FURP.ORG / PUBLIC DATA EXPLORER

ST MARYS WARRICK HOSPITAL INC: Form 990, tax year 2009

View the entire original 990 at ProPublica ↗

Organization
ST MARYS WARRICK HOSPITAL INC (EIN 35-1343019)
Tax period
2009-07-01 to 2010-06-30
Filed
2011-05-16
IRS object ID
201111369349302036
Schema version
2009v1.7
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)
Timestamp2011-05-16T09:55:52-05:00Timestamp
Tax Period End Date2010-06-30TaxPeriodEndDate

Preparer Firm PreparerFirm

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 Date2009-07-01TaxPeriodBeginDate

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
Phone8128974800Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line11116 Millis AvenueAddressLine1
CityBoonvilleCity
StateINState
ZIP Code47601ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameJERRY R LAUEName
TitleCHIEF EXECUTIVETitle
Phone8128974800Phone
Date Signed2011-05-16DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
Phone3174648600Phone
FieldValueIRS element (for citing)
Tax Year2009TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonCarol GodseyNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line11116 Millis AvenueAddressLine1
CityBoonvilleCity
StateINState
ZIP Code47601ZIPCode
FieldValueIRS element (for citing)
Gross Receipts17717486GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501cXOrganization501c
Web Sitewww.stmarys.orgWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1971YearFormation
State Legal DomicileINStateLegalDomicile
Activity Or Mission DescriptionWarrick 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 Body7NbrVotingMembersGoverningBody
Nbr Independent Voting Members4NbrIndependentVotingMembers
Total Nbr Employees226TotalNbrEmployees
Total Nbr Volunteers29TotalNbrVolunteers
Total Gross UBI158579TotalGrossUBI
Net Unrelated Business Txbl Income42294NetUnrelatedBusinessTxblIncome
Contributions Grants Current Year14150ContributionsGrantsCurrentYear
Program Service Revenue Prior Year17591169ProgramServiceRevenuePriorYear
Program Service Revenue CY17441213ProgramServiceRevenueCY
Investment Income Prior Year-152727InvestmentIncomePriorYear
Investment Income Current Year71334InvestmentIncomeCurrentYear
Other Revenue Prior Year130724OtherRevenuePriorYear
Other Revenue Current Year190789OtherRevenueCurrentYear
Total Revenue Prior Year17569166TotalRevenuePriorYear
Total Revenue Current Year17717486TotalRevenueCurrentYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year7868659SalariesEtcPriorYear
Salaries Etc Current Year7915986SalariesEtcCurrentYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year9669247OtherExpensePriorYear
Other Expenses Current Year10799064OtherExpensesCurrentYear
Total Expenses Prior Year17537906TotalExpensesPriorYear
Total Expenses Current Year18715050TotalExpensesCurrentYear
Revenues Less Expenses Prior Year31260RevenuesLessExpensesPriorYear
Revenues Less Expenses CY-997564RevenuesLessExpensesCY
Total Assets BOY12234731TotalAssetsBOY
Total Assets EOY10688087TotalAssetsEOY
Total Liabilities BOY11957361TotalLiabilitiesBOY
Total Liabilities EOY11314611TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY277370NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY-626524NetAssetsOrFundBalancesEOY
Mission DescriptionWarrick 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
Expense4341938Expense
Revenue5941428Revenue
DescriptionWarrick Hospital, Inc. is a Not-For-Profit general short-term hospital which provides health care services including radiology, lab, rehabilitation, physical, speech and occupational therapies, resipratory therapy, surgery and a 24 hour emergency care center. During the fiscal year ending June 30, 2010, the hospital provided healthcare to 997 patients in the community for a total of 7,214 patient days of service.Description

Activity2 Activity2

FieldValueIRS element (for citing)
Expense8421277Expense
Revenue11341206Revenue
DescriptionThe hospital also provided services to 20,949 outpatients, including 472 outpatient surgery services and 7,874 emergency room visits. Other outpatient services available were radiology, lab, observation, rehabilitation, speech, occupational, and physical therapies, cardio diagnostic testing, cardiac rehab sessions, and respiratory therapies.Description
FieldValueIRS element (for citing)
Total Program Service Expense12763215TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Balance Sheet Amounts Reported1BalanceSheetAmountsReported
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
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
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With109635NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees226NumberOfEmployees
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
Nbr Voting Governing Body Members7NbrVotingGoverningBodyMembers
Number Independent Voting Members4NumberIndependentVotingMembers
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 Chapters1LocalChapters
Policies Reference Chapters1PoliciesReferenceChapters
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 PersonDOUGLAS KNIESNamePerson
Telephone Number8124854000TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line13700 Washington AvenueAddressLine1
CityEvansvilleCity
StateINState
ZIP Code47750ZIPCode
FieldValueIRS element (for citing)
No Listed Persons CompensatedXNoListedPersonsCompensated

Form990 Part VII Section A Form990PartVIISectionA (13 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationHighest Compensated EmployeeHighestCompensatedEmployee
Timothy Flesch
Secretary/Treasurer65.00XX0106934629860
Gwen Sandefur
Board Member65.00X035747730582
Lloyd McGinnis MD
Board Member50.00X01568812611
Laurence Steenburg
Vice Chair1.00XX000
Michael Herrell MD
Chair1.00XX000
Judge Donald Hendrickson
Board Member1.00X000
Sally Rideout Lambert
Board Member1.00X000
Carol Godsey
Chief Executive65.00X019793520534
David Vaughn
ER Physician45.0028959506151X
Thomas L Miller
ER Physician42.0022161305370X
James S Mooney
ER Physician35.0014491305185X
Steven Becker
Radiologist40.0021185104589X
Robert W Murphy
Pharmacist55.0013957301183X
FieldValueIRS element (for citing)
Total Reportable Comp From Org1007545TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs1781639TotalReportableCompFrmRltdOrgs
Total Other Compensation106065TotalOtherCompensation
Number Individuals GT100 K5NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation (4 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
Psychiatric Solutions
PO Box 840839DallasTX75284Management Services340600
Kenneth Parker MD
PO Box 129InglefieldIN47618Medical Service161000
GE Healthcare
PO Box 96485ChicagoIL60693Medical Maintenance Services156726
CPSI
6600 Wall StreetMobileAL36695Healthcare Information Management107802
FieldValueIRS element (for citing)
Number Of Contractors GT100 K4NumberOfContractorsGT100K
Related Organizations14150RelatedOrganizations
Total Contributions14150TotalContributions

Program Service Revenue ProgramServiceRevenue (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncomeUnrelated Business RevenueUnrelatedBusinessRevenue
Outpatient Revenue6219901134120611341206
Inpatient Revenue62199059414285941428
Reference Lab Fees541380158579158579
FieldValueIRS element (for citing)
Total Program Service Revenue17441213TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column71334TotalRevenueColumn
Exclusion$71,334ExclusionAmount

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real80908Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real80908Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column80908TotalRevenueColumn
Exclusion$80,908ExclusionAmount

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnExclusionExclusionAmount
Exercise Program/Gym M71394045566$45,566
Vending Machine/Cafete90009929890$29,890
HOUSEKEEPING5617008044$8,044

Miscellaneous Revenue MiscellaneousRevenue

FieldValueIRS element (for citing)
Total Revenue Column26381TotalRevenueColumn
Exclusion$26,381ExclusionAmount
FieldValueIRS element (for citing)
Total Other Revenue109881TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column17717486TotalRevenueColumn
Related Or Exempt Function Income17282634RelatedOrExemptFunctionIncome
Unrelated Business Revenue158579UnrelatedBusinessRevenue
Exclusion$262,123ExclusionAmount

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total6059933Total
Program Services3910225ProgramServices
Management And General2149708ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total337163Total
Program Services217557ProgramServices
Management And General119606ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total1105840Total
Program Services713553ProgramServices
Management And General392287ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total413050Total
Program Services266524ProgramServices
Management And General146526ManagementAndGeneral

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total767636Total
Program Services495324ProgramServices
Management And General272312ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total5805Total
Program Services3746ProgramServices
Management And General2059ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total451337Total
Program Services291229ProgramServices
Management And General160108ManagementAndGeneral

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total26118Total
Program Services16853ProgramServices
Management And General9265ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total163279Total
Management And General163279ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total912709Total
Management And General912709ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total168920Total
Management And General168920ManagementAndGeneral

Other Expenses OtherExpenses (5 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
Bad Debt41859424185942
Purchased services1488902960727528175
Supplies1166805752891413914
Contract Labor779382502903276479
Repair and Maintenance374926247451127475

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total307303Total
Program Services198290ProgramServices
Management And General109013ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total18715050Total
Program Services12763215ProgramServices
Management And General5951835ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY604208BOY
EOY1548507EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY42383BOY
EOY268910EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY3503935BOY
EOY2098613EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY186226BOY
EOY168819EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY54887BOY
EOY77159EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis19118029LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec13118632LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY6814730BOY
EOY5999397EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY672604BOY
EOY111154EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY355758BOY
EOY415528EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY12234731BOY
EOY10688087EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY5253219BOY
EOY4728954EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY6704142BOY
EOY6585657EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY11957361BOY
EOY11314611EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY277370BOY
EOY-626524EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY277370BOY
EOY-626524EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY12234731BOY
EOY10688087EOY
FieldValueIRS element (for citing)
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 B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

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 Basis10876307OtherCostOrOtherBasis
Depreciation6584676Depreciation
Book Value4291631BookValue

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 Basis7758967OtherCostOrOtherBasis
Depreciation6240043Depreciation
Book Value1518924BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis286678OtherCostOrOtherBasis
Depreciation279646Depreciation
Book Value7032BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings5999397TotalOfBookValueLandBuildings

Other Liabilities OtherLiabilities (5 entries)

DescriptionDescriptionAmountAmount
Intercompany Debt to Ascension Health$3,788,208
Pension$1,856,638
Intercompany to St Marys Medical Center$879,856
Deferred Compensation$60,824
Self Insurance$131
FieldValueIRS element (for citing)
Total Of Amounts6585657TotalOfAmounts

Form990 Schedule D Part XIV Form990ScheduleDPartXIV

FieldValueIRS element (for citing)
IdentifierPart X:Identifier
Return ReferenceDescription of Uncertain Tax Positions Under FIN 48:ReturnReference
ExplanationPer the financial statements of St. Mary's Health System of America, INC (which include the activity of St. Mary's Warrick Hospital, Inc.), there is no current year ASC 740 (fka FIN 48) footnote for the current year.Explanation

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 Expense571281TotalCommunityBenefitExpense
Net Community Benefit Expense571281NetCommunityBenefitExpense
Percent Of Total Expense0.03930PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Total Community Benefit Expense1935530TotalCommunityBenefitExpense
Direct Offsetting Revenue1064643DirectOffsettingRevenue
Net Community Benefit Expense870887NetCommunityBenefitExpense
Percent Of Total Expense0.05990PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Total Community Benefit Expense2506811TotalCommunityBenefitExpense
Direct Offsetting Revenue1064643DirectOffsettingRevenue
Net Community Benefit Expense1442168NetCommunityBenefitExpense
Percent Of Total Expense0.09920PercentOfTotalExpense

Community Health Services CommunityHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense50525TotalCommunityBenefitExpense
Net Community Benefit Expense50525NetCommunityBenefitExpense
Percent Of Total Expense0.00350PercentOfTotalExpense

Cash And In Kind Contributions CashAndInKindContributions

FieldValueIRS element (for citing)
Total Community Benefit Expense15328TotalCommunityBenefitExpense
Net Community Benefit Expense15328NetCommunityBenefitExpense
Percent Of Total Expense0.00110PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense65853TotalCommunityBenefitExpense
Net Community Benefit Expense65853NetCommunityBenefitExpense
Percent Of Total Expense0.00460PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense2572664TotalCommunityBenefitExpense
Direct Offsetting Revenue1064643DirectOffsettingRevenue
Net Community Benefit Expense1508021NetCommunityBenefitExpense
Percent Of Total Expense0.10380PercentOfTotalExpense

Other Other

FieldValueIRS element (for citing)
Total Community Building Expense853TotalCommunityBuildingExpense
Net Community Building Expense853NetCommunityBuildingExpense
Percent Of Total Expense0.00010PercentOfTotalExpense

Total Total

FieldValueIRS element (for citing)
Total Community Building Expense853TotalCommunityBuildingExpense
Net Community Building Expense853NetCommunityBuildingExpense
Percent Of Total Expense0.00010PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense Reported0BadDebtExpenseReported
Bad Debt Expense$1,757,677BadDebtExpenseAmount
Amount Attributable To669751AmountAttributableTo
Amount Reimbursed By Medicare7112248AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare8244894CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall-1132646MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

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

Form990 Schedule H Part V Form990ScheduleHPartV

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 VI Form990ScheduleHPartVI

FieldValueIRS element (for citing)
Income Based CriteriaPart 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 MINUMUM, 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 MINUMUM, 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.IncomeBasedCriteria
Costing Method UsedPart I, Line 7: THE COST OF PROVIDING CHARITY CARE, MEANS TESTED GOVERNMENT PROGRAMS, AND COMMUNITY BENEFIT PROGRAMS IS ESTIMATED USING INTERAL 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.CostingMethodUsed
Percent Of Total Expense ExplnPart I, Line 7f: The amount of Bad debt expense reported on Form 990, Part IX, Line 25, Column (a), but subtracted for purposes of calculating the percentages in Part I, Line 7, column (f) is $4,185,942.PercentOfTotalExpenseExpln
Bad Debt FootnotePart 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 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. AFTER SATISFACTION OF AMOUNTS DUE FROM INSURANCE AND REASONABLE EFFORTS TO COLLECT FROM THE PATIENT HAVE BEEN EXHAUSTED, THE CORPORATION FOLLOWS ESTABLISHED GUIDELINES FOR PLACING CERTAIN PAST-DUE PATIENT BALANCES WITHIN COLLECTION AGENCIES, SUBJECT TO THE TERMS OF CERTAIN RESTRICTIONS ON COLLECTION EFFORTS AS DETERMINED BY ASCENSION HEALTH. ACCOUNTS RECEIVABLE ARE WRITTEN OFF AFTER COLLECTION EFFORTS HAVE BEEN FOLLOWED IN ACCORDANCE WITH THE CORPORATION'S POLICIES. THE SHARE OF THE BAD DEBT EXPENSE IN FISCAL YEAR 2010 WAS $4,185,942 AT CHARGES ($1,757,677 AT COST).BadDebtFootnote
Shortfall As Community BenefitPart 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.ShortfallAsCommunityBenefit
Debt Collection PolicyPart 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.DebtCollectionPolicy
Needs AssessmentPart 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 INTERGRATED STRATEGIC FINANCIAL AND OPERATIONAL PLAN. TO THAT END, ST. MARY'S WARRICK HOSPITAL 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 ALSO IDENTIFIES COMMUNITY HEALTH NEED BY EMPLOYING OTHER PUBLIC AGENCY NEEDS ASSESSMENTS SUCH AS WELBORN BAPTIST FOUNDATION AND THE UNITED WAY.NeedsAssessment
Patient Education AssistancePart VI, Line 3: ST. MARY'S WARRICK HOSPITAL COMMUNICATES WITH PATIENTS IN MULTIPLE WAYS TO ENSURE THAT THOSE WHO ARE BILLED FOR SERVICES ARE AWARE OF THE HOSPITAL'S CHARITY CARE PROGRAM AS WELL AS THEIR POTENTIAL ELIGIBILITY FOR LOCAL, STATE OR FEDERAL PROGRAMS. SIGNS ARE PROMINENTLY POSTED IN EACH SERVICE AREA. 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.PatientEducationAssistance
Community InformationPart 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 2009 ESTIMATED US CENSUS, WARRICK COUNTY HAS A POPULATION OF 58,251 AND 9% OF THE CHILDREN IN WARRICK COUNTY ARE DEEMED TO LIVE IN HOUSEHOLDS BELOW THE POVERTY GUIDELINES. IN ADDITION, 12% 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 29% 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 INDIVIDUALSCommunityInformation
Community Building ActivitiesPart VI, Line 5: WHILE MOST OF ST. MARY'S WARRICK HOSPITAL, INC.'S COMMUNITY BENEFIT ACTIVITIES DIRECTLY IMPACT THE HEALTH OF ITS COMMUNITIES, ST. MARY'S 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 2010, ST. MARY'S WARRICK HOSPITAL COMMUNITY BUILDING ACTIVITIES INCLUDED: UNITED WAY DAY OF CARING, ANGEL TREE AT CHRISTMAS, AND THE TEEN DRIVING ACADEMY.CommunityBuildingActivities
Other InformationPart VI, Line 6: 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:- 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.OtherInformation
Affiliated Health Care SystemPart VI, Line 7: AS A PART OF ST. MARY'S HEALTH SYSTEM, ST. MARY'S WARRICK HOSPITAL IS DEDICATED TO IMPROVING THE HEALTH STATUS AND QUALITY OF LIFE FOR THE COMMUNITIES IT SERVES. WHILE DESIGNATED ASSOCIATES AT ST. MARY'S WARRICK 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 RPOVIDE 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 PARTICIPATES.AffiliatedHealthCareSystem
Reports Filed With StatesINReportsFiledWithStates

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 (8 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
046590303966050206838077000221600109920600
Gwen Sandefur
029394005328301025401181029401038805900
Lloyd McGinnis MD
014405305806070220002611015949200
Carol Godsey
011880003277804635703483017051021846900
David Vaughn
2492550700003334000061510295746000
Thomas L Miller
2109000001071300053700226983000
James S Mooney
14476400014900051850150098000
Steven Becker
2118210003000045890216440000

Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
Part I, Line 4aTimothy Flesch, $173,919 Carol Godsey, $16,500 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.
Part 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 CommitteeSupplemental Information

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (13 entries)

IdentifierIdentifierExplanationExplanationReturn ReferenceReturnReference
Form 990, Part VI, Section A, line 6Classes of Members of Stockholders Warrick Hospital has a single corporate member, St. Mary's Health System of America, Inc.
Form 990, Part VI, Section A, line 7aElection of Members and Their Rights St. Mary's Health System of America, Inc. has the ability to elect members to the governing body of the St. Mary's Warrick Hospital Board.
Form 990, Part VI, Section A, line 7bDecisions Subject to Approval of Members All decisions that have a material impact to St. Mary's Warrick Hospital Inc. 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 11ORGANIZATION'S PROCESS USED TO REVIEW FORM 990 THE PROCESS THE ORGANIZATION USES TO REVIEW THE FORM 990 CONSISTS OF PROVIDING THE FORM 990 TO THE GOVERNING BODY IN APRIL TO ALLOW FOR A THOROUGH REVIEW BY THE GOVERNING BODY PRIOR TO THE FILING DATE OF MAY 16TH. THE GOVERNING BODY WILL REVIEW THE FORM 990 VIA A SECURE WEB-BASED PORTAL AND ASK ANY QUESTIONS REGARDING THE FORM 990. ANY QUESTIONS AND RESPONSES WILL BE POSTED TO THE WEB-BASED PORTAL 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 990.
Form 990, Part VI, Section B, line 12cEnforcement of Conflicts Policy THE ORGANIZATION REGULARLY AND CONSISTENTLY MONITORS AND ENFORCES COMPLIANCE WITH THE CONFLICT OF INTEREST POLICY IN THAT ANY DIRECTOR, PRINCIPAL OFFICER, OR MEMBER OF A COMMITTEE WITH GOVERNING BOARD DELEGATED POWERS, WHO HAS A DIRECT OR INDIRECT FINANCIAL INTEREST, MUST DISCLOSE THE EXISTENCE OF THE FINANCIAL INTEREST AND BE GIVEN THE OPPORTUNITY TO DISCLOSE ALL MATERIAL FACTS TO THE DIRECTORS AND MEMBERS OF THE 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 PROCESS FOR TOP OFFICIAL IN DETERMING 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 CONTEMPORANEAOUS SUBSTANTIATION OF THE DELIBERATION AND DECISION. THE EXECUTIVE COMMITTEE OF THE ST MARY'S HEALTH SYSTEM 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 Process for Officers IN DETERMING COMPENSATION OF OTHER OFFICERS OR KEY EMPLOYEES OF THE ORGANIZATION, THE PROCESS INCLUDED A REVIEW AND APPROVAL BY INDEPENDENT PERSONS, COMPARABILITY DATA, AND CONTEMPORANEAOUS SUBSTANTIATION OF THE DELIBERATION AND DECISION. THE EXECUTIVE COMMITTEE OF THE ST MARY'S HEALTH SYSTEM 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. THE COMPENSATION PROCESS IS COMPLETED FROM A RELATED ORGANIZATION.
Form 990, Part VI, Section C, line 19Governing Documents Disclosure Explanation The organization will provide any documents open to public inspection upon request.
FORM 990, PART XI, LINE 2CTHE FINANCIAL STATEMENTS WERE AUDITED ON A CONSOLIDATED BASIS. AN AUDIT COMMITTEE HAS BEEN DELEGATED TO OVERSEE THE AUDITED FINANCIAL STATEMENTS AND THE SELECTION OF THE INDEPENDENT ACCOUNTANTS THAT AUDITED THE FINANCIAL STATEMENTS.CHANGE IN FINANCIAL REVIEW PROCESS
FORM 990, PART I, LINE 6THE TOTAL NUMBER OF VOLUNTEERS FOR THE ORGANIZATION IS 4. THIS CONSISTS OF VOLUNTEERS PARTICIPATING ON THE BOARD OF DIRECTORS.TOTAL NUMBER OF VOLUNTEERS
FORM 990, PART IV, LINE 24aST. 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.TAX EXEMPT HOSPITAL REVENUE BOND
FORM 990, PART VII, LINE 1a, COLUMN BOFFICERS 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 OFFICERS 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.TRACKING OF HOURS BY ENTITY
FORM 990, PART VII, LINE 1A, COLUMNS D, E, AND FOFFICERS 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.COMPENSATION AMOUNTS REPORTED FOR MANAGING ALL ST. MARY'S ENTITIES:
FORM 990, SCHEDULE R, PART V LINE 2ST. MARY'S WARRICK HOSPITAL, INC. USE THE FOLLOWING METHODS TO DETERMINE THE VALUE OF RELATED ORGANIZATION TRANSACTIONS: -FAIR MARKET VALUE FOR SERVICES AND CASH -BOOK VALUE FOR OTHER ASSETSVALUATION OF RELATED ORGANIZATION TRANSACTIONS

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
3700 Washington AveEvansvilleIN47750351935526MammographIN12135131900858Seton
St Mary's Physicians' Health Group LLC
3700 Washington AveEvansvilleIN47750261356310Physician PracticeIN-21567402594755SMMC
Primary Physician Network LLC
3700 Washington AveEvansvilleIN47750208775914Physician PracticeIN-24309363274337SMMC
Physicians' Health Group LLC
3700 Washington AveEvansvilleIN47750043679294DISSOLVEDIN00SMMC
ST MARY'S PHYSICIAN NETWORK LLC
3700 Washington AveEVansvilleIN47750205023387PHYSICIAN PracticeIN-75697676134298SMMC

Form990 Schedule R Part II Form990ScheduleRPartII (11 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Direct Controlling Entity NADirectControllingEntityNA
Seton Health Corporation of Southern Indiana Inc
3700 Washington AvenueEvansvilleIN47750351679526InvestmentIN501c311CSMHS
St Mary's Home Health Care Services Inc
3700 Washington AvenueEvansvilleIN47750351899562DORMANTIN501c311aSeton
St Mary's Medical Center Foundation Inc
3700 Washington AvenueEvansvilleIN47750237045370FundraisingIN501c311aSMMC
St Mary's Medical Center of Evansville Inc
3700 Washington AvenueEvansvilleIN47750350869065HospitalIN501c33SMHS
St Mary's Warrick Hospital Foundation Inc
1116 Millis AvenueBoonvilleIN47601351961890FundraisingIN501c311aSMW
Ascension Health
PO Box 45998St LouisMO63145311662309National Health SystemMO501c311aN/A
St Mary's At Home Inc
3700 Washington AvenueEvansvilleIN47750351899560DME/Home CareIN501c311aSeton
St Mary's Building Corporation
3700 Washington AvenueEvansvilleIN47750237248362Real EstateIN501c2Seton
St Mary's Warrick EMS Inc
3700 Washington AvenueEvansvilleIN47750205342518EMSIN501c4SMHS
Medical Management Inc
3700 Washington AvenueEvansvilleIN47750351831570DormantIN501c311CSMHS
St Mary's Health System of America Inc
3700 Washington AvenueEvansvilleIN47750352057801Health Ministry ParentIN501c311cAscension Health

Form990 Schedule R Part III Form990ScheduleRPartIII (8 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivityPrimaryActivityLegal Domicile StateLegalDomicileStateDirect Controlling Entity NADirectControllingEntityNAPredominant Income TypePredominantIncomeTypeShare Of Total IncomeShareOfTotalIncomeShare Of EOY AssetsShareOfEOYAssetsDisproportionate AllocationsDisproportionateAllocationsGeneral Or Managing PartnerGeneralOrManagingPartnerBusiness Name Line1DirectControllingEntityName/BusinessNameLine1
Memorial HospitalSeton Health Corporation Sleep ManagementLLC
800 West 9th StreetJasperIN47546263635457ManagementINN/ARELATED5407010846000
St Mary's Acute Dialysis Services LLC
3700 Washington AveEvansvilleIN47750271346179ManagementINN/ARELATED31409132609101
Seton Health Services LLC
3700 Washington AveEvansvilleIN47750270451316Equip RentalINN/ARELATED01
St Mary's Freestanding Cath Lab LLC
3700 Washington AveEvansvilleIN47750320086252ManagementINRELATED75713763840101OVHC
St Mary's Peripheral Vascular Services Management Company LLC
3700 Washington AveEvansvilleIN47750205062635ManagementINN/ARELATED4630328255101
Ambulatory Care Center LLC
1125 Professional BlvdEvansvilleIN47714352006018OP SurgeryINN/ARELATED3514663372368001
Genesis Health Alliance LLC
3700 Washington AveEvansvilleIN47750208223181GPOINN/ARELATED85434321601
Radiation Oncology Center of Soutwest Indiana LLC
3699 Epworth RdNewburghIN47630263429077ManagementINN/ARELATED48618287175900

Form990 Schedule R Part IV Form990ScheduleRPartIV (2 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivityPrimaryActivityLegal Domicile StateLegalDomicileStateBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Type Of EntityTypeOfEntityShare Of Total IncomeShareOfTotalIncomeShare Of EOY AssetsShareOfEOYAssetsPercentage OwnershipPercentageOwnership
St Mary's Medical Group Inc
3700 Washington AvenueEvansvilleIN47750352076827InvestmentINSMHSC2840691554691.00000
Ohio Valley Heart Care Inc
901 St Marys Drive Suite 300EvansvilleIN47714351487233CardiologyINSMHSC-79055747122231.00000
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org1GiftGrantOrCapContrToOtherOrg
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 InvolvedAmountInvolved
St Mary's Medical Center
E83077
St Mary's Health System of America
O1843371
St Mary's Medical Center
O416029
Ascension Health
E155450
Ascension Health
O521315