000 |
| HCH SVH CATH LAB SERVICES LLC | |||||||||||||
| 1000 N 16TH STREET | NEW CASTLE | IN | 47362 | 452087950 | CATH LAB SERVICES | IN | STVINCENT HEALTH INC | RELATED | -229738 | 1629927 | 0 | 1 | 0.50000 |
| MERIDIAN HEIGHTS ASSOCIATES LLC | |||||||||||||
| 6100 W 96TH STREET STE 250 | INDIANAPOLIS | IN | 46278 | 264020296 | REAL ESTATE HOLDING | IN | STVINCENT CARMEL HOSPITAL INC | RELATED | 3029284 | 0 | 1 | 0.50000 | |
| NEURO ONCOLOGY EQUIPMENT LLC | |||||||||||||
| 10330 N MERIDIAN ST STE 430N | INDIANAPOLIS | IN | 46290 | 743103803 | SALE AND RENTAL SERVICES | IN | STVINCENT HOSPITAL AND HEALTH CARE CENTER INC | RELATED | 151678 | 1684704 | 0 | 1 | 0.50000 |
| STVINCENT HEALTHUSP LLC | |||||||||||||
| 15305 DALLAS PKWY STE 1600 | ADDISON | TX | 75001 | 203749962 | AMBULATORY SURGERY CENTER | IN | STVINCENT HEALTH INC | RELATED | 136436 | 387939 | 0 | 1 | 0.50000 |
| STVINCENT HEART CENTER OF INDIANA LLC | |||||||||||||
| 10580 N MERIDIAN STREET | INDIANAPOLIS | IN | 46290 | 364492612 | HEART HOSPITAL | IN | CENTRAL INDIANA HEALTH SYSTEM CARDIAC SERVICES INC | RELATED | 20552234 | 78811464 | 0 | 0 | 0.74080 |
| WOMEN'S PHYSICIAN SURGERY CENTER LLC | |||||||||||||
| 8081 TOWNSHIP LINE ROAD | INDIANAPOLIS | IN | 46260 | 352086841 | AMBULATORY SURGERY CENTER | IN | STVINCENT HOSPITAL AND HEALTH CARE CENTER INC | RELATED | -11530 | 252917 | 0 | 0 | 0.58900 |
| AMBULATORY CARE CENTER LLC | |||||||||||||
| 1125 PROFESSIONAL BLVD | EVANSVILLE | IN | 47714 | 352006018 | OP SURGERY | IN | ST MARY'S HEALTH SERVICES INC | RELATED | 4879396 | 4549444 | 0 | 1 | 0.50000 |
| SETON HEALTH SERVICES LLC | |||||||||||||
| 3700 WASHINGTON AVENUE | EVANSVILLE | IN | 47750 | 270451316 | EQUIPMENT RENTAL | IN | ST MARY'S HEALTH SERVICES INC | RELATED | 36943 | 99375 | 0 | 1 | 0.50000 |
| ST MARY'S PERIPHERAL VASCULAR SERVICES MANAGEMENT CO LLC | |||||||||||||
| 3700 WASHINGTON AVENUE | EVANSVILLE | IN | 47750 | 205062635 | MANAGEMENT SERVICES | IN | ST MARY'S MEDICAL CENTER OF EVANSVILLE INC | RELATED | 211137 | 156690 | 0 | 1 | 0.75000 |
Form990 Schedule R Part IV Form990ScheduleRPartIV (2 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivityPrimaryActivity | Legal Domicile StateLegalDomicileState | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Type Of EntityTypeOfEntity | Share Of Total IncomeShareOfTotalIncome | Share Of EOY AssetsShareOfEOYAssets | Percentage OwnershipPercentageOwnership | Controlled OrgControlledOrg |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| SVH REAL ESTATE INC | ||||||||||||
| 8425 HARCOURT ROAD | INDIANAPOLIS | IN | 46260 | 205002285 | REAL ESTATE HOLDING COMPANY | IN | STVINCENT HEALTH INC | C | 2784 | 2969423 | 1.00000 | 1 |
| ST MARY'S MEDICAL GROUP INC | ||||||||||||
| 3700 WASHINGTON AVENUE | EVANSVILLE | IN | 47750 | 352076827 | INVESTMENT | IN | ST MARY'S HEALTH SERVICES INC | C | -641423 | 742 | 1.00000 | 1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 0 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 0 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 1 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 1 | LoansOrGuaranteesFromOtherOrg |
| Dividends Related Organization | 0 | DividendsRelatedOrganization |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 0 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 0 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 0 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 0 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 0 | SharingOfFacilities |
| Sharing Of Paid Employees | 0 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 1 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 1 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 0 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable (6 entries)
| Transaction TypeTransactionType | Amount InvolvedAmountInvolved | Method Of Amt DeterminationMethodOfAmtDetermination |
|---|---|---|
| ASCENSION HEALTH INC | ||
| D | 158664 | FMV OF SERVICES OR CASH |
| ASCENSION HEALTH INC | ||
| P | 297896 | FMV OF SERVICES OR CASH |
| ST MARY'S HEALTH INC | ||
| P | 268855 | FMV OF SERVICES OR CASH |
| ST MARY'S MEDICAL CENTER OF EVANSVILLE INC | ||
| Q | 250000 | FMV OF SERVICES OR CASH |
| ST MARY'S MEDICAL CENTER OF EVANSVILLE INC | ||
| E | 83077 | FMV OF SERVICES OR CASH |
| ST MARY'S MEDICAL CENTER OF EVANSVILLE INC | ||
| P | 1114355 | FMV OF SERVICES OR CASH |