2016-11-10T14:30:33-06:00 2015-12-31 ERNST & YOUNG US LLP 155 N WACKER DR CHICAGO IL 60606 990 2015-01-01 350868132 Memorial Hospital of South Bend Inc % JEFFREY COSTELLO MEMO 5746473549 615 N MICHIGAN STREET SOUTH BEND IN 46601 JEFFREY COSTELLO CFO 5746473549 2016-11-09 true Jacob Zehnder P01564049 3128792702 2015 2017-02-10 21:41:12Z Kreg Gruber 615 N MICHIGAN STREET SOUTH BEND IN 46601 529485707 false X www.qualityoflife.org X 1923 IN MEMORIAL IS COMMITTED TO IMPROVING THE QUALITY OF LIFE OF THE PEOPLE IN OUR COMMUNITY. 16 12 3654 441 749493 267322 2387487 7624707 499527555 502549671 3383928 707304 20196739 17853321 525495709 528735003 1086952 2609678 0 0 177206268 178486757 0 0 0 265035063 261667769 443328283 442764204 82167426 85970799 553998135 555878904 268255961 245545131 285742174 310333773 X MEMORIAL IS COMMITTED TO IMPROVING THE QUALITY OF LIFE OF THE PEOPLE IN OUR COMMUNITY. false false 113820221 245105066 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. 2015 Statistics for this service unit include: - 513,865 Inpatient procedures - 372,878 Outpatient procedures - 962 Inpatient Caths - 810 Outpatient Caths - 180,689 Outpatient visits - 569,932 Meals. 98898395 141656761 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. 2015 Statistics for this service unit include: - 4,207 Inpatient procedures - 201 Open Heart procedures - 8,371 Outpatient procedures. 66446715 129526551 Patient Care Unit Services provides a wide variety of hospital services including: - Inpatient rehabilitation CARF 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. 2015 Statistics for this service unit include: - 112,694 Patient Days - 9,793 Inpatient ER visits - 44,775 Outpatient ER visits - 2,541 Births - 14,096 Observation stays - 310 Medical flights. 107555600 695980 386720931 true true false true false false false false false true true false false true true false false true false false false false false false true false true true true false true true true false false false false false false false false false false false false false false true true true false false true 303 0 true 3654 true true true false false false false false false false false false X 16 12 false false false 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 Robert Yount MD Trustee THRU 3/2015 2.0 40.0 X 0 867826 35723 Gerard Duprat MD Trustee/Employed Physician 2.0 40.0 X 0 758853 36342 Kreg Gruber PRESIDENT 20.0 22.0 X X 168656 393532 172637 Carlton Lyons MD Trustee 2.0 0.0 X 4083 0 0 Charles Miller Secretary THRU 3/2015 2.0 0.0 X X 2902 0 0 Etta K Nevel MD Trustee THRU 3/2015 2.0 2.0 X 3851 0 0 Steven Cramer Trustee THRU 3/2015 2.0 0.0 X 500 0 0 Tracy Graham Treasurer 2.0 0.0 X X 2110 0 0 John Mathis MD Trustee THRU 3/2015 2.0 0.0 X 245 0 0 Maria Slager Trustee 2.0 0.0 X 426 0 0 Perry Watson III Vice Chair 2.0 0.0 X X 2110 0 0 Thomas Burish PhD Chair 2.0 0.0 X X 1913 0 0 Ray Gans Trustee THRU 3/2015 2.0 2.0 X 500 0 0 Peter Baranay Secretary 2.0 2.0 X X 0 0 0 STEPHEN M HUFFMAN PRESIDENT THRU 6/2015 40.0 2.0 X X 332572 0 22745 KAREN BARNETT Trustee 2.0 0.0 X 477 0 0 TIM DURHAM Trustee 2.0 0.0 X 0 0 0 HUGH HEDMAN MD TRUSTEE 2.0 0.0 X 0 0 0 BRYAN BOYER Trustee/Employed Physician 2.0 40.0 X 0 876155 34381 MARK HARMAN Trustee 2.0 0.0 X 0 0 0 THOMAS HAUCH MD Trustee 2.0 0.0 X 0 0 0 PHILLIP KAVANAGH DO Trustee 2.0 0.0 X 0 0 0 BRAD TOOTHAKER Trustee 2.0 0.0 X 0 0 0 Jeffrey P Costello CFO/Asst. Treasurer 2.0 46.0 X 0 598975 180373 Cheryl Wibbens-Lesh MD Asst. Secr./VP 40.0 2.0 X 377217 0 39198 PHILLIP NEWBOLD CEO 2.0 46.0 X 0 1255794 186041 Keith Sherry MD Director 40.0 0.0 X 330154 0 35107 Thomas Sutula MD Employed Physician 40.0 0.0 X 279492 0 35806 Dale A Patterson Employed Physician 40.0 0.0 X 353771 0 33238 LINDA A MANSFIELD EMPLOYED PHYSICIAN 40.0 0.0 X 270370 0 32415 ROBERT J RILEY MD Employed Physician 40.0 0.0 X 268629 0 31263 2399978 4751135 875269 125 false true false SOUTH BEND MEDICAL FOUNDATION 530 N Lafayette Blvd SOUTH BEND IN 46601 Lab services 7399521 SOUTH BEND EMERGENCY PHYSICIANS 615 N MICHIGAN SOUTH BEND IN 46601 PHYSICIAN SERVICES 7163407 BALFOUR BEATTY CONSTRUCTION LLC 3100 MCKINNON STREET 6TH FLOOR DALLAS TX 75201 Construction 4929476 CANCER CARE PARTNERS LLC 211 N EDDY STREET SOUTH BEND IN 46617 ONCOLOGY 2713904 MICHIANA ANESTHESIA CARE PC 416 E MONROE STREET SUITE 200 SOUTH BEND IN 46601 ANESTHESIA 2560794 60 5742757 1881950 7624707 NET PATIENT REVENUE 622110 500889626 500889626 AFFILIATE RENTAL REVENUE 532000 1466785 1446337 20448 AMBULANCE SUPPLY 621910 118641 118641 CASH DISCOUNTS 561499 32668 32668 MEDICAL EDUCATION 611710 41951 41951 502549671 792817 792817 18830 18830 56050 56050 1760020 324963 1435057 0 1435057 1435057 3744 10919 119006 3744 -108087 -104343 -104343 260058 306735 -46677 -46677 0 0 TEAM PHARMACY 561499 5846745 5846745 HLC ATHLETIC CLB 713940 1955860 1915176 40684 MRI PARTNERSHIP 561499 1174958 1174958 7431328 4801828 729045 1900455 16408891 528735003 516267930 749493 4092873 X 2609678 2609678 0 0 0 1021240 1021240 0 139875919 114698254 25177665 6184653 5071415 1113238 21621496 17729627 3891869 9783449 8022428 1761021 920062 754451 165611 94851 94851 253704 253704 32927 27000 5927 0 320727 320727 44595124 36568003 8027121 73866 60570 13296 3779840 3099469 680371 68700 56334 12366 0 8046396 6598045 1448351 828685 679522 149163 0 64882 53203 11679 4770044 3911436 858608 0 28911844 23707712 5204132 3321730 2723819 597911 MEDICAL SUPPLIES 86382718 86382718 0 0 BAD DEBT EXPENSE 36368656 36368656 0 0 CORPORATE FEE 25686125 21062623 4623502 0 HOSPITAL ASSESSMENT FEE 13752884 13752884 0 0 3394004 2783084 610920 442764204 386720931 56043273 0 19625 20637 28328827 45380509 428383 623347 80595970 103575140 0 0 0 0 0 0 14162033 15145029 1559378 1132560 735782103 396771302 336700282 339010801 53593180 24400164 0 0 510558 460516 1171474 1171474 36928425 24958727 553998135 555878904 54623766 45864135 0 0 23795 26264 171318330 166282700 0 0 0 0 1014251 858212 0 0 41275819 32513820 268255961 245545131 X 276614507 303445019 9127667 6888754 0 0 285742174 310333773 553998135 555878904 X 85970799 6974063 -68353263 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 32927 32927 false false Lobbying Detail SCHEDULE 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) 9.5% ASA (AMERICAN SOCIETY OF ANESTHESIOLOGISTS) 20% INDIANA HOSPITAL ASSOCIATION 22.12% ISMA (INDIANA STATE MEDICAL ASSOCIATION) 24% SOCIETY OF TEACHERS OF FAMILY MEDICINE 10% TRAUMA CENTER ASSOCIATION OF AMERICA 30% When unable to ascertain allocation of dues attributed to Lobbying a conservative estimate of 25% is applied. 29619029 4093832 -1367472 5789367 26556022 27642755 2833644 -142883 714487 29619029 24661171 2180336 1785965 984717 27642755 22198822 1501904 1884305 923860 24661171 21769701 2155236 -543657 1182458 22198822 0.73340 0.00720 0.25940 false true true 22038068 22038068 403923357 163623130 240300227 851999 850545 1454 285458465 228637412 56821053 23510214 3660215 19849999 339010801 0 INTEREST RATE SWAP 20522999 ASSET RETIREMENT OBLIGATION 4301999 IBNR 3456891 DUE TO THIRD PARTY 2154853 CAPITAL LEASE PAYABLE 2077078 32513820 PART V, LINE 1 MHF BOOKED A PLEDGE OF $500,000 IN 2014 THAT WAS INCLUDED ON ITS AUDITED FINANCIAL STATEMENTS, AND WHICH MHF UNBOOKED IN 2015 BASED ON INFORMATION RECEIVED FROM MHF IN 2015. FOR MORE ACCURATE REPORTING, MHF DID NOT INCLUDE THE PLEDGE ON ITS 2014 FORM 990, WHICH RESULTED IN A DIFFERENCE FROM ITS AUDITED FINANCIAL STATEMENTS IN 2014 AND 2015 OF $500,000. PART V, LINE 4 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. Term endowments, which are the Temporarily restricted net assets, are used as designated by the donor. The permanent endowment provides income to be used for health care educational purposes and patient care. FIN 48 (ASC 740) Footnote PART X, LINE 2 Memorial Hospital did not have a footnote addressing Fin 48 (ASC 740) liabilities for uncertain tax positions. Memorial Hospital does not have any uncertain tax positions recorded during fiscal year 2015. MARATHON 260058 260058 8849 288 297598 0 260058 260058 8849 288 297598 306735 -46677 Part II Event #1 Memorial Hospital of South Bend conducts an annual Sunburst Marathon that recognizes no contributions. All contributions are directed to and recorded by the Memorial Health Foundation. Memorial Hospital facilitates the Marathon by collecting registration payments and organizing the event. It is common for the event to be run at a net loss as all net income is sent to the Memorial Health Foundation. true true true X true X true true true false true true 3062921 3062921 0.00750 85278933 83256948 2021985 0.00500 88341854 83256948 5084906 0.01250 11722782 1931138 9791644 0.02410 8039898 1550503 6489395 0.01590 71626 63568 8058 0.00000 19834306 3545209 16289097 0.04000 108176160 86802157 21374003 0.05250 2493 2493 38234 14007 24227 1595 1595 42322 14007 28315 true 9888638 4944319 83195631 105912563 -22716932 X true false 1 1 MEMORIAL HOSPITAL OF SOUTH BEND INC 615 N MICHIGAN STREET SOUTH BEND IN 46545 WWW.QUALITYOFLIFE.ORG 15-005053-1 X X X X X X MEMORIAL HOSPITAL OF SOUTH BEND INC 1 false false true X X X X X X X X 15 true true true true X www.qualityoflife.org X X true 15 true www.BeaconHealthSystem.org/community-wellness false false true X 200. 350. X X X true true X X true X qualityoflife.org/assist/ X qualityoflife.org/assist/ X qualityoflife.org/assist/ X X X X X X true X false X X X X true X false false Facility Information Part V, Section B Line 5 During 2015, Beacon Health System conducted a joint Community Health Needs Assessment (CHNA) representing approximately 267,000 residents of St. Joseph County (SJC) and approximately 200,000 residents of Elkhart County, which reflect the primary market service areas for Memorial Hospital of South Bend (MHSB), and Elkhart General Hospital (EGH), respectively. In late 2014 through February 2015, dialogue on the CHNA planning and coordination occurred among Beacon Health System executives and the Community Benefit staff from both MHSB and EGH. It was agreed that a third party consultant Holleran Consulting of Lancaster, Pennsylvania would serve as the data gathering entity for both hospitals. An online CHNA survey conducted through August 2015 provided insight to barriers to accessing care, the impact of social determinants of health, resource utilization and underserved populations. Community engagement and feedback are essential to the integrity and validity of the SJC CHNA process. Therefore, input was actively solicited and secured from three sources: - Key informants (n=44) who hold a broad knowledge of the interests of SJC, including public health, and minority, cultural, and underserved populations - Community members at large (n=543) representing 267,618 SJC residents - Community Health Advisory Council representing medical and health services fields. The first stage of assessment was seeking to gather input from key informants. Organizations invited to provide input included the following: Samaritan Counseling Center; MDWise, a Medicaid Managed Care entity; Harper Cancer Research Institute University of Notre Dame; Junior League of South Bend; Bridges Out of Poverty; City of Mishawaka Fire Department; Memorial Family Residency Program; YMCA of Michiana; Hope Ministries, which serves homeless families; Goodwill Industries; Imani Unidad, a not-for-profit organization providing counseling to minorities and persons with HIV; Saint Mary's College; Bike Michiana Coalition; and Healthy Families of St. Joseph County. Based upon primary and secondary data, a Priority Setting Worksheet was created. The secondary data profile depicts population and household statistics, education and economic measures, morbidity and mortality rates, disease incidence rates, and other health statistics. Input from each source, was inserted into a separate column and assigned a unique weighted percentage based on several factors (e.g., sample size): Key Informants (20%); Community Members at Large (40%); Advisory Council (20%); Secondary Data (20%). The 19 rows in the worksheet represented each of the potential health and social issues listed in the CHNA. After tabulating the total scores for each issue (ranging from 0 -100%), the following six issues emerged with a score greater than eighty percent (80%) and were selected as MHSB 2016-2018 priorities: -Access to Health Care/Uninsured -Mental Health/Suicide -Violence/Safety/Trauma -Diabetes -Maternal/Infant Health/Prenatal Care -Obesity/Overweight The first three were also designated priorities from 2013 through 2015. Of the remaining thirteen (13) issues, nine (9) were scored at zero and four (4) cancer, education, poverty, and substance/ alcohol abuse were scored from forty (40) to sixty (60) percent. MHSB does not intend to include them in its Implementation Strategy due to other community health needs taking precedent, limited resources, and the need being addressed by organizations within the community. Part V, Section B Line 6a & 6b Memorial Hospital of South Bend developed the 2015 St. Joseph County CHNA in partnership with Elkhart General Hospital, a Beacon Health System Care Partner, and the Saint Joseph County Health Department. Elkhart County residents were surveyed at the same time. Part V, Section B Line 7d In 2015 the Saint Joseph Community Health Needs Assessment (CHNA) and Implementation Strategies Report were submitted to the Memorial Hospital Board of Directors for review and were approved in 2015. These documents were subsequently made widely available to the community through posting on the MHSB website at www.beaconhealthsystem.org/community-wellness/community-outreach/assessing -community-needs; through hard copies made available by request; through paper copy made available for MHSB Administration; and through email transmission upon request. MHSB staff were also available to discuss the results of the CHNA and the 2015 implementation strategies in requested community forums. Part V, Section B Line 11 MHSB provided leadership throughout this 2015 CHNA process. The data from this collective CHNA input process identified nineteen health needs; access to care / uninsured, aging population, caner, chronic respiratory disease / asthma, dental health, diabetes, education, health disparities, heart disease, maternal / infant health / prenatal care, mental health / suicide, overweight / obesity, poverty, reproductive health / pregnancies / STDs, stroke, substance abuse / alcohol abuse, tobacco, transportation, and violence / safety / trauma. Of these, the following six were identified as being a priority for 2015: access to care / uninsured, diabetes, maternal / infant health / prenatal care, mental health / suicide, overweight / obesity, and violence / safety / trauma. Of the remaining thirteen issues, MHSB does not intend to include them in its Implementation Strategy due to the prominence of other community health needs, limited resources, and other organizations within the community addressing those needs. We will continue to lead and engage in active community dialogues to measure and ensure movement toward goals as MHSBs Implementation Strategy is executed. We also intend to continue helping support other community needs that emerge from key community leaders and stakeholders, community members at large, and prevalence of health indicators. (1) ACCESS TO HEALTH CARE/ UNINSURED NEED: While the arrival of the Affordable Care Act (ACA) provided many St. Joseph County (SJC) residents with needed health coverage, a large segment of our county continues to fall through the cracks for a myriad of reasons including ineligibility due to lack of legal residency status, the unaffordability of Indiana ACA Marketplace programs for eligible persons, and the increasing trend of high-deductible employer-sponsored plans that are creating delays or barriers for insured persons to utilize health care at the most appropriate time. CURRENT PROGRAMMING: - MHSB provides residents access to health care through the Trauma Center and Emergency Department. MHSB and Beacon Health System also serve the community with three Memorial Neighborhood Health Centers: the Southeast Clinic, Father Richard Warner Clinic at the Center for the Homeless, and Centennial Clinic on the Hospitals campus. - Health coverage enrollment services are available through Federal Navigators at the Federally Qualified Health Centers, notably, HealthLinc and Indiana Health Center. Enrollment services are similarly available through community centers including Olive Street Clinic, United Health Services, Ivy Tech, and the Center for the Homeless. Indiana Navigators are available throughout MHSB and also through Saint Joseph Health System. - Beacon Medical Group physicians practices provide health care at various locations within SJC. Similar to MHSB, these office teams abide by a financial assistance policy. - MHSB provides assistance for low-income SJC residents in securing needed prescription medications through a full-time Medications Assistance Program. MHSB IMPLEMENTATION STRATEGY: - Expand the community-based enrollment platform with a robust outreach-based hub for enrollment, and advocacy services for low-income and/or eligible SJC residents. - Dedicate resources to a multi-agency partnership with Covering Kids and Families Indiana (CKF), a statewide advocacy entity for health coverage. - Dedicate resources to collectively staff a full-time, community-based outreach and enrollment CKF Indiana position for targeting specific eligible but uninsured SJC residents in the ACA Marketplace, Medicaid, Health Indiana Plan, and Hoosier Healthwise. These targeted populations include low-income, the uninsured or underinsured, minority, and working poor. Specific education and enrollment events are held during the ACA Open Enrollment Period, as well as one-on-one assistance during both Open Enrollment and Special Enrollment Periods. - Provide additional hours dedicated to in-reach within MHSB and Beacon Health System overall. MEASUREMENT AND POTENTIAL IMPACT: SJC residents who sign up for insurance and receive services will be tracked. We expect an increase in the provision of health care to SJC residents and referrals to appropriate community resource organizations. (2) MENTAL HEALTH/SUICIDE NEED: Collective results ranked mental health/suicide as a pressing health need in both St. Joseph and Elkhart counties. The suicide rate per 100,000 is higher in SJC (13.4) than the nation (12.6), and Memorials Childrens Hospital reported a dramatic increase in pediatric patients hospitalized from failed suicide attempts. The years of potential life lost before age 75 per age-adjusted 100,000 is also higher in SJC (7,424) than Elkhart County (6,524) and the national benchmark of 5,200. Both counties report more average days of poor mental health when compared to the national benchmark (3.7 and 3.6 versus 2.3 out of 30 days). Of the 549 community survey respondents, 27% reported living with someone depressed, mentally ill, or suicidal; up from 14% in 2012. Mirroring this, 21.5% of SJC respondents repored having been diagnosed with an anxiety disorder (15% in 2012) and 29.2% were diagnosed with a depressive disorder (21% in 2012). CURRENT PROGRAMMING: - Memorial Childrens Hospital is the co-convener of the Suicide Task Force for St. Joseph County. Its purpose is to generate interest in having a community-wide conversation with various stakeholders, with the intent to develop and implement a collective impact strategy for suicide prevention. - Provide training and expert knowledge regarding Adverse Childhood Experiences to South Bend Community School Corporation (SBCSC) administration and personnel in order to educate them on the effects of trauma on children and the link to negative health and educational outcomes. Interventional programming is also delivered when appropriate. - MHSB hosts training in Eye Movement Desensitization and Reprocessing (EMDR) for therapists and licensed community and hospital-based social workers in St. Joseph and Elkhart counties. Additionally, training is offered in Acute-Trauma Intervention Process (A-Tip), a short-term intervention to help individuals become more stable and calm, diminishing the possibility of becoming more traumatized. MHSB IMPLEMENTATION STRATEGIES: - Collaborate with Memorial Childrens Hospital, St. Joseph County Health Department, and the St. Joseph County Suicide Prevention Center to build and implement a best practice model of youth suicide prevention programming. - Continue with current programs listed above. - Collaborate with Indiana University South Bend and University of Notre Dames Mental Health Counseling programs to provide interns to local service agencies. MEASUREMENT AND POTENTIAL IMPACT:The anticipated impact of these efforts will be to identify local risk factors, increase education and prevention activities, increase health outcomes, and improve mental health outcomes. (3) VIOLENCE/ SAFETY/ TRAUMA NEED: The violent crime rate per 100,000 is higher in SJC (370) than in Elkhart County (264), Indiana (334) and the national benchmark (59). Almost 40% of the Key Informants indicated Violence/Safety/Trauma was a key theme. The Community Survey data showed 23% had been hit, beaten, kicked, or physically hurt by a parent or adult in the home, up from the 18.9% in 2012. CURRENT PROGRAMMING: - MHSB is an active partner in the South Bend Group Violence Intervention (SBGVI) commissioned by South Bend Mayor, Pete Buttigieg. The intervention unites community leaders around the common goal of stopping gun violence and keeping South Bends highest risk citizens alive and out of prison. Community members are empowered to set clear moral standards against violence in their communities and reclaim a voice in the way they want to live. SBGVI coordinates the efforts of local, state and federal law enforcement. - In 2014 St. Joseph County Cares was formed by multiple agencies and organizations in our community (e.g., CHE, Oaklawn, the designated community behavioral and mental health provider; the Juvenile Justice Center and Probate Court; Change Matrix, and enFocus, a not-for-profit business providing training and knowledge in the application of data analytics). Their goal is for all public and private environments to provide consistent, trauma-informed experiences, services, and support for all children in utero through their transition to independence, as well as their families, so they can lead productive and healthy lives. - The Trauma Intervention Specialist builds and strengthens working relationships between law enforcement officers, Trauma and Emergency Department personnel, and victims of crime and their families. MHSB IMPLEMENTATION STRATEGIES: - Continue with current programs listed above. - Collaboration between MHSB School Health and Wellness Educator team with Oaklawns STAND (Students Taking a New Direction) team to deliver resiliency educatio 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 this 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 16i Memorial Hospital of South Bend Patient statements note where to obtain information about financial aid by listing both the Hospitals website and a customer service number. Part V, Section B Line 22d When Memorial Hospital makes a determination that an individual is eligible for assistance under this financial assistance policy, Memorial will not charge such individual more than the amounts generally billed (AGB) to individuals who have insurance covering emergency or other medically necessary care. Memorial uses the look-back method to calculate the AGB percentage that it uses to determine AGB for particular care provided to individuals eligible for financial assistance. Memorial calculated its current AGB percentage, 64%, by dividing (1) sum of payments on all claims allowed during the 12-month period from 1/1/2014 to 12/31/2014 by Medicare fee-for-service and all private health insurers that pay claims to the hospital facility by (2) the sum of the associated gross charges for those claims. To determine AGB for a particular episode of care, Memorial multiplies its gross charges for that care by the AGB percentage. 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 Supplemental Information 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 $36,368,656 Part VI, Descriptions for Part I, Line 7G NOT APPLICABLE 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. Coalition Building Memorial Hospital South Bend (MHSB) has long been a supporter for leadership building. In 2015, that included community members attending multiple-day trainings at the Pfeil Innovation Center, hosting education forums, and inviting community members to leadership presentations. Smoke Free St. Joe MHSB also has a history of supporting coalitions. Smoke Free St. Joe is a coalition working together to create healthier and safer communities by providing tobacco education to reduce tobacco use, promoting tobacco cessation to help smokers quit, and supporting stronger smoke free policies that prevent unnecessary exposure to secondhand smoke throughout our community. The coalition, established in 2009 (Previously Known As Tobacco Free St. Joseph County Coalition), has worked with health organizations, civic groups, businesses and schools countywide to reduce the burden of tobacco use on our community and increase everyone's quality of life. The coalition is made up of several community partners including: Interdenominational Ministerial Alliance, Neighborhood Resource Corporation, Select Health Network, South Bend Community School Corporation, St. Joseph County Health Department, St. Joseph Community Wellness Partners and St. Joseph Health System. SJC Suicide Prevention Task Force Mental health was an identified health need from the 2015 CHNA, and as a result MHSB and Memorial Childrens Hospital co-convened the SJC Suicide Prevention Task Force in 2015. The purpose is to generate interest in having a community-wide conversation with various stakeholders with the intent to develop and implement a collective impact strategy for suicide prevention. St. Joseph County Cares - Trauma affects children, youth, families and communities from every race, ethnicity, gender, sexual orientation, geography and socio-economic status. It shows up frequently when addressing children and youth and substance abuse, juvenile justice, child welfare, special education and increasingly in mental health treatment. Understanding and addressing trauma is most effective if it happens on a community-wide basis and therefore, requires a multi-agency and organization approach to create an integrated system of care. Their goal is for all children to have consistent, trauma-informed experiences, services and supports in all public and private environments leading to productive and healthy lives from before they are born through the time they are transitioning to independence, as well as for their families. Line 7. Community Health Improvement/Advocacy Throughout 2015, Memorial Hospital South Bend (MHSB) continued to provide health coverage enrollment assistance and program navigation through Beacon Health System health coverage enrollment efforts for the Affordable Care Act (ACA) Marketplace as well as the emergence of Healthy Indiana Plan 2.0, Indianas response to Medicaid expansion under the ACA. In alignment with the ACA, MHSB provided full-service assistance for enrolling uninsured persons into health coverage programs through certified Beacon Navigators. Navigators provide advocacy, education, linguistic, and application assistance for the purpose of assisting eligible low-income SJC residents in enrolling and maintaining viable coverage in the health coverage programs for Indiana residents, including not only ACA Marketplace, but also Medicaid, Hoosier Healthwise (Childrens Health Insurance Program), and Healthy Indiana Plan 2.0 programs. MHSB remains committed to enrolling uninsured, low-income persons into existing programs for which they are currently eligible but unenrolled as a practical first step in addressing access to health care for the community. Eligibility criteria, while similar between the programs, vary with respect to household income level and its documentation, residency verification, etc. The complexity of eligibility criteria and successful navigation through the application process can be formidable barriers for persons attempting to apply for health coverage on their own. Advocacy on behalf of the applicant serves to ensure that a complete and accurate application and all necessary documentation are submitted in a timely fashion. MHSB Navigators monitor the status of applications, and once the application is approved, also assist in maintaining the individuals coverage viability. Line 9. Other In 2015, Memorial Hospital South Bend began the planning and launch of Blue Zones. Blue Zones is a community well-being improvement initiative designed to make healthy choices easier through permanent changes to environment, policy, and social networks. 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. 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 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 T true NORTHEAST NEIGHBORHOOD REVITALIZATION ORGANIZATION 803 LINCOLNWAY WEST SOUTH BEND IN 46616 352118149 501(C)(3) 50000 CONTRIBUTION COMMUNITY HEALTH PARTNERS OF SOUTH BEND 1010 N Bendix Drive SOUTH BEND IN 46628 263051440 501(C)(3) 131212 Contribution THE CENTER FOR THE HOMELESS 813 South Michigan SOUTH BEND IN 46601 351768544 501(C)(3) 69100 PEDS PROGRAM RONALD MCDONAL HOUSE CHARITIES PO Box 1274 South Bend IN 46628 351831691 501(c)(3) 5100 Sponsorship ENFOCUS INC 506 W South St South Bend IN 46601 455638209 501(C)(3) 100500 Contribution RIVERBEND CANCER SERVICES 919 E JEFFERSON BLVD SOUTH BEND IN 46617 350872359 501(C)(3) 20500 Contribution YMCA OF MICHIANA INC 1201 Northside Blvd South Bend IN 46615 350868216 501(C)(3) 10000 Contribution FRIENDS OF THE ST JOSEPH CNTY JUVENILE JUSTICE CEN 1000 S Michigan St South Bend IN 46601 352097175 501(C)(3) 50000 Contribution SAINT ADALBERTS PARISH 2505 Grace St South Bend IN 46619 351095958 501(C)(3) 31945 Contribution SOUTH BEND ALUMNI ASSOCIATION 215 S ST Joseph St South Bend IN 46601 351674506 501(C)(3) 15000 Contibution CHAMBER OF COMMERCE OF ST JOE COUNTY 401 East Colfax South Bend IN 46634 350153330 501(C)(6) 30000 Contribution COUNCIL ON AGING OF ELKHART COUNTY 230 East Jackson Elkhart IN 46516 510178910 501(C)(3) 10000 Contribution Dr Weldy's Associates Inc 114 N Elkhart St Wakarusa IN 46573 999999999 8861 Book Value Medical Supplies Medical Supply Donation St Luke Foundation for Haiti 3999 Great Harvest Ct Dumfries VA 22025 274377746 501(C)(3) 33429 Book Value Medical Supplies Medical Supplies Donation UNITED WAY OF ELKHART COUNTY INC PO Box 3048 Elkhart IN 46515 350953433 501(C)(3) 50250 Sponsorship INDIANA HEALTH CENTERS INC 8003 CASTLEWAY DR INDIANAPOLIS IN 46250 311003977 501(C)(3) 25000 Sponsorship Beacon Medical Group INC 615 N MICHIGAN STREET SOUTH BEND IN 46601 351536132 501(C)(3) 1913698 CONTRIBUTION 15 2 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 432410 0 137200 0 29365 0 160505 0 19868 0 779348 0 0 Robert Yount MD Trustee THRU 3/2015 0 832248 0 26988 0 8590 0 10600 0 25123 0 903549 0 0 Keith Sherry MD Director 329055 0 0 0 1099 0 10893 0 24214 0 365261 0 0 0 Gerard Duprat MD Trustee/Employed Physician 0 620831 0 126988 0 11034 0 10600 0 25742 0 795195 0 0 Kreg Gruber PRESIDENT 125095 291889 38775 90475 4786 11168 44511 103859 7280 16987 220447 514378 0 0 Cheryl Wibbens-Lesh MD Asst. Secr./VP 332985 0 41642 0 2590 0 12503 0 26695 0 416415 0 0 0 Thomas Sutula MD Employed Physician 252968 0 24544 0 1980 0 15056 0 20750 0 315298 0 0 0 Dale A Patterson Employed Physician 326130 0 26988 0 653 0 10600 0 22638 0 387009 0 0 0 LINDA A MANSFIELD EMPLOYED PHYSICIAN 245730 0 23933 0 707 0 10600 0 21815 0 302785 0 0 0 STEPHEN M HUFFMAN PRESIDENT THRU 6/2015 134376 0 117240 0 80956 0 11237 0 11508 0 355317 0 0 0 PHILLIP NEWBOLD CEO 0 767590 0 295000 0 193204 0 165268 0 20773 0 1441835 0 140103 ROBERT J RILEY MD Employed Physician 243731 0 23608 0 1290 0 15537 0 15726 0 299892 0 0 0 BRYAN BOYER Trustee/Employed Physician 0 853417 0 21788 0 950 0 11041 0 23340 0 910536 0 0 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 MEMORIALS HEALTH AND LIFESTYLE CENTER AND SPOUSAL TRAVEL. BEACON HEALTH SYSTEM ALSO REIMBURSES FOR DIRECT EXPENSES RELATED TO ANY TRAVEL ON THE ORGANIZATIONS BEHALF 1 EMPLOYEE (KREG GRUBER). 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. PART I, 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 2015, REFLECTED IN COLUMN (B)(III): PHIL NEWBOLD $140,103 IN MARCH 2015. THE FOLLOWING INDIVIDUALS RECEIVED DEFFERED PAYMENTS IN 2015 THAT WILL VEST IN FUTURE YEARS, WHICH ARE REFLECTED IN COLUMN C: PHIL NEWBOLD, $142,540 JEFFREY COSTELLO, $77,377 KREG GRUBER, $72,770 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 2015 THAT WILL VEST IN FUTURE YEARS, WHICH ARE REFLECTED IN COLUMN C: JEFFREY COSTELLO, $65,000 KREG GRUBER, $65,000 PART I, LINE 7 - COMPENSATION CONTINGENT ON NET EARNINGS THE RELATED ORGANIZATION, BEACON HEALTH SYSTEM, 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 HOSPITAL AUTHORITY OF SAINT JOSEPH COUNTY 356311914 79061BCP8 2006-03-16 38580000 REFUND BONDS ISSUED 12/12/2000 false false false B HOSPITAL AUTHORITY OF SAINT JOSEPH COUNTY 356311914 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 999999999 2013-04-29 7492187 URGENT CARE HELICOPTER false false false A 920000 0 45510172 0 0 0 467934 775830 0 0 44266408 0 2000 false true true true B 0 0 45523353 0 0 0 511271 0 0 0 45012081 0 2009 true false true true C 10935387 0 96069836 0 0 0 764791 0 0 0 95305045 0 2003 true false true true D 1092394 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 true C false false true true false 0 false false false true D false false false false 0 false false false true A false false false true 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 II, LINE 3, COLUMN A THE DIFFERENCE BETWEEN THE TOTAL PROCEEDS OF THE ISSUE AND THE ISSUE PRICE IS INVESTMENT EARNINGS. PART III, COLUMN A COLUMN A IS NOT COMPLETED BECAUSE SUCH BONDS WERE ISSUED AFTER 12/31/2002 TO REFUND BONDS ISSUED BEFORE 01/01/2003. PART III, LINE 4-6, COLUMN B - D 0% of bonds were for private business use PART IV, LINE 2C, COLUMN A - D A: COMPLIANCE REPORT DATED March 7, 2016, SHOWED THAT NO REBATE WOULD BE DUE. B - D: REBATE REPORT DATED April 21, 2016, SHOWED THAT NO REBATE WOULD BE DUE. 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 2015, MEMORIAL HAD 441 VOLUNTEERS IN THIS PROGRAM WHO SERVED 38,567 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. 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 425 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 CHAIMAN, 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 SYSTEMS KEY FINANCIAL EMPLOYEES THAT BEACONS FINANCIAL INFORMATION IS TO THE BEST OF THEIR KNOWLEDGE TRUE AND ACCURATE. THIS STATEMENT WAS SENT OUT IN EARLY JANUARY 2016 AND THE SIGNED ACKNOWLEDGEMENTS ARE KEPT BY THE DIRECTOR OF INTERNAL AUDIT. IN 2016, 22 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 Medical Group, Inc. (69,263,923) Write off Inter company, Memorial Health Foundation, Inc. 12,058 Write off Inter company, Elkhart General Hospital, Inc. 17,738,065 Write off Inter company, Beacon Health System, Inc. (10,233,525) Write off Inter company, Beacon Health Ventures, Inc. (4,367,025) Change in interest in recipient org (2,238,913) TOTAL (68,353,263) FORM 990 PART IX LINE 11G DESCRIPTION:FEES - PHYSICIANS TOTAL FEES:16461486 FORM 990 PART IX LINE 11G DESCRIPTION:OTHER PURCHASED SERVICES TOTAL FEES:10775788 FORM 990 PART IX LINE 11G DESCRIPTION:LAB FEES TOTAL FEES:6625842 FORM 990 PART IX LINE 11G DESCRIPTION:SERVICE CONTRACTS TOTAL FEES:4499104 FORM 990 PART IX LINE 11G DESCRIPTION:COLLECTION EXPENSE TOTAL FEES:3108349 FORM 990 PART IX LINE 11G DESCRIPTION:REPAIRS PARTS AND MAINT. TOTAL FEES:1641950 FORM 990 PART IX LINE 11G DESCRIPTION:TRANSCRIPTION, RADIOLOGY FEES TOTAL FEES:838460 FORM 990 PART IX LINE 11G DESCRIPTION:CONSULTING TOTAL FEES:644145 Beacon Medical Group Inc 615 N Michigan Street South Bend IN 46601 351536132 PHY PRACTICES IN 501(C)(3) 9 BHS true Memorial 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) 11D III-O MHSB true BEACON HEALTH SYSTEM Inc 615 N MICHIGAN STREET SOUTH BEND IN 46601 453864076 Parent Org. IN 501(C)(3) 11A I NA false 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 true true true true false true true true true true Beacon Health Ventures Inc P 4060507 ACTUAL CHARGES Beacon Health Ventures Inc Q 6271001 ACTUAL CHARGES Beacon Health Ventures Inc R 909193 ACTUAL CHARGES Elkhart General Hospital Inc Q 30602880 ACTUAL CHARGES Elkhart General Hospital Inc R 46500000 CASH TRANSFER Elkhart General Hospital Inc P 1845888 ACTUAL CHARGES Elkhart General Hospital Inc C 17738065 ACTUAL CHARGES Memorial Health Foundation Inc C 5742757 ACTUAL CHARGES Memorial Health Foundation Inc Q 59384 ACTUAL CHARGES Memorial Health Foundation Inc R 73489 ACTUAL CHARGES Beacon Medical Group Inc J 1515729 WRITEOFFINTERCO Beacon Medical Group Inc B 69263922 WRITEOFFINTERCO Beacon Medical Group Inc Q 50000000 CASH TRANSFER Beacon Medical Group Inc P 46713264 WRITEOFFINTERCO Beacon Medical Group Inc S 64499519 WRITEOFFINTERCO