2012-07-30T06:21:46-05:00 2011-09-30 Arnett & Foster PLLC P O Box 2629 Charleston WV 25329 990 2010-10-01 550357050 St Mary's Medical Center STMA 3045268931 2900 First Avenue Huntington WV 257021271 Michael Sellards 3045268931 2012-07-16 1 Harry C Harless 3043460441 2010 2016-02-24 21:20:13Z Michael Sellards 2900 First Avenue Huntington WV 257021271 398750766 0 X www.st-marys.org X 1924 WV Hospital with open emergency room. 12 6 2716 329 0 0 750493 775398 349553830 368164897 1941308 3744034 -4717905 -2098037 347527726 370586292 115650 330038 0 0 156436259 150032531 0 0 0 199003725 204785584 355555634 355148153 -8027908 15438139 293569274 288603326 209770536 212753257 83798738 75850069 X We are inspired by the love of Christ to provide quality health care in ways which respect the God-given dignity of each person and the sacredness of human life. 0 0 282886643 330038 367833060 St. Mary's Medical Center was established in 1924 and, based on thecore values of compassion, hospitality, reverence, trust, interdependency, and stewardship, continues to provide high quality healthcare services to residents of Huntington, West Virginia and the surrounding area. Services are provided without regard to the patient's race, creed, sex, national origin, age, or handicap. Furthermore, while reimbursement for care provided is crucial to the continued operation of St. Mary's Medical Center, it is recognized that circumstances existwhich render certain parties unable to pay for needed services, and no patient is denied services due to the lack of ability to pay. During the fiscal year which ended September 30, 2011, St. Mary's Medical Center provided 94,632 days of inpatient days of care and treated an additional 260,612 patients in the emergency and outpatient settings.Approximately seventy-two percent of the inpatients served were covered by governmental programs, such as Medicare and Medicaid. A similar percentage is applicable to outpatient services. Since care provided to Medicare and Medicaid beneficiaries is subject to contractual reimbursement restrictions, payment received for services provided is often significantly below the actual cost of the services. St. Mary's Medical Center has established charity care policies and guidelines, used to help identify those patients who genuinely do not have the resources to pay for services received. During fiscal 2011, the hospital provided approximately $12.2 million dollars in charity care services, representing care provided at reduced prices or completely free of charge. These services include inpatient services, an adult outpatient clinic,a handicapped children's clinic, and a specialty pregnancy clinic. Also, St. Mary's Medical Center exceeds the guidelines established for the West Virginia ad valorem statute. 951312 329139 200000 In addition to those patients without the wherewithal to pay for services rendered, we assist in the relief of burden of government for several programs. A strong auxiliary (operated as a department of the hospital) exists, which contributes heavily to the activities of SMMC. During fiscal 2011, the auxiliary made cash donations of approximately $200,000. In addition, volunteers provided over 39,000 hours of service valuable to promoting the mission and activities of the hospital. 12398271 131837 St. Mary's Medical Center also recognizes that carrying out its mission of community service is not confined to the walls of the hospital's buildings and that there are residents in need of services who may never be a registered patient of the hospital. In meeting the needs of these individuals and groups, St. Mary's Medical Center provides or participates in numerous educational Activities, support groups and health screenings and provides human resources, as appropriate, to support other charitable organizations. A summary of these community services as prepared by the hospital's mission integration department for the catholic health association is listed below.The programs include the SMMC Triathalon,the SMMC Kids Try-a-Triathalon,AHA Start Heart Walk, Community Presentations/Disease Education, Fundraisers for nonprofits/needy families, Health Fair/Screenings, Health Professional Education, Nursing Professional Education, Clinical Trials, Scholarships, Support Groups and Technical Education. 296236226 1 1 0 0 0 0 0 0 0 1 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 0 1 0 0 0 0 1 1 1 1 0 0 1 111 0 1 2716 1 0 0 0 0 0 0 0 0 X 12 6 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 X Angela Swearingen 3045268931 2900 First Avenue Huntington WV 25702 Sister Celeste Lynch 2.00 X 0 0 0 Michael G Sellards 34.00 X X 0 628376 74071 Sister Marian Ruth Creamer 38.00 X 0 0 0 Sister Joanne Obrochta 1.00 X 0 0 0 Rocco Morabito MD 1.00 X 0 0 0 Tim Robarts MD 1.00 X 0 0 0 Thomas Houvouras 1.00 X 0 0 0 Julia Hutchison 1.00 X 0 0 0 Richard Muth 1.00 X 0 0 0 Sister Rosella Sparks 1.00 X 0 0 0 Sister Elisabeth Heptner 1.00 X 0 0 0 Matt Miller 1.00 X 0 0 0 Todd Campbell 40.00 X 346813 0 53551 Angela D Swearingen 40.00 X 121280 0 16179 Sr Diane Bushee SAC 34.00 X 0 0 0 Vera Rose MD 40.00 X 265174 0 33377 Tyson Smith 40.00 X 306463 0 35235 Susan Beth Robinson 40.00 X 200778 0 30479 Timothy Parnell 40.00 X 188913 0 29945 Elizabeth Bosley 40.00 X 172703 0 23254 Dave Sheils 40.00 X 126240 0 27125 Robert Hay 40.00 X 152241 0 28295 Jeffrey Hamrick 40.00 X 148174 0 28112 Sonya Arthur 40.00 X 143122 0 27884 Rita Barker 40.00 X 150151 0 22239 Christie Gray 40.00 X 135784 0 13790 2331596 628376 416411 67 0 1 0 University Physicians & Surgeons 1600 Medical Center Drive Ste B501 Huntington WV 25701 Medical 3231020 American Red Cross 4 Chase Metrotech Center 7th Floor Brooklyn NY 11245 Medical 2798779 Masterplan Inc Dept LA 21431 Pasadena CA 91185 Medical 2090460 Alliance Heathcare Services PO box 96485 Chicago IL 60693 Medical 1523468 River Cities Anesthesia PO Box 515 Barboursville WV 25504 Medical 1454157 71 269009 58926 447463 775398 Patient Service Revenu 621400 363722831 363722831 Purchase Rebates 900099 1207444 1207444 School of Nursing 611600 1076182 1076182 Rental Income 531120 698191 698191 School Radiology 611600 466481 466481 993768 993768 368164897 999830 999830 29863463 93903 27213162 2650301 93903 2744204 2744204 702085 951312 -249227 -249227 Cafeteria Sales 722100 2396474 2396474 Maintenance of Sisters 811000 58750 58750 Other Investment Incom 900099 -4131319 -4131319 -172715 -172715 -1848810 370586292 368164897 0 1645997 330038 330038 1440314 1178609 261705 107296771 87800948 19495823 4667651 3819539 848112 27170873 22233925 4936948 9456922 7738599 1718323 2058155 2058155 598102 598102 32463394 26564795 5898599 2048345 1676161 372184 86549679 70809154 15740525 2958115 2420626 537489 4246016 3474515 771501 161714 132331 29383 1221 999 222 3977374 3254685 722689 15473141 12661671 2811470 1808896 1480220 328676 Bad debts 35258096 35258096 Repairs & Maintenance 8149669 6668874 1480795 Provider tax 7375849 7375849 Dues & subscriptions 839409 686888 152521 HCA Assessments 571937 468016 103921 246472 201688 44784 355148153 296236226 58911927 0 5027 5027 16172930 26971075 79297975 73784392 7888479 9924139 3466690 3144454 356664283 224837372 138560872 131826911 53539366 51971227 -9373699 -14303905 4011634 5280006 293569274 288603326 37625577 28846859 2692 99619666 97468141 2958677 2745337 69566616 83690228 209770536 212753257 X 82597178 74441562 1201560 1408507 83798738 75850069 293569274 288603326 X 15438139 -23386808 X X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 6308971 6308971 165487186 99790156 65697030 174917725 123088159 51829566 9950401 1959057 7991344 131826911 Deferred salaries & wages 1544059 General reserves 3047370 Accrued pension costs 77932158 St Mary's Medical Management LLC 1166641 83690228 1 1 1 X 1 X 1 1 1 0 1 1 9649 4600316 0 4600316 0.01300 37101 57231251 42153534 15077717 0.04250 46750 61831567 42153534 19678033 0.05550 2 1319 3460 3460 0.00000 4 19 8445990 4165930 4280060 0.01210 0 0 0 3 5501 292843 292843 0.00080 9 6839 8742293 4165930 4576363 0.01290 9 53589 70573860 46319464 24254396 0.06840 1 32000 32000 0.00010 1 5285 48316 48316 0.00010 2 5285 80316 80316 0.00020 1 13479346 2695869 105684784 106046049 -361265 X 1 1 1 Huntington Area MRI Provide MRI scans. 0.49000 0.51000 2 St Mary's Occupational Health Occupational therapy. 0.51000 0.49000 1 1 St Mary's Medical Center

2900 First Avenue Huntington WV 25702

X X X Not required 1 Part I, Line 3c: Eligibility is determined by comparing household family income against the income poverty guidelines for financial indigence; a ratio of total medical expenses to annual disposable income for medical indigence. Income is defined as the total annual cash receipts before taxes from all sources.Financially indigent. Uncompensated care shall include unreimbursed services to the financially indigent. Financially indigent shall mean uninsured or underinsured patients accepted for care with no obligation or a discounted obligation to pay for services rendered based on the medical center's eligibility system which may include:(a) income levels and means testing or other criteria for determining a patient's inability to pay; or (b) other criteria for determining a patient's inability to pay that are consistent with the medical center's mission and established policy. The federal poverty level shall serve as an index for the threshold below which patients receiving care at St. Mary's Medical Center are deemed financially indigent. Financially indigent services include noncovered services for patients eligible for the Medicaid program, services providedunder county indigent care contracts, and other state or federal assistance programs for low income groups.Medically indigent. Uncompensated care shall include unreimbursed services to the medically indigent. Medically indigent shall mean patients who are responsible for their living expenses, but whose medical and hospital bills, after payment by third party payers, where applicable, exceed: (a) a specified percentage of the patient's annual gross income (i.e., catastrophic medical expenses) in accordance with the medical center's formal eligibility system in such instances where payment would require liquidation of assets critical to living or earning a living; or (b) the criteria for determining a patient's inability to pay.While financial indigence is based strictly on an income level, medical indigence considers both income and the financial obligation for healthcare services to calculate the patient's ability to pay without liquidating assets critical to living or earning a living, such as a home, car, personal belongings, etc. Therefore, patients are considered for medically indigent status on a case by case basis. The patient would be required to provide documentation of income to determine if he/she is to be considered medically indigent. All patients are eligible to be considered for medically indigent status with the exception of patients with income below 200% of the federal poverty level as these patients are considered for some level of uncompensated care under the financially indigent category. Part I, Line 6a: SMMC prepares an annual written report that describes programs and services that promote the health of our community. The community benefit report provides valuable information on programs and services provided by the medical center. The report is distributed to Hospital board members but it has not been distributed to the general public. The report is compiled using the program "a guide for planning and reporting community benefit." Part I, Line 7: The cost to charge ratio as calculated fromworksheet 2 was used to determine community benefit expenses for all subsidized health services. Part I, L7 Col(f): The text of the footnote reads as follows: "thehospitals provide care to patients who meet specific criteria, defined by their charity care policies, without charge or at amounts less than theirestablished rates, as approved by the West Virginia Health Care Authority (HCA). Because the hospitals do not pursue collection of amounts determined to qualify as charity care, such amounts are not reported as revenue."The hospital's cost-to-charge ratio was used to compute bad debt expense at cost. Part II: St. Mary's has sponsored a number of community building activities during the past year. Some of these are as follows:The St. Mary's tri-state triathlon includes three separateraces - a triathlon, triathlon relay and duathlon. The triathlonconsists of a half-mile swim, 15-mile bike ride and2.9-mile loop run. In the duathlon, the swim course is replaced by a2.9-mile loop run in the opposite direction of the previous loop.Races use computer-chip timing. The event averages 200+ participantseach year but it has a wider reaching impact of promoting fitness inthe community with news coverage of stories about first timeparticipants and their ability to complete a triathlon. Many familyand friends also gather at the event as spectators and some areinspired to compete in the next year's event.The St. Mary's kids try-a-triathlon for ages 6-14 was held on July 31at Beech Fork lake. Races consist of either a 50- or 100-yard swim, aTwo- or four-mile bike course, and a one- or two-mile run, dependingon the age group. There is a kids camp leading up to this event thathelps train young people to participate in the triathlon. Race dayparticipation 100+.Path project - St. Mary's is a sponsor of the Paul Ambrose trail forhealth (path) project which is designed to develop a 26-mile bicycleand pedestrian path system that will link the various HuntingtonParks. This project will promote wellness by offering family-healthyarea throughout Huntington for the public. Fitfest is held annuallyeach year on 9-11 to focus the entire community on fitness and St.Mary's is a major sponsor. 500+ participants at fitfest. Web site: www.paulambrosetrailforhealth.orgAHA start heart walk - St. Mary's has been the main sponsor for theHeart walk each year. As one of St. Mary's major service lines, theregional heart institute promotes healthy heart activities for thepublic throughout the year, but the heart walk and the go redluncheon for women are two of our main events. The heart walkgenerates team building by raising funds for the American HeartAssociation, ending with the actual walk at Ritter park. St. Mary'semployee teams are joined by teams all across Cabell and Waynecounties both raising funds for heart research and supporting walkingas a family heart-healthy activity. 300+ participants each year forthe walk. Wider exposure through advertising heart healthy educationtips and information.An evening of Zumba - a local cancer survivor and instructor of Zumbaat St. Mary's promoted the idea of an evening of Zumba in order toraise funds for the pink ribbon fund - a fund set aside to cover thecosts of mammograms for women who cannot afford to be tested forbreast cancer. The event was free, but donations were accepted and100% was given to the pink ribbon fund at St. Mary's breast center.There were over 100 participants.Heart (helping educators attack cvd risk factors together) and heartchampions program. With over 6,000 children screened during thistime, it has become evident that a different approach is needed toaddress overweight children and adolescents with multiple riskfactors for heart disease, diabetes, and a number of other healthproblems. Data collected from the 2008-2009 school year, showed 238out of 529 children (45 percent) screened had had a body mass indexabove the 85th percentile for their age. In 2008, the KaiserFoundation ranked West Virginia second in the nation for childhoodobesity with 21 percent of children statewide identified as beingoverweight.Healthy heart u program is an outgrowth of the heart programs and isfighting childhood obesity in southern West Virginiathe healthy heart u project will be a network of comprehensivechildhood obesity facilities serving overweight children in southernWest virginia. In partnership with existing health providers,community centers and public schools, the goal of the project is toincrease children's access to fitness facilities and a team of healthprofessionals focused on their nutrition, fitness, body image, andself-esteem. The title of the project is to promote a positiveenvironment for children and eliminate any negative perceptions thatmay limit their participation.Tips program: tips is a two-part program developed by St. Mary'sRegional Neuroscience Center that consists of an annual youth safetyfair and an education plan delivered to school children throughoutthe school year. Matt Herbert speaks to 1000+ school students everyyear in addition to free bicycle helmet giveaways. Approximately 500students receive free helmets each year.Additionally St. Mary's participates in numerous health fairsThroughout the year. They provide screenings for health issues suchAs cholesterol, blood sugar, HDL, osteoporosis, etc. At no charge.also, education about various health issues such as stroke risk,joint replacement surgery, and other health risk factors areprovided. There are 1000+ people screened each year through freescreenings. Part III, Line 4: The text of the footnote reads as follows: "thehospitals provide care to patients who meet specific criteria, defined by their charity care policies, without charge or at amounts less than theirestablished rates, as approved by the West Virginia Health Care Authority (HCA). Because the hospitals do not pursue collection of amounts determined to qualify as charity care, such amounts are not reported as revenue."The hospital's cost-to-charge ratio was used to compute bad debt expense at cost. Part III, Line 8: Patient level detail data is used to calculate the uncompensated cost of bad debt and charity. Once an account is written off to bad debt and/or charity, the entire cost of the account is classified as bad debt and/or charity and any payments received are netted against the cost of the account to determine the uncompensated costs.The cost-to-charge ratio as reported on the facility's Medicare costReport was used to compute the Medicare allowable costs. Part III, Line 9b: The hospital provides care to patients who meet specific criteria, defined by its charity care policy, without charge or at amounts less than the rates approved by the West Virginia Health Care Authority. Because the hospital does not pursue collection of amounts determined to qualify as charity care, such amounts are not reported as revenue. Part V, Section A: This facility includes a school of nursing, school of respiratory therapy, a school of medical imaging and a clinical pastoral education program. Interns and residents from Marshall University School of Medicine are also assigned at the hospital for their clinical rotations as are students in community based practicalnursing programs. Part VI, Line 2: SMMC takes steps to determine what the most pressing needs are in order provide services to address them. The hospital regularly assesses the needs of the community. Periodic needs assessments are conducted in partnership with our local health department.Additionally, we monitor county, state, and national health indicators and work in partnership with service agencies in the communities we serve to meet identified needs. Part VI, Line 3: SMMC employs a variety of methods to reach patients with information about financial assistance, including:* financial assistance posters are displayed in all emergency,admitting, outpatient, and clinic areas that include a phone numberto call for financial assistance counseling.* hospital departments that have initial contact with incominginpatients and outpatients are supplied with brochures aboutfinancial assistance for distribution to patients and family members.* the hospital employs trained financial assistance counselors whowork individually with patients to assess financial need andrecommend appropriate assistance such as application for federaland/or state programs; qualification for charity care; determinationof automatic discounts and /or further reductions in charges; andsetting up long-term financial arrangements. Part VI, Line 4: St. Mary's Medical Center serves the greater Huntington, West Virginia community with a primary service area that includes Cabell, Wayne, Mason, Putnam and Lincoln counties in West Virginia and Lawrence county in Ohio. St. Mary's also serves a much wider service area because of specialty medical services including advanced emergency trauma care, advanced stroke care, advanced spine care, advanced heart care, advanced cancer care, and advanced orthopedic care. That secondary service area includes Logan and Mingo counties in West Virginia, as well as Boyd, Greenup, Carter, Lawrence, Johnson, Floyd and Pike counties in Kentucky and Scioto and Gallia Counties in Ohio.Competitors within our primary service area are Cabell HuntingtonHospital (Cabell county) and CAMC Teays Valley (Putnam county).The most recent statistics from the U.S. census bureau show that thehigh school graduation rate (age 25+) for Huntington is 79.6%. Thepercentage of Huntington residents living below that federal povertylevel is 24.7%. Cabell county birth rates for 15 to 19 year-olds is42.3 per 1000 females. Part VI, Line 6: St. Mary's operates an emergency room that is open to all persons regardless of ability to pay and has an open medical staff with privileges available to all qualified physicians in the area. The board of directors represents medical and business professionals, as well sisters from the Pallottine Missionary Sisters. All provide hours of service in support of our hospital. They are deeply involved in our needs assessment process, building programs and services, and community outreach to ensure that people know about services available to them through our hospital.St. Mary's engages in medical and scientific research programs; engages in the training and education of health care professionals: physicians, nurses, medical imaging tech, respiratory techs, and chaplains; and participates in Medicare, Medicaid, and other government-sponsored health care programs.St. Mary's adheres to community benefit guidelines outlined in the Catholic Health Association's publication, "A Guide for Planning and Reporting Community Benefit."Community benefit work is driven by community health needs and directed in collaboration with other health care organizations and the broader community. Community benefit strategies are integrated in the organizational strategic plan. Programs are located throughout the organization, and staff and board education is conducted. Dedicated staff is committed to community benefit efforts.The St. Mary's Foundation is a non-profit organization that provides grant writing and fundraising for both medical center programs and for community benefit programs that reach both the poor and the broader community. Operations of the Foundation are governed by a separate Foundation board with voluntary memberships from the local community.When St. Mary's has excess revenue over operating expenses, we use those funds to obtain current health care technologies and equipment, improve patient care, provide medical training education and research, and to expand access to points of care. These investments ensure that we will be here to care for future generations. Part VI, Line 7: St. Mary's Medical Center is a not-for-profit health care facility wholly sponsored by Pallottine Health Services, Inc. (PHS). Pallottine Health Services is a ministry of the Pallottine Missionary Sisters and includes both St. Joseph Hospital of Buckhannon, West Virginia and St. Mary's Medical Center of Huntington, West Virginia. Both of these hospitals are committed to the core values of compassion, hospitality, reverence, interdependence, stewardship, and trust. 1 American Heart Association 162 Court St Charleston WV 25301 135613797 501(c)(3) 20000 For general operations of the Association in furtherence of their mission to reduce heart disease. For general operations of the Association in furtherence of their mission to reduce heart disease. Huntington Museum of Art 2033 McCoy Road Huntington WV 25701 530372921 501(c)(3) 7800 For general operations of the Museum. Rahall Transportation Institute Foundation PO Box 5425 Huntington WV 25703 550683361 501(c)(3) 10000 To help promote transportation safety. Huntington Area Development Council 916 Fifth Ave Huntington WV 25701 550714570 501(c)(3) 18750 To promote job creation. Healthy Huntington Organization 2 Partridge Court Huntington WV 25705 261775212 501(c)(3) 12000 To sponsor fundraising race. Cabell Co Emergency Medical Services 846 8th Ave Huntington WV 25701 556000305 501(c)(3) 138197 To support emergency medical services. Ebenezer Community Outreach 1448 Tenth Ave Huntington WV 25701 550745033 501(c)(3) 50000 To support community pharmacy. Procedure for Monitoring Grants in the U.S.: Part I, Line 2: Schedule I, Part I, Line 2: To ensure proper use of funds, the requesting organization is require to document the use of the grant monies. Other Information: Part IV: When a request for funds is received and has been approved, the funds are either authorized for use or disbursed to the requesting organization. X X 0 0 X X X X 1 1 0 0 0 0 0 0 0 Michael G Sellards 0 522720 0 0 0 105656 0 57688 0 17543 0 703607 0 0 Todd Campbell 346813 0 0 0 0 0 15607 16500 22267 0 384687 16500 0 0 Vera Rose MD 265174 0 0 0 0 0 11933 0 22087 0 299194 0 0 0 Tyson Smith 306463 0 0 0 0 0 13791 0 22178 0 342432 0 0 0 Susan Beth Robinson 200778 0 0 0 0 0 9035 0 21946 0 231759 0 0 0 Timothy Parnell 188913 0 0 0 0 0 8501 0 21920 0 219334 0 0 0 Elizabeth Bosley 172703 0 0 0 0 0 7772 0 15922 0 196397 0 0 0 Robert Hay 152241 0 0 0 0 0 6851 0 21839 0 180931 0 0 0 Jeffrey Hamrick 148174 0 0 0 0 0 6668 0 21830 0 176672 0 0 0 Sonya Arthur 143122 0 0 0 0 0 6440 0 21819 0 171381 0 0 0 Rita Barker 150151 0 0 0 0 0 6757 0 15872 0 172780 0 0 0 Part I, Line 1a Michael Sellards, the CEO, is entitled to reimbursement for reasonable travel expense for his spouse to accompany him to three educational meetings per year; one of which being the West Virginia Hospital Association annual meeting. Part I, Lines 4a-b During fiscal year 2011, the following officers of the organization received payment under a supplemental non-qualified retirement (SERF) plan: Michael Sellards - $94,376 Todd Campbell - $27,757 Mary Ann Brown Former CFO and current Director of Business Development and Outreach 139760 SMMC paid $139,760 to Mountain State Cabling, which is partially owned by Mary Ann Brown. 0 Form 990, Part VI, Section A, line 6 The organization is a membership (not a stock) corporation under West Virginia state law. The organization's sole corporate member is Pallottine Health Services, a related not-for-profit organization. Form 990, Part VI, Section A, line 7a In accordance with the terms and requirements of its governing documents (i.e. bylaws), on an annual basis, the organization's current board members recommend the list of candidates for membership to the governing body for the subsequent term to the St. Mary's Medical Center board of directors. The board of directors approve and elect these candidates to serve as the organization's board of directors. Form 990, Part VI, Section A, line 7b Pallottine Health Services, as the sole corporate member, also has the right to approve or ratify significant decisions of the organization's governing body including the amendment of bylaws and charters, removal of members of the governing body, and the decision to dissolve the organization. Form 990, Part VI, Section B, line 11 The Form 990 is reviewed by the organization's management in consultation with an independent accounting firm. The financial review is based on the organization's audited financial statements for the relevant time period. Before the Form 990 is filed with the IRS, representatives of the organization's board of directors review the Form 990. A complete copy of the same was provided to the St. Mary's Medical Center full board at their board meeting on June 19, 2012. Form 990, Part VI, Section B, line 12c Upon employment and annually thereafter each key employee and officer of the organization is required to complete a conflict of interest and disclosure form, providing sufficient information about his/her personal interests and relationships so the organization can (1) determine whether any potential or actual conflicts of interest may exist, and (2) monitor work or service assignments to avoid placing the key employee, officer or director in a position where there may be an appearance, potential or actual, of a conflict of interest or a question of objectivity. The completed conflicts of interest and disclosure forms for directors are returned to the organization. In the event that any board member is deemed to lack independence or a conflict of interest exists, he/she is required to leave the room and cannot be part of the discussion or vote. Form 990, Part VI, Section B, line 15 On a regular basis, the organization provides documentation to the compensation committee of the Pallottine Health Services, Inc. board with respect to the compensation of the organization's officers and key employees for review and approval. Such information includes comparable data from similar size tax-exempt organizations in the Huntington, West Virginia community as well as compensation for these positions (as disclosed on form 990) with other organizations in the health care industry that are of similar size, demographics, and geography. Review and approval of the compensation arrangement by the officers/executive committee is documented. Form 990, Part VI, Section C, line 19 The organization makes its governing documents, conflict of interest policy, and financial statements available to the public upon request at its office at 2900 First Avenue, Huntington, WV 25702. A nominal fee is charged if copies are requested. Changes in Net Assets or Fund Balances: Form 990, Part XI, line 5: Net unrealized losses on investments: -1,025,142. Transfer to affiliates -5,121,962. Change in pension fund status -12,891,154. Loss from St. Mary's Medical Management -4,348,550. Total to Form 990, Part XI, Line 5: -23,386,808. Audit oversight Form 990, Part XII, line 2c The procedure for oversight of the audit of financial statements has not changed from prior year. Tax-Exempt Bonds Schedule K The tax exempt bonds are reported on the Form 990s of St. Josephs's Hospital of Buckhannon, Inc. and St. Mary's Medical Center. Since the bond proceeds are issued on behalf of Pallottine Health Services, Inc., Schedule K has been reported on Pallottine Health Service Inc. Form 990. Hours devoted to related organizations Part VII Michael Sellards - 6 hours (PHS, SJH and SMF) Sr. Celeste Lynch - 38 hours (PHS and SMF) Sr, Diane Bushee - 6 hours (PHS, SJH and SMF) Sr. Marian Ruth Creamer - 2 hours (PHS) Todd Campbell - 2 hours (PHS and SJH) Angela Swearingen - 2 hours (PHS and SJH) Rita Barker - 4 hours (SJH) Evaluation Process for Joint Venture Form 990, Part VI, line 16b The organization has adopted a formal written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements. However, the normal due diligence process for analyzing any such arrangements undertaken in conjunction with the organization's external legal counsel, accountants and other business advisors does include a review to determine the following: 1) the impact of the arrangement under applicable federal and state law 2) whether the arrangement will jeopardize the organization's exempt status as a section 501(c)(3) charitable organization - hospital 3) whether the arrangement will result in any unrelated business taxable income 4) the impact of the arrangement on any existing contractual agreements or other business relationships and 5) whether the arrangement will result in any conflicts of interest. If there are concerns with respect to any of the above matters, the organization will take appropriate steps to ensure that, if the joint venture is pursued, the arrangement will be in compliance with applicable federal and state law and to safeguard the organization's tax-exempt status. A formal written policy and procedure has been approved. St Mary's Medical Management LLC 2900 First Avenue Huntington WV 25702 208017790 Medical Practice WV -5011779 5326422 N/A Pallottine Health Services 2900 First Avenue Huntington WV 25702 550688201 Parent Oversight WV 501(c)(3) Line 11a, I N/A 0 Pallottine Missionary Sisters 2900 First Avenue Huntington WV 25702 431783315 Church WV 501(c)(3) Line 1 N/A 0 St Mary's Medical Center Foundation 2900 First Avenue Huntington WV 25702 141887211 Foundation WV 501(c)(3) Line 11b, II N/A 0 St Joseph's Hospital of Buckhannon One Amalia Drive Buckhannon WV 26201 550356996 Hospital WV 501(c)(3) Line 3 N/A 0 St Joseph's Foundation of Buckhannon One Amalia Drive Buckhannon WV 26201 550727650 Foundation WV 501(c)(3) Line 11b, II N/A 0 St Mary's Occupational Health Services 2900 First Avenue Huntington WV 25702 542136110 Medical Services WV Related -44307 -53675 0 1 Tri State Cyberknife 2900 First Avenue Huntington WV 25702 205744723 Medical Services WV Related 0 1 Tri State MRI 2900 First Avenue Huntington WV 25702 550669726 Medical Services WV Related -215616 641996 0 1 Claire Frances Health Services 200 Mall Road Ste 3 Ashland KY 41101 311517507 Medical Services WV Related 88439 609746 0 1 Huntington Area MRI Services LLC 2900 First Avenue Huntington WV 25702 Medical Services WV Related 388515 198736 0 1 Vanguard Financial Services 2900 First Avenue Huntington WV 25702 450496141 Collection Agency WV N/A C -18707 907161 1.00000 1 0 1 1 0 0 0 0 1 0 0 1 0 1 1 0 0 1 St Mary's Medical Center Foundation N 182433 St Mary's Medical Management N 534701 Vanguard Financial Services A 669 Claire Frances Health Services R 175000 Huntington Area MRI Services D 113791