2019-11-11T09:45:19-06:00 2018-12-31 ERNST & YOUNG US LLP 155 N WACKER DRIVE 20 FLOOR CHICAGO IL 60606 990 2018-01-01 350868132 Memorial Hospital of South Bend Inc % JEFFREY COSTELLO MEMO 5746473549 615 N MICHIGAN STREET SOUTH BEND IN 46601 JEFFREY COSTELLO CFO 5746473549 2019-11-07 true JACOB ZEHNDER P01564049 3128792702 164.57.159.253 36964520193145000004 2019-11-10 P BCBDB63E84B28D3E7A2870F33781C9A569B15318 3D6D3C2D4C8BC107A1740E261440CB51ACA7B417 2018 2020-04-17 16:48:07Z Larry Tracy 615 N MICHIGAN STREET SOUTH BEND IN 46601 605699077 false X beaconhealthsystem.org X 1923 IN SEE SCHEDULE O 8 6 3700 441 289629 94334 5312171 4212683 528776191 588328326 -563224 289708 10773080 12403981 544298218 605234698 1994226 2391343 0 0 182459922 193387208 0 0 0 267366711 289795056 451820859 485573607 92477359 119661091 522189204 538957796 224388480 220825979 297800724 318131817 X BEACON HEALTH SYSTEM, INC. IS COMMITTED TO ENHANCING THE PHYSICAL, MENTAL, AND EMOTIONAL AND SPIRITUAL WELL-BEING OF THE COMMUNITIES WE SERVE AS THE COMMUNITY'S PROVIDER OF OUSTANDING QUALITY, SUPERIOR VALUE AND COMPREHENSIVE HEALTH CARE SERVICES. false false 113955380 0 313435995 Ancillary Services offers the following services for patients and facilities: - Imaging Services - Outpatient Physical, Occupational and Speech Therapy - Infusion Treatments - Radiation Oncology Therapy - Cancer Research - Cardiac Cath Lab - Sleep Lab - Interventional Radiology - Environmental Services - Nutritional Services - Pharmacy Services - Laboratory. 2018 STATISTICS FOR THIS SERVICE UNIT INCLUDE: - 541,468 INPATIENT PROCEDURES - 445,019 OUTPATIENT PROCEDURES - 1,316 INPATIENT CATHS - 1,745 OUTPATIENT CATHS. 109041990 0 157981491 Patient Care Unit Services provides a wide variety of hospital services including: - Inpatient rehabilitation CARF (Commission on Accreditation of Rehabilitation Facilities) accredited - Medical - Post surgical - Orthopedic - Oncology - Intensive and intermediate - Heart and Vascular - Mother and Child - Special Care Obstetrics - Neonatal Intensive Care Level III - Emergency - Trauma Level II - Pediatrics - Pediatric Intensive Care - Pediatric Hematology Oncology - Medical Flight program - Pediatric Intensive Care Transports. 2018 STATISTICS FOR THIS SERVICE UNIT INCLUDE: - 104,035 PATIENT DAYS - 10,651 INPATIENT ER VISITS - 47,088 OUTPATIENT ER VISITS - 2,419 BIRTHS - 17,128 OBSERVATION STAYS. 57525721 0 126745357 Surgical Services provides the following services: - General Surgery - Vascular Surgery - Cardiac Surgery - Orthopedic Surgery - Gynecological Surgery - Trauma Surgery - GI Labs - Pulmonary Services - Pain Center - DaVinci Robotic Surgery. 2018 STATISTICS FOR THIS SERVICE UNIT INCLUDE: - 8,928 INPATIENT PROCEDURES - 548 OPEN HEART PROCEDURES - 18,882 OUTPATIENT PROCEDURES. 174948669 2391343 0 455471760 true true false true false false false false false true true false false true true true false true false false false false false false true false true true true false true true false false false false false false false true false false false false false false false true true true false false true 270 0 true 3700 true true true false false false false false false false false false false false X 8 6 false false true false true true true true true false false true true true true true true false false true true IN X JEFFREY COSTELLO 5746473549 615 N MICHIGAN STREET SOUTH BEND IN 46601 X Peter Baranay Chair 2.0 2.0 X X 3209 0 0 KAREN BARNETT VICE CHAIR 2.0 0.0 X X 1370 0 0 TIM DURHAM Trustee 2.0 0.0 X 0 0 0 HUGH HEDMAN MD TRUSTEE 2.0 0.0 X 1370 0 0 BRYAN BOYER Trustee/Employed Physician 2.0 40.0 X 0 874115 33996 MARK HARMAN Trustee 2.0 0.0 X 0 0 0 THOMAS HAUCH MD SECRETARY/TREASURER 2.0 0.0 X X 1370 0 0 BRAD TOOTHAKER Trustee 2.0 0.0 X 2409 0 0 Jeffrey P Costello CFO/Asst. Treasurer 2.0 48.0 X 0 773461 184073 Kreg Gruber CEO 2.0 48.0 X 0 1099330 235802 PHILLIP NEWBOLD CEO - LEFT NOVEMBER 2017 0.0 0.0 X 0 619376 15351 Larry Tracy President 40.0 0.0 X 473708 0 97724 Dale A Patterson Employed Physician 40.0 0.0 X 393581 0 34017 Marion Mahone Employeed Physician 40.0 5.0 X 312250 30800 20225 Matthew R Reed Employeed Physician 40.0 0.0 X 309558 0 17012 LINDA A MANSFIELD EMPLOYED PHYSICIAN 40.0 0.0 X 272910 0 31626 JANEL LOUISE CHARLTON EMPLOYED PHYSICIAN 40.0 0.0 X 268828 0 36159 Cheryl Wibbens-Lesh MD Asst. Secr./VP 0.0 40.0 X 224062 160886 35572 2264625 3557968 741557 108 true true false BALFOUR BEATTY CONSTRUCTION LLC 3100 MCKINNON STREET 6TH FLOOR DALLAS TX 75201 CONSTRUCTION 2653290 SOUTH BEND EMERGENCY PHYSICIANS 615 N MICHIGAN SOUTH BEND IN 46601 PHYSICIAN SERVICES 8283900 SOUTH BEND MEDICAL FOUNDATION 530 N LAFAYETTE BLVD SOUTH BEND IN 46601 LAB SERVICES 5834282 GIBSON LEWIS LLC 1001 W 11TH STREET MISHAWAKA IN 46544 CONSTRUCTION 2570535 METRO AVIATION INC 1214 HAWN AVENUE SHREVEPORT LA 71107 MEDICAL FLIGHTS 1980266 56 1747378 2465305 3500 4212683 NET PATIENT REVENUE 622110 582032317 582032317 OUTPATIENT PHARMACY 561499 5060953 5060953 JOINT VENTURE ACTIVITY 561499 1045973 1045973 AMBULANCE SUPPLY 621910 113115 113115 CASH DISCOUNTS 611710 72612 72612 3356 3356 588328326 151057 151057 27 27 0 223593 1702 221891 0 221891 221891 0 349079 3900 206555 -3900 142524 138624 138624 266278 252222 14056 14056 0 0 0 0 0 0 HLC ATHLETIC CLUB 713940 4554954 4486528 68426 VENDOR REBATES 561499 1694582 1694582 CAFETERIA SALES 561499 1054684 1054684 4863814 3653407 289629 920778 12168034 605234698 593101890 289629 7630496 2391343 2391343 0 0 0 581161 581161 236873 236873 150436745 137649622 12787123 4714560 4313822 400738 26988657 24694621 2294036 10429212 9542729 886483 292006 267185 24821 175982 175982 275580 275580 21310 19499 1811 0 17006 17006 44371507 42800187 1571320 73614 67357 6257 3684101 3370952 313149 53933 49349 4584 0 7281906 6662944 618962 718615 657533 61082 0 79860 73072 6788 5604175 5127820 476355 0 30114882 27555117 2559765 3289527 3009917 279610 MEDICAL SUPPLIES 96538119 96538119 0 0 BAD DEBT EXPENSE 38194104 38194104 0 0 CORPORATE ALLOCATION 35013649 28746206 6267443 0 HOSPITAL ASSESSMENT FEE 20989625 20989625 0 0 3005555 2750637 254918 485573607 455471760 30101847 0 19951 20401 -160911 -3714006 513766 596814 90151301 98674931 0 0 0 0 0 0 16812808 17813996 1075123 1773700 824826673 460417935 372320204 364408738 2681368 2718128 0 0 295382 261355 1171474 1171474 37308738 55232265 522189204 538957796 39242145 44212885 0 0 21589 144305 154532285 148972182 0 0 0 0 483720 296473 0 0 30108741 27200134 224388480 220825979 X 290986527 312373852 6814197 5757965 0 0 297800724 318131817 522189204 538957796 X 119661091 1603508 -100933506 X false true X true true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 21310 21310 false false SCHED C, PART IV MEMORIAL HOSPITAL PAID DUES TO THE FOLLOWING ORGANIZATIONS FOR WHICH THE AMOUNT OR PERCENTAGE LISTED WAS ATTRIBUTED TO LOBBYING: AAFP (AMERICAN ACADEMY OF FAMILY PHYSICIANS) - 8% AASM (American Academy of Sleep Medicine) - 2% AMA (American Medical Association) - 60% APTA (American Physical Therapy Association) - 18% IHA (INDIANA HOSPITAL ASSOCIATION) - 23% When unable to ascertain allocation of dues attributed to Lobbying a conservative estimate of 22% is applied. 34205140 1352757 -2479196 2243989 30834712 33854961 2155261 2479263 4284345 34205140 26556022 9605449 339397 2645907 33854961 29619029 4093832 -1367472 5789367 26556022 27642755 2833644 -142883 714487 29619029 0.81090 0.00240 0.18670 false true true 21501410 21501410 504034194 206974859 297059335 851999 851999 0 294502578 251402770 43099808 3936492 1188307 2748185 364408738 DUE FROM 3RD PARTY PAYORS 44999259 INT IN NET ASSETS OF REC ORG 5757965 INTEREST RECEIVABLE - SWAP 198966 OTHER RECEIVABLES 4260636 2016 BOND FUND 11543 AFFILIATE INTERCO 3896 55232265 0 INTEREST RATE SWAP 14050977 ASSET RETIREMENT OBLIGATION 4740731 IBNR 3250491 DUE TO THIRD PARTY 4888162 CAPITAL LEASE PAYABLE 175890 MEDTRONIC O-ARM AGREEMENT 93883 DUE FROM AFFILIATES 0 27200134 X PART V, LINE 4 Net assets with donor restrictions consist of assets whose use is limited by donor imposed, time and/or purpose restrictions. Some net assets have been restricted by donors to be maintained by the Corporation in perpetuity. In accordance with the restriction, a majority of the investment income and investment gains or losses from these net assets are restricted by the donor for a specific purpose. A specified portion of income earned by the net assets is released from restriction and used for operations each year and, therefore, is included in the consolidated statements of operations and changes in net assets as other revenue. THE BOARD HAS DISCRETION TO UTILIZE EACH YEAR THE INCOMES, REVENUES AND PROFITS ARISING AND ACCRUING FROM THE ENDOWMENTS IN DEFRAYING COSTS ASSOCIATED WITH THE TRUST AND THE REMAINDER FOR SUPPORT, BETTERMENT, IMPROVEMENT, UPKEEP, EXPANSION AND REPLACEMENT OF BEACON HEALTH SYSTEM, INC. AND ITS CORPORATE AFFILIATES. PART X, LINE 2 ASC 740, Income Taxes, requires that realization of an uncertain income tax position is more likely than not (i.e., greater than 50% likelihood of receiving a benefit) before it is recognized in the financial statements as the amount most likely to be realized assuming a review by tax authorities having all relevant information and applying current conventions. This interpretation also clarifies the financial statement classification of tax-related penalties and interest and sets forth new disclosures regarding unrecognized tax benefits. No amount was recorded for the years ended December 31, 2018 or 2017. MARATHON 266278 0 266278 1303 9231 0 471 0 241217 0 266278 0 266278 1303 9231 0 471 0 241217 252222 14056 Part II Event #1 Memorial Hospital of South Bend facilitates an annual sunburst marathon by collecting registration payment and organizing the event. All contributions are directed to and recorded by Beacon Health Foundation. Although the 2018 event had a small profit, it is common for the event to be run at a loss as all the sponsorship and contribution income is recorded by Beacon Health Foundation. true true X true X true X true true false true true 2824321 2824321 0.00630 95646035 87807966 7838069 0.01750 98470356 87807966 10662390 0.02380 5012619 2221448 2791171 0.00620 7254666 1700348 5554318 0.01240 426060 102641 323419 0.00070 268087 0 268087 0.00060 12961432 4024437 8936995 0.01990 111431788 91832403 19599385 0.04370 2 24774 24774 2 24774 24774 true 9823524 4911762 89912303 121560180 -31647877 X true true 1 1 MEMORIAL HOSPITAL OF SOUTH BEND INC 615 N MICHIGAN STREET SOUTH BEND IN 46545 www.BeaconHealthSystem.org 16-005053-1 X X X X X X MEMORIAL HOSPITAL OF SOUTH BEND INC 1 false false true X X X X X X X X X 18 true true true true X www.beaconhealthsystem.org/chna X X true 19 true www.beaconhealthsystem.org/chna false true X 200. 350. X X X true true X X X true X See Section C for full URL X See Section C for full URL X See Section C for full URL X X X X X X true X false X X X X true X false false PART V, Section B, Line 5 The data collection and analysis process started in February and concluded on September 2018. The key findings were consolidated in two reports: the first provided a snapshot of the three-county overall health status, and the second focused on the health needs of children in Elkhart, St. Joseph and Marshall counties. The Key Informant Survey collected information from March 28th to August 20th, 2018. The Community Survey was launched on May 7th and was closed on August 20th, 2018. The methodology followed for the needs assessment was based on three steps: 1) Identify needs; 2) Analyze the links between the needs and the information required to make decisions; 3) Make recommendations that guide decision-making. Since community engagement and feedback are essential to the integrity and validity of the CHNA process, input was actively solicited and secured from three sources (elaborated below) to understand community health needs. To ensure a representative sample of the community completed the community survey, a special effort was made to get feedback from hard to reach and minority populations. In addition to the survey being pushed out through digital platforms and listservs in both English and Spanish, the BCH/enFocus team partnered with 35 different organizations to collect feedback and attended 8 community events (listed below) to directly target individuals who typically do not complete community surveys. BCH's partner organizations provided recommendations and restrictions for creating a variety of strategies to engage these harder-to reach samples within the tri-county population. For the purpose of the Community Health Needs Assessment (CHNA), the community served is defined as those persons residing in Elkhart and St Joseph Counties, who were program participants. Beacon Community Impact makes a special effort to focus on populations with the highest unmet needs, specifically those persons who are known as vulnerable, through chronic diseases, lower-income and poverty, members of a minority population and/or the uninsured. Stakeholders in the community participated and represented a broad knowledge of interests, including public health, and minority, cultural, and underserved populations. Through the following organizations Beacon along with Enfocus also ensured that under-represented populations (Medically Underserved, Low-Income, and Minority Populations) were engaged in the consultation process, actively reaching out to them, ensuring that needs and perceptions from a wide range of demographic and socioeconomic groups were taken into consideration in the definition of top community health issues. The following organizations helped increase the reach of the survey, hence solicited in order for Beacon to take into account input received from persons who represent the broad interests of the community it serves: St. Joseph County: - 100 Black Men of SJC - Center for the Homeless - Community Foundation of St. Joseph County - Goodwill Industries - Hope Ministries - Imani Unidad - IUSB Division of Health Sciences - IUSB School of Nursing - Ivy Tech Community College - La Casa de Amistad - The LGBTQ Center - Notre Dame - South Bend Community School Corporation - South Bend-Elkhart Regional Partnership - South Bend Heritage Foundation - South Bend Veterans Center - St. Joseph County Public Library - St. Margaret's House - TREES, Inc - United Church of Christ - United Religious Community - United Way - Youth Service Bureau South Bend Elkhart County: - Community Foundation of Elkhart County - Church Community Services - Elkhart County Public Library - Faith Mission of Elkhart - Greater Elkhart Chamber of Commerce - Heart City Health - Mosaic Health & Healing Arts - Minority Health Coalition - Northern Indiana Hispanic Health Coalition - RETA - Reason Enough to Act - Ribbon of Hope Cancer Support - United Health Services Marshall County: -Bowen Center hosting Marshall County System of Care and United Way of Marshall County Additional efforts were made to reach the at-risk individuals in the community. Beacon and Enfocus solicited and received input from the vulnerable and broader community by attending the following community events. Community Outreach Events: - Faith Mission of Elkhart - Elkhart County Public Library - Best Week Ever - St. Joseph County Public Library - Minority Health Coalition - Northern Indiana Hispanic Health Coalition - Center for the Homeless - Heart City Health The assessment process identified four health priorities that can be streamlined into the essential components of Beacon Health System's mission. The Healthy Mind, Healthy Body, Healthy Spirit and Healthy Families pillars provide a framework for the alignment of intervention strategies with BHS mission and values that aim for 1) providing information and enhance skills to patients/practitioners/community; 2) improving equitable access to health and wellness; 3) leveraging incentives for long-term behavioral change; and 4) improving and strengthening the social and healthcare systems in the three-county area. Part V, Section B, Line 6a & 6b Memorial Hospital of South Bend (MHSB) developed the 2018 St. Joseph County CHNA in partnership with Elkhart General Hospital and Community Hospital of Bremen, Beacon Health System (BHS) Care Partners. Part V, Section B, Line 7D The Community Health Needs Assessment (CHNA) was made widely available to the community through posting on the MHSB website at BeaconHealthSystem.org/CHNA and through email transmission upon request. Hospital staff were also available to discuss the results of the CHNA and implementation strategies in requested community forums. Part V, Section B, Line 11 Implementation Strategies - As a general rule, the implementation of any of the four strategies will take into consideration the following approaches: 1) the program should address discrete factors, such as knowledge, beliefs and skills, at individual and family levels; and 2) the program should address context factors such as social support, available resources and services, and access barriers to financial/physical/information resources, at family and community levels. By addressing risk and protective factors in a comprehensive way, BHS acknowledges the fact that comorbidities are very likely to happen to chronic disease patients, because different health issues or disorders share the same risk factors, so the interventions addressing such factors are reasonably expected to reduce the prevalence of these multiple conditions. Healthy Body - Obesity/ Overweight Current Gap: - Obesity rates in 2017 for EC (14.5%), MC (15.2%) and SJC (14.3%) are higher than IN. - 1 in 3 children ages 10-17 are overweight or obese (33.9%), - According to WIC, by 2017, 13.5% of children between 2-5 years of age who were part of the program were obese. Intended Health Outcome: - By the end of the program cycle, obesity and overweight rates are reduced through the adoption of individual habits of healthier nutrition and increased physical activity. Behavioral Objective: - By the end of the program cycle, participants are consuming enough healthier food to cover their caloric needs and are engaged in regular physical activity, in accordance to attitudes and practices promoted by BHS. Rationale: - Obesity results from a combination of causes and contributing factors, including individual factors such as behavior and genetics. Behaviors can include dietary patterns, physical activity, inactivity, medication use, and other exposures. - Obesity is often associated with poorer mental health outcomes, reduced quality of life, and the leading causes of death in the U.S. and worldwide, including diabetes, heart disease, stroke, and some types of cancer. Healthy Mind - Mental Health Current Gap: - The prevalence estimates for the IN North Central Region show that 4.7% of resident adults have suffered from a serious mental illness (diagnoses resulting in serious functional impairment). - EC and SJC averaged 4.2 days of poor mental in the past 30 days before being surveyed. Intended Health Outcome: - By the end of the program cycle, participants are better able to cope with mental and emotional distress through enhanced community capacities (ability to provide mental health services). Behavioral Objective: - By the end of the program cycle, participants' socioemotional competences to reduce mental and emotional distress are strengthened. Rationale: - Conditions like depression, anxiety, bipolar disorder, or schizophrenia, among many others, may occur occasionally or over a long period, affecting people's ability to have a normal social life and be functional on a daily basis. - Mental illness, especially depression, increases the risk for many types of physical health problems, particularly long-lasting conditions like stroke, type 2 diabetes, and heart disease. Similarly, the presence of chronic conditions can increase the risk for mental illness. - Several factors can contribute to risk for mental illness, such as Adverse Child Experiences (ACEs), experiencing other chronic medical conditions (such as cancer or diabetes), biological factors, use of alcohol or drugs, and being/feeling lonely or isolated. Healthy Spirit - Substance Abuse Current Gap: - Drug overdose mortality rates have increased from 2014 to 2016 in all three counties (SJC, from 13.5% to 22.3%; EC, from 11.9% to 12.3%; and MC, from 7.8% to 9.3%). - Excessive Drinking rates have increased from 2014 to 2016 in all three counties (SJC, from 15.6% to 19.5%; EC, from 15.5% to 15.7%; and MC, from 16.2% to 17.2%). Intended Health Outcome: - By the end of the program cycle, participants are better able to cope with substance use disorder (SUD) by strengthening their socioemotional competencies. Behavioral Objective: - By the end of the program cycle, participants' socioemotional competences to reduce exposure to SUDs are strengthened. Rationale: - Excessive drinking is a risk factor for a number of adverse health outcomes, such as alcohol poisoning, hypertension, acute myocardial infarction, sexually transmitted infections, unintended pregnancy, fetal alcohol syndrome, sudden infant death syndrome, suicide, interpersonal violence, and motor vehicle crashes. - Drug use is also a risk factor for respiratory conditions and cancer. - Substance use disorders can be fatal to the user or others, by causing drunk driving fatalities and drug overdoses. - Mental illnesses and substance use disorders often occur together (sometimes as a contributing factor to the other, or by making it worse). Healthy Families - Maternal/Infant Health Current Gap: - The infant mortality rate for the Northern IN region (EC, MC, SJC) is 7.7 compared to 7.1 for the state. - African-American infants in IN have a higher mortality rate overall (14.4%), and for the Northern IN region is higher than the state rate (17.4%). - The teenage birth rate is higher in EC (41%) than in MC (28%), SJC (29%), or the state (30%). Intended Health Outcome: - By the end of the program cycle, participant mothers and children have improved access to prenatal care and child development programs. Behavioral Objective: - By the end of the program cycle, participant families are able to sustain habits that promote healthy child development (e.g. prenatal care, safe sleep, smoking prevention during pregnancy, teen pregnancy prevention). Rationale: - Malnutrition, smoking and alcohol/substance use in pregnant women increase the risk of children having cardiovascular disease, respiratory conditions and cognitive problems (like palsy, and sensory impairments) later in life. - Child Brain Development depends on many factors, like good nutrition starting in pregnancy, exposure to toxins or infections, and Adverse Child Experiences (ACEs). Exposure to stress and trauma can have long-term negative consequences for children. Community Health Needs Not Being Directly Addressed and Rationale - BHS is focusing in the most pressing community health needs identified in the CHNA Report. In order to avoid overlapping with other organizations and use the limited resources available strategically, it is worth acknowledging that gaps in community health are not isolated, and that oftentimes they reinforce each other, or coexist in the form of comorbidities, as medical research evidence suggest: - There are proven correlations between diabetes and obesity. - Diabetic patients are more likely to suffer depression and anxiety, and more likely to be smokers and drinkers. - Predictive risk factors of violence and trauma are often associated to behavioral issues, physical and emotional abuse, and substance abuse. - Other drivers of violence and trauma are associated to lack of stress management and skills, conflict management skills, and supportive family/social relationships. Community capacity-building and sustained behavioral change are expected to be the building blocks to improve community health outcomes, by creating transferable skills and healthy behaviors, effecting community-wide positive change. By doing this, BHS will continue to support efforts to address other community needs that emerged from key community leaders and stakeholders, community members at large, and prevalent health indicators. Coverage and Access to Insurance as a Cross-cutting Issue - Access to Healthcare is considered transversal to the four issues identified above as priorities - Healthy Body (Overweight/Obesity), Healthy Mind (Mental Health), Healthy Spirit (Substance Abuse), and Healthy Families (Maternal, Infant and Child Health). Increasing healthcare access, quality and equity implies addressing all major social, economic, environmental and behavioral factors that prevent individuals and communities to make healthy choices and enjoy a long, healthy life. BHS will leverage its Community Benefit programs to close health gaps, through increased awareness, knowledge and referral of under-served/underinsured residents to insurance providers. This is an important outcome for the health system: the burden of disease is often shared by patients, families, communities and health services. Health Insurance not only reduces costs across the system, it also enables patients to receive timely, life-saving treatment and assistance. As a result, financial resources and social networks benefit from improved management practices that reduce the risk of disease, while increasing capacities at individual, family, community and organizational levels. Part V, Section B, Line 13h Financial Assistance Criteria The policy allows for patients to qualify for assistance by two means: financial or catastrophic. The Financial Assistance Program also allows for partial assistance or full assistance based on eligibility criteria in this policy. Financial Assistance 1. A patient qualifying for financial assistance is a person who is uninsured or underinsured, receives care and unable to pay their bill. 2.To be eligible for assistance under the financial assistance guidelines, a person's income shall be at or below a percentage of the Federal Poverty Level (FPL) as determined by Federal Poverty Guidelines. Household size and income determines the % of FPL. Memorial Hospital of South Bend, or its designee, may consider other financial assets and liabilities of the person when determining eligibility. 3. Memorial Hospital of South Bend will use the most current poverty income guidelines issued by the U.S. Department of Health and Human Services to determine an individual's eligibility for financial assistance. The poverty income guidelines are published annually in the Federal Register and for the purposes of this policy will become effective the first day of the month following the month of publication. 4. To qualify under the Financial Assistance portion of this policy, a completed, signed Financial Assistance application must be submitted and proof of income, proof of no income, proof of lack of financial assets and other required documents must accompany the application. Catastrophic Assistance Criteria 1. A patient qualifying for catastrophic assistance is a person whose hospital bills exceed a specified percentage of the person's annual gross income as set forth in the policy and who is unable to pay the remaining bill. 2. To be eligible for catastrophic assistance the amount owed by the patient must exceed one hundred fifty (150) percent of the patient's annual gross income and the patient must be unable to pay the remaining bill. Memorial Hospital of South Bend may consider other financial assets and liabilities of the person when determining ability to pay. 3. If a determination is made that a patient has the ability to pay the remainder of the bill, such a determination does not prevent a reassessment of the patient's ability to pay at a later date should their financial circumstances change. 4. After eligibility is determined under this provision, assistance will be provided to discount the bill by 75% of the current balance. Part V, Section B, Line 16 a, b, & c The Financial Assistance Policy, application and plain language summary can all be found at: beaconhealthsystem.org/assist 6 MEMORIAL SLEEP DISORDER CENTER 53990 CARMICHAEL DRIVE SOUTH BEND IN 46601 OUTPATIENT CLINIC PROVIDING SLEEP RELATED DIAGNOSIS AND TREATMENT MEMORIAL HEALTH PLEX 111 W JEFFERSON ST SOUTH BEND IN 46601 OUTPATIENT REHABILITATION FACILITY AND FITNESS FACILITY MEMORIAL BREAST CARE CENTER 100 NAVARRE PLACE SOUTH BEND IN 46601 OUTPATIENT DIAGNOSIS AND TREATMENT MEMORIAL CHILDREN'S THERAPY CENTER 100 NAVARRE PLACE SOUTH BEND IN 46601 OUTPATIENT DIAGNOSIS AND TREATMENT MEMORIAL RADIOLOGY 100 NAVARRE PLACE SOUTH BEND IN 46601 OUTPATIENT DIAGNOSIS AND TREATMENT MEMORIAL LIGHTHOUSE PHYSICAL THERAPY 6913 N MAIN STREET GRANGER IN 46530 OUTPATIENT DIAGNOSIS AND TREATMENT Part VI, Descriptions for Part I, Line 3c Factors to be considered for Financial Assistance Household Size and Income The following factors may be considered in determining the eligibility of the patient for assistance and must be provided by all income earning residents in the countable household unit unless they are not dependents based on IRS guidelines for determining whether a household member can be considered a dependent. 1. Indiana workforce wage report for last 2 quarters (unemployment income) 2. Last 3 pay stubs or a letter or printout from employer(s) providing verification of gross income if currently employed. This documentation should not be more than 30 days old from date of issue and include year-to-date information. 3. Last 3 bank statements (including explanations of regular deposits not explained by pay stubs) 4. Social Security award or entitlement letter or other proof of gross monthly award. 5. Retirement income. 6. Investment income. 7. Statement from person(s) that are providing direct support. 8. Number of dependents. 9. Most recent tax return (including W2 and all supporting schedules). 10. Other financial obligations. 11. Amount and frequency of hospital/medical bills. 12. Other financial resources that produce income. 13. If Self-Employed, Gross Income less Cost of Goods sold and employee salaries. Financial Capacity 1. Individuals with the financial capacity to purchase health insurance coverage through the Health Insurance Marketplace may be required to purchase and will be provided access to meet with an Indiana Certified Navigator as a means of assuring access to healthcare services, for their overall personal health, and for the protection of their individual assets. 2. Individuals have been found they are ineligible for Medicaid or other affordable health care coverage must provide proof of denial. 3. Food Stamps or Supplemental Nutrition Assistance Program (SNAP) will not be counted as income. 4. Cosmetic Services are not eligible for any type of assistance and cannot be included in the amount of hospital/medical bills owed. Part VI, Descriptions for Part I, Line 6a Beacon Health System, Inc, EIN 45-3864076, prepares the annual community benefit reporting for Memorial Hospital of South Bend, Inc. Part VI, Descriptions for Part I, Line 7, Column F BAD DEBT EXPENSE REMOVED FROM TOTAL EXPENSES $38,194,104 Part VI, Descriptions for Part I, Line 7 COSTING METHODOLOGY The costing method used to calculate financial assistance reported on lines 7 a through d was the cost-to-charge ratio as derived on TAX FORM 990, SCHEDULE H, WORKSHEET 2. All other community benefits were calculated using direct costs. PART VI, Descriptions for Part II, Line 6 In 2017, The Executive Director of Beacon Community Impact was asked to represent Beacon Health System as one of six anchor organizations. This group, now recognized as the St. Joseph County Health Improvement Alliance Group, has met several times since the original assessment. Together the group worked on a vision, mission, and direction for the group. As a result of these brainstorming sessions, the group decided to focus on our stakeholders top priorities in order to increase public health infrastructure and ultimately improve the community's health. The ultimate goal is to improve the health of our community by collaboratively working together to decrease duplication of services and increase the utilization of existing services and resources. The Director of Community Impact participates on the executive team of the St. Joseph County System of Care. This group is a network of services and supports that identify and meet the needs of families, youth, and children so they may define and reach their potential. Part VI, Descriptions for Part III, Line 2 THE CORPORATION EVALUATES THE COLLECTABILITY OF ITS ACCOUNTS RECEIVABLE BASED ON THE LENGTH OF TIME THE RECEIVABLE IS OUTSTANDING, PAYOR CLASS, AND THE ANTICIPATED FUTURE UNCOLLECTIBLE AMOUNTS BASED ON HISTORICAL EXPERIENCE. ACCOUNTS RECEIVABLE ARE CHARGED TO THE ALLOWANCE FOR DOUBTFUL ACCOUNTS WHEN THEY ARE DEEMED UNCOLLECTIBLE. THE COSTING METHODOLOGY IS THE SAME AS THE TAX FORM 990, SCHEDULE H, WORKSHEET 2 METHODOLOGY. PATIENT CARE COST IS ADJUSTED BY NON-PATIENT ACTIVITY EXPENSES, AND PATIENT CARE CHARGES. The amount of bad debt reported on Part III, Line 2 is calculated by applying the cost-to-charge ratio, as determined by Worksheet 2, to total bad debt expense per the audited financial statements. Part VI, Descriptions for Part III, Line 3 Bad debt attributable to the FAP is estimated based on the historical trend of the sources of the bad debt (50%). The majority of bad debt is attributable to uninsured patients which represent the majority of the population that would fall under the FAP. We have applied the historical estimate to the total bad debt expense to determine the amount attributable to the FAP. Part VI, Descriptions for Part III, Line 4 THE PROVISION FOR BAD DEBTS IS BASED UPON MANAGEMENT'S ASSESSMENT OF HISTORICAL AND EXPECTED NET COLLECTIONS TAKING INTO CONSIDERATION THE TRENDS IN HEALTH CARE COVERAGE, HISTORICAL ECONOMIC TRENDS, AND OTHER COLLECTION INDICATORS. MANAGEMENT ASSESSES THE ADEQUACY OF THE ALLOWANCES PERIODICALLY THROUGHOUT THE YEAR BASED UPON HISTORICAL WRITE-OFF EXPERIENCE BY MAJOR PAYOR CATEGORY. THE RESULTS OF THE REVIEW ARE THEN UTILIZED TO MAKE MODIFICATIONS, AS NECESSARY, TO THE PROVISION FOR BAD DEBTS TO PROVIDE FOR AN APPROPRIATE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS. A SIGNIFICANT PORTION OF THE CORPORATION'S UNINSURED PATIENTS WILL BE UNABLE OR UNWILLING TO PAY FOR THE SERVICES PROVIDED. THUS, THE CORPORATION RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS RELATED TO UNINSURED PATIENTS IN THE PERIOD THE SERVICES ARE PROVIDED. Part VI, Descriptions for Part III, Line 8 RATIONALE FOR INCLUSION OF THE MEDICARE SHORTFALL AS A COMMUNITY BENEFIT PARTICIPATION IN THE GOVERNMENTAL MEDICARE PROGRAM DOES NOT PROVIDE THE OPPORTUNITY FOR A HOSPITAL TO NEGOTIATE A REIMBURSEMENT RATE OR STRUCTURE THAT WOULD ALLOW THE HOSPITAL TO COVER THE COST OF THE MEDICAL SERVICE RENDERED TO THE PROGRAM PARTICIPANT, AS WOULD BE THE CASE IN CONTRACTUAL NEGOTIATIONS WITH COMMERCIAL INSURANCE COMPANIES. NOR IS THE HOSPITAL ALLOWED TO PROVIDE ONLY THE SERVICES FOR WHICH REIMBURSEMENT COVERS THE DIRECT COST OF CARE. THIS PRODUCES THE SAME SHORTFALL OUTCOME AS DOES THE PARTICIPATION IN THE MEDICAID PROGRAM. THE MEDICAID PROGRAM IS RECOGNIZED AS A COMMUNITY BENEFIT ON SCHEDULE H AND ON COMMUNITY BENEFIT REPORTS FOR MOST STATES. THE QUALITY AND COST OF THE PATIENT CARE IS THE SAME REGARDLESS OF PAYOR SOURCE. HENCE THE ACCEPTANCE OF MEDICARE REIMBURSEMENT REPRESENTS A REDUCTION OR RELIEF OF THE GOVERNMENT BURDEN TO PAY THE FULL COST OF CARE PROVIDED. Part VI, Descriptions for Part III, Line 9b Collections Practices Patients known to qualify for financial assistance follow the same collection policy as all individuals with balances remaining after application of financial assistance. Credit and Collections Policy: Memorial Hospital of South Bend relies on timely payment of patient accounts receivable to allow the Hospital to continue to provide high-quality medical care and to secure the latest in health care technology for its patients. Memorial Hospital, recognizing the burden that unexpected health care expenses can place on patients and their families, will assist patients to resolve open accounts for hospital services by working with third party payers to adjudicate patient's insurance claims and by providing alternative payment plans for patients. The Hospital also provides subsidized care for those patients who qualify. However, with the exception of some Government and contracted care plans, ultimate responsibility for resolution or payment of accounts rests with the patient. Patients are expected to work with Hospital personnel to resolve accounts with their insurance companies and/or employers as appropriate. Where there is an estimated self-pay balance due, Memorial Hospital will ask non-emergency patients to pay that balance prior to or at the time of admission/registration. 1. If a patient does not qualify for financial assistance and does not pay their account according to the options provided, then the patient's account will be processed according to the Bad Debt Write Off policy. 2. If a patient has begun making payments but then is later determined to qualify under the FAP, Memorial Hospital would issue a refund to the patient for any amount that has been determined to exceed their newly determined financial responsibility. 3. Memorial Hospital of South Bend may request and collect a deposit, based on the patient's total estimated portion of a bill, from appropriate non-emergency inpatient admissions, same day surgery patients, and patients scheduled for high-dollar outpatient procedures prior to or at the time of admission or registration. In the event that a request for payment is not made prior to or at the time of the patient's arr true NORTHEAST NEIGHBORHOOD REVITALIZATION ORGANIZATION 803 LINCOLNWAY WEST SOUTH BEND IN 46616 352118149 501(C)(3) 100000 project sponsor MARCH OF DIMES 6045 Eddy St Suite A SOUTH BEND IN 46615 131846366 501(C)(3) 10000 project sponsor SOUTH BEND HERITAGE FOUNDATION INC 803 Lincolnway West SOUTH BEND IN 46616 237394320 501(c)(3) 22500 project sponsor UNITED WAY OF ST JOSEPH 3517 E Jefferson SOUTH BEND IN 46660 351063368 501(c)(3) 55000 Corporate Sponsor UNITY GARDENS INC PO Box 10022 South Bend IN 46628 270901122 501(C)(3) 5500 summer project sponsor YMCA OF MICHIANA INC 1201 Northside Blvd South Bend IN 46615 350868216 501(C)(3) 50000 diabetes prevention sponsorship Beacon Medical Group INC 615 N MICHIGAN STREET SOUTH BEND IN 46601 351536132 501(C)(3) 2066643 CONTRIBUTION FOR CLINICS SOUTH BEND PARKS FOUNDATION INC 321 E WALTER STREET South Bend IN 46614 273843043 501(C)(3) 40000 project sponsor ST JOSEPH COUNTY HEALTH DEPARTMENT 227 W JEFFERSON BLVD SOUTH BEND IN 46601 356000194 501(C)(3) 7000 project sponsor 9 0 GRANT MONITORING PROCEDURES Sch I, PART I, QUESTION 2 Donations and grants given to organizations that improve the health and well-being of our community are monitored through Outcome Measurement Reports that are provided to Memorial by the various organizations. These reports inform us of how the donations and grants were used. X X X true true false true false false false false false true false Jeffrey P Costello CFO/Asst. Treasurer 0 494865 0 161286 0 117310 0 164827 0 19246 0 957534 0 73501 Kreg Gruber CEO 0 736877 0 260000 0 102453 0 207845 0 27957 0 1335132 0 75198 Cheryl Wibbens-Lesh MD Asst. Secr./VP 172803 159972 49279 0 1980 914 0 11000 12811 11761 236873 183647 0 0 Dale A Patterson Employed Physician 334273 0 28823 0 30485 0 11000 0 23017 0 427598 0 0 0 PHILLIP NEWBOLD CEO - LEFT NOVEMBER 2017 0 218903 0 200000 0 200473 0 11000 0 4351 0 634727 0 197121 BRYAN BOYER Trustee/Employed Physician 0 866796 0 5309 0 2010 0 11000 0 22996 0 908111 0 0 Marion Mahone Employeed Physician 262410 30800 11703 0 38137 0 11000 0 9225 0 332475 30800 0 0 Matthew R Reed Employeed Physician 263449 0 11659 0 34450 0 11000 0 6012 0 326570 0 0 0 Larry Tracy President 389448 0 75376 0 8884 0 73479 0 24245 0 571432 0 0 0 LINDA A MANSFIELD EMPLOYED PHYSICIAN 258550 0 13910 0 450 0 11000 0 20626 0 304536 0 0 0 JANEL LOUISE CHARLTON EMPLOYED PHYSICIAN 240932 0 12626 0 15270 0 10771 0 25388 0 304987 0 0 0 SCHED J, PART I, LINE 1A MEMORIAL HOSPITAL OF SOUTH BEND, INC. REIMBURSES DIRECTORS FOR THE TAX EFFECT OF THE 1099 REPORTABLE BENEFITS OF COMPLIMENTARY USE OF MEMORIAL'S HEALTH AND LIFESTYLE CENTER AND SPOUSAL TRAVEL. BEACON HEALTH SYSTEM ALSO REIMBURSES FOR DIRECT EXPENSES RELATED TO ANY TRAVEL ON THE ORGANIZATION'S BEHALF. SPOUSAL TRAVEL FOR THE FOLLOWING INDIVIDUALS WAS INCLUDED IN TAXABLE COMPENSATION: PETER BARANAY AND LARRY TRACY. HEALTH OR SOCIAL CLUB DUES FOR THE FOLLOWING INDVIDUALS WERE INCLUDED IN TAXABLE COMPENSATION: JEFF COSTELLO, PETER BARANAY, THOMAS HAUCH, BRAD TOOTHAKER, KAREN BARNETT AND HUGH HEDMAN, MD. TAX INDEMNIFICATION AND GROSS-UP PAYMENTS FOR THE FOLLOWING INDIVIDUALS WERE INCLUDED IN TAXABLE COMPENSATION: LARRY TRACY, PETER BARANAY, THOMAS HAUCH, BRAD TOOTHAKER, KAREN BARNETT AND HUGH HEDMAN, MD. PART I, LINE 3 MEMORIAL HOSPITAL OF SOUTH BEND, INC. USES A RELATED ORGANIZATION'S (BEACON HEALTH SYSTEM, INC.) COMPENSATION REVIEW PROCESS. THIS REVIEW PROCESS INCLUDES AN EXTENSIVE EXAMINATION USING COMPARABLE MARKET DATA THAT IS THEN REVIEWED BY AN INDEPENDENT CONSULTANT HIRED BY, AND REPORTING TO, THE BOARD OF DIRECTORS. RECOMMENDATIONS ARE PRESENTED TO THE BOARD FOR DELIBERATION AND FINAL DECISION. SCH. J - PART 1, LINE 4B - EXECUTIVE RETENTION PLAN BEACON HEALTH SYSTEM IMPLEMENTED AN EXECUTIVE RETENTION PLAN TO ATTRACT AND RETAIN KEY EMPLOYEES BY PROVIDING ADDITIONAL DEFERRED COMPENSATION. THE CHIEF EXECUTIVE OFFICER WILL PARTICIPATE IN THE PLAN AND WILL SELECT OTHER PARTICIPANTS PURSUANT TO THE GUIDELINES SET BY THE EMPLOYER'S BOARD OF DIRECTORS. THE EMPLOYER MAY MAKE CONTRIBUTIONS UNDER THE PLAN AND HAS SOLE DISCRETION OVER WHETHER TO MAKE A CONTRIBUTION. VESTING OCCURS ON JANUARY 1 OF THE FIFTH YEAR FOR WHICH SUCH CONTRIBUTIONS ARE MADE FOR PARTICIPANTS WHO HAVE BEEN CONTINUOUSLY EMPLOYED. THE PLAN ALSO ALLOWS VESTING TO OCCUR IF THE PARTICIPANT ATTAINS THE AGE OF 62. THE FOLLOWING INDIVIDUALS RECEIVED VESTED PAYMENTS IN 2018, REFLECTED IN COLUMN (B)(III): . PHIL NEWBOLD, $198,860 . KREG GRUBER, $92,073 . JEFFREY COSTELLO, $86,519 THE FOLLOWING INDIVIDUALS RECEIVED DEFFERED PAYMENTS IN 2018 THAT WILL VEST IN FUTURE YEARS, WHICH ARE REFLECTED IN COLUMN C: . JEFFREY COSTELLO, $88,827 . KREG GRUBER, $131,845 . LARRY TRACY, $62,479 BEACON HEALTH SYSTEM IMPLEMENTED AN EXECUTIVE LONGEVITY BONUS PLAN FOR THE PURPOSE OF PROVIDING A LONGEVITY BONUS FOR ITS DESIGNATED EXECUTIVES. THIS UNFUNDED PLAN WAS EFFECTIVE APRIL 1, 2014. THE PARTICIPANTS MUST REMAIN IN AN ACTIVE EMPLOYMENT STATUS WITH BEACON FOR A PERIOD OF 5 CONSECUTIVE YEARS FROM THE EFFECTIVE DATE TO BE ELIGIBLE TO RECEIVE THE FULL LONGEVITY BONUS AMOUNT AT WHICH TIME VESTING IS 100%. VESTING PRIOR TO THE 5 YEARS IS AT 0%. THE MAXIMUM BONUS AWARD AT 100% VESTING IS $325,000. THE FOLLOWING INDIVIDUALS RECEIVED DEFFERED PAYMENTS IN 2018 THAT WILL VEST IN FUTURE YEARS, WHICH ARE REFLECTED IN COLUMN C: . JEFFREY COSTELLO, $65,000 . KREG GRUBER, $65,000 SCH. J - PART 1, LINE 7 - INCENTIVE PLANS THE ORGANIZATION HAS THREE INCENTIVE PLANS (EMPLOYEE, MANAGEMENT AND EXECUTIVE) WHICH HAVE A NET OPERATING INCOME TO BUDGET MEASUREMENT FOR THE PAYOUT THRESHOLD. THE EMPLOYEE PLAN SHARES THE EXCESS OVER BUDGET NET OPERATING INCOME WITH THE NON-MANAGMENT EMPLOYEES FOR BEACON HEALTH SYSTEM, INC AND THE AFFILIATED ENTITIES. THE EMPLOYEE INCENTIVE HAS A MAXIMUM CAP OF $4,500,000. THE PAYOUT AND AMOUNT OF THE PAYOUT FOR THE EMPLOYEE INCENTIVE PLAN IS MADE AT THE DISCRETION OF THE BOARD. THE MANAGEMENT INCENTIVE PLAN PAYS A SLIDING PERCENTAGE OF BASE COMPENSATION IF THE NET OPERATING INCOME IS EQUAL TO OR GREATER THAN 80% OF THE BUDGETED NET OPERATING INCOME. THE SLIDING SCALE CAPS WHEN OPERATING INCOME REACHES 120% OF THE BUDGETED OPERATING INCOME. THE PAYOUT OF THE MANAGEMENT INCENTIVE PLAN IS MADE AT THE DISCRETION OF THE BOARD. EXECUTIVES ARE COVERED UNDER THE BEACON HEALTH SYSTEM EXECUTIVE SHORT-TERM INCENTIVE PLAN (ESTIP). THE ESTIP PLAN PAYS A SLIDING PERCENTAGE OF BASE COMPENSATION IF THE NET OPERATING INCOME IS EQUAL TO OR GREATER THAN 80% OF THE BUDGETED NET INCOME. THE SLIDING SCALE CAPS WHEN OPERATING INCOME REACHES 120% OF THE BUDGETED OPERATING INCOME. THE PAYOUT OF THE ESTIP IS MADE AT THE DISCRETION OF THE BOARD. A Indiana Finance Authority 351602316 45471AQL9 2017-09-08 37240000 REFUND BONDS ISSUED 03/16/2006 false false false B HOSPITAL AUTHORITY OF SAINT JOSEPH COUNTY 911914363 79062WAA6 2013-05-21 45523353 REFUND BONDS ISSUED 05/10/2007 false false false C INDIANA FINANCE AUTHORITY 351602316 45471ALS9 2013-05-21 96069836 REFUND BOND ISSD 2/3/98 & 10/22/08 false false false D INDIANA FINANCE AUTHORITY 351602316 000000000 2013-04-29 7492187 URGENT CARE HELICOPTER false false false A 0 0 37240000 0 0 0 0 0 0 0 37240000 0 2000 true false true true B 0 0 45523353 0 0 0 511271 0 0 0 45012082 0 2009 true false true true C 17860721 0 96069836 0 0 0 764791 0 0 0 96305045 0 2003 true false true true D 4926300 0 7492187 0 0 0 66925 0 0 7425262 0 0 2013 false false true true A 0 B false false true true false 0 false false false true C false false true true false 0 false false false true D false false false 0 false false false true A false false true false true true WELLS FARGO BANK NA 21.7 false false false 0 false true B false false false true false false 0 false 0 false true C false false false true false false 0 false 0 false true D false false false true false false 0 false 0 false true A true B true C true D true PART III, COLUMN A COLUMN A IS NOT COMPLETED BECAUSE SUCH BONDS WERE ISSUED AFTER 12/31/2002 TO REFUND, THROUGH A SERIES OF 2006 REFUNDINGS, BONDS ISSUED BEFORE 01/01/2003. PART IV, LINE 2C, COLUMN B-D THE DATE THE REBATE COMPUTATION WAS PERFORMED ON THE HOSPITAL AUTHORITY OF SANT JOSEPH COUNTY AND INDIANA FINANCE AUTHORITY WAS 5/18/2018. STANZ FOOD BOARD MEMBER GREATER THAN 35% OWNERSHIP 202500 Purchased Services false CORE FORM, PART I, LINE 1 BEACON HEALTH SYSTEM, INC. IS COMMITTED TO ENHANCING THE PHYSICAL, MENTAL, AND EMOTIONAL AND SPIRITUAL WELL-BEING OF THE COMMUNITIES WE SERVE AS THE COMMUNITY'S PROVIDER OF OUSTANDING QUALITY, SUPERIOR VALUE AND COMPREHENSIVE HEALTH CARE SERVICES. CORE FORM, PART I, LINE 6 VOLUNTEERS - MEMORIAL HOSPITAL OF SOUTH BEND HAS A DEPARTMENT CALLED AMBASSADOR AND CUSTOMER SERVICES. IT IS THE RESPONSIBILITY OF THIS DEPARTMENT TO RECRUIT, ORIENT, PROCESS AND PLACE NEW AMBASSADORS IN APPROXIMATELY 30 SERVICE AREAS OF THE HOSPITAL. IT IS ALSO THE RESPONSIBILITY OF THE DEPARTMENT TO FOLLOW UP, SCHEDULE AND RECOGNIZE AMBASSADORS. SOME OF THE AREAS OF SERVICE INCLUDE A MAJOR SURGERY WAITING ROOM, PATIENT ESCORTS, FLOWER DELIVERY, MAIL DELIVERY, LIVING HISTORY PROGRAM, EMERGENCY DEPARTMENT VOLUNTEERS AND COOKIE BAKERS. IN 2018, MEMORIAL HAD 441 VOLUNTEERS IN THIS PROGRAM WHO SERVED 36,277 HOURS. CORE FORM, PART III, LINE 4D OTHER PROGRAM SERVICES OTHER PROGRAM SERVICES INCLUDE PSYCHIATRIC DEPARTMENTS, SOCIAL SERVICES, COMMUNITY OUTREACH PROGRAMS, TITHING, GRANTS, AND SUPPORTING SERVICES SUCH AS ADMINISTRATION, FINANCE, PAYROLL, PATIENT ACCOUNTING, LAUNDRY SERVICES, HEALTH AND LIFESTYLE CENTER, AND MEDICAL RECORDS. DUE TO THE NON-REVENUE GENERATING OR COMMUNITY INVESTMENT NATURE OF MANY OF THE PROGRAMS, THEY OPERATE AT A LOSS. SEE SCHEDULE H FOR DETAILS ON THE HOSPITALS TITHING AND COMMUNITY OUTREACH REPRESENTED IN OTHER PROGRAM SERVICES. FORM 990, PART VI, SECTION A, LINE 4 MEMORIAL HOSPITAL OF SOUTH BEND, INC. UPDATED THEIR CORPORATE BYLAWS IN 2017 TO CHANGE THE ROLE OF THE PRESIDENT OF THE MEDICAL STAFF. THIS POSITION HAS BEEN CHANGED FROM A DIRECTOR POSITION TO NOW AN EX-OFFICO POSITION. CORE FORM, PART VI, SECTION A, QUESTION 6 MEMBERS OF THE ORGANIZATION - BEACON HEALTH SYSTEM, INC. IS THE SOLE CORPORATE MEMBER OF MEMORIAL HOSPITAL OF SOUTH BEND, INC. CORE FORM, PART VI, SECTION A, QUESTION 7A ELECTION OF BOARD MEMBERS THE CORPORATE MEMBER SHALL APPOINT THE BOARD OF DIRECTORS OF MEMORIAL HOSPITAL OF SOUTH BEND AND SHALL HAVE SUCH POWERS OF ADVANCE APPROVAL REGARDING CORPORATE ACTIONS AS ARE DELINEATED IN THE BY-LAWS OF MEMORIAL HOSPITAL OF SOUTH BEND. CORE FORM, PART VI, SECTION A, QUESTION 7B DECISIONS OF THE BOARD OF DIRECTORS DECISIONS OF THE BOARD OF DIRECTORS MUST BE APPROVED BY THE CORPORATE MEMBER. CORE FORM, PART VI, SECTION B, LINE 11B FORM 990 REVIEW PROCESS THE ORGANIZATION INCORPORATES NUMEROUS PARTIES IN THE PRODUCTION AND REVIEW OF THE FORM 990 AND ASSOCIATED SCHEDULES. SENIOR ACCOUNTING STAFF AND MANAGEMENT COMPLETE THE FORM 990 AND SCHEDULES. SOME FORMS AND SCHEDULES ARE REVIEWED BY THE CONTROLLER. SUBSEQUENT TO THOSE STEPS, THE ORGANIZATION ENGAGED ERNST & YOUNG TO REVIEW THE COMPLETED FORM 990 AND APPROPRIATE SCHEDULES. PRIOR TO FILING THE RETURN, THE CFO, THE COMPENSATION COMMITTEE OF THE ORGANIZATION AND THE CEO CONDUCT A GENERAL OVERVIEW OF THE FORM 990, INCLUDING APPLICABLE COMPENSATION SCHEDULES. IN ADDITION, EACH BOARD MEMBER RECEIVES NOTIFICATION OF THE IRS FORM 990 PLACEMENT ON THE ORGANIZATION'S BOARD PORTALS WHICH ALLOWS FOR BOARD MEMBER REVIEW PRIOR TO FILING THE RETURN. CORE FORM, PART VI, SECTION B, LINE 12C CONFLICT OF INTEREST DISCLOSURE THERE ARE THREE SEPARATE FORMS THAT ARE SENT OUT THROUGH THE INTERNAL AUDIT DEPARTMENT TO KEY EMPLOYEES OR BOARD MEMBERS REGARDING CONFLICT OF INTEREST. THEY ARE AS FOLLOWS: 1. THE FIRST IS A CONFLICT OF INTEREST STATEMENT THAT IS SENT TO SENIOR LEVEL ADMINISTRATION, MANAGEMENT, AND SELECT STAFF SUCH AS PURCHASING DEPARTMENT EMPLOYEES. THE PURPOSE OF THE STATEMENT IS TO REQUIRE THESE EMPLOYEES TO DISCLOSE ANY POTENTIAL CONFLICT OF INTERESTS THEY MAY HAVE. THE STATEMENTS ARE SENT IN JANUARY OF EACH YEAR FOR THE PREVIOUS YEAR ACTIVITIES AND WE PURSUE THE REPLIES TO GET A 100% RESPONSE RATE. IN THE CURRENT YEAR WE SENT OUT OVER 353 STATEMENTS AND ARE WORKING TO ACHIEVE A 100% RESPONSE RATE. EACH RESPONSE IS REVIEWED BY THE DIRECTOR OF INTERNAL AUDIT AND THE RESULTS ARE REPORTED TO THE CEO OF BEACON HEALTH SYSTEM, THE AUDIT COMMITTEE CHAIRMAN, AS WELL AS THE AUDIT COMMITTEE OF THE BOARD OF DIRECTORS. 2. THE SECOND STATEMENT IS THE BOARD DUALITY OF INTEREST STATEMENT THAT IS SENT TO CURRENT BOARD MEMBERS, FORMER BOARD MEMBERS FROM THE LAST FIVE YEARS, AND OTHER KEY EMPLOYEES. THE DUALITY OF INTEREST STATEMENT IS SENT USING A WEB BASED SURVEY TOOL PROVIDED BY ERNST & YOUNG. THE REPLIES ARE REVIEWED BY THE DIRECTOR OF INTERNAL AUDIT. THE RESULTS OF THE SURVEYS ARE SUMMARIZED USING THE WEB BASED TOOL, AND ARE REVIEWED BY ERNST & YOUNG IN COMPLETING THE 990. THE RESULTS ARE REPORTED TO THE CEO OF BEACON HEALTH SYSTEM, THE AUDIT COMMITTEE CHAIRMAN, AND THE AUDIT COMMITTEE OF THE BOARD OF DIRECTORS. 3. THE THIRD STATEMENT IS ENTITLED "CODE OF ETHICS FOR SENIOR FINANCIAL OFFICERS". THE STATEMENT REQUIRES AN ACKNOWLEDGEMENT FORM TO BE SIGNED BY BEACON HEALTH SYSTEM'S KEY FINANCIAL EMPLOYEES THAT BEACON'S FINANCIAL INFORMATION IS TO THE BEST OF THEIR KNOWLEDGE TRUE AND ACCURATE. THIS STATEMENT WAS SENT OUT IN EARLY FEBRUARY 2019 AND THE SIGNED ACKNOWLEDGEMENTS ARE KEPT BY THE DIRECTOR OF INTERNAL AUDIT. IN 2019, 18 DESIGNATED EMPLOYEES WERE REQUESTED TO SIGN THE FORM AND WE HAD A 100% COMPLIANCE RATE. ANY POTENTIAL CONFLICTS OF INTERESTS ARE REVIEWED BY INDEPENDENT PARTIES BOTH INTERNAL AND EXTERNAL TO THE ORGANIZATION, AND IF NECESSARY, CORRECTIVE ACTION WOULD BE TAKEN TO RESOLVE A TRUE CONFLICT. THE INDIVIDUAL WITH THE POTENTIAL CONFLICT OF INTEREST WOULD BE EXCLUDED FROM ALL REVIEW PROCEEDINGS. CORE FORM, PART VI, SECTION B, LINE 15A & 15B COMPENSATION DETERMINATION PROCESS MEMORIAL HOSPITAL OF SOUTH BEND'S PARENT, BEACON HEALTH SYSTEM, INC. HAS AN EXTENSIVE EXAMINATION THAT IS CONDUCTED, FOR VICE PRESIDENT AND HIGHER, USING COMPARABLE MARKET DATA THAT IS THEN REVIEWED BY AN INDEPENDENT CONSULTANT HIRED BY, AND REPORTING TO, THE BOARD OF DIRECTORS. HUMAN RESOURCES CONDUCTS THE ANALYSIS AND MAKES RECOMMENDATIONS TO THE CEO WHO THEN MAKES THE RECOMMENDATIONS FOR ALL OTHER EXECUTIVES/OFFICERS TO THE BOARD FOR APPROVAL. THE INDEPENDENT CONSULTING GROUP SEPARATELY MAKES THE RECOMMENDATIONS REGARDING THE CEO'S COMPENSATION TO THE BOARD FOR APPROVAL. RECOMMENDATIONS ARE PRESENTED TO THE COMPENSATION COMMITTEE OF THE BEACON HEALTH SYSTEM, INC. BOARD FOR DELIBERATION AND FINAL DECISION. DELIBERATION AND FINAL DECISION ARE PERFORMED BY THE INDEPENDENT MEMBERS OF THE BOARD. CORE FORM, PART VI, SECTION C, LINE 19 AVAILABILITY OF ORGANIZATIONAL DOCUMENTS THE GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE NOT MADE AVAILABLE TO THE PUBLIC. THE FINANCIAL STATEMENTS ARE DISTRIBUTED QUARTERLY TO THE ELECTRONIC MUNICIPAL MARKET ACCESS (EMMA) WEBSITE AS PART OF THE CONTINUING DISCLOSURES FOR THE BEACON HEALTH SYSTEM, INC. BONDS. PART XI, LINE 9 Other Changes in the net assets of Fund Balances Write off Inter company, Beacon Health System, Inc. - (99,873,774) Change in interest in recipient org - (1,056,232) Capital Donation from Beacon Health Foundation, Inc. - (3,500) TOTAL - (100,933,506) Beacon Medical Group Inc 615 N Michigan Street South Bend IN 46601 351536132 PHY PRACTICES IN 501(C)(3) 10 BHS true Beacon Health Foundation Inc 615 N Michigan Street South Bend IN 46601 351536129 Financial Sup IN 501(C)(3) 7 BHS true Elkhart General Hospital Inc 600 East Boulevard Elkhart IN 46514 350877574 Hospital IN 501(C)(3) 3 BHS true MEMORIAL ENDOWMENT FUND FOR MEM HOS PO BOX 1602 SOUTH BEND IN 46634 356068581 ENDOWMENT IN 501(C)(3) 12D MHSB true BEACON HEALTH SYSTEM Inc 615 N MICHIGAN STREET SOUTH BEND IN 46601 453864076 Parent Org IN 501(C)(3) 12A NA false COMMUNITY HOSPITAL OF BREMEN INC 1020 HIGH RD BREMEN IN 46506 350835006 HOSPITAL IN 501(C)(3) 3 BHS true COMMUNITY HOSPITAL OF BREMEN FOUNDATION 1020 HIGH RD BREMEN IN 46506 351813755 FINANCIAL SUP IN 501(C)(3) 12B, 11 CHB true BEACON HEALTH VENTURES INC 615 N Michigan Street South Bend IN 46601 351901068 Home Medical IN NA C BEACON HEALTH VENTURES MICHIGAN INC 615 N MICHIGAN ST SOUTH BEND IN 46601 208259773 HOME MEDICAL MI NA C false true true false false false false false false false false false true true true true true true true BEACON HEALTH VENTURES INC Q 165729 ACTUAL CHARGES ELKHART GENERAL HOSPITAL INC P 1195917 ACTUAL CHARGES ELKHART GENERAL HOSPITAL INC Q 2770855 ACTUAL CHARGES BEACON MEDICAL GROUP Q 4670709 ACTUAL CHARGES BEACON HEALTH FOUNDATION C 1747378 ACTUAL CHARGES BEACON MEDICAL GROUP P 4366706 ACTUAL CHARGES BEACON MEDICAL GROUP B 2066643 ACTUAL CHARGES BEACON MEDICAL GROUP O 1544654 ACTUAL CHARGES BEACON HEALTH VENTURES INC P 78079 ACTUAL CHARGES