2013-05-14T15:59:07-05:00 2012-06-30 861065772 Deloitte Tax LLP 111 Monument Circle Suite 2000 Indianapolis IN 462045108 990 2011-07-01 351712001 StVincent Seton Specialty Hospital Inc STVI 3174158357 8071 Township Line Road No 200 Indianapolis IN 46260 Peter H Alexander 3174158354 2013-05-14 1 Shawna M Jimenez P01222873 3174648600 2013-05-09 2011 2016-02-24 21:20:13Z Peter H Alexander 8071 Township Line Road No 200 Indianapolis IN 46260 61699888 0 X www.stvincent.org X 1987 IN We are a nonprofit hospital dedicated to providing healthcare that leaves no one behind. 7 5 482 5 0 0 2763173 46302 61967530 58753209 3857346 2764449 140061 124948 68728110 61688908 1600000 0 0 0 31400566 30387036 0 0 0 24159014 19548670 57159580 49935706 11568530 11753202 79640105 86802537 8562466 7879907 71077639 78922630 X St.Vincent Seton Specialty Hospital is dedicated to providing spiritually-centered, holistic healthcare that sustains and improves the health of those served, with special attention to the poor and vulnerable. Both inpatient and outpatient health services are provided without regard to patient race, creed, national origin, economic status, insurance status or ability to pay. This mission extends well beyond the provision of core medical services to encompass medical and scientific research programs, the training and educating of health care professionals and active support of community-based partnerships and programs to improve health and quality of life. 0 0 42128912 58753209 St.Vincent Seton Specialty Hospital is a 104 (74+30)-bed, long term acute care hospital serving primarily Marion, Tippecanoe and contiguous counties and providing services without regard to patient race, creed, national origin, economic status, or ability to pay. It is a unique organization that specializes in caring for acute, critically ill and catastrophically injured patients requiring longer hospital stays averaging more than 25 days. During fiscal year 2012, St.Vincent Seton Specialty Hospital treated 967 patients for a total of 28,398 inpatient days of service. See Schedule O for a non-exhaustive list of community benefit programs and descriptions. 1640004 During the fiscal year ending June 30, 2012, the unreimbursed cost of free or discounted services provided to patients who were deemed indigent under state, county, or hospital guidelines was $1,640,004 which included $737,940 of traditional charity care and $902,064 in unpaid costs of care for those qualifying for Medicaid or other public programs for the poor. (Note that St.Vincent Seton Specialty Hospital also provides a substantial portion of its services to the elderly, but in keeping with Catholic Healthcare Association guidelines, the total of unreimbursed cost of free or discounted services does NOT include $2,500,886 in unpaid costs of care for elderly covered through Medicare.) See Schedule O for a non-exhaustive list of community benefit programs and descriptions. 151424 In addition to core medical services, St.Vincent Seton Specialty Hospital partners with its community to assess community assets and needs and to work together to address issues impacting health and quality of life, with special emphasis on the poor and vulnerable. In fiscal year 2012, SVSSH provided $151,424 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, SVSSH provided a total Community Benefit of $1,791,428 in fiscal year 2012.) SVSSH serves and supports its community through such programs as Indiana Veterans' Home, Fay Biccard Glick Neighborhood Center at Crooked Creek, and health fairs. See Schedule O for a non-exhaustive list of community benefit programs and descriptions. 43920340 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 34 0 1 482 1 0 0 0 0 0 0 0 0 0 0 X 7 5 0 0 0 0 1 1 1 1 1 0 1 1 1 1 1 1 1 1 1 1 0 IN X David M Girten CFO 3174158357 8071 Township Line Road Ste 200 Indianapolis IN 46260 X George D Martin 0.50 X X 0 0 0 Ronald E Rosenberg 0.50 X X 0 0 0 Deborah A Lawrence 0.50 X X 0 0 0 David J Handel 0.50 X 0 0 0 David A Heimansohn MD 0.50 X 0 303942 22440 James S Parsons 0.50 X 0 0 0 Alan D Snell MD 0.50 X 0 305591 56359 Peter H Alexander 40.00 X 305377 0 73119 David M Girten 40.00 X 200696 0 61605 Troy T Reiff 40.00 X 189542 0 41797 Melanie G Holt 40.00 X 172552 0 20900 Linda Carroll 40.00 X 0 112175 38983 Merly S Shaw 40.00 X 196290 0 49596 Toni A Turpin 40.00 X 166513 0 45094 Theresa M Anderson 40.00 X 167822 0 46559 Sepideh S Crawford 40.00 X 218635 0 37118 Timothy Chambers 40.00 X 162309 0 20747 1779736 721708 514317 35 0 1 0 South Bend Medical Foundation 530 N Lafayette Blvd South Bend IN 46601 Lab services 1056205 Fresenius Medical Services 16343 Collections Center Dr Chicago IL 60693 Medical services 564592 Assured Healthcare LLC 7922 E Edgewood Avenue Indianapolis IN 46239 Nursing services 408444 Liberty Dialysis PO Box 10147 Uniondale NY 11555 Dialysis services 201992 Action Ambulance dba Integrated Transpor 5647 Dividend Drive Indianapolis IN 462414301 Ambulance services 186815 6 6380 39922 46302 Net Medicare/Medicaid 621990 36786788 36786788 Net patient revenue 621990 21966421 21966421 58753209 2775429 2775429 10980 -10980 -10980 -10980 Cafeteria revenue 722210 124948 124948 124948 61688908 58753209 0 2889397 1065588 1065588 23087941 20656873 2431068 399339 357290 42049 4242155 3795473 446682 1592013 1424380 167633 725611 649207 76404 94192 84274 9918 15270 13662 1608 159 142 17 446873 399819 47054 913755 817540 96215 165901 148432 17469 15914 14238 1676 1472316 1317287 155029 70467 70467 Supplies 5838804 5224001 614803 Purchased services 3844144 3439371 404773 Community benefit 1791428 1791428 Corporate expenses 1248714 1117229 131485 2905122 2599227 305895 49935706 43920340 6015366 0 2847928 2337632 8017836 11285974 466268 548972 12187 23860244 9282418 15876219 14577826 52431854 58039946 79640105 86802537 4664017 4674168 3898449 3205739 8562466 7879907 X 71038422 78909689 39217 12941 71077639 78922630 79640105 86802537 X 11753202 -3908211 X 0 1 1 X 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 2074 2074 0 Explanation of Lobbying Activities: Part II-B, Line 1: Lobbying expenses represent the portion of dues paid to national and state hospital associations that is specifically allocable to lobbying. 847629 847629 16813421 5113107 11700314 3157 1289 1868 6146101 4168022 1978079 49936 49936 14577826 Receivable from third party payors 391249 Donor restricted funds 12941 Interest in investments held by Ascension Health Alliance 57622745 Other assets 13011 58039946 Payables to third party programs 1070909 Intercompany payables 1628840 Other liabilities 70231 Intercompany debt with Ascension Health Alliance 435759 3205739 1 1 X 1 X 1 X 1 1 1 0 1 1 737940 737940 0.01480 1453423 551359 902064 0.01810 2191363 551359 1640004 0.03290 457 37195 37195 0.00070 3183 21430 350 21080 0.00040 2282 93149 93149 0.00190 5922 151774 350 151424 0.00300 5922 2343137 551709 1791428 0.03590 916 8023 8023 0.00020 916 8023 8023 0.00020 0 254566 76370 34669265 37170151 -2500886 X 1 1 2 1 StVincent Seton - Indianapolis

8071 Township Line Road Indianapolis IN 46260

X 2 StVincent Seton - Lafayette

1501 Hartford Street Lafayette IN 47904

X StVincent Seton - Indianapolis 1 1 1 200.000000000000 1 400.000000000000 1 X X 1 1 X X X 1 0 1 X 0 0 StVincent Seton - Lafayette 2 1 1 200.000000000000 1 400.000000000000 1 X X 1 1 X X X 1 0 1 X 0 0 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, which may be adjusted for cost of living utilizing the local wage index compared to the national wage index, 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 400% of the FPL, subject to adjustments for cost of living utilizing the local wage index compared to national wage index, will 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 a cost 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: St.Vincent Seton Specialty Hospital promotes the health of its communities by striving to improve the 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. Additionally, helping to create greater capacity within the community to address a broad range of quality of life issues also impacts health. St.Vincent Seton Specialty Hospital meets regularly with local organizations in the community to learn what resources are available and plan community health improvement efforts. In fiscal year 2012, these organizations included: Salvation Army, Indiana Veterans Home, Fay Biccard Glick Neighborhood Center at Crooked Creek, and Indiana Kids Environmental Coalition. Part III, Line 4: The organization is a part of the St.Vincent Health System consolidated audit. The provision for bad debts is based upon management's assessment of expected net collections considering economic conditions, historical experience, trends in health care coverage, and other collection indicators. On a monthly basis, management assesses the adequacy of the allowance for uncollectible accounts for each patient, including those amounts not covered by insurance. The results of this review are then used to make modifications to the provision for bad debts to establish an appropriate allowance for uncollectible accounts. 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 Corporations policies. The share of the bad debt expense in fiscal year 2012 was $721,420 at charges ($254,566 at cost). Part III, Line 8: Ascension Health and 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 community benefit. Part III, Line 9b: 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. St.Vincent Seton - Indianapolis Part V, Section B, Line 19d: 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. St.Vincent Seton - Lafayette Part V, Section B, Line 19d: 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. St.Vincent Seton - Indianapolis Part V, Section B, Line 20: 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 13. 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 11). St.Vincent Seton - Lafayette Part V, Section B, Line 20: 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 13. 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 11). St.Vincent Seton - Indianapolis 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 13. 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 11). St.Vincent Seton - Lafayette 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 13. 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 11). Part V, Section B, Line 15: St.Vincent Seton - Indianapolis: The following steps were followed and considered reasonable efforts for purposes of Question 15:- 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 13. This includes, but is not limited to, providing the following:- A 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 11). Part V, Section B, Line 15: St.Vincent Seton - Lafayette: The following steps were followed and considered reasonable efforts for purposes of Question 15:- 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 13. This includes, but is not limited to, providing the following:- A 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 11). Part V, Section B, Line 16: St.Vincent Seton - Indianapolis: The following steps were followed and considered reasonable efforts for purposes of Question 16:- 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 13. 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 11). Part V, Section B, Line 16: St.Vincent Seton - Lafayette: The following steps were followed and considered reasonable efforts for purposes of Question 16:- 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 13. 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 11). Part VI, Line 2: Communities are dynamic systems in which multiple factors interact to impact quality of life and health status. St.Vincent Seton Specialty Hospital helps to periodically assess assets and needs within the long term acute care community, prioritize action, and work in partnership to address identified challenges. As part of the St.Vincent Health System, the goal of St.Vincent Seton Specialty Hospital is to work with its community to conduct an assessment at least every three years. Assessments may include primary survey data, secondary data, focus group input, community leaders' survey and other data. St.Vincent Seton Specialty Hospital follows the St.Vincent Indianapolis's protocol for this procedure. 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. Part VI, Line 3: St.Vincent Seton Specialty Hospital 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, and bills contain a formal notice explaining the hospital's charity care program. In addition, the hospital employs financial counselors, 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.Vincent Seton Specialty Hospital is located in Indianapolis and Lafayette, Indiana and serves Marion, Tippecanoe and contiguous counties, in northwest and Central Indiana. With the special care that St.Vincent Seton Specialty Hospital performs, the patients come from all over the state of Indiana and even bordering states. Patients of all ages come to St.Vincent Seton Specialty Hospital from motorcycle accidents to severe strokes. St.Vincent Seton Specialty Hospital is for medically complex patients who still need a high level of acute care services. 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.Vincent Seton Specialty Hospital:- delivers patient 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- trains and educates health care professionals- participates in government-sponsored programs such as Medicaid and Medicare to provide healthcare to the poor and elderly- is governed by a board in which independent persons who are representative of the community comprise a majority Part VI, Line 6: As part of the St.Vincent Health System, St.Vincent Seton Specialty Hospital is dedicated to improving the health status and quality of life for the communities it serves. While designated associates at St.Vincent Seton Specialty Hospital devote all or a significant portion of their 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.Vincent Health community development and service staff who work with each healthcare facility 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.Vincent Health in which St.Vincent Seton Specialty Hospital participates. Reports Filed With States Part VI, Line 7 IN X 1 1 X X X X 0 1 0 0 0 0 0 0 0 David A Heimansohn MD 0 239637 0 64305 0 0 0 11008 0 11432 0 326382 0 0 Alan D Snell MD 0 269201 0 36390 0 0 0 36586 0 19773 0 361950 0 0 Peter H Alexander 243798 0 61579 0 0 0 53516 0 19603 0 378496 0 0 0 David M Girten 174234 0 26462 0 0 0 50680 0 10925 0 262301 0 0 0 Troy T Reiff 163190 0 26352 0 0 0 17232 0 24565 0 231339 0 0 0 Melanie G Holt 149177 0 23375 0 0 0 17748 0 3152 0 193452 0 0 0 Linda Carroll 0 99095 0 13080 0 0 0 28066 0 10917 0 151158 0 0 Merly S Shaw 194899 0 1391 0 0 0 31843 0 17753 0 245886 0 0 0 Toni A Turpin 165122 0 1391 0 0 0 33589 0 11505 0 211607 0 0 0 Theresa M Anderson 150010 0 17812 0 0 0 23107 0 23452 0 214381 0 0 0 Sepideh S Crawford 217244 0 1391 0 0 0 15982 0 21136 0 255753 0 0 0 Timothy Chambers 156182 0 6127 0 0 0 7779 0 12968 0 183056 0 0 0 Part I, Line 1a St.Vincent Seton Specialty Hospital paid for cell phone usage and deminimus gift for nine of the listed officers/directors and highest compensated employees in Part VII. St.Vincent Seton Specialty Hospital will only reimburse a business expense when all three (3) of the following IRS requirements are met: 1. The expense must have a business connection (i.e., the expenses must be incurred while performing services on behalf of a SVH Entity); 2. The expense must be adequately substantiated by the Associate within a reasonable period of time; and 3. The Associate must return any excess reimbursement or allowance within a reasonable period of time. St.Vincent Seton Specialty Hospital "grossed up" the above applicable non-business expenses and included in the employees' W-2 as additional taxable compensation. 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(B). The exact purpose of each plan varies but they include: compensation limitation make-up plans, voluntary deferral plans, deferral of a portion of incentive bonus type plans, etc. No payments were made to listed persons in Part VII under the various non-qualified deferred compensation plans during the year. Form 990, Part VI, Section A, line 6 St.Vincent Seton Specialty Hospital, Inc. has a single corporate member, St.Vincent Health, Inc. Form 990, Part VI, Section A, line 7a St.Vincent Seton Specialty Hospital, Inc. has a single corporate member, St.Vincent Health, Inc. who has the ability to elect members to the governing body of St.Vincent Seton Specialty Hospital, Inc. Form 990, Part VI, Section A, line 7b All decisions that have a material impact to St.Vincent Seton Specialty Hospital, Inc.'s financial information or corporation as a whole are subject to approval by its sole corporate member, St.Vincent Health, Inc. Form 990, Part VI, Section B, line 11 Management, including certain officers, works diligently to complete the Form 990 and attached schedules in a thorough manner. Management presents the Form 990 to a designated committee of the Board to review and answer any questions. Prior to filing the returns, all Board members are provided the Form 990 and management team members are available to answer any Board member questions. 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 committee 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.Vincent Seton Specialty Hospital, Inc.'s CEO, executive director, or top management official are made by a compensation committee of St.Vincent Seton Specialty Hospital, Inc. and/or St.Vincent 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 board, in executive session, reviewed and approved the compensation. In review of the compensation, the CEO was 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.Vincent Seton Specialty Hospital, Inc.'s other officers or key employees are made by a compensation committee of St.Vincent Seton Specialty Hospital, Inc. and/or St.Vincent 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 board, in executive session, 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. Form 990, Part VI, Section C, line 19 The organization will provide any documents open to public inspection upon request. Form 990, Part VII, Section A: The average hours per week that was devoted to related organizations during the year: Alan D Snell, MD - 40 hours David A Heimansohn, MD - 40 hours Changes in Net Assets or Fund Balances: Form 990, Part XI, line 5: Net unrealized losses on investments: -3,908,211. Total Number of Volunteers Part I, Line 6: The total number of volunteers for the organization is 5. This consists of the board members which participate in all board activities as well as activities that include various community service programs that the hospital performs within the community. Tax Exempt Bond Issuance Part IV, Line 24A: St.Vincent Seton Specialty Hospital, Inc. is a health facility that is part of Ascension Health System. Ascension Health is the borrower for tax exempt hospital revenue bonds. St.Vincent Seton Specialty Hospital, Inc. holds an intercompany note payable with Ascension Health, and this information is reported on the balance sheet. Community Benefit Report Form 990, Part III, Line 4a, 4b and 4c: St.Vincent Seton Specialty Hospital provides inpatient health care services that include: adult nursing services, surgical services, radiology, laboratory, pharmacy, endoscopy, electrocardiology, renal dialysis, respiratory therapy, physical therapy, occupational therapy, speech therapy, wound care, and electroencephanlography. Some of these services operate at a loss in order to ensure that comprehensive services are available to the community. Such community-focused programs improve access to healthcare, advocate for the poor and vulnerable, promote health through free education and screenings and help build better communities by improving quality of life. Community Benefit Overview St.Vincent Seton Specialty Hospital is part of St.Vincent Health, a non-profit healthcare system consisting of 20 locally-sponsored ministries serving over 47 counties throughout Central Indiana. Sponsored by Ascension Health, the nation's largest Catholic healthcare system, St.Vincent Health is one of the largest healthcare employers in the state. As part of St.Vincent Health, the St.Vincent Seton Specialty vision is to deliver a continuum of holistic, high-quality health services and improve the lives and health of Indiana individuals and communities, with special attention to the poor and vulnerable. This is accomplished through strong partnerships with businesses, community organizations, local, state and federal government, physicians, St.Vincent Seton Specialty associates and others. Community benefit is not the work of a single department or group within St.Vincent Seton Specialty, but is part of the St.Vincent mission and cultural fabric. It is initiated and implemented at all levels of the organization, by each ministry, and in every community. Community Benefit Report Patient Services for Poor and Vulnerable Hospital and outpatient care is provided to patients that cannot pay for services, including hospitalizations, surgeries, prescription drugs, medical equipment and medical supplies. Patients with income less than 200% of the Federal Poverty level (FPL) are eligible for 100% charity care for services. Patients with incomes at or above 200% of the FPL, but not exceeding 400% of the FPL, receive discounted services based on an income-dependent sliding scale. Hospital financial counselors assist patients in determining eligibility and in completing necessary documentation. SVSSH is committed to 100% access, and is proactive in providing healthcare that leaves no one behind. Public Program Participation St.Vincent Seton Specialty Hospital participates in government programs including Medicaid, SCHIP (Hoosier Healthwise), Healthy Indiana Plan (HIP) and Medicare and assists patients in enrolling for programs for which they are eligible. Per Catholic Health Association guidelines and St.Vincent Health's conservative approach, Medicare shortfall is not included as community benefit. Community Assessment St.Vincent Seton Specialty Hospital draws patients from all over the state who need the special care provided by this facility, bridging the gap between the Intensive Care Unit and sub-acute services. Seton participates in local, state, and national dialogues about best practices for caring for these patients and families, and advocates for their specialized needs. In addition, the Indianapolis location's close proximity to the St.Vincent Indianapolis Hospital allows Seton Specialty to use the geographic survey completed by St.Vincent Indianapolis to target initiatives to the needs and service gaps of the local community. For more information about the assessment process, please refer to the St.Vincent Indianapolis campus report. Health Professions Clinical Training In an effort to prepare future healthcare professionals, especially in the area of long-term acute care, St.Vincent Seton Specialty in Indianapolis and Lafayette, in collaboration with area schools, offers a variety of clinical settings and internships for undergraduate and vocational allied health professionals, including nurses and respiratory therapists. Last year students from Ball State University, IUPUI, Ivy Tech, Marian University and University of Indianapolis received specialized training from Seton Specialty health professionals. Health Fairs and Screenings St.Vincent Seton Specialty participated in St.Vincent Health Fair Day at the Indiana State Fair. In fiscal year 2012, more than 150 fair-goers learned the importance of good lung health, and were offered free pulmonary function tests by Seton Specialty associates. Pulmonary function tests measure how well the lungs take in and release air, and are used to diagnose certain types of lung disease, especially asthma bronchitis, and emphysema, to find the cause behind shortness of breath and determine exposure to contaminants at home or work. Community Benefit Cash and In-Kind Contributions In addition to the outreach programs operated by the hospital, the hospital makes cash and in-kind donations to a variety of community organizations focused on improving health status in the community. These take the form of cash donations to outside organizations, the donation of employee time and services to outside organizations and the representation of the hospital on community boards and committees working to improve health status and quality of life within the community. In fiscal year 2012, these organizations included: Indiana Kids Environment Coalition and National Breast Cancer Foundation. Community Building Activities Research shows that social determinants and quality of life play a major role in the health status of individuals and communities. Community building activities, which focus on improving the quality of life within a community, ultimately influence and improve health status. Fay Biccard Glick Neighborhood Center Associates from St.Vincent Seton Specialty Indianapolis are involved with Fay Biccard Glick Neighborhood Center at Crooked Creek programs over the course of the year. Last December associates served snacks and spent time making holiday crafts with children of the Sweet Pickles and Sweet Peas pre-school class. One associate put on the "Vincent the Bear" costume and made new pals with the children at the Center. In addition to Hope for the Holidays, Seton associates bought and wrapped gifts for a family of three from the Crooked Creek neighborhoods. Back Pack 'Em Project The Back Pack 'Em project focuses on equipping Indianapolis area children grades K-5 in need with school supplies, school clothing, and funds necessary for their education. Through the St.Vincent Health Back Pack 'Em for School Program, St.Vincent Seton Specialty associates collect money, gift cards, and school supplies. Last year, 25 back packs were fully filled with supplies to support this incredible cause. Medical Supplies Donations Donations of medical supplies are made throughout the year to Nehemiah Vision Ministries for use in medical clinics in Haiti. Donations of trach and intubation tubes for educational purposes are made throughout the year to Ivy Tech College. Salvation Army With the need greater than ever, Seton associates take a major interest in the Lafayette community raising awareness and funds for the Salvation Army Angel Tree program with an annual Chili Cook-Off. The Angel Tree program provides needed support and a special Christmas to children and seniors living in poverty. St.Vincent Seton Specialty Lafayette associates joined other community members committed to ringing the army bell to help raise additional funds. Indiana Veterans' Home Each year associates from St.Vincent Seton Specialty reach out to Indiana Veterans' Home, a landmark facility in West Lafayette that provides nursing and domiciliary care for Hoosier Veterans and their spouses. Last year several associates volunteered to help serve a Thanksgiving lunch at the Veterans Home. Over 100 Veterans were served. In December associates coordinated the Christmas dance, providing cookies and ice cream for the event. Community Building Cash and In-kind Contributions The hospital makes cash and in-kind donations to a variety of community organizations focused on building the community. These take the form of cash donations to outside organizations, the donation of employee time and services to outside organizations and the representation of the hospital on community boards and committees working to improve infrastructure for the community. CIHS Newco LLC 8425 Harcourt Road Indianapolis IN 46260 352174403 Land holding company IN 723127 5783692 Central Indiana Health System Cardiac Services Inc HRH SVH Real Estate Development Co LLC 10330 N Meridian Ste 430N Indianapolis IN 46290 272933470 Land holding company IN -53 3078 StVincent Health Inc StJoseph Primary Care LLC 1907 W Sycamore Street Kokomo IN 46901 742979291 Physician practices IN 2466221 1093367 StJoseph Hospital & Health Center Inc Quality Healthcare Solutions LLC 8425 Harcourt Road Indianapolis IN 46260 272818049 Health care consulting IN 12511241 33190971 StVincent Health Inc StVincent Physician Network LLC 10330 N Meridian Ste 300 Indianapolis IN 46290 201338729 Physician practices IN 75733004 24853307 StVincent Health Inc Ascension Health PO Box 45998 St Louis MO 63145 311662309 National health system MO 501(C)(3) 11A, I N/A 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 StJohn's Foundation Inc 2015 Jackson Street Anderson IN 46016 352053693 Supporting organization IN 501(C)(3) 11A, I StVincent Madison County Health System 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 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 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 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 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 175851 43187 0 0 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 5550103 2123722 0 0 0.45000 Chartwell Midwest Indiana LLC 8040 Castleway Drive Indianapolis IN 46250 351985233 Home care IV/infusion services IN StVincent Hospital and Health Care Center Inc Related 21594 0 0 Cooperative Managed Care Services LLC 6602 E 75th Street Suite 300 Indianapolis IN 46250 351999227 Case management IN StVincent Hospital and Health Care Center Inc Unrelated 225965 1948010 0 0 0.50000 Endoscopy Center LLC 13421 Old Meridian St Ste 150 Carmel IN 46032 320029881 Endoscopy center IN StVincent Carmel Hospital Inc Related 739619 386382 0 0 0.51000 Fishers Ambulatory Surgery Center LLC 136914 E State Road 238 Fishers IN 46037 262001288 Ambulatory surgery center IN StVincent Hospital and Health Care Center Inc Related -277416 1482158 0 0 0.81720 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 -2449051 1776331 0 0 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 1742 1794248 0 0 0.50000 Lafayette Heart Program Holding LLC 11515 W Dragoon Trail Mishawaka IN 46544 383750811 Cardiac care services IN Central Indiana Health System Cardiac Services Inc Related 8000000 0 0 0.49000 Meridian Heights Associates LLC 6100 W 96th Street Ste 250 Indianapolis IN 46278 264020296 Real estate holding IN StVincent Carmel Hospital Inc Related -509229 2230351 0 0 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 169059 1983633 0 0 0.50000 StVincent HealthUSP LLC 15305 Dallas Pkwy Ste 1600 Addison TX 75001 203749962 Ambulatory surgery center IN StVincent Health Inc Related 140666 445060 0 0 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 18258387 78629927 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 -57227 264483 0 0 0.58900 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0