2011-05-16T09:55:52-05:00 2010-06-30 Deloitte Tax LLP 111 Monument Circle Suite 2000 Indianapolis IN 46204 990 2009-07-01 351343019 St Mary's Warrick Hospital Inc WARR 8128974800 1116 Millis Avenue Boonville IN 47601 JERRY R LAUE 8128974800 2011-05-16 1 3174648600 2009 2016-02-24 21:20:13Z Carol Godsey 1116 Millis Avenue Boonville IN 47601 17717486 0 X www.stmarys.org X 1971 IN 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. 7 4 226 29 158579 42294 14150 17591169 17441213 -152727 71334 130724 190789 17569166 17717486 0 0 7868659 7915986 0 0 9669247 10799064 17537906 18715050 31260 -997564 12234731 10688087 11957361 11314611 277370 -626524 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. 0 0 4341938 5941428 Warrick 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. 8421277 11341206 The 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. 12763215 1 1 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 1 35 0 1 226 1 1 1 0 0 0 0 0 0 0 0 7 4 0 0 0 0 1 1 1 1 1 0 1 1 1 1 1 1 1 1 1 1 0 IN X DOUGLAS KNIES 8124854000 3700 Washington Avenue Evansville IN 47750 X Timothy Flesch 65.00 X X 0 1069346 29860 Gwen Sandefur 65.00 X 0 357477 30582 Lloyd McGinnis MD 50.00 X 0 156881 2611 Laurence Steenburg 1.00 X X 0 0 0 Michael Herrell MD 1.00 X X 0 0 0 Judge Donald Hendrickson 1.00 X 0 0 0 Sally Rideout Lambert 1.00 X 0 0 0 Carol Godsey 65.00 X 0 197935 20534 David Vaughn 45.00 X 289595 0 6151 Thomas L Miller 42.00 X 221613 0 5370 James S Mooney 35.00 X 144913 0 5185 Steven Becker 40.00 X 211851 0 4589 Robert W Murphy 55.00 X 139573 0 1183 1007545 1781639 106065 5 0 1 0 Psychiatric Solutions PO Box 840839 Dallas TX 75284 Management Services 340600 Kenneth Parker MD PO Box 129 Inglefield IN 47618 Medical Service 161000 GE Healthcare PO Box 96485 Chicago IL 60693 Medical Maintenance Services 156726 CPSI 6600 Wall Street Mobile AL 36695 Healthcare Information Management 107802 4 14150 14150 Outpatient Revenue 621990 11341206 11341206 Inpatient Revenue 621990 5941428 5941428 Reference Lab Fees 541380 158579 158579 17441213 71334 71334 80908 80908 80908 80908 Exercise Program/Gym M 713940 45566 45566 Vending Machine/Cafete 900099 29890 29890 HOUSEKEEPING 561700 8044 8044 26381 26381 109881 17717486 17282634 158579 262123 6059933 3910225 2149708 337163 217557 119606 1105840 713553 392287 413050 266524 146526 767636 495324 272312 5805 3746 2059 451337 291229 160108 26118 16853 9265 163279 163279 912709 912709 168920 168920 Bad Debt 4185942 4185942 Purchased services 1488902 960727 528175 Supplies 1166805 752891 413914 Contract Labor 779382 502903 276479 Repair and Maintenance 374926 247451 127475 307303 198290 109013 18715050 12763215 5951835 0 604208 1548507 42383 268910 3503935 2098613 186226 168819 54887 77159 19118029 13118632 6814730 5999397 672604 111154 355758 415528 12234731 10688087 5253219 4728954 6704142 6585657 11957361 11314611 X 277370 -626524 277370 -626524 12234731 10688087 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 181810 181810 10876307 6584676 4291631 14267 14267 0 7758967 6240043 1518924 286678 279646 7032 5999397 Intercompany Debt to Ascension Health 3788208 Pension 1856638 Intercompany to St Marys Medical Center 879856 Deferred Compensation 60824 Self Insurance 131 6585657 Part X: Description of Uncertain Tax Positions Under FIN 48: Per 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. 1 1 X 1 X 1 X 1 1 0 1 1 571281 571281 0.03930 1935530 1064643 870887 0.05990 2506811 1064643 1442168 0.09920 50525 50525 0.00350 15328 15328 0.00110 65853 65853 0.00460 2572664 1064643 1508021 0.10380 853 853 0.00010 853 853 0.00010 0 1757677 669751 7112248 8244894 -1132646 X 1 1 St Mary's Warrick Hospital INc

1116 Millis Avenue Boonville IN 47601

X X X X 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 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. Part 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. Part 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. 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 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). 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 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. Part 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. 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 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 INDIVIDUALS Part 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. Part 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. Part 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. IN 0 1 0 0 0 0 0 0 0 Timothy Flesch 0 465903 0 396605 0 206838 0 7700 0 22160 0 1099206 0 0 Gwen Sandefur 0 293940 0 53283 0 10254 0 1181 0 29401 0 388059 0 0 Lloyd McGinnis MD 0 144053 0 5806 0 7022 0 0 0 2611 0 159492 0 0 Carol Godsey 0 118800 0 32778 0 46357 0 3483 0 17051 0 218469 0 0 David Vaughn 249255 0 7000 0 33340 0 0 0 6151 0 295746 0 0 0 Thomas L Miller 210900 0 0 0 10713 0 0 0 5370 0 226983 0 0 0 James S Mooney 144764 0 0 0 149 0 0 0 5185 0 150098 0 0 0 Steven Becker 211821 0 0 0 30 0 0 0 4589 0 216440 0 0 0 Part I, Line 4a Timothy 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. Supplemental Information Part III Part 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 Form 990, Part VI, Section A, line 6 Classes 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 7a Election 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 7b Decisions 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 11 ORGANIZATION'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 12c Enforcement 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 15 COMPENSATION 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 19 Governing Documents Disclosure Explanation The organization will provide any documents open to public inspection upon request. FORM 990, PART XI, LINE 2C CHANGE IN FINANCIAL REVIEW PROCESS THE 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. FORM 990, PART I, LINE 6 TOTAL NUMBER OF VOLUNTEERS THE TOTAL NUMBER OF VOLUNTEERS FOR THE ORGANIZATION IS 4. THIS CONSISTS OF VOLUNTEERS PARTICIPATING ON THE BOARD OF DIRECTORS. FORM 990, PART IV, LINE 24a TAX EXEMPT HOSPITAL REVENUE BOND 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. FORM 990, PART VII, LINE 1a, COLUMN B TRACKING OF HOURS BY ENTITY OFFICERS 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. FORM 990, PART VII, LINE 1A, COLUMNS D, E, AND F COMPENSATION AMOUNTS REPORTED FOR MANAGING ALL ST. MARY'S ENTITIES: 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, SCHEDULE R, PART V LINE 2 VALUATION OF RELATED ORGANIZATION TRANSACTIONS ST. 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 ASSETS St Mary's Breast Center 3700 Washington Ave Evansville IN 47750 351935526 Mammograph IN 1213513 1900858 Seton St Mary's Physicians' Health Group LLC 3700 Washington Ave Evansville IN 47750 261356310 Physician Practice IN -2156740 2594755 SMMC Primary Physician Network LLC 3700 Washington Ave Evansville IN 47750 208775914 Physician Practice IN -2430936 3274337 SMMC Physicians' Health Group LLC 3700 Washington Ave Evansville IN 47750 043679294 DISSOLVED IN 0 0 SMMC ST MARY'S PHYSICIAN NETWORK LLC 3700 Washington Ave EVansville IN 47750 205023387 PHYSICIAN Practice IN -7569767 6134298 SMMC Seton Health Corporation of Southern Indiana Inc 3700 Washington Avenue Evansville IN 47750 351679526 Investment IN 501c3 11C SMHS St Mary's Home Health Care Services Inc 3700 Washington Avenue Evansville IN 47750 351899562 DORMANT IN 501c3 11a Seton St Mary's Medical Center Foundation Inc 3700 Washington Avenue Evansville IN 47750 237045370 Fundraising IN 501c3 11a SMMC St Mary's Medical Center of Evansville Inc 3700 Washington Avenue Evansville IN 47750 350869065 Hospital IN 501c3 3 SMHS St Mary's Warrick Hospital Foundation Inc 1116 Millis Avenue Boonville IN 47601 351961890 Fundraising IN 501c3 11a SMW Ascension Health PO Box 45998 St Louis MO 63145 311662309 National Health System MO 501c3 11a N/A St Mary's At Home Inc 3700 Washington Avenue Evansville IN 47750 351899560 DME/Home Care IN 501c3 11a Seton St Mary's Building Corporation 3700 Washington Avenue Evansville IN 47750 237248362 Real Estate IN 501c2 Seton St Mary's Warrick EMS Inc 3700 Washington Avenue Evansville IN 47750 205342518 EMS IN 501c4 SMHS Medical Management Inc 3700 Washington Avenue Evansville IN 47750 351831570 Dormant IN 501c3 11C SMHS St Mary's Health System of America Inc 3700 Washington Avenue Evansville IN 47750 352057801 Health Ministry Parent IN 501c3 11c Ascension Health Memorial HospitalSeton Health Corporation Sleep ManagementLLC 800 West 9th Street Jasper IN 47546 263635457 Management IN N/A RELATED 54070 108460 0 0 St Mary's Acute Dialysis Services LLC 3700 Washington Ave Evansville IN 47750 271346179 Management IN N/A RELATED 314091 326091 0 1 Seton Health Services LLC 3700 Washington Ave Evansville IN 47750 270451316 Equip Rental IN N/A RELATED 0 1 St Mary's Freestanding Cath Lab LLC 3700 Washington Ave Evansville IN 47750 320086252 Management IN OVHC RELATED 757137 638401 0 1 St Mary's Peripheral Vascular Services Management Company LLC 3700 Washington Ave Evansville IN 47750 205062635 Management IN N/A RELATED 46303 282551 0 1 Ambulatory Care Center LLC 1125 Professional Blvd Evansville IN 47714 352006018 OP Surgery IN N/A RELATED 3514663 3723680 0 1 Genesis Health Alliance LLC 3700 Washington Ave Evansville IN 47750 208223181 GPO IN N/A RELATED 8543 43216 0 1 Radiation Oncology Center of Soutwest Indiana LLC 3699 Epworth Rd Newburgh IN 47630 263429077 Management IN N/A RELATED 486182 871759 0 0 St Mary's Medical Group Inc 3700 Washington Avenue Evansville IN 47750 352076827 Investment IN SMHS C 28406 9155469 1.00000 Ohio Valley Heart Care Inc 901 St Marys Drive Suite 300 Evansville IN 47714 351487233 Cardiology IN SMHS C -790557 4712223 1.00000 0 1 0 0 1 0 0 0 0 0 0 0 0 0 1 1 0 0 St Mary's Medical Center E 83077 St Mary's Health System of America O 1843371 St Mary's Medical Center O 416029 Ascension Health E 155450 Ascension Health O 521315