2013-05-14T18:06:16-05:00 2012-06-30 ERNST & YOUNG US LLP 111 MONUMENT CIRCLE SUITE 2600 INDIANAPOLIS IN 46204 990 2011-07-01 351738708 ST CATHERINE HOSPITALINC % MARY ANN SHACKLETT STCA 2193921700 4321 FIR STREET EAST CHICAGO IN 46312 MARY ANN SHACKLETT 2013-05-14 3176817000 2011 2016-02-24 21:20:13Z JO ANN BIRDZELL 4321 FIR STREET EAST CHICAGO IN 46312 166190031 false X www.comhs.org X 1928 IN St. Catherine Hospital is committed to providing the highest quality care in the most cost-efficient manner, respecting the dignity of the individual, providing for the (continued on note on mission statement) 18 14 1501 50 836765 280420 1199357 156492325 159322493 59752 -93943 3117084 5292786 159949581 165720693 0 0 0 0 72563824 72891515 0 0 0 94689895 95280849 167253719 168172364 -7304138 -2451671 54867614 66165015 22333865 32133975 32533749 34031040 X ST. CATHERINE HOSPITAL IS COMMITTED TO PROVIDING THE HIGHEST QUALITY CARE IN THE MOST COST-EFFICIENT MANNER, RESPECTING THE DIGNITY OF THE INDIVIDUAL, PROVIDING FOR THE WELL-BEING OF THE COMMUNITY AND SERVING THE NEEDS OF ALL PEOPLE, INCLUDING THE POOR AND DISADVANTAGED. false false 60998274 60019443 NURSING - 26,451 PATIENT DAYS 15029479 45563563 SURGERY - 5,032 IP AND OP SURGERIES 10564695 14442342 PHYSICIANS - 31,747 OFFICE VISITS 7600335 34070343 CARDIOLOGY - 21,426 VISITS 7292562 31235476 PHARMACY - 2,591,879 DOSES ADMINISTERED 6648047 51772348 LAB - 545,510 SPECIMENS COLLECTED 6099986 10812595 IMCU - 10,648 PATIENT DAYS 5352641 33278800 ER 30,703 VISITS WITH 4,821 ADMISSIONS 4439902 4172334 OCC HEALTH - 14,532 VISITS 4306794 14948462 PT OT SPEECH - 125,283 PROCEDURES 3883933 49662716 RADIOLOGY - 61,052 PROCEDURES 3810398 756 DIETARY - 149,876 IP MEALS 3034773 3943642 ICU - 2,559 PATIENT DAYS 2735156 PATIENT SERVICES - 43,678 VISITS 2504984 HIM - 89,652 MEDICAL RECORDS CODED 2280172 2568432 HOME HEALTH - 27,132 VISITS 1844707 8760387 RESPIRATORY THERAPY - 56,285 PROCEDURES 1247663 SECURITY 1217381 ADMITTING - 9,243 IP ADMISSIONS 943284 6058523 NUCLEAR MED - 2,189 PROCEDURES 835481 MEDICAL STAFF 650203 922422 PSYCH - 2,884 VISITS & PROCEDURES 627541 4954518 CYBERKNIFE - 331 CLICKS 527074 1622021 OUTPATIENT SERVICES - 88,314 VISITS 422026 119603 CENTRAL SUPPLY - 2,853 CHARGEABLE SUPPLIES 372195 CENTRAL STERILIZATION - PROVIDE STERILE INSTRUMENT 326686 PUBLIC RELATIONS 148333 2695871 EEG - 6,688 PROCEDURES 106920 POB 57954 LTAC 454288 MISC -187073639 CONTRACTUALS -16933947 CHARITY -11176804 BAD DEBT -3734228 INTERCOMPANY ELIMINATION 69317131 43134919 155909579 true true false true false false false false false false true false false true true false false true false false false false false false false false true true false false true false false false false false true true true false false false false false true true true false false true 159 0 true 1501 true true true false false false false false false false false false X 18 14 false false false false true true true true true false false true true true true true true false true false IN X MARY ANN SHACKLETT 2199348250 10010 DONALD S POWERS DR STE 201 MUNSTER IN 46321 X LORENZO ARREDONDO 1.0 X 0 0 0 JOHN ARTIS 1.0 X 0 0 0 MARIA LUZ CORONA MAGISTRATE 1.0 X 0 0 0 R LOUIE GONZALEZ 1.0 X 0 0 0 JUDITH GRESKO 1.0 X 0 0 0 HENRY HADIDIAN MD 10.0 X 72340 0 0 DAVID HERBSTMAN MD 1.0 X 0 0 0 SR ANNEMARIE KAMPWERTH PHJC 1.0 X 0 0 0 THOMAS P KEILMAN 1.0 X 0 0 0 JOSEPH SEMANCIK MONSIGNOR 1.0 X 0 30400 0 JAIME RUIZ-MONTERO MD 29.0 X 139504 0 0 GEORGE RYAN 1.0 X 0 0 0 EDWARD WILLIAMS PHD 1.0 X 0 38315 0 JOSEPH COSTANZA 1.0 X X 0 31100 0 PEGGY GERARD RN DNSC 1.0 X X 0 0 0 KIMBERLY ARTHUR MD 41.0 X X 303907 0 23490 JOHN CABAN 1.0 X X 0 0 0 JOANN BIRDZELL 41.0 X X 496187 0 76433 MARY ANN SHACKLETT 1.0 X 0 546591 56960 JOSEPH WINTERHALER 40.0 X 212271 0 21434 PAULA SWENSON 41.0 X 221195 0 16845 CRAIG BOLDA 41.0 X 0 216880 52762 PASTOR LLOBET MD 40.0 X 746784 0 8950 SAMER ABBAS MD 40.0 X 550486 0 8950 DANIEL SAAH MD 40.0 X 517990 0 31105 SUBHASH JOSHI MD 40.0 X 389961 0 23728 JATIN PATEL DO 40.0 X 365225 0 33979 4015850 863286 354636 101 false true false REHAB CARE GROUP INC PO BOX 502096 ST LOUIS MO 63150 REHAB SERVICES 2299322 COOPERATIVE MANAGED CARE SERVICES L ST FRANCIS HOSPITAL DEPT 9010 BEECH GROVE IN 46107 CLAIMS PROCESSING 1615679 ISM SECURITY MANAGEMENT 905 W GLEN PARK AVENUE GRIFFITH IN 46319 security 870526 EPMG OF INDIANA PC 2000 GREEN ROAD SUITE 3000 ANN ARBOR MI 48105 EMERGENCY ROOM SRVCS 421196 MECHANICAL CONCEPTS INCORPORATED 750 S COUNTY LINE ROAD GARY IN 46403 HEATING/COOLING SRVS 396899 24 1087397 111960 1199357 NET PATIENT SERVICE REVENUE 900099 129933367 129096602 836765 CAPITATION REVENUE 900099 29389126 29389126 159322493 68214 68214 0 0 1037404 306831 730573 730573 730573 350 162507 -162157 -162157 -162157 0 0 0 OCC HEALTH OFFSITE STAFFING 900099 2776302 2776302 CAFETERIA 900099 602030 602030 PHARMACY 340B 900099 425163 425163 758718 636309 122409 4562213 165720693 162323502 836765 1361069 0 0 0 0 1312567 393529 919038 12714 12714 57214377 52941881 4272496 3205948 2926300 279648 6926871 6407894 518977 4219038 3851020 368018 2006000 1938072 67928 144837 1600 143237 0 2303 2303 0 0 9125553 7813867 1311686 306210 285886 20324 2050385 1550085 500300 108830 39645 69185 0 2113720 2084225 29495 131403 126503 4900 0 60323 56808 3515 850067 850067 29400 29400 4788380 4418678 369702 2126635 1970847 155788 CAPITATION EXPENSE 24784090 24784090 CORP SUPP SRVCS ALLOCATION 17774541 16224103 1550438 MEDICAL SUPPLIES 17492331 17492331 HEALTH ASSESSMENT FEE 4248871 4248871 7136970 5461163 1675807 168172364 155909579 12262785 0 5642445 5401715 136076 134364 0 0 15811128 20091682 0 0 0 0 0 0 4320457 4990493 668885 799277 65024385 39832774 26099844 25191611 0 0 0 0 0 0 0 0 2188779 9555873 54867614 66165015 20737503 28078959 0 0 372864 282589 0 0 0 0 0 0 0 0 0 0 1223498 3772427 22333865 32133975 X 32317614 33792070 216135 238969 0 0 32533749 34031039 54867614 66165015 X -2451671 3948961 X X false true true X false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 2303 2303 false SUPPLEMENTAL INFORMATION PT II-B LINE 1i THE INDIANA HOSPITAL ASSOCIATION ESTIMATED THAT 5.44% OF ITS DUES ARE ATTRIBUTABLE TO LOBBYING. 25245 25245 28611642 16116226 12495415 853821 104178 749643 33965645 22482707 11482938 1568031 1129663 438369 25191610 HEALTH ASSESSMENT FEE RCVBL 6264484 MISCELLANEOUS RECEIVABLE 1466997 LT LEGAL CLAIMS RECEIVABLE 1207584 US STEEL RCVBL - OCC HEALTH 616808 9555873 0 CAPITAL LEASES-CURRENT PORTION 38218 ASSET RETIREMENT OBLIGATION 594514 3RD PARTY SETTLEMENTS 1603856 CAPITAL LEASES-LT PORTION 16405 LT LEGAL CLAIMS LIABILITY 1519434 3772427 SUPPLEMENTAL INFORMATION The adoption of ASC 740 did not materially impact the financial statements. true true X true X true X true true true false true true 4924 5912477 1978 5910499 0.03510 28434 40296625 33621466 6675159 0.03960 33358 46209102 33623444 12585658 0.07470 90 12854 455863 1385 454478 0.00270 10 285 262871 262871 0.00160 52 125682 106889 18793 0.00010 43 29731 29731 0.00020 143 13191 874147 108274 765873 0.00460 143 46549 47083249 33731718 13351531 0.07930 true 3876787 38768 55007387 63453898 -8446511 X true true 1 1 ST CATHERINE HOSPITAL INC

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X X X ST CATHERINE HOSPITAL INC 1 true true 200. true 400. true X X X X X X true true X X X X X true false true X false false 12 HOME HEALTH OF ST CATHERINE HOSPITAL

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HOME HEALTH HESSVILLE FAMILY CARE

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PHYSICIAN PRACTICE FAMILY HEALTH AND WELLNESS CENTER

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PHYSICIAN PRACTICE OCCUPATIONAL HEALTH

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PHYSICIAN PRACTICE ENT

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PHYSICIAN PRACTICE ORTHOPEDIC CLINIC

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PHYSICIAN PRACTICE COMMUNITY HEALTHCARE SYSTEM CARE NETWORK

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PHYSICIAN PRACTICE ST CATHERINE CARE NETWORK

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PHYSICIAN PRACTICE ST CATHERINE CARE NETWORK

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PHYSICIAN PRACTICE ST CATHERINE CARDIOLOGY ASSOC

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PHYSICIAN PRACTICE ST CATHERINE CARE NETWORK

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PHYSICIAN PRACTICE CENTER OF HOPE

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PHYSICIAN PRACTICE PART V, LINE 19 N/A PART I, LINE 6A N/A PART I, LINE 7G COMPLETED THE IRS WORKSHEETS AND USED COST TO CHARGE RATIO FOR THE METHODOLOGY. WE DID NOT INCLUDE ANY PHYSICIAN PRACTICE INFORMATION WHEN CALCULATING SUBSIDIZED SERVICES. PART I, LINE 7, COLUMN F BAD DEBT OF $11,176,805 IS EXCLUDED FROM THE CALCULATION. PART I, LINE 7 THE METHODOLOGY TOOK THE FINANCIAL STATEMENT COST TO CHARGE RATIO AND MULTIPLIED IT BY THE RELATED CHARGES. THIS NUMBER WAS THEN REDUCED BY THE ACTUAL PAYMENTS RECEIVED. PART III, LINE 4 ST. CATHERINE HOSPITAL EVALUATES THE COLLECTIBILITY OF ITS ACCOUNTS RECEIVABLE BASED ON THE LENGTH OF TIME THE RECEIVABLE IS OUTSTANDING AND THE ANTICIPATED FUTURE UNCOLLECTIBLE AMOUNTS BASED ON HISTORICAL EXPERIENCE. ACCOUNTS RECEIVABLE ARE CHARGED TO THE ALLOWANCE FOR DOUBTFUL ACCOUNTS WHEN THEY ARE DEEMED UNCOLLECTIBLE. ST. CATHERINE HOSPITAL DOES NOT REQUIRE COLLATERAL. PART III, LINE 8 THE TOTAL REVENUE RECEIVED FROM MEDICARE WAS CALCULATED BY USING THE COST TO CHARGE RATIO. WE PROVIDE THE NECESSARY SERVICES REGARDLESS OF THE PATIENT'S ABILITY TO PAY FOR THE SERVICE PROVIDED OR THE REIMBURSEMENT RECEIVED FROM MEDICARE, QUALIFYING THE $8,446,511 OF MEDICARE SHORTFALL AS A COMMUNITY BENEFIT. PART III, LINE 9B COLLECTION POLICIES ARE THE SAME FOR ALL PATIENTS. PATIENTS ARE SCREENED FOR ELIGIBILITY FOR FINANCIAL ASSISTANCE BEFORE COLLECTION PROCEDURES BEGIN. IF AT ANY POINT IN THE COLLECTION PROCESS, DOCUMENTATION IS RECEIVED THAT INDICATES THE PATIENT IS POTENTIALLY ELIGIBLE FOR FINANCIAL ASSISTANCE BUT HAS NOT APPLIED FOR IT, THE ACCOUNT IS REFERRED BACK FOR A FINANCIAL ASSISTANCE REVIEW. PART V, LINE 1J N/A PART V, LINE 3 N/A PART V, LINE 5C N/A PART V, LINE 6I N/A PART V, LINE 7 N/A PART V, LINE 11H N/A PART V, LINE 13G N/A PART V, LINE 15E N/A PART V, LINE 16E N/A PART V, LINE 17E N/A PART V, LINE 18D N/A PART V, LINE 19D Our maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care is based on a sliding scale. Up to 200% of federal poverty guidelines (FPG) is 100% free care. 201% -250% is charged based on Medicare rates. 251%-300% is charged based on average of lowest managed care rates. 301%-400% is charged based on average managed care rates. PART V, LINE 20 N/A PART V, LINE 21 N/A NEEDS ASSESSMENT ST. CATHERINE HOSPITAL USES A THIRD-PARTY CONSULTING FIRM TO ASSESS THE HEALTH CARE NEEDS OF THE COMMUNITY. ST. CATHERINE HOSPITAL SERVES ONE OF THE LARGEST POPULATIONS IN NORTHWEST INDIANA AND IS THE OLDEST POPULATION IN THE AREA WITH AN EXPECTED LOSS OF POPULATION IN THE NEXT FIVE YEARS. ST. CATHERINE HAS DOMINANT MARKET POSITION IN ALL PRODUCT LINES AND CONTINUES TO SEE GROWTH IN AREAS SUCH AS ORTHOPEDICS, ONCOLOGY AND GENERAL SURGERY. PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE PATIENTS WHO ARE ADMITTED WITHOUT INSURANCE ARE REFERRED TO THE HOSPITAL'S FINANCIAL COUNSELORS. THE FINANCIAL COUNSELORS PERFORM AN INTERVIEW WITH THE PATIENT TO EXPLAIN TO THEM THE PROCESS NECESSARY TO RECEIVE FINANCIAL ASSISTANCE. THIS PROCESS INCLUDES APPLYING FOR MEDICAID OR OTHER GOVERNMENT AID. THE APPLICANT THEN MUST FILL OUT A FINANCIAL INFORMATION WORKSHEET AND SUBMIT VARIOUS INFORMATION TO DETERMINE IF THEY QUALIFY FOR FINANCIAL ASSISTANCE IN ACCORDANCE WITH THE FINANCIAL ASSISTANCE POLICY. THE FINANCIAL ASSISTANCE POLICY IS POSTED AT EACH INPATIENT WAITING DESK. COMMUNITY INFORMATION THE COMMUNITY SERVED INCLUDES NORTHWEST INDIANA. OUR MARKET SHARE FOR THE PRIMARY SERVICE AREA IS 69%. THE POPULATION IS AMONG THE YOUNGEST WITH THE LOWEST MEDIAN INCOME WHEN COMPARED TO OTHER MARKETS IN NORTHWEST INDIANA. OUR MEDIAN INCOME IS $28,386. WE ALSO HAVE THE LEAST INSURANCE COVERAGE - 62% UNINSURED OR MEDICAID. PROMOTION OF COMMUNITY HEALTH SEE COMMUNITY BENEFITS STATEMENT IN SCHEDULE O AFFILIATED HEALTH CARE SYSTEM ST. CATHERINE HOSPITAL IS PART OF AN AFFILIATED SYSTEM. EACH HOSPITAL IN THE SYSTEM PROVIDES MEDICAL SERVICES TO THEIR COMMUNITIES AND ADJOINING COMMUNITIES. EACH ENTITY'S PURPOSE IS TO PROVIDE HEALTH CARE TO THOSE WHO NEED IT, INCLUDING THE UNINSURED OR UNDERINSURED. PART III, LINE 7 Cost Report (826,798) Physician practices (2,578,521) Medicare Managed Care (434,159) Fee-based Outpatient charges (2,222,060) Disallowed Medicare expenses (2,384,973) Total (Shortfall) (8,446,511) STATE FILING OF COMMUNITY BENEFIT REPORT 990 SCHEDULE H, PART VI IN, X true true X X X X X false false false false false false false false false KIMBERLY ARTHUR MD 301585 0 0 0 2322 0 7956 0 15534 0 327397 0 0 0 JOANN BIRDZELL 382793 0 101923 0 11471 0 54253 0 22180 0 572620 0 0 0 MARY ANN SHACKLETT 0 369682 0 148077 0 28832 0 34787 0 22173 0 603551 0 0 JOSEPH WINTERHALER 168570 0 43215 0 486 0 1463 0 19971 0 233705 0 0 0 PAULA SWENSON 177502 0 42920 0 773 0 9012 0 7833 0 238040 0 0 0 CRAIG BOLDA 0 187854 0 27865 0 1161 0 30761 0 22001 0 269642 0 0 PASTOR LLOBET MD 743220 0 0 3564 0 7350 0 1600 0 755734 0 0 0 SAMER ABBAS MD 550000 0 0 0 486 0 7350 0 1600 0 559436 0 0 0 DANIEL SAAH MD 503168 0 12500 0 2322 0 10432 0 20673 0 549095 0 0 0 SUBHASH JOSHI MD 386397 0 0 0 3564 0 9777 0 13951 0 413689 0 0 0 JATIN PATEL DO 364373 0 0 0 852 0 7350 0 26629 0 399204 0 0 0 SUPPLEMENTAL INFORMATION PART I, LINE 1a THE ORGANIZATION PAYS HEALTH/SOCIAL CLUB DUES ON BEHALF OF CERTAIN OFFICERS, KEY EMPLOYEES AND THE FIVE HIGHEST PAID EMPLOYEES WHICH IS THEN TAXED AS A FRINGE BENEFIT TO THE INDIVIDUAL. Jaime Ruiz-Montero MD Owner of Centro Medical 139504 House Physician & Medical Dir. false PATRICK WINTERHALER FAM MEM OF J WINTERHALER 12714 EMPLOYMENT false SUPPLEMENTAL INFORMATION Part III Line 4a and Schedule H - Other Information In 1928, St. Catherine Hospital, East Chicago, Indiana was opened to fill a need for health service to the communities of East Chicago, Whiting, Hammond and Gary. Today the hospital continues to provide a full range of medical services for inpatients and outpatients. St. Catherine Hospital is a non-profit hospital operating as a part of the Community Healthcare System, which includes Community Hospital in Munster, Indiana and St. Mary Medical Center in Hobart, Indiana. The hospitals are committed to providing the highest quality healthcare in the most cost-efficient manner, respecting the dignity of the individual, providing for the well-being of the community and serving the needs of all people, including the poor and disadvantaged. Community Healthcare System is the leading medical provider in Northwest Indiana, operating three non-profit hospitals, several outpatient clinics and physician offices. Together, the three operate the largest cardiovascular and cancer programs in the area. In the spirit of Katherine Kasper's founding charisma, St. Catherine Hospital continues to minister to our neighbors within the community; providing compassionate care of body and spirit. St. Catherine Hospital focuses on designing and providing services that meet the needs of its diverse community in East Chicago and the surrounding communities of Northwest Indiana. The hospital regularly surveys its patients to ascertain their satisfaction with its facilities and the programs that are offered and to identify the community's outstanding needs. By working in conjunction with our medical staff and associates, we ensure that programs and services not only address the patient's medical needs, but consider the patient's cultural and social needs as well. At St. Catherine Hospital, our mission and values guide us to provide quality, compassionate care for our patients and comfort for our visitors. Our philosophy is to care for all guests as if they were members of our own family. We have been recognized locally and nationally for various programs, proving our commitment to excellent service. The Joint Academy and Hand Center provides evidence based care for joint replacement surgeries. The Chest Pain Center is certified by the Society of Chest Pain Centers. It provides evidence based guidelines for patients arriving with a complaint of chest pain. For patients experiencing chest pain, the hospital achieves the ninety minute door to balloon time for STEMI (ST Segment Elevation Myocardial Infarction) patients. The Stroke Unit is Joint Commission certified. Our Emergency Services are recognized by HealthGrades. St. Catherine Hospital takes pride in being responsive to the needs of our community. Over the last several years, focused efforts have been made to develop outreach education programs and offer health screenings that address challenges unique in our neighborhoods. STOP Diabetes in East Chicago, Lupus education, the Well Walkers' Club, and free car seats provided to all families who deliver at St. Catherine Hospital are just a few of these programs. When possible, our community outreach team embraces innovative approach-taking programs out of the hospital and into local churches, community centers and the workplace. This approach allows us to serve more people in settings they find comfortable and convenient. A.A. Support Group-Our Alcoholics Anonymous support groups are open meetings for anyone wanting to learn how Alcoholics Anonymous functions. Blood Profile Screening-These screenings offer a way for those concerned about heart health to monitor cholesterol, HDL, triglycerides or glucose. No physician order is necessary for the screening. Cancer Survivors Day-The Cancer Resource Centre and St. Catherine Hospital provide a local celebration of this national event, honoring the strength and courage of those who have lived - and continue to live - with cancer. Prizes are raffled and each attendee receives a strength gift. Food and entertainment are also provided. Cardiac Rehab-Informational sessions are held that give patients an opportunity to ask a pharmacist questions regarding their cardiac medications. Handouts are provided to patients comparing certain blood pressure medications. Consoling Hearts Grief Support-This support group is offered to those suffering from the loss of a loved one. Participants include family members, friends, or those who are having a difficulty dealing with the loss of a loved one. Coronary Health Appraisal-This appraisal helps to determine risk for heart disease and other related medical conditions. Screening includes: cholesterol (total, HDL, LDL, triglycerides), blood sugar, metabolic syndrome, blood pressure, body mass index and a Heart Health Profile. Hope Network Cancer Support Group-The last Wednesday of each month this group meets for informative sessions where they can share thoughts and feelings in a comfortable and confidential atmosphere. Keeping Baby Safe and Healthy-Pediatrician, Dr. Iyer, discusses when to call the doctor, child-proofing the house, what to do in an emergency and nutritional needs of babies. Information on child seat safety is also available. Moving Forward-Stroke Education-This five part series helps Stroke survivors and caregivers learn to prevent future strokes through risk detection and management. N.A. Support-Narcotics Anonymous offers hope for anyone with the desire to stop using narcotics and a willingness to try a new way of life. Nutrition Counseling-Dietary evaluation and counseling is provided by a registered dietitian. PAD-What's It All About?-The Cardiac Rehabilitation Medical Director discusses peripheral arterial disease (PAD). Attendees learn the signs, symptoms, causes and treatment of this serious disease. Skin Cancer Screenings-Physician examines any questionable areas of the body to look for indications of cancer or pre-cancerous conditions. This screening takes place at a participating St. Catherine Hospital physician's office on a monthly basis. Collection Policy Schedule H Part III Line 9B Collection policies are the same for all patients. Patients are screened for eligibility for financial assistance before collection procedures begin. If at any point in the collection process, documentation is received that indicates the patient is potentially eligible for financial assistance but has not applied for it, the account is referred back for a financial assistance review. PART VI Line 7a Community Foundation of Northwest Indiana Inc is the parent company of St Catherine Hospital Inc and has control to elect members of their governing body. PART VI Line 7b Community Foundation of Northwest Indiana Inc is the parent of St Catherine Hospital Inc and has the rights to approve decisions made by St Catherine Hospital Inc. PART VI Line 11a THE 990 IS SUBMITTED TO THE SENIOR VP AND CFO FOR REVIEW. ONCE THIS REVIEW IS COMPLETE THE RETURNS ARE THEN PRESENTED TO SENIOR LEADERSHIP FOR REVIEW. THE 990 IS ALSO REVIEWED BY AN INDEPENDENT PUBLIC ACCOUNTING FIRM BEFORE IT IS POSTED TO A SECURE WEBSITE TO ALLOW THE BOARD OF DIRECTORS TO REVIEW PRIOR TO FILING. PART VI Line 12c AS PART OF THE ORGANIZATION'S ANNUAL MONITORING AND ENFORCEMENT PROCEDURES RELATING TO ITS CONFLICT OF INTEREST POLICY, ALL CONFLICT OF INTEREST QUESTIONNAIRES ARE REVIEWED AND THOSE OFFICERS, DIRECTORS, OR KEY EMPLOYEES WHO DO NOT RETURN OR FULLY COMPLETE THE QUESTIONNAIRE ARE CONTACTED TO RECONCILE THE OMISSION. PART VI Line 15a and 15b SCH FOLLOWS THE PARENT (CFNI) POLICY. THE CFNI BOARD HAS ADOPTED EXECUTIVE AND BOARD OF DIRECTORS COMPENSATION PHILOSOPHY AND REASONABLENESS STANDARDS. THIS IS TO ASCERTAIN THAT THESE STANDARDS ARE ADHERED TO. THEIR PROCESS FOR COLLECTING AND ASSEMBLING MARKET DATA IS CONSISTENT WITH THE REBUTTABLE PRESUMPTION CHECKLIST AND GUIDELINES ALONG WITH FAIR MARKET VALUE USED BY THE IRS IN CONDUCTING EXECUTIVE COMPENSATION REVIEWS AS WELL AS CONTEMPORARY COMPENSATION PRACTICES. ALL MARKET DATA IS ASSEMBLED FROM REPUTABLE COMMERCIALLY AVAILABLE SURVEYS. PART VI Line 19 ST CATHERINE HOSPITAL INC DOES NOT MAKE ITS GOVERNING DOCUMENTS OR CONFLICT OF INTEREST POLICY AVAILABLE TO THE PUBLIC. IN ACCORDANCE WITH BOND COVENANTS, ST CATHERINE HOSPITAL INC THROUGH COMMUNITY FOUNDATION OF NORTHWEST INDIANA MAKES ITS FINANCIAL STATEMENTS AND DISCLOSURES AVAILABLE TO THE PUBLIC THROUGH THE EMMA DATABASE. PART VII SECTION A. HOURS FOR RELATED ORGANIZATIONS CFNI SCH SMMC CH CVI TATC CVPA CCRF TOTAL Henry Hadidian, MD 10 10 Joseph Semancik, Monsignor 1 1 1 Jaime Ruiz-Montero, MD 29 29 Edward Williams, PHD 1 1 1 Joseph Costanza 1 1 2 Peggy S. Gerard 1 1 2 Kimberly Arthur, MD 41 41 JoAnn Birdzell 41 41 Mary Ann Shacklett 41 1 1 1 1 1 1 1 48 Craig Bolda 41 41 Henry Hadidian, MD: Compensation is for hours worked as Medical Director of Utilization Review and Wound Care Joseph Semancik, Monsignor: Related organization compensation is for attending CFNI monthly BOD and Committee meetings Jaime Ruiz-Montero, MD: Compensation is for hours worked as Medical Director of Diabetes Center and as a House Physician Edward Williams, PHD: Related organization compensation is for attending CFNI monthly BOD and Committee meetings Joseph Costanza: Related organization compensation is for attending CFNI monthly BOD and Committee meetings Peggy Gerard: Related organization uncompensated CVI BOD and Committee meetings Kimberly Arthur, MD: Compensation is for hours worked as an Employed Physician JoAnn Birdzell: Compensation is for hours worked as the Hospital Administrator Mary Ann Shacklett: Related organization compensation is for hours worked as the system CFO. Related organization hours are for attending BOD and committee meetings Craig Bolda: Related organization compensation is for hours worked as the Hospital COO Part XI Line 5 Other Changes in Net Assets AMOUNT TRANSFERED FROM COMMUNITY FOUNDATION OF NORTHWEST INDIANA, INC. (PARENT) $3,948,961. COMMUNITY FOUNDATION OF NW INDIANA INC 10010 DONALD POWERS DR MUNSTER IN 46321 311128781 SUPPORTNG ORG IN 501(C)(3) 11(C) NA false MUNSTER MEDICAL RESEARCH FOUNDATION INC 800 MACARTHUR BLVD MUNSTER IN 46321 351107009 HOSPITAL IN 501(C)(3) 3 CFNI true ST MARY MEDICAL CENTER 1500 SOUTH LAKE PARK AVE HOBART IN 46342 352007327 HOSPITAL IN 501(C)(3) 3 CFNI true COMMUNITY CANCER RESEARCH FOUNDATION 901 MACARTHUR BLVD MUNSTER IN 46321 352146374 CANCER FUNDRA IN 501(C)(3) 7 MMRF true COMMUNITY VILLAGE INC 10000 COLUMBIA AVE MUNSTER IN 46321 351956395 RETIREMT HOME IN 501(C)(3) 9 CFNI true THEATRE AT THE CENTER 1040 RIDGE RD MUNSTER IN 46321 351939427 CONCERTS IN 501(C)(3) 9 CFNI true CVPA HOLDING COMPANY 905 RIDGE RD MUNSTER IN 46321 351938136 SUPPORTNG ORG IN 501(C)(2) N/A CFNI true COMMUNITY RESOURCES INC 907 RIDGE RD MUNSTER IN 46321 351727711 MGMT SERVICES IN NA C CORP false true true false false false false false true false false false false true true true false false MUNSTER MEDICAL RESEARCH FOUNDATION INC N 2089978 FMV ST MARY MEDICAL CENTER N 331189 FMV MUNSTER MEDICAL RESEARCH FOUNDATION INC O 5690158 FMV ST MARY MEDICAL CENTER O 1236870 FMV MUNSTER MEDICAL RESEARCH FOUNDATION INC P 2541255 FMV ST MARY MEDICAL CENTER P 128639 FMV