2013-08-14T07:30:16-05:00 2012-09-30 550486667 Arnett Foster Toothman PLLC P O Box 2629 Charleston WV 25329 990 2011-10-01 550357050 St Mary's Medical Center STMA 3045268931 2900 First Avenue Huntington WV 257021271 Michael Sellards 3045268931 2013-07-18 1 Harry C Harless P01042847 3043460441 2011 2016-02-25 16:41:14Z Michael Sellards 2900 First Avenue Huntington WV 257021271 405524123 0 0928 X www.st-marys.org X 1924 WV Hospital with open emergency room. 12 6 2725 376 0 0 775398 819525 368164897 387668763 3744034 3048203 -2098037 -1711710 370586292 389824781 330038 570850 0 0 150032531 164415846 0 0 0 204785584 209898182 355148153 374884878 15438139 14939903 288603326 326242340 212753257 239555098 75850069 86687242 X We are inspired by the love of Christ to provide quality health care in ways which respect the God-given dignity of each person and the sacredness of human life. 0 0 325487813 171904 382915816 St. Mary's Medical Center was established in 1924 and, based on thecore values of compassion, hospitality, reverence, trust, interdependency, and stewardship, continues to provide high quality healthcare services to residents of Huntington, West Virginia and the surrounding area. Services are provided without regard to the patient's race, creed, sex, national origin, age, or handicap. Furthermore, while reimbursement for care provided is crucial to the continued operation of St. Mary's Medical Center, it is recognized that circumstances existwhich render certain parties unable to pay for needed services, and no patient is denied services due to the lack of ability to pay. During the fiscal year which ended September 30, 2012, St. Mary's Medical Center provided 100,003 days of inpatient days of care and treated an additional 261,256 patients in the emergency and outpatient settings.Approximately seventy-two percent of the inpatients served were covered by governmental programs, such as Medicare and Medicaid. A similar percentage is applicable to outpatient services. Since care provided to Medicare and Medicaid beneficiaries is subject to contractual reimbursement restrictions, payment received for services provided is often significantly below the actual cost of the services. St. Mary's Medical Center has established charity care policies and guidelines, used to help identify those patients who genuinely do not have the resources to pay for services received. During fiscal 2012, the hospital provided approximately $13.6 million dollars in charity care services, representing care provided at reduced prices or completely free of charge. These services include inpatient services, an adult outpatient clinic,a handicapped children's clinic, and a specialty pregnancy clinic. Also, St. Mary's Medical Center exceeds the guidelines established for the West Virginia ad valorem statute. 1090288 365141 450000 In addition to those patients without the wherewithal to pay for services rendered, we assist in the relief of burden of government for several programs. A strong auxiliary (operated as a department of the hospital) exists, which contributes heavily to the activities of SMMC. During fiscal 2012, the auxiliary made cash donations of approximately $450,000. In addition, volunteers provided over 38,165 hours of service valuable to promoting the mission and activities of the hospital. 9130303 4302947 St. Mary's Medical Center also recognizes that carrying out its mission of community service is not confined to the walls of the hospital's buildings and that there are residents in need of services who may never be a registered patient of the hospital. In meeting the needs of these individuals and groups, St. Mary's Medical Center provides or participates in numerous educational activities, support groups and health screenings and provides human resources, as appropriate, to support other charitable organizations. A summary of these community services as prepared by the hospital's mission integration department for the Catholic Health Association is listed below.The St. Mary's Tri-State Triathlon was held on August 1 and includes three separate races - a triathlon, triathlon relay and duathlon. The triathlon consists of a half-mile swim, 15-mile bike ride and 2.9-mile loop run. In the duathlon, the swim course is replaced by a 2.9-mile loop run in the opposite direction of the previous loop. Races use computer-chip timing. The event averages 200+ participants each year but it has a wider reaching impact of promoting fitness in the community with news coverage of stories about first time participants and their ability to complete a triathlon. Many family and friends also gather at the event as spectators and some are inspired to compete in the next year's event.The St. Mary's Kids Try-A-Triathlon for ages 6-14 was held on July 31 at Beech Fork Lake. Races consist of either a 50- or 100-yard swim, a two- or four-mile bike course, and a one- or two-mile run, depending on the age group. There is a kids camp leading up to this event that helps train young people to participate in the triathlon. Race day participation 100+.PATH Project - St. Mary's is a sponsor of the Paul Ambrose Trail for Health (PATH) project which is designed to develop a 26-mile bicycle and pedestrian path system that will link the various Huntington parks. This project will promote wellness by offering family-healthy area throughout Huntington for the public. FitFest is held annually each year on 9-11 to focus the entire community on fitness and St. Mary's is a major sponsor. 500+ participants at FitFest. Web site: www.paulambrosetrailforhealth.orgAHA Start Heart Walk - St. Mary's has been the main sponsor for the Heart Walk each year. As one of St. Mary's major service lines, the Regional Heart Institute promotes healthy heart activities for the public throughout the year, but the Heart Walk and the Go Red Luncheon for Women are two of our main events. The Heart Walk generates team building by raising funds for the American Heart Association, ending with the actual walk at Ritter Park. St. Mary's employee teams are joined by teams all across Cabell and Wayne Counties both raising funds for heart research and supporting walking as a family heart-healthy activity. 300+ participants each year for the walk. Wider exposure through advertising heart healthy education tips and information.An Evening of Zumba - A local cancer survivor and instructor of Zumba at St. Mary's promoted the idea of an Evening of Zumba in order to raise funds for the Pink Ribbon Fund - a fund set aside to cover the costs of mammograms for women who cannot afford to be tested for breast cancer. The event was free, but donations were accepted and 100% was given to the Pink Ribbon Fund at St. Mary's Breast Center. There were over 100 participants.The Mileage Club is now a program in every elementary school in Cabell County, West Virginia and some schools in Lawrence County, Ohio. The program is run by St. Mary's Regional Heart Institute in cooperation with school physical education teachers. It encourages kids to set walking goals with incentives to complete those goals. Hundreds of kids are healthier as a result of this program.TIPS Program: TIPS is a two-part program developed by St. Mary's Regional Neuroscience Center that consists of an annual youth safety fair and an education plan delivered to school children throughout the school year. Matt Herbert speaks to 1000+ school students every year in addition to free bicycle helmet giveaways. Approximately 500 students receive free helmets each year.Additionally St. Mary's participates in numerous health fairs throughout the year. They provide screenings for health issues such as cholesterol, blood sugar, HDL, osteoporosis, etc. at no charge. Also, education about various health issues such as stroke risk, joint replacement surgery, and other health risk factors are provided. There are 1000+ people screened each year through free screenings. St. Mary's also sponsored many other races and walks that promoted wellness and fitness and those include the Ridge to River 10 mile trail run in June, the St. Mary's Veteran's Memorial Day 5K run in May in Ironton, Ohio, the Herald Dispatch West Virginia 5K in June, the Marshall/St. Mary's Marathon in November, the St. Mary's/Lion's Club 5K in March and the Path to the Cure 5K in September. 335708404 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 0 1 0 0 0 0 1 1 1 1 0 0 1 124 0 1 2725 1 0 0 0 0 0 0 0 0 X 12 6 0 1 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 X Angela Swearingen 3045268931 2900 First Avenue Huntington WV 25702 X Sister Celeste Lynch 1.00 X 0 0 0 Michael G Sellards 34.00 X X 0 840980 39713 Sister Marian Ruth Creamer 38.00 X 0 0 0 Sister Joanne Obrochta 1.00 X 0 0 0 Tom Houvouras 2.00 X 0 0 0 Julia Hutchison 1.00 X 0 0 0 Jeff Leaberry 1.00 X 0 0 0 Tim Daly 1.00 X 0 0 0 Richard Muth 1.00 X 0 0 0 Sister Rosella Sparks 1.00 X 0 0 0 Sister Elisabeth Heptner 1.00 X 0 0 0 Matt Miller 1.00 X 0 0 0 Todd Campbell 34.00 X 0 404789 45857 Angela D Swearingen 34.00 X 0 269117 28765 Vera Rose MD 40.00 X 274922 0 30323 Susan Beth Robinson 40.00 X 231657 0 29923 Timothy Parnell 40.00 X 214909 0 29420 Elizabeth Bosley 40.00 X 193899 0 28790 Robert Hay 40.00 X 144478 0 27307 Sonya Arthur 40.00 X 155945 0 27565 Rita Barker 40.00 X 166021 0 21303 Susan Greer 40.00 X 137245 0 27090 Jeffrey Zopp 40.00 X 137116 0 27086 Tyson Smith 40.00 X 127908 0 11495 1784100 1514886 374637 73 1 1 0 American Red Cross 4 Chase Metrotech Center 7th Floor Brooklyn NY 11245 Medical 3110726 University Physicians & Surgeons 1600 Medical Center Drive Ste B501 Huntington WV 25701 Medical 2829096 Aramark Corporation 12483 Collections Center Drive Chicago IL 60693 Biomedical Services 1885511 Executive Health Resources PO Box 822688 Philadelphia PA 19182 Consulting 1522265 Alliance Heathcare Services PO box 96485 Chicago IL 60693 Medical 1473259 56 99831 719694 819525 Patient Service Revenu 621400 383733328 383733328 School of Nursing 611600 1065737 1065737 Rental Income 531120 882877 882877 School Radiology 611600 539040 539040 Purchase Rebates 900099 478190 478190 969591 969591 387668763 1649558 1649558 16363867 8973 14974195 0 1389672 8973 1398645 1398645 779846 725147 54699 54699 Cafeteria Sales 722100 2849900 2849900 Maintenance of Sisters 811000 54000 54000 Other Investment Incom 900099 -5502329 -5502329 832020 832020 -1766409 389824781 387668763 0 1336493 570850 570850 1583667 1362587 221080 112219812 96553926 15665886 6319817 5437571 882246 34009813 29262043 4747770 10282737 8847267 1435470 2075160 2075160 166667 166667 33300417 28651679 4648738 2581884 2221453 360431 24731409 21278904 3452505 3370116 2899648 470468 4530881 3898370 632511 167880 144444 23436 3708092 3190442 517650 15047540 12946903 2100637 1658455 1426935 231520 Medical supplies 61890338 61890338 Bad debts 35700966 35700966 Provider tax 9929629 9929629 Repairs & Maintenance 9336901 8033470 1303431 1701847 1460979 240868 374884878 335708404 39176474 0 5027 5027 26971075 13319721 73784392 79289937 9924139 10314370 3144454 6951651 374988812 240234416 131826911 134754396 51971227 71322242 -14303905 6046973 5280006 4238023 288603326 326242340 28846859 31883988 2692 7213 97468141 95010276 2745337 1813073 83690228 110840548 212753257 239555098 X 74441562 84902717 1408507 1784525 75850069 86687242 288603326 326242340 X 14939903 -4102730 X X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 6613123 6613123 169025242 103943813 65081429 189615844 134267629 55348215 9734603 2022974 7711629 134754396 Deferred salaries & wages 1647172 General reserves 3531370 Accrued pension costs 104286182 St Mary's Medical Management LLC 1375824 110840548 389824781 374884878 14939903 2854087 -6956817 -4102730 10837173 Part XI, Line 8 - Other Adjustments: Transfer from Affiliates 26,307,138. Change in pension fund status -26,050,150. Loss from affiliate -5,951,855. Difference in book/tax partnership income -190,654. Prior period adjustment-affiliate -1,071,296. Total to Schedule D, Part XI, Line 8: -6,956,817. 1 1 1 X 1 X 1 1 1 0 1 1 10439 5062553 5062553 0.01350 36289 54409886 44266051 10143835 0.02710 46728 59472439 44266051 15206388 0.04060 3 1372 6286 6286 0.00000 4 86 8634056 4302947 4331109 0.01160 3 3024 421660 421660 0.00110 10 4482 9062002 4302947 4759055 0.01270 10 51210 68534441 48568998 19965443 0.05330 1 812 24016 24016 0.00010 1 6268 44285 44285 0.00010 2 7080 68301 68301 0.00020 1 13272220 2613661 106806664 109277079 -2470415 X 1 1 1 Huntington Area MRI Provide MRI scans. 0.49000 0.51000 2 St Mary's Occupational Health Occupational therapy. 0.51000 0.49000 1 1 St Mary's Medical Center

2900 First Avenue Huntington WV 25702

X X X X St Mary's Medical Center 1 1 1 100.000000000000 1 200.000000000000 1 X X X X 1 1 X X X X 1 X 1 X X X X 1 0 0 Part I, Line 3c: Eligibility is determined by comparing household family income against the income poverty guidelines for financial indigence; a ratio of total medical expenses to annual disposable income for medical indigence. Income is defined as the total annual cash receipts before taxes from all sources.Financially indigent. Uncompensated care shall include unreimbursed services to the financially indigent. Financially indigent shall mean uninsured or underinsured patients accepted for care with no obligation or a discounted obligation to pay for services rendered based on the medical center's eligibility system which may include:(a) income levels and means testing or other criteria for determining a patient's inability to pay; or (b) other criteria for determining a patient's inability to pay that are consistent with the medical center's mission and established policy. The federal poverty level shall serve as an index for the threshold below which patients receiving care at St. Mary's Medical Center are deemed financially indigent. Financially indigent services include noncovered services for patients eligible for the Medicaid program, services providedunder county indigent care contracts, and other state or federal assistance programs for low income groups.Medically indigent. Uncompensated care shall include unreimbursed services to the medically indigent. Medically indigent shall mean patients who are responsible for their living expenses, but whose medical and hospital bills, after payment by third party payers, where applicable, exceed: (a) a specified percentage of the patient's annual gross income (i.e., catastrophic medical expenses) in accordance with the Medical Center's formal eligibility system in such instances where payment would require liquidation of assets critical to living or earning a living; or (b) the criteria for determining a patient's inability to pay.While financial indigence is based strictly on an income level, medical indigence considers both income and the financial obligation for healthcare services to calculate the patient's ability to pay without liquidating assets critical to living or earning a living, such as a home, car, personal belongings, etc. Therefore, patients are considered for medically indigent status on a case by case basis. The patient would be required to provide documentation of income to determine if he/she is to be considered medically indigent. All patients are eligible to be considered for medically indigent status with the exception of patients with income below 200% of the federal poverty level as these patients are considered for some level of uncompensated care under the financially indigent category. Part I, Line 6a: SMMC prepares an annual written report that describes programs and services that promote the health of our community. The Community Benefit Report provides valuable information on programs and services provided by the Medical Center. The report is distributed to Hospital board members but it has not been distributed to the general public. The report is compiled using the program "A Guide for Planning and Reporting Community Benefit." Part I, Line 7: The cost to charge ratio as calculated fromworksheet 2 was used to determine community benefit expenses for all subsidized health services. Part II: St. Mary's has sponsored a number of community building activities during the past year that promote wellness and help enrich the lives of people in the Tri-State. Some of these are as follows:The St. Mary's Tri-State Triathlon was held on August 1 and includes three separate races - a triathlon, triathlon relay and duathlon. The triathlon consists of a half-mile swim, 15-mile bike ride and 2.9-mile loop run. In the duathlon, the swim course is replaced by a 2.9-mile loop run in the opposite direction of the previous loop. Races use computer-chip timing. The event averages 200+ participants each year but it has a wider reaching impact of promoting fitness in the community with news coverage of stories about first time participants and their ability to complete a triathlon. Many family and friends also gather at the event as spectators and some are inspired to compete in the next year's event.The St. Mary's Kids Try-A-Triathlon for ages 6-14 was held on July 31 at Beech Fork Lake. Races consist of either a 50- or 100-yard swim, a two- or four-mile bike course, and a one- or two-mile run, depending on the age group. There is a kids camp leading up to this event that helps train young people to participate in the triathlon. Race day participation 100+.PATH Project - St. Mary's is a sponsor of the Paul Ambrose Trail for Health (PATH) project which is designed to develop a 26-mile bicycle and pedestrian path system that will link the various Huntington parks. This project will promote wellness by offering family-healthy area throughout Huntington for the public. FitFest is held annually each year on 9-11 to focus the entire community on fitness and St. Mary's is a major sponsor. 500+ participants at FitFest. Web site: www.paulambrosetrailforhealth.orgAHA Start Heart Walk - St. Mary's has been the main sponsor for the Heart Walk each year. As one of St. Mary's major service lines, the Regional Heart Institute promotes healthy heart activities for the public throughout the year, but the Heart Walk and the Go Red Luncheon for Women are two of our main events. The Heart Walk generates team building by raising funds for the American Heart Association, ending with the actual walk at Ritter Park. St. Mary's employee teams are joined by teams all across Cabell and Wayne Counties both raising funds for heart research and supporting walking as a family heart-healthy activity. 300+ participants each year for the walk. Wider exposure through advertising heart healthy education tips and information.An Evening of Zumba - A local cancer survivor and instructor of Zumba at St. Mary's promoted the idea of an Evening of Zumba in order to raise funds for the Pink Ribbon Fund - a fund set aside to cover the costs of mammograms for women who cannot afford to be tested for breast cancer. The event was free, but donations were accepted and 100% was given to the Pink Ribbon Fund at St. Mary's Breast Center. There were over 100 participants.The Mileage Club is now a program in every elementary school in Cabell County, West Virginia and some schools in Lawrence County, Ohio. The program is run by St. Mary's Regional Heart Institute in cooperation with school physical education teachers. It encourages kids to set walking goals with incentives to complete those goals. Hundreds of kids are healthier as a result of this program.TIPS Program: TIPS is a two-part program developed by St. Mary's Regional Neuroscience Center that consists of an annual youth safety fair and an education plan delivered to school children throughout the school year. Matt Herbert speaks to 1000+ school students every year in addition to free bicycle helmet giveaways. Approximately 500 students receive free helmets each year.Additionally St. Mary's participates in numerous health fairs throughout the year. They provide screenings for health issues such as cholesterol, blood sugar, HDL, osteoporosis, etc. at no charge. Also, education about various health issues such as stroke risk, joint replacement surgery, and other health risk factors are provided. There are 1000+ people screened each year through free screenings. St. Mary's also sponsored many other races and walks that promoted wellness and fitness and those include the Ridge to River 10 mile trail run in June, the St. Mary's Veteran's Memorial Day 5K run in May in Ironton, Ohio, the Herald Dispatch West Virginia 5K in June, the Marshall/St. Mary's Marathon in November, the St. Mary's/Lion's Club 5K in March and the Path to the Cure 5K in September. Part III, Line 4: The text of the footnote reads as follows: "theHospitals provide care to patients who meet specific criteria, defined by their charity care policies, without charge or at amounts less than theirestablished rates, as approved by the West Virginia Health Care Authority (HCA). Because the Hospitals do not pursue collection of amounts determined to qualify as charity care, such amounts are not reported as revenue."The hospital's cost-to-charge ratio was used to compute bad debt expense at cost. Part III, Line 8: Patient level detail data is used to calculate the uncompensated cost of bad debt and charity. Once an account is written off to bad debt and/or charity, the entire cost of the account is classified as bad debt and/or charity and any payments received are netted against the cost of the account to determine the uncompensated costs.The cost-to-charge ratio as reported on the facility's Medicare CostReport was used to compute the Medicare allowable costs. Part III, Line 9b: The hospital provides care to patients who meet specific criteria, defined by its charity care policy, without charge or at amounts less than the rates approved by the West Virginia Health Care Authority. Because the hospital does not pursue collection of amounts determined to qualify as charity care, such amounts are not reported as revenue. Part V, Section A: This facility includes a school of nursing, school of respiratory therapy, a school of medical imaging and a clinical pastoral education program. Interns and residents from Marshall University School of Medicine are also assigned at the hospital for their clinical rotations as are students in community based Practical nursing programs. Part VI, Line 2: SMMC takes steps to determine what the most pressing needs are in order provide services to address them. The hospital regularly assesses the needs of the community. Periodic needs assessments are conducted in partnership with our local health department.Additionally, we monitor county, state, and national health indicators and work in partnership with service agencies in the communities we serve to meet identified needs. Part VI, Line 3: SMMC employs a variety of methods to reach patients with information about financial assistance, including:* Financial assistance posters are displayed in all emergency,admitting, outpatient, and clinic areas that include a phone numberto call for financial assistance counseling.* Hospital departments that have initial contact with incominginpatients and outpatients are supplied with brochures aboutfinancial assistance for distribution to patients and family members.* The hospital employs trained financial assistance counselors whowork individually with patients to assess financial need andrecommend appropriate assistance such as application for federaland/or state programs; qualification for charity care; determinationof automatic discounts and/or further reductions in charges; andsetting up long-term financial arrangements. Part VI, Line 4: St. Mary's Medical Center serves the greater Huntington, West Virginia community with a primary service area that includes Cabell, Wayne, Mason, Putnam and Lincoln counties in West Virginia and Lawrence county in Ohio. St. Mary's also serves a much wider service area because of specialty medical services including advanced emergency trauma care, advanced stroke care, advanced spine care, advanced heart care, advanced cancer care, and advanced orthopedic care. That secondary service area includes Logan and Mingo counties in West Virginia, as well as Boyd, Greenup, Carter, Lawrence, Johnson, Floyd and Pike counties in Kentucky and Scioto and Gallia Counties in Ohio.Competitors within our primary service area are Cabell HuntingtonHospital (Cabell county) and CAMC Teays Valley (Putnam county).The most recent statistics from the U.S. census bureau show that thehigh school graduation rate (age 25+) for Huntington is 86.0%. Thepercentage of Huntington residents living below that federal povertylevel is 30.2%. Cabell county birth rates for 15 to 19 year-olds is42.3 per 1000 females. Part VI, Line 5: St. Mary's operates an emergency room that is open to all persons regardless of ability to pay and has an open medical staff with privileges available to all qualified physicians in the area. The board of directors represents medical and business professionals, as well sisters from the Pallottine Missionary Sisters. All provide hours of service in support of our hospital. They are deeply involved in our needs assessment process, building programs and services, and community outreach to ensure that people know about services available to them through our hospital.St. Mary's engages in medical and scientific research programs; engages in the training and education of health care professionals: physicians, nurses, medical imaging tech, respiratory techs, and chaplains; and participates in Medicare, Medicaid, and other government-sponsored health care programs.St. Mary's adheres to community benefit guidelines outlined in the Catholic Health Association's publication, "A Guide for Planning and Reporting Community Benefit."Community benefit work is driven by community health needs and directed in collaboration with other health care organizations and the broader community. Community benefit strategies are integrated in the organizational strategic plan. Programs are located throughout the organization, and staff and board education is conducted. Dedicated staff is committed to community benefit efforts.The St. Mary's Foundation is a non-profit organization that provides grant writing and fundraising for both medical center programs and for community benefit programs that reach both the poor and the broader community. Operations of the Foundation are governed by a separate Foundation board with voluntary memberships from the local community.When St. Mary's has excess revenue over operating expenses, we use those funds to obtain current health care technologies and equipment, improve patient care, provide medical training education and research, and to expand access to points of care. These investments ensure that we will be here to care for future generations. Part VI, Line 6: St. Mary's Medical Center is a not-for-profit health care facility wholly sponsored by Pallottine Health Services, Inc. (PHS). Pallottine Health Services is a ministry of the Pallottine Missionary Sisters and includes both St. Joseph Hospital of Buckhannon, West Virginia and St. Mary's Medical Center of Huntington, West Virginia. Both of these hospitals are committed to the core values of compassion, hospitality, reverence, interdependence, stewardship, and trust. Reports Filed With States Part VI, Line 7 WV 1 American Heart Association 162 Court St Charleston WV 25301 135613797 501(c)(3) 20000 For general operations of the Association in furtherence of their mission to reduce heart disease. Huntington Museum of Art 2033 McCoy Road Huntington WV 25701 530372921 501(c)(3) 9500 For general operations of the Museum. Rahall Transportation Institute Foundation PO Box 5425 Huntington WV 25703 550683361 501(c)(3) 10000 To help promote transportation safety. Huntington Area Development Council 916 Fifth Ave Huntington WV 25701 550714570 501(c)(3) 31250 To promote job creation. Healthy Huntington Organization 2 Partridge Court Huntington WV 25705 261775212 501(c)(3) 25000 To sponsor fundraising race. Huntington Regional Chamber of Commerce PO Box 1509 Huntington WV 25716 550199470 501(c)(6) 6900 To support economic development in the County. American Cancer Society 611 7th Ave Ste 101 Huntington WV 25701 131788491 501(c)(3) 5000 To support the organization in their fight against cancer. Lawrence County Emergency Medical Service 836 4th Ave Huntington WV 25701 316400073 County government 54000 For the purchase of ambulance monitors. Marshall Artist Series (Marshall Foundation) One John Marshall Drive Huntington WV 25701 556011111 501(c)(3) 11200 To support arts in Huntington, WV. Huntington Symphony Orchestra 763 3rd Ave Huntington WV 25725 237427617 501(c)(3) 5000 To support arts in Huntington, WV. Cabell County 4-H Foundation 2726 Howells Mill Road Ona WV 25545 556000305 County government 10000 To support the development of youth. United Way of the River Cities 820 Madison Ave Huntington WV 25704 550384704 501(c)(3) 7000 To support community development. Ebenezer Community Outreach 1448 Tenth Ave Huntington WV 25701 550745033 501(c)(3) 51000 To support community pharmacy. Ironton-Lawrence County CAO 305 N 5th St Ironton OH 45638 310714190 501(c)(3) 150000 To support community development. Valley Health 2585 Third Ave Huntington WV 25703 550554001 501(c)(3) 175000 To support community health. Procedure for Monitoring Grants in the U.S.: Part I, Line 2: Schedule I, Part I, Line 2: To ensure proper use of funds, the requesting organization is required to document the use of the grant monies. When a request for funds is received and has been approved, the funds are either authorized for use or disbursed to the requesting organization. X X 0 0 X X X X 1 0 0 0 0 0 0 0 0 Michael G Sellards 0 565000 0 141250 0 134730 0 23850 0 26560 0 891390 0 16500 Todd Campbell 0 300237 0 59658 0 44894 0 23850 0 23238 0 451877 0 16500 Angela D Swearingen 0 225272 0 31695 0 12150 0 6758 0 23273 0 299148 0 0 Vera Rose MD 262922 0 12000 0 0 0 7350 0 23638 0 305910 0 0 0 Susan Beth Robinson 203081 0 28576 0 0 0 6950 0 23543 0 262150 0 0 0 Timothy Parnell 186832 0 28077 0 0 0 6447 0 23506 0 244862 0 0 0 Elizabeth Bosley 170171 0 23728 0 0 0 5817 0 23460 0 223176 0 0 0 Robert Hay 144478 0 0 0 0 0 4334 0 23351 0 172163 0 0 0 Sonya Arthur 153075 0 2870 0 0 0 4592 0 23370 0 183907 0 0 0 Rita Barker 157162 0 8859 0 0 0 4715 0 16994 0 187730 0 0 0 Susan Greer 137245 0 0 0 0 0 4117 0 23335 0 164697 0 0 0 Jeffrey Zopp 137116 0 0 0 0 0 4113 0 23335 0 164564 0 0 0 Tyson Smith 127908 0 0 0 0 0 3837 0 7999 0 139744 0 0 0 Part I, Line 1a Michael Sellards, the CEO, is entitled to reimbursement for reasonable travel expense for his spouse to accompany him to three educational meetings per year; one of which being the West Virginia Hospital Association annual meeting. Mary Ann Brown Former CFO and current Director of Business Development and Outreach 133182 SMMC paid $133,182 to Mountain State Cabling, which is partially owned by Mary Ann Brown. 0 Form 990, Part VI, Section A, line 3 The organization utilizes an outside contractor that supplies a director over the organization's IT staff. The director manages the two IT managers (employees of the organization), who in-turn manage the rest of the IT staff. The director is responsible for completing evaluations for the two managers and then signs off on the evaluations of their staff, which includes the rest of the IT staff. The outside contractor does not have the ability to hire or fire an employee without the approval of the CFO (as would other Directors who are SMMC employees). Form 990, Part VI, Section A, line 6 The organization is a membership (not a stock) corporation under West Virginia state law. The organization's sole corporate member is Pallottine Health Services, a related not-for-profit organization. Form 990, Part VI, Section A, line 7a In accordance with the terms and requirements of its governing documents (i.e. bylaws), on an annual basis, the organization's current board members recommend the list of candidates for membership to the governing body for the subsequent term to the St. Mary's Medical Center board of directors. The board of directors approve and elect these candidates to serve as the organization's board of directors. Form 990, Part VI, Section A, line 7b Pallottine Health Services, as the sole corporate member, also has the right to approve or ratify significant decisions of the organization's governing body including the amendment of bylaws and charters, removal of members of the governing body, and the decision to dissolve the organization. Form 990, Part VI, Section B, line 11 The Form 990 is reviewed by the organization's management in consultation with an independent accounting firm. The financial review is based on the organization's audited financial statements for the relevant time period. Before the Form 990 is filed with the IRS, representatives of the organization's board of directors review the Form 990. A complete copy of the same was provided to the St. Mary's Medical Center full board at their board meeting on June 18, 2013. Form 990, Part VI, Section B, line 12c Upon employment and annually thereafter each key employee and officer of the organization is required to complete a conflict of interest and disclosure form, providing sufficient information about his/her personal interests and relationships so the organization can (1) determine whether any potential or actual conflicts of interest may exist, and (2) monitor work or service assignments to avoid placing the key employee, officer or director in a position where there may be an appearance, potential or actual, of a conflict of interest or a question of objectivity. The completed conflicts of interest and disclosure forms for directors are returned to the organization. In the event that any board member is deemed to lack independence or a conflict of interest exists, he/she is required to leave the room and cannot be part of the discussion or vote. Form 990, Part VI, Section B, line 15 On a regular basis, the organization provides documentation to the compensation committee of the Pallottine Health Services, Inc. board with respect to the compensation of the organization's officers and key employees for review and approval. Such information includes comparable data from similar size tax-exempt organizations in the Huntington, West Virginia community as well as compensation for these positions (as disclosed on form 990) with other organizations in the health care industry that are of similar size, demographics, and geography. Review and approval of the compensation arrangement by the officers/executive committee is documented. Form 990, Part VI, Section C, line 19 The organization makes its governing documents, conflict of interest policy, and financial statements available to the public upon request at its office at 2900 First Avenue, Huntington, WV 25702. A nominal fee is charged if copies are requested. Evaluation Process for Joint Venture Form 990, Part VI, line 16b The organization has adopted a formal written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements. However, the normal due diligence process for analyzing any such arrangements undertaken in conjunction with the organization's external legal counsel, accountants and other business advisors does include a review to determine the following: 1) the impact of the arrangement under applicable federal and state law 2) whether the arrangement will jeopardize the organization's exempt status as a Section 501(c)(3) charitable organization - hospital 3) whether the arrangement will result in any unrelated business taxable income 4) the impact of the arrangement on any existing contractual agreements or other business relationships and 5) whether the arrangement will result in any conflicts of interest. If there are any concerns with respect to any of the above matters, the organization will take appropriate steps to ensure that, if the joint venture is pursued, the arrangement will be in compliance with applicable federal and state law and to safeguard the organization's tax-exempt status. A formal written policy and procedure has been approved. Hours devoted to related organizations Form 990, Part VII Michael Sellards - 6 hours (PHS, SJH and SMF) Sr. Celeste Lynch - 38 hours (PHS and SMF) Sr. Diane Bushee - 6 hours (PHS, SJH and SMF) Sr. Marian Ruth Creamer - 2 hours (PHS) Todd Campbell - 6 hours (PHS and SJH) Angela Swearingen - 6 hours (PHS and SJH) Rita Barker - 4 hours (SJH) Changes in Net Assets or Fund Balances: Form 990, Part XI, line 5: Net unrealized gains on investments: 2,854,087. Transfer from Affiliates 26,307,138. Change in pension fund status -26,050,150. Loss from affiliate -5,951,855. Difference in book/tax partnership income -190,654. Prior period adjustment-affiliate -1,071,296. Total to Form 990, Part XI, Line 5: -4,102,730. Audit oversight Form 990, Part XII, line 2c The procedure for oversight of the audit of financial statements has not changed from prior year. Tax-Exempt Bonds Schedule K The tax exempt bonds are reported on the Form 990s of St. Joseph's Hospital of Buckhannon, Inc. and St. Mary's Medical Center. Since the bond proceeds are issued on behalf of Pallottine Health Services, Inc., Schedule K has been reported on Pallottine Health Services, Inc. Form 990. St Mary's Medical Management LLC 2900 First Avenue Huntington WV 25702 208017790 Medical Practice WV -5951855 6259453 N/A Pallottine Health Services 2900 First Avenue Huntington WV 25702 550688201 Parent Oversight WV 501(c)(3) Line 11a, I N/A 0 Pallottine Missionary Sisters 2900 First Avenue Huntington WV 25702 431783315 Church WV 501(c)(3) Line 1 N/A 0 St Mary's Medical Center Foundation 2900 First Avenue Huntington WV 25702 141887211 Foundation WV 501(c)(3) Line 11b, II N/A 0 St Joseph's Hospital of Buckhannon One Amalia Drive Buckhannon WV 26201 550356996 Hospital WV 501(c)(3) Line 3 N/A 0 St Joseph's Foundation of Buckhannon One Amalia Drive Buckhannon WV 26201 550727650 Foundation WV 501(c)(3) Line 11b, II N/A 0 St Mary's Occupational Health Services 2900 First Avenue Huntington WV 25702 542136110 Medical Services WV Related -45751 -99426 0 1 0.51000 Tri State MRI 2900 First Avenue Huntington WV 25702 550669726 Medical Services WV Related -138114 503882 0 1 0.50000 Claire Frances Health Services 200 Mall Road Ste 3 Ashland KY 41101 311517507 Medical Services WV Related 178460 538206 0 1 0.33330 Huntington Area MRI Services LLC 2900 First Avenue Huntington WV 25702 Medical Services WV Related 269002 261765 0 1 0.49000 Vanguard Financial Services 2900 First Avenue Huntington WV 25702 450496141 Collection Agency WV N/A C 4995 481838 1.00000 1 0 1 1 0 0 0 0 1 0 0 1 0 1 1 0 0 1 Vanguard Financial Services A 441 Claire Frances Health Services R 175000 Huntington Area MRI Services N 90298