FURP.ORG / PUBLIC DATA EXPLORER

ST MARYS WARRICK HOSPITAL INC: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization
ST MARYS WARRICK HOSPITAL INC (EIN 35-1343019)
Tax period
2011-07-01 to 2012-06-30
Filed
2013-05-14
IRS object ID
201341349349301559
Schema version
2011v1.5
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2013-05-14T09:31:24-05:00Timestamp
Tax Period End Date2012-06-30TaxPeriodEndDate

Preparer Firm PreparerFirm

FieldValueIRS element (for citing)
EIN861065772EIN

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1DELOITTE TAX LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1111 MONUMENT CIRCLE SUITE 2000AddressLine1
CityINDIANAPOLISCity
StateINState
ZIP Code46204ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2011-07-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN351343019EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1ST MARY'S WARRICK HOSPITAL INCBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlWARRNameControl
Phone8124854178Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line11116 MILLIS AVENUEAddressLine1
CityBOONVILLECity
StateINState
ZIP Code47601ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameKIMBERLY A HODGKINSONName
TitleCHIEF FINANCIAL OFFICERTitle
Phone8124854178Phone
Date Signed2013-05-14DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameSHAWNA M JIMENEZName
PTINP01222873PTIN
Phone3174648600Phone
Date Prepared2013-05-09DatePrepared
FieldValueIRS element (for citing)
Tax Year2011TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonTIMOTHY A FLESCHNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line11116 MILLIS AVENUEAddressLine1
CityBOONVILLECity
StateINState
ZIP Code47601ZIPCode
FieldValueIRS element (for citing)
Gross Receipts14975015GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.STMARYS.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1971YearFormation
State Legal DomicileINStateLegalDomicile
Activity Or Mission DescriptionST. MARY'S WARRICK HOSPITAL, INC. IS A CRITICAL ACCESS HOSPITAL IN RURAL WARRICK COUNTY. THE HOSPITAL PROVIDES ACUTE CARE AND OUTPATIENT SERVICES TO PERSONS REGARDLESS OF ABILITY TO PAY.ActivityOrMissionDescription
Nbr Voting Members Governing Body9NbrVotingMembersGoverningBody
Nbr Independent Voting Members5NbrIndependentVotingMembers
Total Nbr Employees228TotalNbrEmployees
Total Nbr Volunteers5TotalNbrVolunteers
Total Gross UBI60763TotalGrossUBI
Net Unrelated Business Txbl Income-17908NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year0ContributionsGrantsPriorYear
Contributions Grants Current Year430ContributionsGrantsCurrentYear
Program Service Revenue Prior Year18851815ProgramServiceRevenuePriorYear
Program Service Revenue CY14679999ProgramServiceRevenueCY
Investment Income Prior Year20901InvestmentIncomePriorYear
Investment Income Current Year10205InvestmentIncomeCurrentYear
Other Revenue Prior Year237797OtherRevenuePriorYear
Other Revenue Current Year284381OtherRevenueCurrentYear
Total Revenue Prior Year19110513TotalRevenuePriorYear
Total Revenue Current Year14975015TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year8091856SalariesEtcPriorYear
Salaries Etc Current Year7944564SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year10713688OtherExpensePriorYear
Other Expenses Current Year7383193OtherExpensesCurrentYear
Total Expenses Prior Year18805544TotalExpensesPriorYear
Total Expenses Current Year15327757TotalExpensesCurrentYear
Revenues Less Expenses Prior Year304969RevenuesLessExpensesPriorYear
Revenues Less Expenses CY-352742RevenuesLessExpensesCY
Total Assets BOY9406823TotalAssetsBOY
Total Assets EOY9850454TotalAssetsEOY
Total Liabilities BOY8355363TotalLiabilitiesBOY
Total Liabilities EOY10137297TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY1051460NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY-286843NetAssetsOrFundBalancesEOY
Mission DescriptionST. MARY'S WARRICK HOSPITAL, INC. IS A CRITICAL ACCESS HOSPITAL IN RURAL WARRICK COUNTY. THE HOSPITAL PROVIDES ACUTE CARE AND OUTPATIENT SERVICES TO PERSONS REGARDLESS OF ABILITY TO PAY.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense7981954Expense
Revenue14625842Revenue
DescriptionST. MARY'S WARRICK HOSPITAL, INC. (SMW) IS A NOT-FOR-PROFIT GENERAL SHORT-TERM CRITICAL ACCESS HOSPITAL SERVING WARRICK, POSEY, SPENCER, AND OTHER RURAL POPULATED COUNTIES SURROUNDING THE AREA WITHOUT REGARD TO PATIENT RACE, CREED, NATIONAL ORIGIN, ECONOMIC STATUS, OR ABILITY TO PAY. DURING THE FISCAL YEAR ENDING JUNE 30, 2012, THE HOSPITAL PROVIDED HEALTHCARE TO 969 PATIENTS IN THE COMMUNITY FOR A TOTAL OF 6,577 PATIENT DAYS OF SERVICE. ADDITIONALLY, THE HOSPITAL ALSO PROVIDED SERVICES TO 20,979 OUTPATIENTS, INCLUDING 213 OUTPATIENT SURGERY SERVICES AND 7,890 EMERGENCY ROOM VISITS. SEE SCHEDULE H FOR A NON-EXHAUSTIVE LIST OF COMMUNITY BENEFIT PROGRAMS AND DESCRIPTIONS.Description

Activity2 Activity2

FieldValueIRS element (for citing)
Expense2642188Expense
DescriptionSMW PROVIDES A SUBSTANTIAL PORTION OF ITS CORE HEALTH SERVICES TO THE POOR, UNINSURED, OR UNDERINSURED AND HAS PROACTIVELY TAKEN STEPS TO ADDRESS ACCESSIBILITY, AND THE FINANCING, AND DELIVERY OF HEALTHCARE TO THE UNDERSERVED. DURING THE FISCAL YEAR ENDING JUNE 30, 2012, THE UNREIMBURSED COST OF FREE OR DISCOUNTED SERVICES PROVIDED TO PATIENTS WHO WERE DEEMED INDIGENT UNDER STATE, COUNTY, OR HOSPITAL GUIDELINES WAS $2,642,188 WHICH INCLUDED $562,719 OF TRADITIONAL FINANCIAL ASSISTANCE AND $2,079,469 IN UNPAID COSTS OF CARE FOR THOSE QUALIFYING FOR MEDICAID OR OTHER PUBLIC PROGRAMS FOR THE POOR. SEE SCHEDULE H FOR A NON-EXHAUSTIVE LIST OF COMMUNITY BENEFIT PROGRAMS AND DESCRIPTIONS.Description

Activity3 Activity3

FieldValueIRS element (for citing)
Expense83682Expense
DescriptionIN ADDITION TO CORE MEDICAL SERVICES, SMW AND COMMUNITY PARTNERS ASSESS COMMUNITY ASSETS AND NEEDS AND WORK TOGETHER TO ADDRESS ISSUES IMPACTING HEALTH AND QUALITY OF LIFE, WITH SPECIAL EMPHASIS ON THE POOR AND VULNERABLE. IN FISCAL YEAR 2012, SMW PROVIDED $83,682 IN UNBILLED SERVICES TO THE POOR AND TO THE BROADER COMMUNITY. (WHEN COMBINED WITH THE COSTS OF FREE OR DISCOUNTED SERVICES FOR THE POOR LISTED IN LINE 4B, SMW PROVIDED A TOTAL COMMUNITY BENEFIT OF $2,725,870 IN FISCAL YEAR 2012.) SMW SERVES AND SUPPORTS ITS COMMUNITY THROUGH SUCH PROGRAMS AS HEALTH FAIRS AND SCREENINGS, TRANSPORTATION FOR PATIENT AT NO COST TO PATIENT, AS WELL AS VARIOUS COMMUNITY SUPPORT GROUPS. SEE SCHEDULE H FOR A NON-EXHAUSTIVE LIST OF COMMUNITY BENEFIT PROGRAMS AND DESCRIPTIONS.Description
FieldValueIRS element (for citing)
Total Program Service Expense10707824TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required0ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities1LobbyingActivities
Subject To Proxy Tax0SubjectToProxyTax
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets1ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
Report Fin48 Footnote0ReportFin48Footnote
Independent Audit Financial Stmt0IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt1ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital1Hospital
Financial Stmt Attached1FinancialStmtAttached
Grants To Organizations0GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds0TaxExemptBonds
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity1RelatedOrgControlledEntity
Transaction Related Entity1TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With109624NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees228NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income1UnrelatedBusinessIncome
Form990-T Filed1Form990-TFiled
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members9NbrVotingGoverningBodyMembers
Number Independent Voting Members5NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders1MembersOrStockholders
Election Of Board Members1ElectionOfBoardMembers
Decisions Subject To Approval1DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other1CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
States Where Copy Of Return Is FiledINStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonKIMBERLY A HODGKINSONNamePerson
Telephone Number8124854178TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line13700 WASHINGTON AVENUEAddressLine1
CityEVANSVILLECity
StateINState
ZIP Code47750ZIPCode
FieldValueIRS element (for citing)
Info In Schedule O Part VIIXInfoInScheduleOPartVII

Form990 Part VII Section A Form990PartVIISectionA (15 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationHighest Compensated EmployeeHighestCompensatedEmployee
TIMOTHY FLESCH
SECRETARY/TREASURER65.00XX0117569066599
GWEN SANDEFUR
BOARD MEMBER65.00X037278148407
LLOYD MCGINNIS MD
BOARD MEMBER50.00X012700426337
LAURENCE STEENBERG
VICE CHAIR1.00XX000
MICHAEL HERRELL MD
CHAIR1.00XX000
JUDGE DONALD HENDRICKSON
BOARD MEMBER1.00X000
SALLY RIDEOUT LAMBERT
BOARD MEMBER1.00X000
JERRY L AIGNER
BOARD MEMBER1.00X000
SR JANE BURGER DC
BOARD MEMBER1.00X000
CAROL GODSEY
EXECUTIVE VP65.00X019322077099
DAVID VAUGHN
ER PHYSICIAN45.00279679038564X
THOMAS L MILLER
ER PHYSICIAN42.0020602807343X
MATTHEW P DATZMAN
ER PHYSICIAN45.00276040013962X
STEVEN BECKER
RADIOLOGIST40.0017781703043X
KENNETH PARKER
PHYSICIAN45.0022892500X
FieldValueIRS element (for citing)
Total Reportable Comp From Org1168489TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs1868695TotalReportableCompFrmRltdOrgs
Total Other Compensation281354TotalOtherCompensation
Number Individuals GT100 K6NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
DANCO CONSTRUCTION
3201 INTERSTATE DRIVEEVANSVILLEIN47715CONSTRUCTION SERVICES584047
CPSI
6600 WALL STREETMOBILEAL36695HEALTHCARE INFORMATION MANAGEMENT578969
EMCARE
7032 COLLECTION CENTER DRIVECHICAGOIL60693MEDICAL SERVICES/CODING512959
HORIZON HEALTH
PO BOX 840839DALLASTX75284MANAGEMENT SERVICES420573
KENNETH PARKER MD
PO BOX 129INGLEFIELDIN47618MEDICAL SERVICE207750
FieldValueIRS element (for citing)
Number Of Contractors GT100 K9NumberOfContractorsGT100K
Related Organizations430RelatedOrganizations
Noncash Contributions430NoncashContributions
Total Contributions430TotalContributions

Program Service Revenue ProgramServiceRevenue (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncomeUnrelated Business RevenueUnrelatedBusinessRevenue
OUTPATIENT REVENUE62199095336479533647
INPATIENT REVENUE62199050855895085589
REFERENCE LAB FEES5413806076360763
FieldValueIRS element (for citing)
Total Program Service Revenue14679999TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column4705TotalRevenueColumn
Exclusion$4,705ExclusionAmount

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real75067Real

Less Rental Expenses LessRentalExpenses

FieldValueIRS element (for citing)
Real0Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real75067Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column75067TotalRevenueColumn
Exclusion$75,067ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Other5500Other

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Other0Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Other5500Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column5500TotalRevenueColumn
Related Or Exempt Function Income5500RelatedOrExemptFunctionIncome

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnExclusionExclusionAmount
VENDING MACHINE/CAFETE90009936462$36,462
EXERCISE PROGRAM/GYM M71394029065$29,065
HOUSEKEEPING5617007370$7,370

Miscellaneous Revenue MiscellaneousRevenue

FieldValueIRS element (for citing)
Total Revenue Column136417TotalRevenueColumn
Related Or Exempt Function Income1106RelatedOrExemptFunctionIncome
Exclusion$135,311ExclusionAmount
FieldValueIRS element (for citing)
Total Other Revenue209314TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column14975015TotalRevenueColumn
Related Or Exempt Function Income14625842RelatedOrExemptFunctionIncome
Unrelated Business Revenue60763UnrelatedBusinessRevenue
Exclusion$287,980ExclusionAmount

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total6409624Total
Program Services4666033ProgramServices
Management And General1743591ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total15084Total
Program Services10981ProgramServices
Management And General4103ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total1087432Total
Program Services791621ProgramServices
Management And General295811ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total432424Total
Program Services314793ProgramServices
Management And General117631ManagementAndGeneral

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total1301168Total
Program Services947215ProgramServices
Management And General353953ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total23623Total
Program Services17197ProgramServices
Management And General6426ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total600Total
Program Services437ProgramServices
Management And General163ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total427918Total
Program Services311513ProgramServices
Management And General116405ManagementAndGeneral

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total32615Total
Program Services23743ProgramServices
Management And General8872ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total182091Total
Management And General182091ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total799650Total
Management And General799650ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total41888Total
Management And General41888ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
PURCHASED SERVICES17567671278879477888
PROVIDER TAX EXPENSE10837341083734
SUPPLIES1010988735972275016
CONTRACT LABOR542203394709147494

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total179948Total
Program Services130997ProgramServices
Management And General48951ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total15327757Total
Program Services10707824ProgramServices
Management And General4619933ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY930143BOY
EOY240719EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY2355829BOY
EOY2312039EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY187784BOY
EOY194086EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY62716BOY
EOY49870EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis21073646LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec14771020LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY5398024BOY
EOY6302626EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY192304BOY
EOY106367EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY280023BOY
EOY644747EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY9406823BOY
EOY9850454EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY2957974BOY
EOY4279124EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY5397389BOY
EOY5858173EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY8355363BOY
EOY10137297EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY1051460BOY
EOY-286843EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY1051460BOY
EOY-286843EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY9406823BOY
EOY9850454EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses-352742ReconcilationRevenueExpenses
Reconcilation Other Changes-985561ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Volunteers0Volunteers
Paid Staff Or Management0PaidStaffOrManagement
Media Advertisements0MediaAdvertisements
Mailings Members0MailingsMembers
Publications Or Broadcast0PublicationsOrBroadcast
Grants Other Organizations0GrantsOtherOrganizations
Direct Contact Legislators0DirectContactLegislators
Rallies Demonstrations0RalliesDemonstrations
Other Activities1OtherActivities
Other Activities$559OtherActivitiesAmount
Total Lobbying Expenditures IIB559TotalLobbyingExpendituresIIB
Not Described In501c30NotDescribedIn501c3

Form990 Schedule C Part IV Form990ScheduleCPartIV

FieldValueIRS element (for citing)
IdentifierEXPLANATION OF LOBBYING ACTIVITIES:Identifier
Return ReferencePART II-B, LINE 1:ReturnReference
ExplanationLOBBYING EXPENSES REPRESENT THE PORTION OF DUES PAID TO NATIONAL AND STATE HOSPITAL ASSOCIATIONS THAT IS SPECIFICALLY ALLOCABLE TO LOBBYING.Explanation

Schedule D IRS990ScheduleD

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis181810OtherCostOrOtherBasis
Book Value181810BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis11794182OtherCostOrOtherBasis
Depreciation7296056Depreciation
Book Value4498126BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis14267OtherCostOrOtherBasis
Depreciation14267Depreciation
Book Value0BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis8779051OtherCostOrOtherBasis
Depreciation7171664Depreciation
Book Value1607387BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis304336OtherCostOrOtherBasis
Depreciation289033Depreciation
Book Value15303BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings6302626TotalOfBookValueLandBuildings

Other Assets OtherAssets (6 entries)

DescriptionDescriptionBook ValueBookValue
RECEIVABLE FROM 3RD PARTY PROGRAM323584
INVESTMENT IN UNCONSOLIDATED ENTITIES9763
AH DEFERRED COMPENSATION188180
OTHER CURRENT ASSETS95342
INTERCOMPANY RECEIVABLES284
INTEREST IN INVESTMENTS HELD BY ASCENSION HEALTH ALLIANCE27594
FieldValueIRS element (for citing)
Total Book Value Other Assets644747TotalBookValueOtherAssets

Other Liabilities OtherLiabilities (5 entries)

DescriptionDescriptionAmountAmount
INTERCOMPANY DEBT WITH ASCENSION HEALTH ALLIANCE$3,730,610
PENSION LIABILITY$1,136,963
INTERCOMPANY TO ST. MARY'S MEDICAL CENTER$802,254
DEFERRED COMPENSATION$188,180
SELF INSURANCE LIABILITY$166
FieldValueIRS element (for citing)
Total Of Amounts5858173TotalOfAmounts

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care Policy1CharityCarePolicy
Written Policy1WrittenPolicy
Policy Applied To All HospitalsXPolicyAppliedToAllHospitals
FPG Reference Free Care1FPGReferenceFreeCare
Pcent200XPcent200
FPG Reference Discounted Care1FPGReferenceDiscountedCare
Pcent300XPcent300
Free Disc Care Medically Indigent1FreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity Care1AmountsBudgetedForCharityCare
Expenses Exceeded Budget0ExpensesExceededBudget
Annual Community Benefit Report1AnnualCommunityBenefitReport
Report Publically Available1ReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Total Community Benefit Expense562719TotalCommunityBenefitExpense
Net Community Benefit Expense562719NetCommunityBenefitExpense
Percent Of Total Expense0.03670PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Total Community Benefit Expense3365766TotalCommunityBenefitExpense
Direct Offsetting Revenue1286297DirectOffsettingRevenue
Net Community Benefit Expense2079469NetCommunityBenefitExpense
Percent Of Total Expense0.13570PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Total Community Benefit Expense3928485TotalCommunityBenefitExpense
Direct Offsetting Revenue1286297DirectOffsettingRevenue
Net Community Benefit Expense2642188NetCommunityBenefitExpense
Percent Of Total Expense0.17240PercentOfTotalExpense

Community Health Services CommunityHealthServices

FieldValueIRS element (for citing)
Persons Served424PersonsServed
Total Community Benefit Expense424TotalCommunityBenefitExpense
Net Community Benefit Expense424NetCommunityBenefitExpense
Percent Of Total Expense0.00000PercentOfTotalExpense

Cash And In Kind Contributions CashAndInKindContributions

FieldValueIRS element (for citing)
Persons Served2867PersonsServed
Total Community Benefit Expense50367TotalCommunityBenefitExpense
Net Community Benefit Expense50367NetCommunityBenefitExpense
Percent Of Total Expense0.00330PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Persons Served3291PersonsServed
Total Community Benefit Expense50791TotalCommunityBenefitExpense
Net Community Benefit Expense50791NetCommunityBenefitExpense
Percent Of Total Expense0.00330PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Persons Served3291PersonsServed
Total Community Benefit Expense3979276TotalCommunityBenefitExpense
Direct Offsetting Revenue1286297DirectOffsettingRevenue
Net Community Benefit Expense2692979NetCommunityBenefitExpense
Percent Of Total Expense0.17570PercentOfTotalExpense

Community Support CommunitySupport

FieldValueIRS element (for citing)
Persons Served123PersonsServed
Total Community Building Expense850TotalCommunityBuildingExpense
Net Community Building Expense850NetCommunityBuildingExpense
Percent Of Total Expense0.00010PercentOfTotalExpense

Coalition Building CoalitionBuilding

FieldValueIRS element (for citing)
Persons Served263PersonsServed
Total Community Building Expense941TotalCommunityBuildingExpense
Net Community Building Expense941NetCommunityBuildingExpense
Percent Of Total Expense0.00010PercentOfTotalExpense

Other Other

FieldValueIRS element (for citing)
Persons Served221PersonsServed
Total Community Building Expense31100TotalCommunityBuildingExpense
Net Community Building Expense31100NetCommunityBuildingExpense
Percent Of Total Expense0.00200PercentOfTotalExpense

Total Total

FieldValueIRS element (for citing)
Persons Served607PersonsServed
Total Community Building Expense32891TotalCommunityBuildingExpense
Net Community Building Expense32891NetCommunityBuildingExpense
Percent Of Total Expense0.00220PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense Reported0BadDebtExpenseReported
Bad Debt Expense$2,036,394BadDebtExpenseAmount
Amount Attributable To203639AmountAttributableTo
Amount Reimbursed By Medicare8815505AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare9450747CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall-635242MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

FieldValueIRS element (for citing)
Cost To Charge RatioXCostToChargeRatio
FieldValueIRS element (for citing)
Written Debt Collection Policy1WrittenDebtCollectionPolicy
Provision For Charity Care1ProvisionForCharityCare
Number Of Hospital Facilities1NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA

FieldValueIRS element (for citing)
Facility Number1FacilityNumber

Name Name

FieldValueIRS element (for citing)
Business Name Line1ST MARY'S WARRICK HOSPITAL INCBusinessNameLine1

Address Address

FieldValueIRS element (for citing)
Address Line11116 MILLIS AVENUEAddressLine1
CityBOONVILLECity
StateINState
ZIP Code47601ZIPCode
FieldValueIRS element (for citing)
Licensed HospitalXLicensedHospital
General Medical And SurgicalXGeneralMedicalAndSurgical
Critical Access HospitalXCriticalAccessHospital
Er24 HoursXEr24Hours

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1ST MARY'S WARRICK HOSPITAL INCBusinessNameLine1
FieldValueIRS element (for citing)
Hospital Facility Number1HospitalFacilityNumber
Eligibility Criteria Explained1EligibilityCriteriaExplained
Uses FPG Free1UsesFPGFree
FPG Free Percent200.000000000000FPGFreePercent
Uses FPG Discounted1UsesFPGDiscounted
FPG Discount Percent300.000000000000FPGDiscountPercent
Explains Basis1ExplainsBasis
Income LevelXIncomeLevel
Asset LevelXAssetLevel
Explains Application Method1ExplainsApplicationMethod
Includes Publicity Measures1IncludesPublicityMeasures
Attached To InvoicesXAttachedToInvoices
Posted In Emergency RoomXPostedInEmergencyRoom
Posted In Admission OfficeXPostedInAdmissionOffice
Actions On Nonpayment1ActionsOnNonpayment
Collection Activities0CollectionActivities
Nondiscrim Emergency Care Policy1NondiscrimEmergencyCarePolicy
Used Other MethodXUsedOtherMethod
Amounts Generally Billed0AmountsGenerallyBilled
Gross Charges0GrossCharges

Form990 Schedule H Part VI Form990ScheduleHPartVI (17 entries)

ExplanationExplanationIdentifierIdentifierReturn ReferenceReturnReference
PART I, LINE 3C: THE ORGANIZATION PROVIDES MEDICALLY NECESSARY CARE TO ALL PATIENTS, REGARDLESS OF RACE, COLOR, CREED, ETHNIC ORIGIN, GENDER, DISABILITY, OR ECONOMIC STATUS. THE HOSPITAL USES A PERCENTAGE OF FEDERAL POVERTY LEVEL (FPL) TO DETERMINE FREE AND DISCOUNTED CARE. AT A MINIMUM, PATIENTS WITH INCOME LESS THAN OR EQUAL TO 200% OF THE FPL, WILL BE ELIGIBLE FOR 100% CHARITY CARE WRITE OFF OF CHARGES FOR SERVICES THAT HAVE BEEN PROVIDED TO THEM. ALSO, AT A MINIMUM, PATIENTS WITH INCOMES ABOVE 200% OF THE FPL BUT NOT EXCEEDING 300% OF THE FPL, ARE ELIGIBLE TO RECEIVE A DISCOUNT ON THE SERVICES PROVIDED TO THEM.
PART I, LINE 7: THE COST OF PROVIDING CHARITY CARE, MEANS TESTED GOVERNMENT PROGRAMS, AND COMMUNITY BENEFIT PROGRAMS IS ESTIMATED USING INTERNAL COST DATA, AND IS CALCULATED IN COMPLIANCE WITH CATHOLIC HEALTH ASSOCIATION ("CHA") GUIDELINES. THE ORGANIZATION USES AN ACCOUNTING SYSTEM THAT ADDRESSES ALL PATIENT SEGMENTS (FOR EXAMPLE, INPATIENT, OUTPATIENT, EMERGENCY ROOM, PRIVATE INSURANCE, MEDICAID, MEDICARE, UNINSURED, OR SELF PAY). THE BEST AVAILABLE DATA WAS USED TO CALCULATE THE AMOUNTS REPORTED IN THE TABLE. FOR THE INFORMATION IN THE TABLE, A COST-TO-CHARGE RATIO WAS CALCULATED AND APPLIED.
PART II: WHILE MOST OF ST. MARY'S WARRICK HOSPITAL, INC.'S COMMUNITY BENEFIT ACTIVITIES DIRECTLY IMPACT THE HEALTH OF ITS COMMUNITIES, ST. MARY'S WARRICK HOSPITAL, INC. ALSO INVESTS IN COMMUNITY BUILDING ACTIVITIES THAT INDIRECTLY IMPROVE HEALTH BY IMPROVING QUALITY OF LIFE WITHIN THE COMMUNITY. RESEARCH HAS ESTABLISHED THAT FACTORS SUCH AS ECONOMIC STATUS, EMPLOYMENT, HOUSING, EDUCATION LEVEL, AND BUILT ENVIRONMENT CAN ALL BE POWERFUL SOCIAL DETERMINANTS OF HEALTH. ADDITIONALY, HELPING TO CREATE GREATER CAPACITY WITHIN THE COMMUNITY TO ADDRESS A BROAD RANGE OF QUALITY OF LIFE ISSUES ALSO IMPACTS HEALTH. IN FISCAL YEAR 2012, ST. MARY'S WARRICK HOSPITAL, INC.'S COMMUNITY BUILDING ACTIVITIES INCLUDED: UNITED WAY DAY OF CARING, PARTNERING WITH THE WARRICK CO. HEALTH COALITION, AND EMBRACING PROJECT SEARCH STUDENTS WITHIN THE HOSPITAL.
PART III, LINE 4: THE ORGANIZATION IS A PART OF THE ST. MARY'S HEALTH SYSTEM OF AMERICA, INC. CONSOLIDATED AUDIT. THE PROVISION FOR BAD DEBT EXPENSE IS BASED UPON MANAGEMENT'S ASSESSMENT OF EXPECTED NET COLLECTIONS CONSIDERING ECONOMIC CONDITIONS, HISTORICAL EXPERIENCE, TRENDS IN HEALTH CARE COVERAGE, AND OTHER COLLECTION INDICATORS. PERIODICALLY THROUGHOUT THE YEAR, MANAGEMENT ASSESSES THE ADEQUACY OF THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS BASED UPON HISTORICAL WRITE-OFF EXPERIENCE BY PAYOR CATEGORY, INCLUDING THOSE AMOUNTS NOT COVERED BY INSURANCE. THE RESULTS OF THIS REVIEW ARE THEN USED TO MAKE ANY MODIFICATIONS TO THE PROVISION FOR BAD DEBT EXPENSE 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 WITH COLLECTION AGENCIES, SUBJECT TO THE TERMS OF CERTAIN RESTRICTIONS ON COLLECTION EFFORTS AS DETERMINED BY ASCENSION HEALTH. ACCOUNTS RECEIVABLE ARE WRITTEN OFF AFTER COLLECTION EFFORTS HAVE BEEN FOLLOWED, IN ACCORDANCE WITH THE CORPORATION'S POLICIES. THE SHARE OF THE BAD DEBT EXPENSE IN FISCAL YEAR 2012 WAS $5,866,879 AT CHARGES ($2,036,394 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 SURPLUS (SHORTFALL) IS NOT TREATED AS A 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 AND THE FINANCIAL ASSISTANCE PROGRAM IS FOLLOWED.
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. MARY'S WARRICK HOSPITAL, INC.
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 TRANSALATIONS 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. MARY'S WARRICK HOSPITAL, INC.
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 TRANSALATIONS 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. MARY'S WARRICK HOSPITAL, INC.
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 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. MARY'S WARRICK HOSPITAL, INC.:
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:- A 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 TRANSALATIONS 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. MARY'S WARRICK HOSPITAL, INC.:
PART VI, LINE 2: COMMUNITIES ARE DYNAMIC IN WHICH MULTIPLE FACTORS INTERACT TO IMPACT QUALITY OF LIFE AND HEALTH STATUS. AS PART OF THE ST. MARY'S HEALTH SYSTEM, THE GOAL OF ST. MARY'S WARRICK HOSPITAL, INC. IS TO WORK WITH ITS COMMUNITY TO CONDUCT AN ASSESSMENT AT LEAST EVERY THREE YEARS IN PARTNERSHIP WITH ST. MARY'S MEDICAL CENTER OF EVANSVILLE, INC. ASSESSMENTS MAY INCLUDE PRIMARY SURVEY DATA, SECONDARY SURVEY DATA, FOCUS GROUP INPUT, COMMUNITY LEADERS' SURVEY AND OTHER DATA. RESULTS ARE MADE AVAILABLE TO ORGANIZATIONS AND INDIVIDUALS THROUGHOUT THE COMMUNITY. THESE NEEDS ASSESSMENTS ARE ALSO UTILIZED IN CREATING THE HOSPITAL'S INTEGRATED STRATEGIC FINANCIAL AND OPERATIONAL PLAN. TO THAT END, ST. MARY'S WARRICK HOSPITAL, INC. HAS BROUGHT TOGETHER A COMMUNITY ROUNDTABLE WITH THE PURPOSE OF DETERMINING THE RESOURCES AND NEEDS, PRIORITIZING ACTION AND WORKING IN PARTNERSHIP TO ADDRESS IDENTIFIED CHALLENGES WITHIN A DESIGNATED AREA SURROUNDING THE HOSPITAL. ST. MARY'S WARRICK HOSPITAL, INC. ALSO IDENTIFIES COMMUNITY HEALTH NEEDS BY EMPLOYING OTHER PUBLIC AGENCY NEEDS ASSESSMENTS SUCH AS WELBORN BAPTIST FOUNDATION AND THE UNITED WAY.
PART VI, LINE 3: ST. MARY'S WARRICK HOSPITAL, INC. COMMUNICATES WITH PATIENTS IN MULTIPLE WAYS TO ENSURE THAT THOSE WHO ARE BILLED FOR SERVICES ARE AWARE OF THE HOSPITAL'S CHARITY CARE PROGRAM AS WELL AS THEIR POTENTIAL ELIGIBILITY FOR LOCAL, STATE OR FEDERAL PROGRAMS. SIGNS ARE PROMINENTLY POSTED IN EACH SERVICE AREA. IN ADDITION, THE HOSPITAL CONTRACTS HEALTH ACCESS WORKERS AND ENROLLMENT SPECIALISTS WHO CONSULT WITH PATIENTS ABOUT THEIR ELIGIBILITY FOR FINANCIAL ASSISTANCE PROGRAMS AND HELP PATIENTS IN APPLYING FOR ANY PUBLIC PROGRAMS FOR WHICH THEY MAY QUALIFY.
PART VI, LINE 4: ST. MARY'S WARRICK HOSPITAL, INC. IS A CRITICAL ACCESS HOSPITAL LOCATED IN BOONVILLE, INDIANA SERVING WARRICK, POSEY, SPENCER, AND OTHER RURAL POPULATED COUNTIES SURROUNDING THE AREA. ACCORDING TO THE 2012 COUNTY AND HEALTH RANKINGS, WARRICK COUNTY HAS A POPULATION OF 58,521 AND 10% OF THE CHILDREN IN WARRICK COUNTY ARE DEEMED TO LIVE IN HOUSEHOLDS BELOW THE POVERTY GUIDELINES. IN ADDITION, 15% OF THOSE LIVING IN WARRICK COUNTY UNDER THE AGE OF 65 DO NOT HAVE HEALTH INSURANCE. CHILD AND ADULT OBESITY CONTINUES TO BE ONE OF THE HIGHEST COMMUNITY ISSUES FOR WARRICK COUNTY WITH 32% OF ADULTS WITH A BODY MASS GREATER THAN 30. OTHER COMMUNITY ISSUES INCLUDE:- FAMILIES' UNDERSTANDING OF FINANCES, BUDGETING, AND TAX CREDITS;- UNDERSTANDING THE CYCLE OF POVERTY THAT OCCURS IN SUCCESSIVE GENERATIONS;- COST OF PRESCRIPTION MEDICINE; AND- AFFORDABLE AND ACCESSIBLE HEALTH CARE FOR LOW- TO MODERATE-INCOME INDIVIDUALS
PART VI, LINE 5: TO PROVIDE THE HIGHEST QUALITY HEALTHCARE TO ALL PERSONS IN THE COMMUNITY, AND IN KEEPING WITH ITS NOT-FOR-PROFIT STATUS, ST. MARY'S WARRICK HOSPITAL, INC.:- DELIVERS PATIENT SERVICES, INCLUDING EMERGENCY DEPARTMENT SERVICES TO ALL INDIVIDUALS REQUIRING HEALTHCARE, WITHOUT REGARD TO PATIENT RACE, ETHNICITY, ECONOMIC STATUS, INSURANCE STATUS OR ABILITY TO PAY.- MAINTAINS AN OPEN MEDICAL STAFF THAT ALLOWS CREDENTIALED PHYSICIANS TO PRACTICE AT ITS FACILTIES.- PARTICIPATES IN GOVERNMENT-SPONSORED PROGRAMS SUCH AS MEDICAID AND MEDICARE TO THE POOR AND ELDERLY.- HOLDS MEMBERSHIP ON OTHER PUBLIC AGENCY BOARDS TO ENHANCE WELL BEING OF THE COMMUNITY IN PARTNERSHIP PROGRAMS.
PART VI, LINE 6: AS A PART OF ST. MARY'S HEALTH SYSTEM, ST. MARY'S WARRICK HOSPITAL, INC. IS DEDICATED TO IMPROVING THE HEALTH STATUS AND QUALITY OF LIFE FOR THE COMMUNITIES IT SERVES. WHILE DESIGNATED ASSOCIATES AT ST. MARY'S WARRICK HOSPITAL, INC. DEVOTE SIGNIFICANT PORTIONS OF TIME TO LEADING AND ADMINISTERING LOCAL COMMUNITY-BASED PROGRAMS AND PARTNERSHIPS, ASSOCIATES THROUGHOUT THE ORGANIZATION ARE ACTIVE PARTICIPANTS IN COMMUNITY OUTREACH. THEY ARE ASSISTED AND SUPPORTED BY DESIGNATED ST. MARY'S HEALTH COMMUNITY DEVELOPMENT AND SERVICE STAFF WHO WORK WITH EACH OF ITS HEALTHCARE FACILITIES TO ADVOCATE FOR AND PROVIDE TECHNICAL ASSISTANCE FOR COMMUNITY OUTREACH, NEEDS ASSESSMENTS AND PARTNERSHIPS AS WELL AS TO SUPPORT REGIONAL AND STATE-WIDE PROGRAMS, COMMUNITY PROGRAMS SPONSORED BY ST. MARY'S HEALTH IN WHICH ST. MARY'S WARRICK HOSPITAL, INC. PARTICIPATES.
INREPORTS FILED WITH STATESPART VI, LINE 7

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan1SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org0CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments0AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (9 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
TIMOTHY FLESCH
048201006312460624340391140274850124228900
GWEN SANDEFUR
031883004887705074019559028848042118800
LLOYD MCGINNIS MD
01092190750001028502227404063015334100
CAROL GODSEY
0127441025014040765065147011952027031900
DAVID VAUGHN
26283400016845033708048560318243000
THOMAS L MILLER
200420000560801462058810213371000
MATTHEW P DATZMAN
2421640003387605775081870290002000
STEVEN BECKER
177817000000030430180860000
KENNETH PARKER
228925000000000228925000

Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
SUPPLEMENTAL INFORMATIONPART IIIPART I, LINE 3: ST. MARY'S HEALTH SYSTEM OF AMERICA, INC., A RELATED ORGANIZATION OF ST. MARY'S WARRICK HOSPITAL, INC., USES THE FOLLOWING TO ESTABLISH THE COMPENSATION OF THE ORGANIZATION'S CEO/EXECUTIVE DIRECTOR: COMPENSATION COMMITTEE COMPENSATION SURVEY OR STUDY APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE
SUPPLEMENTAL INFORMATIONPART IIIPART I, LINE 4B: ALL EMPLOYEES AND AMOUNTS LISTED ARE VOLUNTARY DEFERRALS OR COMPANY CONTRIBUTIONS TO VARIOUS NON-QUALIFIED DEFERRED COMPENSATION PLANS ORGANIZED UNDER CODE SECTION 457 (F). THE EXACT PURPOSE OF EACH PLAN VARIES BUT THEY INCLUDE: COMPENSATION LIMITATION MAKE-UP PLANS, VOLUNTARY DEFERRAL PLANS, DEFERRAL OF A PORTION OF INCENTIVE BONUS TYPE PLANS, ETC. NO PAYMENTS WERE MADE TO LISTED PERSONS IN PART VII UNDER THE VARIOUS NON-QUALIFIED DEFERRED COMPENSATION PLANS DURING THE YEAR.

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (12 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
FORM 990, PART VI, SECTION A, LINE 6ST. MARY'S WARRICK HOSPITAL, INC. HAS A SINGLE CORPORATE MEMBER, ST. MARY'S HEALTH SYSTEM OF AMERICA, INC.
FORM 990, PART VI, SECTION A, LINE 7AST. MARY'S WARRICK HOSPITAL, INC. HAS A SINGLE CORPORATE MEMBER, ST. MARY'S HEALTH SYSTEM OF AMERICA, INC., WHO HAS THE ABILITY TO ELECT MEMBERS TO THE GOVERNING BODY OF THE ST. MARY'S WARRICK HOSPITAL, INC. BOARD.
FORM 990, PART VI, SECTION A, LINE 7BALL DECISIONS THAT HAVE A MATERIAL IMPACT TO ST. MARY'S WARRICK HOSPITAL, INC.'S FINANCIAL INFORMATION OR CORPORATION AS A WHOLE ARE SUBJECT TO APPROVAL BY ITS SOLE CORPORATE MEMBER, ST. MARY'S HEALTH SYSTEM OF AMERICA, INC.
FORM 990, PART VI, SECTION B, LINE 11ST. MARY'S HEALTH SYSTEM OF AMERICA, INC.'S FINANCE COMMITTEE REVIEWS THE FORM 990 IN MARCH UPON RECEIVING DIRECTION FROM ITS TAX PREPARER. THE FORM 990 IS THEN SENT TO THE GOVERNING BODY IN APRIL TO ALLOW FOR A THOROUGH REVIEW BY THE GOVERNING BODY PRIOR TO THE FILING DATE OF MAY 15TH. THE GOVERNING BODY WILL RECEIVE THE FORM 990 VIA EMAIL FOR REVIEW ELECTRONICALLY AND WILL SEND ANY QUESTIONS REGARDING THE FORM 990 VIA EMAIL. RESPONSES TO ANY QUESTIONS RECEIVED WILL BE PROVIDED ELECTRONICALLY TO THE BOARD MEMBERS BEFORE THE RETURN IS FILED. ALL QUESTIONS AND RESPONSES WILL BE REVIEWED AND DISCLOSED IN THE MEETING MINUTES OF THE NEXT BOARD MEETING FOLLOWING THE REVIEW OF THE FORM 990.
FORM 990, PART VI, SECTION B, LINE 12CTHE ORGANIZATION REGULARLY AND CONSISTENTLY MONITORS AND ENFORCES COMPLIANCE WITH THE CONFLICT OF INTEREST POLICY IN THAT ANY DIRECTOR, PRINCIPAL OFFICER, OR MEMBER OF A COMMITTEE WITH GOVERNING BOARD DELEGATED POWERS, WHO HAS A DIRECT OR INDIRECT FINANCIAL INTEREST, MUST DISCLOSE THE EXISTENCE OF THE FINANCIAL INTEREST AND BE GIVEN THE OPPORTUNITY TO DISCLOSE ALL MATERIAL FACTS TO THE DIRECTORS AND MEMBERS OF THE COMMITTEES WITH GOVERNING BOARD DELEGATED POWERS CONSIDERING THE PROPOSED TRANSACTION OR ARRANGEMENT. THE REMAINING INDIVIDUALS ON THE GOVERNING BOARD OR COMMITTEE MEETING WILL DECIDE IF CONFLICTS OF INTEREST EXIST. EACH DIRECTOR, PRINCIPAL OFFICER AND MEMBER OF A COMMITTEE WITH GOVERNING BOARD DELEGATED POWERS ANNUALLY SIGNS A STATEMENT WHICH AFFIRMS SUCH PERSON HAS RECEIVED A COPY OF THE CONFLICTS OF INTEREST POLICY, HAS READ AND UNDERSTANDS THE POLICY, HAS AGREED TO COMPLY WITH THE POLICY, AND UNDERSTANDS THAT THE ORGANIZATION IS CHARITABLE AND IN ORDER TO MAINTAIN ITS FEDERAL TAX EXEMPTION IT MUST ENGAGE PRIMARILY IN ACTIVITIES WHICH ACCOMPLISH ITS TAX-EXEMPT PURPOSE.
FORM 990, PART VI, SECTION B, LINE 15COMPENSATION DETERMINATIONS OF ST. MARY'S WARRICK HOSPITAL, INC.'S CEO, EXECUTIVE DIRECTOR, OR TOP MANAGEMENT OFFICIAL ARE MADE BY A COMPENSATION COMMITTEE OF ST. MARY'S WARRICK HOSPITAL, INC. AND/OR ST. MARY'S HEALTH SYSTEM OF AMERICA, INC. IN DETERMINING COMPENSATION OF THE ORGANIZATION'S CEO, EXECUTIVE DIRECTOR, OR TOP MANAGEMENT OFFICIAL, THE PROCESS INCLUDED A REVIEW AND APPROVAL BY INDEPENDENT PERSONS, COMPARABILITY DATA, AND CONTEMPORANEOUS SUBSTANTIATION OF THE DELIBERATION AND DECISION. THE EXECUTIVE COMMITTEE OF THE ST. MARY'S HEALTH SYSTEM OF AMERICA, INC. BOARD REVIEWED AND APPROVED THE COMPENSATION. IN THE REVIEW OF THE COMPENSATION, THE CEO, EXECUTIVE DIRECTOR, AND TOP MANAGEMENT WERE COMPARED TO OTHER HOSPITALS IN THE AREA THAT HOLD THE SAME POSITION. DURING THE REVIEW AND APPROVAL OF THE COMPENSATION, DOCUMENTATION OF THE DECISION WAS RECORDED IN THE BOARD MINUTES. INDIVIDUALS WERE NOT PRESENT WHEN THEIR COMPENSATION WAS DECIDED. COMPENSATION DETERMINATIONS OF ST. MARY'S WARRICK HOSPITAL, INC.'S OTHER OFFICERS OR KEY EMPLOYEES ARE MADE BY A COMPENSATION COMMITTEE OF ST. MARY'S WARRICK HOSPITAL, INC. AND/OR ST. MARY'S HEALTH SYSTEM OF AMERICA, INC. IN DETERMINING COMPENSATION OF OTHER OFFICERS OR KEY EMPLOYEES OF THE ORGANIZATION, THE PROCESS INCLUDED A REVIEW AND APPROVAL BY INDEPENDENT PERSONS, COMPARABILITY DATA, AND CONTEMPORANEOUS SUBSTANTIATION OF THE DELIBERATION AND DECISION. THE EXECUTIVE COMMITTEE OF THE ST. MARY'S HEALTH SYSTEM OF AMERICA, INC. BOARD REVIEWED AND APPROVED THE COMPENSATION. IN THE REVIEW OF THE COMPENSATION, THE OTHER OFFICERS OR KEY EMPLOYEES OF THE ORGANIZATION WERE COMPARED TO OTHER HOSPITALS' EMPLOYEES IN THE AREA THAT HOLD THE SAME POSITION. DURING THE REVIEW AND APPROVAL OF THE COMPENSATION, DOCUMENTATION OF THE DECISION WAS RECORDED IN THE BOARD MINUTES.
FORM 990, PART VI, SECTION C, LINE 19THE ORGANIZATION WILL PROVIDE ANY DOCUMENTS OPEN TO PUBLIC INSPECTION UPON REQUEST.
FORM 990, PART VII, LINE 1A, COLUMN B:OFFICERS, DIRECTORS, AND KEY EMPLOYEES OF ST. MARY'S WARRICK HOSPITAL, INC. PROVIDE SERVICES TO ST. MARY'S HEALTH SYSTEM OF AMERICA, INC. AND AFFILIATES. HOURS WORKED ARE NOT TRACKED SEPARATELY FOR EACH ENTITY. THEREFORE, HOURS FOR ALL INDIVIDUALS REPORTED ON FORM 990, PART VII, COMPENSATION OF OFFICERS, DIRECTORS, TRUSTEES, KEY EMPLOYEES, HIGHEST COMPENSATED EMPLOYEES, AND INDEPENDENT CONTRACTORS REPRESENT AGGREGATE HOURS WORKED PER WEEK FOR ALL ENTITIES.
FORM 990, PART VII, LINE 1A, COLUMNS D, E, AND F:OFFICERS OF ST. MARY'S WARRICK HOSPITAL, INC. PROVIDE SERVICES TO ST. MARY'S HEALTH SYSTEM OF AMERICA, INC. AND ITS AFFILIATES. COMPENSATION IS NOT REPORTED SEPARATELY BY ENTITY. THEREFORE, COMPENSATION AMOUNTS REPORTED ON FORM 990, PART VII, COMPENSATION OF OFFICERS, DIRECTORS, TRUSTEES, AND KEY EMPLOYEES REPRESENT COMPENSATION PAID FOR MANAGING ST. MARY'S HEALTH SYSTEM OF AMERICA, INC. AND ALL RELATED ENTITIES.
FORM 990, PART XI, LINE 5:NET UNREALIZED LOSSES ON INVESTMENTS: -3,194. FAS 158 PENSION LIABILITY -982,367. TOTAL TO FORM 990, PART XI, LINE 5: -985,561.CHANGES IN NET ASSETS OR FUND BALANCES:
FORM 990, PART I, LINE 6:THE TOTAL NUMBER OF VOLUNTEERS FOR THE ORGANIZATION IS 5. THIS CONSISTS OF VOLUNTEERS PARTICIPATING ON THE BOARD OF DIRECTORS.
FORM 990, PART IV, LINE 24A:ST. MARY'S WARRICK HOSPITAL, INC. IS A HEALTH FACILITY THAT IS PART OF THE ASCENSION HEALTH SYSTEM. ASCENSION HEALTH SYSTEM IS THE HOLDER OF THE TAX EXEMPT HOSPITAL REVENUE BONDS. ST. MARY'S WARRICK HOSPITAL, INC. HOLDS AN INTERCOMPANY NOTE PAYABLE WITH ASCENSION HEALTH AND THIS INFORMATION IS REPORTED ON THE BALANCE SHEET.

Schedule R IRS990ScheduleR

Form990 Schedule R Part I Form990ScheduleRPartI (5 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateTotal IncomeTotalIncomeEOY AssetsEOYAssetsBusiness Name Line1DirectControllingEntityName/BusinessNameLine1
ST MARY'S BREAST CENTER LLC
3700 WASHINGTON AVEEVANSVILLEIN47750351935526MAMMOGRAPHYIN9198601477316SETON
PHYSICIANS' HEALTH GROUP LLC
3700 WASHINGTON AVEEVANSVILLEIN47750043679294DISSOLVEDIN00SMMC
ST MARY'S PHYSICIANS' HEALTH GROUP LLC
3700 WASHINGTON AVEEVANSVILLEIN47750261356310PHYSICIAN PRACTICEIN-30932342385048SMMC
ST MARY'S AT WORK LLC
3700 WASHINGTON AVEEVANSVILLEIN47750272085003DORMANTIN00SETON
ST MARY'S MEDICAL GROUP LLC
3700 WASHINGTON AVEEVANSVILLEIN47750261356310DORMANTIN00SMMC

Form990 Schedule R Part II Form990ScheduleRPartII (15 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Controlled OrgControlledOrgDirect Controlling Entity NADirectControllingEntityNA
ST MARY'S AT HOME INC
3700 WASHINGTON AVENUEEVANSVILLEIN47750351899560DME/HOME CAREIN501(C)(3)11A, ISETON1
ST MARY'S BUILDING CORPORATION
3700 WASHINGTON AVENUEEVANSVILLEIN47750237248362REAL ESTATEIN501(C)(2)SETON1
ST MARY'S WARRICK EMS INC
3700 WASHINGTON AVENUEEVANSVILLEIN47750205342518EMSIN501(C)(4)SMHS1
MEDICAL MANAGEMENT INC
3700 WASHINGTON AVENUEEVANSVILLEIN47750351831570DORMANTIN501(C)(3)11C, III-FISMHS1
ST MARY'S HEALTH SYSTEM OF AMERICA INC
3700 WASHINGTON AVENUEEVANSVILLEIN47750352057801HEALTH MINISTRY PARENTIN501(C)(3)11C, III-FIASCENSION HEALTH0
ST MARY'S PHYSICIAN NETWORK LLC
3700 WASHINGTON AVEEVANSVILLEIN47750205023387PHYSICIAN PRACTICEIN501(C)(3)9SMMC1
PRIMARY PHYSICIAN NETWORK LLC
3700 WASHINGTON AVEEVANSVILLEIN47750208775914PHYSICIAN PRACTICEIN501(C)(3)9SMMC1
SETON HEALTH CORPORATION OF SOUTHERN INDIANA INC
3700 WASHINGTON AVENUEEVANSVILLEIN47750351679526INVESTMENTIN501(C)(3)11C, III-FISMHS1
ST MARY'S HOME HEALTH CARE SERVICES INC
3700 WASHINGTON AVENUEEVANSVILLEIN47750351899562DORMANTIN501(C)(3)11A, ISETON1
ST MARY'S MEDICAL CENTER FOUNDATION INC
3700 WASHINGTON AVENUEEVANSVILLEIN47750237045370FUNDRAISINGIN501(C)(3)11A, ISMMC1
ST MARY'S MEDICAL CENTER OF EVANSVILLE INC
3700 WASHINGTON AVENUEEVANSVILLEIN47750350869065HOSPITALIN501(C)(3)3SMHS1
ST MARY'S WARRICK HOSPITAL FOUNDATION INC
1116 MILLIS AVENUEBOONVILLEIN47601351961890FUNDRAISINGIN501(C)(3)11A, ISMW1
ST MARY'S OHIO VALLEY HEARTCARE LLC
901 ST MARYS DRIVEEVANSVILLEIN47714273474697CARDIOLOGIST SERVICESIN501(C)(3)11A, ISMMC1
SVSM INC
2001 W 86TH STREETINDIANAPOLISIN46260810607827HOLDING COMPANYIN501(C)(3)11A, ISVH1
ASCENSION HEALTH
PO BOX 45998ST LOUISMO63145311662309NATIONAL HEALTH SYSTEMMO501(C)(3)11A, I0N/A

Form990 Schedule R Part III Form990ScheduleRPartIII (4 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivityPrimaryActivityLegal Domicile StateLegalDomicileStateBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Predominant Income TypePredominantIncomeTypeShare Of Total IncomeShareOfTotalIncomeShare Of EOY AssetsShareOfEOYAssetsDisproportionate AllocationsDisproportionateAllocationsGeneral Or Managing PartnerGeneralOrManagingPartnerPercentage OwnershipPercentageOwnership
AMBULATORY CARE CENTER LLC
1125 PROFESSIONAL BLVDEVANSVILLEIN47714352006018OP SURGERYINSETONRELATED38929854257562000.50000
ST MARY'S ACUTE DIALYSIS SERVICES LLC
3700 WASHINGTON AVEEVANSVILLEIN47750271346179MANAGEMENTINSETONRELATED618570119625000.50000
SETON HEALTH SERVICES LLC
3700 WASHINGTON AVEEVANSVILLEIN47750270451316EQUIP RENTALINSETONRELATED28967140493000.50000
ST MARY'S PERIPHERAL VASCULAR SERVICES MANAGEMENT COMPANY LLC
3700 WASHINGTON AVEEVANSVILLEIN47750205062635MANAGEMENTINSMOVHCRELATED-1263340241000.50000

Form990 Schedule R Part IV Form990ScheduleRPartIV

Name Of Related Org NameOfRelatedOrg

FieldValueIRS element (for citing)
Business Name Line1ST MARY'S MEDICAL GROUP INC AND SUBBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line13700 WASHINGTON AVEAddressLine1
CityEVANSVILLECity
StateINState
ZIP Code47750ZIPCode
FieldValueIRS element (for citing)
EIN352076827EIN
Primary ActivityINVESTMENTPrimaryActivity
Legal Domicile StateINLegalDomicileState

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1SMHSBusinessNameLine1
FieldValueIRS element (for citing)
Type Of EntityCTypeOfEntity
Share Of Total Income-611983ShareOfTotalIncome
Share Of EOY Assets641965ShareOfEOYAssets
Percentage Ownership1.00000PercentageOwnership
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org0GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org0GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org1LoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs0RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs0RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs0PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs0PerformOfServicesByOtherOrgs
Sharing Of Facilities0SharingOfFacilities
Sharing Of Paid Employees0SharingOfPaidEmployees
Reimbursement Paid To Other Org1ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org1ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (5 entries)

Transaction TypeTransactionTypeAmount InvolvedAmountInvolvedMethod Of Amt DeterminationMethodOfAmtDetermination
ST MARY'S MEDICAL CENTER OF EVANSVILLE INC
E83076FMV OF SERVICES OR CASH
ST MARY'S HEALTH SYSTEM OF AMERICA INC
O1272224FMV OF SERVICES OR CASH
ST MARY'S MEDICAL CENTER OF EVANSVILLE INC
O354635FMV OF SERVICES OR CASH
ASCENSION HEALTH
E163269FMV OF SERVICES OR CASH
ASCENSION HEALTH
O258661FMV OF SERVICES OR CASH