2016-05-10T13:57:37-05:00 2015-06-30 990 2014-07-01 350868157 SAINT JOSEPH REGIONAL MEDICAL CENTER- SOUTH BEND CAMPUS INC SAIN 5743355000 5215 HOLY CROSS PARKWAY MISHAWAKA IN 465451469 JANICE DUNN CFO 5744726083 2016-05-10 2014 2016-08-17 19:52:53Z (SEE SCHEDULE O FOR LIST) ALBERT GUTIERREZ 5215 HOLY CROSS PARKWAY MISHAWAKA IN 465451469 325326439 0 0928 X WWW.SJMED.COM X 1958 IN TO PROVIDE HEALTHCARE AND HOSPITAL SERVICES 17 13 2057 13 0 0 1390233 2579193 308969791 317496122 -816314 151220 4853704 4617157 314397414 324843692 1526819 1550970 0 0 98018336 101184775 0 0 0 205550107 203365546 305095262 306101291 9302152 18742401 416857731 410896665 348329709 344369663 68528022 66527002 X WE, SAINT JOSEPH REGIONAL MEDICAL CENTER, INC. AND TRINITY HEALTH, SERVE TOGETHER IN THE SPIRIT OF THE GOSPEL AS A COMPASSIONATE AND TRANSFORMING HEALING PRESENCE WITHIN OUR COMMUNITIES.SAINT JOSEPH REGIONAL MEDICAL CENTER - SOUTH BEND CAMPUS, INC. IS A MEMBER OF SAINT JOSEPH REGIONAL MEDICAL CENTER, INC. AND TRINITY HEALTH. 0 0 246314033 1550970 319204953 SAINT JOSEPH REGIONAL MEDICAL CENTER (SJRMC) - SOUTH BEND CAMPUS, INC., REFERRED TO AS "MISHAWAKA MEDICAL CENTER", HAS BEEN DELIVERING QUALITY HEALTHCARE TO THE SOUTH BEND/MISHAWAKA, INDIANA AREA SINCE 1958. SJRMC - SOUTH BEND CAMPUS, INC. PROVIDES FREE CARE, SUBSIDIZES THE CARE OF MEDICARE AND MEDICAID PATIENTS WHERE THE GOVERNMENT REIMBURSEMENT IS BELOW COST, AND SPONSORS HEALTH PROGRAMS AND ACTIVITIES FOR THE COMMUNITY. THESE PROGRAMS INCLUDE WELLNESS PROGRAMS, COMMUNITY EDUCATION PROGRAMS, SPECIAL PROGRAMS FOR THE ELDERLY, HANDICAPPED, MEDICALLY UNDERSERVED AND A VARIETY OF BROAD COMMUNITY SUPPORT ACTIVITIES. SJRMC - SOUTH BEND CAMPUS, INC. OFFERS A FULL RANGE OF SERVICES IN AN INPATIENT AND OUTPATIENT SETTING AS WELL AS 24 HOUR EMERGENCY CARE, SURGICAL SERVICES, CANCER CARE, HEART AND STROKE CARE, REHABILITATION SERVICES, SENIOR BEHAVIORAL HEALTH CARE, AMONG MANY OTHER HEALTH CARE SERVICES. THE MISHAWAKA MEDICAL CENTER HOSPITAL OFFERS 254 PRIVATE INPATIENT ROOMS AND PROVIDED 60,602 PATIENT DAYS OF HEALTHCARE SERVICES IN FY15. THE SAINT JOSEPH REHABILITATION INSTITUTE OFFERS 40 PRIVATE INPATIENT BEDS AND PROVIDED 4,539 PATIENT DAYS OF REHABILITATION SERVICES TO THE COMMUNITY IN FY15.PLEASE VISIT SCHEDULE H AND OUR WEBSITE FOR ADDITIONAL INFORMATION ABOUT OUR SERVICES, RECOGNITION AND AWARDS: WWW.SJMED.COM/MISHAWAKA-MEDICAL-CENTER 246314033 1 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 1 1 1 0 0 1 208 0 1 2057 1 0 0 0 0 0 0 0 0 0 0 X 17 13 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 IN X WAYNE NOETHE CONTROLLER 5743354655 707 EAST CEDAR STREET SOUTH BEND IN 466172000 ALBERT GUTIERREZ DIRECTOR; PRES & CEO SJRMC 10.00 40.00 X X 0 732362 51022 ABRAHAM MARCUS DIRECTOR; CHAIR 2.00 2.00 X X 0 0 0 JOHN ROSENTHAL DIRECTOR; VICE CHAIR 2.00 2.00 X X 0 0 0 CHARLES VIATER DIRECTOR; TREASURER 2.00 2.00 X X 0 0 0 BILAL ANSARI MD DIRECTOR 4.00 2.00 X 0 21577 647 ROBERT E CLEMENCY MD DIRECTOR 2.00 2.00 X 0 0 0 MARIANNE CORR DIRECTOR AS OF 01/15 2.00 2.00 X 0 0 0 MICHAEL FINEGAN DIRECTOR AS OF 10/14 2.00 48.00 X 0 487352 39565 FR JAMES FOSTER CSC MD DIRECTOR 2.00 2.00 X 0 7200 0 SR NORA HAHN DIRECTOR 2.00 2.00 X 0 0 0 RODNEY GANEY DIRECTOR 2.00 2.00 X 0 0 0 MICHAEL R LEEP SR DIRECTOR 2.00 2.00 X 0 0 0 CAROL A MOONEY JD DIRECTOR 2.00 2.00 X 0 0 0 SR JOY O'GRADY CSC DIRECTOR 2.00 4.00 X 0 0 0 JOHN OLIVER DIRECTOR 2.00 2.00 X 0 0 0 LOUIS PIERCE DIRECTOR 2.00 2.00 X 0 0 0 JOHN ZEGLIS DIRECTOR 2.00 4.00 X 0 0 0 ROBERT CASALOU DIRECTOR THR 09/14; SE MICH REG CEO 1.00 54.00 X 0 904315 39120 UTHMAN CAVALLO MD DIRECTOR THROUGH 03/15;PHYSICIAN 2.00 26.00 X 0 200273 10641 JASON SCHULTZ SECRETARY; SJRMC GENERAL COUNSEL 10.00 40.00 X 0 163837 11628 JANICE DUNN CFO SJRMC 10.00 40.00 X 0 352534 30207 STEPHEN ANDERSON MD RHM CMO 20.00 30.00 X 0 337676 34618 CHRIS KARAM COO 50.00 0.00 X 236623 0 33625 KURT MEYER CHRO SJRMC 29.00 21.00 X 0 265516 27132 KENNETH HALL CNO SJRMC 30.00 10.00 X 0 207624 38810 MARTIN F WIESCHHAUS MD PHYSICIAN 50.00 0.00 X 325534 0 48083 KRISTEN T HOUGLAND MD PHYSICIAN 50.00 0.00 X 294279 0 30174 STEPHEN SIMONS MD PHYSICIAN 50.00 0.00 X 258914 0 54471 THEODORE R NEUMANN MD PHYSICIAN 50.00 0.00 X 222831 0 50410 DAVID T WYNCOTT MD PHYSICIAN 50.00 0.00 X 218251 0 16342 KEDRICK ADKINS FORMER KEY EMPLOYEE 0.00 0.00 X 0 1069394 1656 J RICHARD O'CONNELL FORMER KEY EMPLOYEE 0.00 55.00 X 0 1748402 54577 LORI PRICE FORMER OFFICER 0.00 50.00 X 0 488743 48243 1556432 6986805 620971 52 1 1 0 SOUTH BEND MEDICAL FOUNDATION 530 N LAFAYETTE BLVD SOUTH BEND IN 466011098 LABORATORY SERVICES 14020280 SOUND INPATIENT PHYS OF OH LLC 1123 PACIFIC AVENUE TACOMA WA 98402 HEALTH CARE SERVICES 4022865 ALLIED PHYSICIANS OF MICHIANA 6301 UNIVERSITY COMMONS SUIT 100 SOUTH BEND IN 45635 HEALTH CARE SERVICES 2573164 ST JOSEPH VALLEY ANESTHESIA PO BOX 1742 SOUTH BEND IN 46634 HEALTH CARE SERVICES 2570110 GIBSON LEWIS LLC 1001 WEST 11TH STREET MISHAWAKA IN 46544 CONSTRUCTION SERVICES 1159156 36 2464413 65880 48900 2579193 NET PATIENT SVC REV 622110 317496122 317496122 317496122 633967 633967 712394 0 712394 712394 712394 457345 25402 -457345 -25402 -482747 -482747 CAFETERIA REVENUE 722514 2195932 2195932 PROVIDER INCENTIVE REVENUE 622110 330672 330672 GOV'T SUBSIDY- EHR 622110 34000 34000 1344159 1344159 3904763 324843692 319204953 0 3059546 1550970 1550970 292472 22224 270248 74063 74063 79422252 76734535 2687717 2610969 2526835 84134 13048061 12590239 457822 5736958 5475879 261079 382910 382910 14593 14593 49149 49149 30025320 29791429 233891 44433 44433 1888248 1204851 683397 84655 52915 31740 7605810 5814143 1791667 142683 133733 8950 313347 302804 10543 11211820 11211820 18430917 10186515 8244402 1944167 1944167 MEDICAL SUPPLIES 51222846 51222846 INTERCO. PURCHASED SVCS 43655887 1177837 42478050 BAD DEBT 21986016 21986016 HOSPITAL PROVIDER TAX 11169837 11169837 3192908 2657199 535709 306101291 246314033 59787258 0 7756363 1849877 44376984 43159105 120000 5235109 5634532 1668299 1791607 420355177 108279992 322633512 312075185 19530582 23503156 14767903 20642144 888979 2121059 416857731 410896665 19475234 22324540 66106 11405874 10693956 317448601 311285061 348329709 344369663 X 68528022 66527002 68528022 66527002 416857731 410896665 X 18742401 -718334 -20025087 X X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1553389 1553389 211154950 32169252 178985698 205525121 76110740 129414381 2121717 2121717 312075185 COMMINGLED FUNDS DIRECTLY HOLDING SECURITIES 5779800 F EQUITY METHOD INVESTMENTS 7844015 C HEDGE FUNDS 7018329 C 20642144 INTERCOMPANY NOTES PAYABLE 307096227 DEFERRED COMPENSATION LIABILITY 2861012 INTERCOMPANY ACCOUNTS PAYABLE 1082040 ASSET RETIREMENT OBLIGATION (FIN 47) 126630 OTHER LONG-TERM LIABILITIES 119152 311285061 PART V, LINE 4: ENDOWMENTS HELD BY THE FOUNDATION OF SAINT JOSEPH REGIONAL MEDICAL CENTER, INC. FOR THE BENEFIT OF SAINT JOSEPH REGIONAL MEDICAL CENTER- SOUTH BEND CAMPUS, INC. ARE REPORTED ON THE FORM 990 OF THE FOUNDATION OF SAINT JOSEPH REGIONAL MEDICAL CENTER, INC. 1 1 X 1 X 1 X 1 1 1 0 1 1 1 1916 8573529 8573529 0.03020 45 30088 44867786 21953766 22914020 0.08070 46 32004 53441315 21953766 31487549 0.11090 7 100117 1052749 343736 709013 0.00250 4 285 4897204 3477701 1419503 0.00500 8 40965 6429872 3405679 3024193 0.01060 7 2700 1059756 9221 1050535 0.00370 26 144067 13439581 7236337 6203244 0.02180 72 176071 66880896 29190103 37690793 0.13270 3 89800 89800 0.00030 1 12842 680 12162 0.00000 4 238775 3420 235355 0.00080 1 13469 13469 0.00000 1 900 225 675 0.00000 1 80062 80062 0.00030 11 435848 4325 431523 0.00140 0 21986016 0 73898382 82865874 -8967492 X 1 1 1 1 ST JOSEPH REG MED CTR-SOUTH BEND CAMPUS 5215 HOLY CROSS PARKWAY MISHAWAKA IN 46544 WWW.SJMED.COM/MISHAWAKA-CAMPUS LICENSE #15-005012-1 X X X X SJRMC-SOUTH BEND CAMPUS 1 0 0 1 X X X X X X X X X 14 1 1 1 1 X SEE PART V, SECTION C X X 1 14 1 SEE PART V, SECTION C 0 0 1 X 200.000000000000 400.000000000000 X X X X X X 1 1 X X X X 1 X HTTP://WWW.SJMED.COM/FINANCIAL-ASSISTANCE X HTTP://WWW.SJMED.COM/FINANCIAL-ASSISTANCE X X X X X 1 X 0 X X X X 1 X 0 0 SJRMC-SOUTH BEND CAMPUS PART V, SECTION B, LINE 5: COMMUNITY FOCUS GROUPS, DURING THE MONTHS OF SEPTEMBER THROUGH NOVEMBER OF 2014, WERE USED TO GATHER INPUT FROM PEOPLE REPRESENTING THE COMMUNITY SERVED FOR THE RECENT CHNA. THE FOCUS GROUP PARTICIPANTS WERE ASKED A SERIES OF QUESTIONS ABOUT TOPICS CONSIDERED TO BE CRITICAL TO THE VARIOUS MEMBERS OF THE COMMUNITY. THE IMPORTANT ISSUES IDENTIFIED BY THE SURVEY TAKERS WERE: MENTAL HEALTH, TRANSPORTATION AND ACCESS.EXAMPLES OF THE PARTICIPANTS INCLUDED: YOUNG PROFESSIONALS, SENIORS, CLINICS, BUSINESS LEADERS, EXPECTANT & NEW MOTHERS, VETERANS, COLLEGE STUDENTS AND LATINO COMMUNITY LEADERS. THE FOCUS GROUPS WERE ASKED TO DISCUSS ISSUES THAT HAD BEEN IDENTIFIED AS IMPORTANT BY SAINT JOSEPH HEALTH SYSTEM.COMMUNITY BENEFIT COUNCIL MET TO DISCUSS HOW TO IMPROVE THE THREE DEFINED AREAS. AFTER DISCUSSION, ACTION PLANS WERE DEVELOPED, APPROVED AND BUDGETED. SJRMC-SOUTH BEND CAMPUS PART V, SECTION B, LINE 6A: THE CHNA WAS CONDUCTED IN COLLABORATION WITH SAINT JOSEPH REGIONAL MEDICAL CENTER - PLYMOUTH CAMPUS. SJRMC-SOUTH BEND CAMPUS PART V, SECTION B, LINE 6B: COLLABORATING ORGANIZATIONS INCLUDED ST. JOSEPH COUNTY HEALTH DEPARTMENT, OAKLAWN, LA CASA DE AMISTAD, MHIN, SCHOOL CITY OF MISHAWAKA, PENN-HARRIS-MADISON SCHOOLS, TRANSPO, NOTRE DAME CENTER, ENFOCUS, UNITED WAY OF ST. JOSEPH COUNTY, DR. ANGIE'S DENTAL HEALTH EXCHANGE, NORTHERN INDIANA FOOD BANK, AND UNITY GARDENS. SJRMC-SOUTH BEND CAMPUS PART V, SECTION B, LINE 7D: ALL FOCUS GROUP MEMBERS AND COMMUNITY BENEFIT COUNCIL MEMBERS RECEIVED A PRINTED OR E-MAILED COPY OF THE COMPLETE CHNA. SJRMC-SOUTH BEND CAMPUS PART V, SECTION B, LINE 11: THERE IS A THREE-YEAR STRATEGIC PLAN TO ADDRESS THE THREE SIGNIFICANT NEEDS IDENTIFIED IN THE CHNA. IT IS OUR INTENTION TO ADDRESS ALL THREE NEEDS, INCLUDING MENTAL HEALTH, TRANSPORTATION AND PROVIDER ACCESS. THE UNDER ONE ROOF CONCEPT WAS ESTABLISHED TO ADDRESS ALL THREE. THIS CONCEPT WAS TO EVALUATE AND DETERMINE IF IT WOULD BE FEASIBLE TO HAVE MULTIPLE SERVICES/AGENCIES CO-EXIST IN ONE BUILDING. MENTAL HEALTH ACTION PLANS INCLUDE TRAINING SCHOOL HEALTH STAFF IN MENTAL HEALTH FIRST AID, SUPPORTING OAKLAWN MENTAL HEALTH AWARENESS WEEK, AS WELL AS PROMOTING SERVICES OFFERED AT THEIR FACILITIES. HEALTH AND WELLNESS EDUCATOR HOURS WERE INCREASED TO FULL TIME TO ADDRESS MULTIPLE CONCERNS FOR OUR LATINO COMMUNITY, INCLUDING MENTAL HEALTH. A MODEL/PILOT PROJECT WAS STARTED TO WORK WITH MICHIGAN HEALTH INFORMATION NETWORK AND ONE OF THE SAFETY NET CLINICS ON AN INTEGRATED CARE MODEL FOR REFERRALS. TRANSPORTATION ACTION PLANS INCLUDE PARTICIPATING IN LOCAL ALLIANCE AND SUBCOMMITTEE WHICH WILL ADDRESS TRANSPORTATION NEEDS FOR THE COUNTY. THE HOSPITAL COLLABORATES WITH HOPE MINISTRIES, TRANSPO AND OTHER AGENCIES TO ADDRESS TRANSPORTATION TO WORK. PROVIDER ACCESS ACTION PLANS INCLUDE PARTICIPATING IN LOCAL HEALTH ALLIANCE SUBCOMMITTEE ON DIABETES PREVENTION AND EDUCATION, EXPAND WELLNESS INITIATIVE THIS COUNTS, SUPPORT AND PROMOTE DR. ANGIE'S DENTAL HEALTH EXCHANGE PROGRAM -PAY IT FORWARD DENTAL PROGRAM, EXPAND FOOD BANK HEALTHY FOODS PROGRAM, AS WELL AS CREATE RESOURCE GUIDES WITH LOCAL PROVIDERS' HOURS OF SERVICE. WHILE BUDGETS FOR SJRMC - SOUTH BEND CAMPUS HAVE BEEN APPROVED, FINANCIAL CONSTRAINTS MAY LIMIT SOME OF THE ACTIONABLE ITEMS FOR STRATEGIES. POVERTY AS A COMMUNITY NEED COULD NOT BE COMPLETELY ADDRESSED AS IT IS VAST. ALSO, DAY CARE, JOBLESSNESS AND HOMELESSNESS WERE MENTIONED AS NEEDS BUT NOT ADDRESSED. SJRMC-SOUTH BEND CAMPUS PART V, SECTION B, LINE 13H: THE HOSPITAL RECOGNIZES THAT NOT ALL PATIENTS ARE ABLE TO PROVIDE COMPLETE FINANCIAL AND/OR SOCIAL INFORMATION. THEREFORE, APPROVAL FOR FINANCIAL SUPPORT MAY BE DETERMINED BASED ON AVAILABLE INFORMATION. EXAMPLES OF PRESUMPTIVE CASES INCLUDE: DECEASED PATIENTS WITH NO KNOWN ESTATE, THE HOMELESS, UNEMPLOYED PATIENTS, NON-COVERED MEDICALLY NECESSARY SERVICES PROVIDED TO PATIENTS QUALIFYING FOR PUBLIC ASSISTANCE PROGRAMS, PATIENT BANKRUPTCIES, AND MEMBERS OF RELIGIOUS ORGANIZATIONS WHO HAVE TAKEN A VOW OF POVERTY AND HAVE NO RESOURCES INDIVIDUALLY OR THROUGH THE RELIGIOUS ORDER.FOR THE PURPOSE OF HELPING FINANCIALLY NEEDY PATIENTS, A THIRD PARTY IS UTILIZED TO CONDUCT A REVIEW OF PATIENT INFORMATION TO ASSESS FINANCIAL NEED. THIS REVIEW UTILIZES A HEALTHCARE INDUSTRY-RECOGNIZED, PREDICTIVE MODEL THAT IS BASED ON PUBLIC RECORD DATABASES. THESE PUBLIC RECORDS ENABLE THE HOSPITAL TO ASSESS WHETHER THE PATIENT IS CHARACTERISTIC OF OTHER PATIENTS WHO HAVE HISTORICALLY QUALIFIED FOR FINANCIAL ASSISTANCE UNDER THE TRADITIONAL APPLICATION PROCESS. IN CASES WHERE THERE IS AN ABSENCE OF INFORMATION PROVIDED DIRECTLY BY THE PATIENT, AND AFTER EFFORTS TO CONFIRM COVERAGE AVAILABILITY, THE PREDICTIVE MODEL PROVIDES A SYSTEMATIC METHOD TO GRANT PRESUMPTIVE ELIGIBILITY TO FINANCIALLY NEEDY PATIENTS. SJRMC-SOUTH BEND CAMPUS PART V, SECTION B, LINE 22D: PATIENTS WITH INCOME AT OR BELOW 200% OF THE FEDERAL POVERTY GUIDELINES (FPG) ARE ELIGIBLE FOR 100% CHARITY CARE WRITE OFF OF THE CHARGES FOR MEDICALLY NECESSARY SERVICES. ACUTE CARE PATIENTS WITH INCOME BETWEEN 201% AND 400% OF THE FPG RECEIVE A DISCOUNT OFF TOTAL CHARGES FOR MEDICALLY NECESSARY SERVICES EQUAL TO THE HOSPITAL'S AVERAGE ACUTE CARE CONTRACTUAL ADJUSTMENT FOR MEDICARE. AMBULATORY PATIENTS WITH INCOME BETWEEN 201% AND 400% OF THE FPG RECEIVE A DISCOUNT OFF TOTAL CHARGES FOR MEDICALLY NECESSARY SERVICES EQUAL TO THE HOSPITAL'S AVERAGE PHYSICIAN CONTRACTUAL ADJUSTMENT FOR MEDICARE. THE ACUTE AND PHYSICIAN AVERAGE CONTRACTUAL ADJUSTMENT AMOUNTS FOR MEDICARE ARE CALCULATED UTILIZING THE LOOK BACK METHODOLOGY OF CALCULATING THE SUM OF PAID CLAIMS DIVIDED BY THE TOTAL GROSS CHARGES FOR THOSE CLAIMS ANNUALLY USING TWELVE MONTHS OF PAID CLAIMS WITH A 30 DAY LAG FROM REPORT DATE TO THE MOST RECENT DISCHARGE DATE. PART V, SECTION B, LINE 7A: HTTP://WWW.SJMED.COM/COMMUNITY-NEEDS-HEALTH-ASSESSMENT PART V, SECTION B, LINE 10A: HTTP://WWW.SJMED.COM/COMMUNITY-NEEDS-HEALTH-ASSESSMENT PART V, SECTION B, LINE 16 FINANCIAL ASSISTANCE POLICY WEBSITE AVAILABILITY SJRMC-SOUTH BEND CAMPUS PART V, SECTION B, LINE 16B WEBSITE: HTTP://WWW.SJMED.COM/FINANCIAL-ASSISTANCE SJRMC-SOUTH BEND CAMPUS PART V, SECTION B, LINE 16C WEBSITE: HTTP://WWW.SJMED.COM/FINANCIAL-ASSISTANCE 2 FAMILY MEDICINE CENTER 611 E DOUGLAS RD SUITE 407 MISHAWAKA IN 46545 FAMILY HEALTH CENTER SPORTS MEDICINE INSTITUTE 611 E DOUGLAS RD SUITE 137 MISHAWAKA IN 46545 SPORTS MEDICINE CLINIC PART I, LINE 3C: IN ADDITION TO LOOKING AT A MULTIPLE OF THE FEDERAL POVERTY GUIDELINES, OTHER FACTORS ARE CONSIDERED SUCH AS THE PATIENT'S FINANCIAL STATUS AND/OR ABILITY TO PAY AS DETERMINED THROUGH THE ASSESSMENT PROCESS. PART I, LINE 6A: SAINT JOSEPH REGIONAL MEDICAL CENTER - SOUTH BEND CAMPUS PREPARES AN ANNUAL COMMUNITY BENEFIT REPORT, WHICH IT SUBMITS TOTHE STATE OF INDIANA. IN ADDITION, SAINT JOSEPH REGIONAL MEDICAL CENTER - SOUTH BEND CAMPUS REPORTS ITS COMMUNITY BENEFIT INFORMATION AS PART OF THE CONSOLIDATED COMMUNITY BENEFIT INFORMATION REPORTED BY TRINITY HEALTH (EIN 35-1443425) IN ITS AUDITED FINANCIAL STATEMENTS, AVAILABLE AT WWW.TRINITY-HEALTH.ORG.IN ADDITION, SAINT JOSEPH REGIONAL MEDICAL CENTER - SOUTH BEND CAMPUS INCLUDES A COPY OF ITS MOST RECENTLY FILED SCHEDULE H ON BOTH ITS OWN WEBSITE AND TRINITY HEALTH'S WEBSITE. PART I, LINE 7: THE BEST AVAILABLE DATA WAS USED TO CALCULATE THE COST AMOUNTS REPORTED IN ITEM 7. FOR CERTAIN CATEGORIES, PRIMARILY TOTAL CHARITY CARE AND MEANS-TESTED GOVERNMENT PROGRAMS, SPECIFIC COST-TO-CHARGE RATIOS WERE CALCULATED AND APPLIED TO THOSE CATEGORIES. THE COST-TO-CHARGE RATIO WAS DERIVED FROM WORKSHEET 2, RATIO OF PATIENT CARE COST-TO-CHARGES. IN OTHER CATEGORIES, THE BEST AVAILABLE DATA WAS DERIVED FROM THE HOSPITAL'S COST ACCOUNTING SYSTEM. PART I, LN 7 COL(F): THE FOLLOWING NUMBER, $21,986,016, REPRESENTS THE AMOUNT OF BAD DEBT EXPENSE INCLUDED IN TOTAL FUNCTIONAL EXPENSES IN FORM 990, PART IX, LINE 25. PER IRS INSTRUCTIONS, THIS AMOUNT WAS EXCLUDED FROM THE DENOMINATOR WHEN CALCULATING THE PERCENT OF TOTAL EXPENSE FOR SCHEDULE H, PART I, LINE 7, COLUMN (F). PART II, COMMUNITY BUILDING ACTIVITIES: MOST OF THE COMMUNITY BUILDING PROGRAMS AND ORGANIZATIONS THAT SAINT JOSEPH REGIONAL MEDICAL CENTER (SJRMC)-SOUTH BEND CAMPUS SUPPORTS PROVIDE ASSISTANCE TO LOW INCOME OR VULNERABLE POPULATIONS OR OFFER EDUCATION TO MEMBERS OF THE COMMUNITY WHO HELP THOSE POPULATIONS.OVER THE COURSE OF THE PAST YEAR, KEY CONTRIBUTIONS BY SJRMC-SOUTH BEND CAMPUS INCLUDED:PHYSICAL IMPROVEMENT - CONTRIBUTED TO:- NORTHEAST NEIGHBORHOOD REVITALIZATION- HABITAT FOR HUMANITY - SAINT ADALBERT PARISH- UNIVERSITY OF NOTRE DAMEECONOMIC DEVELOPMENT - CONTRIBUTED TO:- CHAMBER OF COMMERCE - ST. JOSEPH COUNTY- CHAMBER OF COMMERCE - ELKHART COUNTY - MISHAWAKA BUSINESS ASSOCIATION- GRANGER BUSINESS ASSOCIATIONCOMMUNITY SUPPORT DONATIONS TO:- SAINT ADALBERT PARISH- 100 BLACK MEN OF GREATER SOUTH BEND AREA - MISHAWAKA EDUCATION FOUNDATION- COMMUNITY FOUNDATION OF SJ COUNTY- GIRLS ON THE RUN - EDUCATION PROGRAM FOR 3RD - 5TH GRADE GIRLS ON SELF-RESPECT AND HEALTHY LIVING - YMCA- BIG BROTHERS BIG SISTERS SPONSORSHIP- MARTIN LUTHER KING FOUNDATION -- EDUCATE THE COMMUNITY ABOUT DIVERSITY, WORKING TOGETHER, CREATING COMMON GOALS AND DEVELOPING A STRONG PATH TO POSITIVE OUTCOMES AND ONGOING VITALITY- ST. MARGARET'S HOUSE - SAFE DAY HOUSE FOR HOMELESS WOMEN AND CHILDREN- ST. VINCENT DEPAUL SOCIETY- YOUTH SERVICE BUREAU- HOPE MINISTRIES- BOYS AND GIRLS CLUB- ST. JOSEPH HIGH SCHOOL- MARIAN HIGH SCHOOL- UNITED WAY OF SAINT JOSEPH COUNTY- SAINT MARY'S COLLEGE- UNIVERSITY OF NOTRE DAME- LA CASA DE AMISTAD- DISMAS HOUSE OF SOUTH BENDLEADERSHIP DEVELOPMENT DONATIONS TO:-HOLY CROSS COLLEGE-SISTERS OF THE HOLY CROSS-JEWISH FEDERATION OF ST. JOSEPH VALLEYWORKFORCE DEVELOPMENT DONATIONS TO:-HOLY CROSS COLLEGE-LA CASA DE AMISTAD PART III, LINE 2: METHODOLOGY USED FOR LINE 2 - ANY DISCOUNTS PROVIDED OR PAYMENTS MADE TO A PARTICULAR PATIENT ACCOUNT ARE APPLIED TO THAT PATIENT ACCOUNT PRIOR TO ANY BAD DEBT WRITE-OFF AND ARE THUS NOT INCLUDED IN BAD DEBT EXPENSE. AS A RESULT OF THE PAYMENT AND ADJUSTMENT ACTIVITY BEING POSTED TO BAD DEBT ACCOUNTS, WE ARE ABLE TO REPORT BAD DEBT EXPENSE NET OF THESE TRANSACTIONS. PART III, LINE 3: SAINT JOSEPH REGIONAL MEDICAL CENTER - SOUTH BEND CAMPUS USES A PREDICTIVE MODEL THAT INCORPORATES THREE DISTINCT VARIABLES IN COMBINATION TO PREDICT WHETHER A PATIENT QUALIFIES FOR CHARITY: (1) SOCIO-ECONOMIC SCORE, (2) ESTIMATED FEDERAL POVERTY LEVEL (FPL), AND (3) HOMEOWNERSHIP. BASED ON THE MODEL, CHARITY CARE CAN STILL BE EXTENDED TO PATIENTS EVEN IF THEY HAVE NOT RESPONDED TO FINANCIAL COUNSELING EFFORTS AND ALL OTHER FUNDING SOURCES HAVE BEEN EXHAUSTED. FOR FINANCIAL STATEMENT PURPOSES, SAINT JOSEPH REGIONAL MEDICAL CENTER - SOUTH BEND CAMPUS IS RECORDING AMOUNTS AS CHARITY CARE (INSTEAD OF BAD DEBT EXPENSE) BASED ON THE RESULTS OF THE PREDICTIVE MODEL. THEREFORE, SAINT JOSEPH REGIONAL MEDICAL CENTER - SOUTH BEND CAMPUS IS REPORTING ZERO ON LINE 3, SINCE THEORETICALLY ANY POTENTIAL CHARITY CARE SHOULD HAVE BEEN IDENTIFIED THROUGH THE PREDICTIVE MODEL. PART III, LINE 4: SAINT JOSEPH REGIONAL MEDICAL CENTER - SOUTH BEND CAMPUS IS INCLUDED IN THE CONSOLIDATED FINANCIAL STATEMENTS OF TRINITY HEALTH. THE FOLLOWING IS THE TEXT OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS FOOTNOTE FROM PAGE 15 OF THOSE STATEMENTS: "THE CORPORATION RECOGNIZES A SIGNIFICANT AMOUNT OF PATIENT SERVICE REVENUE AT THE TIME THE SERVICES ARE RENDERED EVEN THOUGH THE CORPORATION DOES NOT ASSESS THE PATIENT'S ABILITY TO PAY AT THAT TIME. AS A RESULT, THE PROVISION FOR BAD DEBTS IS PRESENTED AS A DEDUCTION FROM PATIENT SERVICE REVENUE (NET OF CONTRACTUAL PROVISIONS AND DISCOUNTS). FOR UNINSURED AND UNDERINSURED PATIENTS THAT DO NOT QUALIFY FOR CHARITY CARE, THE CORPORATION ESTABLISHES AN ALLOWANCE TO REDUCE THE CARRYING VALUE OF SUCH RECEIVABLES TO THEIR ESTIMATED NET REALIZABLE VALUE. THIS ALLOWANCE IS ESTABLISHED BASED ON THE AGING OF ACCOUNTS RECEIVABLE AND THE HISTORICAL COLLECTION EXPERIENCE BY THE HEALTH MINISTRIES AND FOR EACH TYPE OF PAYOR. A SIGNIFICANT PORTION OF THE CORPORATION'S PROVISION FOR DOUBTFUL ACCOUNTS RELATES TO SELF-PAY PATIENTS, AS WELL AS CO-PAYMENTS AND DEDUCTIBLES OWED TO THE CORPORATION BY PATIENTS WITH INSURANCE." PART III, LINE 8: SAINT JOSEPH REGIONAL MEDICAL CENTER - SOUTH BEND CAMPUS DOES NOT BELIEVE ANY MEDICARE SHORTFALL SHOULD BE TREATED AS COMMUNITY BENEFIT. THIS IS SIMILAR TO CHA RECOMMENDATIONS, WHICH STATE THAT SERVING MEDICARE PATIENTS IS NOT A DIFFERENTIATING FEATURE OF TAX-EXEMPT HEALTHCARE ORGANIZATIONS AND THAT THE EXISTING COMMUNITY BENEFIT FRAMEWORK ALLOWS COMMUNITY BENEFIT PROGRAMS THAT SERVE THE MEDICARE POPULATION TO BE COUNTED IN OTHER COMMUNITY BENEFIT CATEGORIES.PART III, LINE 8: COSTING METHODOLOGY FOR LINE 6 - MEDICARE COSTS WERE OBTAINED FROM THE FILED MEDICARE COST REPORT. THE COSTS ARE BASED ON MEDICARE ALLOWABLE COSTS AS REPORTED ON WORKSHEET B, COLUMN 27, WHICH EXCLUDE DIRECT MEDICAL EDUCATION COSTS. INPATIENT MEDICARE COSTS ARE CALCULATED BASED ON A COMBINATION OF ALLOWABLE COST PER DAY TIMES MEDICARE DAYS FOR ROUTINE SERVICES AND COST TO CHARGE RATIO TIMES MEDICARE CHARGES FOR ANCILLARY SERVICES. OUTPATIENT MEDICARE COSTS ARE CALCULATED BASED ON COST TO CHARGE RATIO TIMES MEDICARE CHARGES BY ANCILLARY DEPARTMENT. PART III, LINE 9B: THE HOSPITAL'S COLLECTION POLICY CONTAINS PROVISIONS ON THE COLLECTION PRACTICES TO BE FOLLOWED FOR PATIENTS WHO ARE KNOWN TO QUALIFY FOR FINANCIAL ASSISTANCE. CHARITY DISCOUNTS ARE APPLIED TO THE AMOUNTS THAT QUALIFY FOR FINANCIAL ASSISTANCE. COLLECTION PRACTICES FOR THE REMAINING BALANCES ARE CLEARLY OUTLINED IN THE ORGANIZATION'S COLLECTION POLICY. THE HOSPITAL HAS IMPLEMENTED BILLING AND COLLECTION PRACTICES FOR PATIENT PAYMENT OBLIGATIONS THAT ARE FAIR, CONSISTENT AND COMPLIANT WITH STATE AND FEDERAL REGULATIONS. PART VI, LINE 2: NEEDS ASSESSMENT- SAINT JOSEPH REGIONAL MEDICAL CENTER-SOUTH BEND CAMPUS ASSESSES THE HEALTH STATUS OF ITS COMMUNITY IN THE NORMAL COURSE OF OPERATIONS AND IN THE CONTINUOUS EFFORTS TO IMPROVE PATIENT CARE AND THE HEALTH OF THE OVERALL COMMUNITY. THE HOSPITAL MAY USE PATIENT DATA, PUBLIC HEALTH DATA, ANNUAL COUNTY HEALTH RANKINGS, MARKET STUDIES AND GEOGRAPHICAL MAPS SHOWING AREAS OF HIGH UTILIZATION FOR EMERGENCY SERVICES AND INPATIENT CARE, WHICH MAY INDICATE POPULATIONS OF INDIVIDUALS WHO DO NOT HAVE ACCESS TO PREVENTATIVE SERVICES OR ARE UNINSURED, IN THE ASSESSMENT OF THE COMMUNITY. PART VI, LINE 3: SAINT JOSEPH REGIONAL MEDICAL CENTER - SOUTH BEND CAMPUS IS COMMITTED TO:-PROVIDING ACCESS TO QUALITY HEALTHCARE SERVICES WITH COMPASSION, DIGNITY AND RESPECT FOR THOSE WE SERVE, PARTICULARLY THE POOR AND THE UNDERSERVED IN OUR COMMUNITIES-CARING FOR ALL PERSONS, REGARDLESS OF THEIR ABILITY TO PAY FOR SERVICES-ASSISTING PATIENTS WHO CANNOT PAY FOR PART OR ALL OF THE CARE THEY RECEIVE -BALANCING NEEDED FINANCIAL ASSISTANCE FOR SOME PATIENTS WITH BROADER FISCAL RESPONSIBILITIES IN ORDER TO SUSTAIN VIABILITY AND PROVIDE THE QUALITY AND QUANTITY OF SERVICES FOR ALL WHO MAY NEED CARE IN A COMMUNITYIN ACCORDANCE WITH AMERICAN HOSPITAL ASSOCIATION RECOMMENDATIONS, SAINT JOSEPH REGIONAL MEDICAL CENTER - SOUTH BEND CAMPUS HAS ADOPTED THE FOLLOWING GUIDING PRINCIPLES WHEN HANDLING THE BILLING, COLLECTION AND FINANCIAL SUPPORT FUNCTIONS FOR OUR PATIENTS: -PROVIDE EFFECTIVE COMMUNICATIONS WITH PATIENTS REGARDING HOSPITAL BILLS-MAKE AFFIRMATIVE EFFORTS TO HELP PATIENTS APPLY FOR PUBLIC AND PRIVATE FINANCIAL SUPPORT PROGRAMS-OFFER FINANCIAL SUPPORT TO PATIENTS WITH LIMITED MEANS-IMPLEMENT POLICIES FOR ASSISTING LOW-INCOME PATIENTS IN A CONSISTENT MANNER-IMPLEMENT FAIR AND CONSISTENT BILLING AND COLLECTION PRACTICES FOR ALL PATIENTS WITH PATIENT PAYMENT OBLIGATIONSSAINT JOSEPH REGIONAL MEDICAL CENTER - SOUTH BEND CAMPUS COMMUNICATES EFFECTIVELY WITH PATIENTS REGARDING PATIENT PAYMENT OBLIGATIONS. FINANCIAL COUNSELING IS PROVIDED TO PATIENTS ABOUT THEIR PAYMENT OBLIGATIONS AND HOSPITAL BILLS. INFORMATION ON HOSPITAL-BASED FINANCIAL SUPPORT POLICIES AND EXTERNAL PROGRAMS THAT PROVIDE COVERAGE FOR SERVICES ARE MADE AVAILABLE TO PATIENTS DURING THE PRE-REGISTRATION AND REGISTRATION PROCESSES AND/OR THROUGH COMMUNICATIONS WITH PATIENTS SEEKING FINANCIAL ASSISTANCE. FINANCIAL COUNSELORS MAKE AFFIRMATIVE EFFORTS TO HELP PATIENTS APPLY FOR PUBLIC AND PRIVATE PROGRAMS FOR WHICH THEY MAY QUALIFY AND THAT MAY ASSIST THEM IN OBTAINING AND PAYING FOR HEALTHCARE SERVICES. EVERY EFFORT IS MADE TO DETERMINE A PATIENT'S ELIGIBILITY PRIOR TO OR AT THE TIME OF ADMISSION OR SERVICE. FINANCIAL ASSISTANCE APPLICATIONS WILL BE ACCEPTED UNTIL ONE YEAR AFTER THE FIRST BILLING STATEMENT TO THE PATIENT. SAINT JOSEPH REGIONAL MEDICAL CENTER - SOUTH BEND CAMPUS OFFERS FINANCIAL SUPPORT TO PATIENTS WITH LIMITED MEANS. THIS SUPPORT IS AVAILABLE TO UNINSURED AND UNDERINSURED PATIENTS WHO DO NOT QUALIFY FOR PUBLIC PROGRAMS OR OTHER ASSISTANCE. NOTIFICATION ABOUT FINANCIAL ASSISTANCE, INCLUDING CONTACT INFORMATION, IS AVAILABLE THROUGH PATIENT BROCHURES, MESSAGES ON PATIENT BILLS, POSTED NOTICES IN PUBLIC REGISTRATION AREAS INCLUDING EMERGENCY ROOMS, ADMITTING AND REGISTRATION DEPARTMENTS, AND OTHER PATIENT FINANCIAL SERVICES OFFICES. SUMMARIES OF HOSPITAL PROGRAMS ARE MADE AVAILABLE TO APPROPRIATE COMMUNITY HEALTH AND HUMAN SERVICES AGENCIES AND OTHER ORGANIZATIONS THAT ASSIST PEOPLE IN NEED. INFORMATION REGARDING FINANCIAL ASSISTANCE PROGRAMS IS ALSO AVAILABLE ON HOSPITAL WEBSITES. IN ADDITION TO ENGLISH, THIS INFORMATION IS ALSO AVAILABLE IN SPANISH, REFLECTING OTHER PRIMARY LANGUAGES SPOKEN BY THE POPULATION SERVICED BY OUR HOSPITAL. SAINT JOSEPH REGIONAL MEDICAL CENTER - SOUTH BEND CAMPUS HAS ESTABLISHED A WRITTEN POLICY FOR THE BILLING, COLLECTION AND SUPPORT FOR PATIENTS WITH PAYMENT OBLIGATIONS. SAINT JOSEPH REGIONAL MEDICAL CENTER - SOUTH BEND CAMPUS MAKES EVERY EFFORT TO ADHERE TO THE POLICY AND IS COMMITTED TO IMPLEMENTING AND APPLYING THE POLICY FOR ASSISTING PATIENTS WITH LIMITED MEANS IN A PROFESSIONAL, CONSISTENT MANNER. PART VI, LINE 4: SAINT JOSEPH REGIONAL MEDICAL CENTER-SOUTH BEND CAMPUS SERVES 898,595 PEOPLE IN A DIVERSE NINE COUNTY SYSTEM MARKET IN INDIANA AND MICHIGAN AT TWO HOSPITAL CAMPUSES, ONE IN MISHAWAKA AND ONE IN PLYMOUTH. THE PRIMARY SERVICE AREA INCLUDES ST. JOSEPH, MARSHALL, AND ELKHART COUNTIES IN INDIANA AND BERRIEN COUNTY, MICHIGAN, WHILE THE SECONDARY SERVICE AREA ENCOMPASSES FULTON, LAPORTE, PULASKI AND STARKE COUNTIES IN INDIANA AND CASS COUNTY, MICHIGAN.COUNTIES ARE GENERALLY SUBURBAN OR RURAL IN NATURE, WITH THE EXCEPTION OF URBAN CITY-CENTERS IN ELKHART AND SOUTH BEND, THE FOURTH LARGEST CITY IN INDIANA. THE REGION OFFERS DIVERSITY, A STABLE ECONOMY AND A FAMILY-FRIENDLY ENVIRONMENT, ALL WITHIN CLOSE PROXIMITY OF CHICAGO. OUR REGION INCLUDES A VARIETY OF QUALITY EDUCATION OPPORTUNITIES, INCLUDING BOTH PUBLIC AND PRIVATE SCHOOLS FROM PRESCHOOL THROUGH HIGH SCHOOL. THOSE PURSUING A HIGHER LEVEL OF EDUCATION HAVE SEVERAL OPTIONS, INCLUDING THE UNIVERSITY OF NOTRE DAME, INDIANA UNIVERSITY AT SOUTH BEND, ST. MARY'S COLLEGE, HOLY CROSS COLLEGE, ANCILLA COLLEGE, BETHEL COLLEGE, INDIANA TECH AND IVY TECH STATE COLLEGE. OTHER COMMUNITY HOSPITALS IN THE PRIMARY SERVICE AREA INCLUDE MEMORIAL HOSPITAL OF SOUTH BEND, ELKHART GENERAL HOSPITAL AND INDIANA UNIVERSITY GOSHEN TO THE EAST, IN ELKHART COUNTY. HOSPITALS LOCATED IN THE SECONDARY SERVICE AREA INCLUDE INDIANA UNIVERSITY LAPORTE HOSPITAL AND SAINT ANTHONY MEMORIAL HOSPITAL TO THE WEST IN LAPORTE COUNTY, AND TO THE SOUTH, WOODLAWN HOSPITAL IN ROCHESTER, INDIANA UNIVERSITY STARKE MEMORIAL IN STARKE COUNTY, AND PULASKI MEMORIAL IN WINAMAC. TOTAL POPULATION FOR THE SYSTEM SERVICE AREA IS EXPECTED TO GROW 0.6% FROM 2015 THROUGH 2020. COMPARED TO THE STATE OF INDIANA, THE SERVICE AREA HAS A LOWER PROJECTED POPULATION GROWTH, A HIGHER MEDIAN AGE AND A DECLINE IN FEMALES OF CHILD BEARING AGE 15-44 AT 0.2%. HOWEVER, OF THE STATES THAT BORDER NORTHERN INDIANA; OHIO, MICHIGAN AND ILLINOIS HAVE DECLINING NUMBERS OF FEMALES OF CHILD BEARING AGE 15-44. THE POPULATION AGED 65 AND OLDER REPRESENTS 15.7% OF THE TOTAL POPULATION, AND IS EXPECTED TO INCREASE 13.2% OVER THE NEXT FIVE YEARS. AVERAGE HOUSEHOLD INCOME FOR THE AREA IS $58,987. MEDIAN HOUSEHOLD INCOME OF $46,029 IS BELOW THE RATE FOR THE STATES OF INDIANA, MICHIGAN AND OHIO AS WELL AS THE USA. TWENTY-SIX PERCENT OF THE POPULATION IN THE SYSTEM SERVICE AREA EARNS AN ANNUAL SALARY $25,000 OR BELOW.THE JUNE 2015 UNEMPLOYMENT RATE IN THE SERVICE ARE INCLUDES THE SOUTH BEND/MISHAWAKA MSA AT 5.0%, THE ELKHART/GOSHEN MSA AT 3.9% AND THE PLYMOUTH MICRO AREA AT 4.7%. THE SOUTH BEND/MISHAWAKA MSA EXCEEDS THE INDIANA STATE WIDE RATE OF 4.8% BUT IS BELOW THE NATIONAL RATE OF 5.3%. AN ESTIMATE OF THE UNINSURED IN THE SYSTEM SERVICE AREA IS 130,157 AND RANGES FROM 19.3% IN MARSHALL COUNTY, IN TO 14.7% IN CASS COUNTY, MI. THIS IS COMPARED TO AN INDIANA RATE OF 16.6%. [U.S. CENSUS BUREAU/SMALL AREA HEALTH INSURANCE (SAHIE) PROGRAM/MARCH 2014]THE TARGETED SERVICE AREA INCLUDES SEVERAL MEDICALLY UNDERSERVED AREAS (MUA) AND MEDICALLY UNDERSERVED POPULATIONS (MUP). IN INDIANA, THESE INCLUDE PORTIONS OF ELKHART COUNTY, LAPORTE COUNTY, AND ST. JOSEPH COUNTY. IN MICHIGAN, THEY INCLUDE PORTIONS OF BERRIEN COUNTY, CASS COUNTY, AND ST. JOSEPH COUNTY.THERE ARE ALSO THREE CRITICAL ACCESS HOSPITALS (CAH)-COMMUNITY HOSPITAL OF BREMEN, PULASKI MEMORIAL HOSPITAL, AND WOODLAWN HOSPITAL, AT WHICH PRIMARY CARE PROFESSIONALS WITH PRESCRIPTIVE PRIVILEGES FURNISH OUTPATIENT PRIMARY-CARE SERVICES.IN THE STATE OF INDIANA, ACCORDING TO THE U.S. CENSUS BUREAU'S SMALL AREA INCOME AND POVERTY ESTIMATES (SAIPE), IN 2013 15.5% OF FAMILIES LIVED IN POVERTY. THE STATE OF MICHIGAN'S PERCENTAGE WAS HIGHER, AT 17.4%. SJRMC- SOUTH BEND CAMPUS SERVES A LARGE MEDICAID POPULATION ACROSS MANY DELIVERY SITES, MOST OF WHICH ARE LOCATED IN ST. JOSEPH COUNTY. [U.S. CENSUS BUREAU, SMALL AREA INCOME AND POVERTY ESTIMATES (SAIPE) PROGRAM, DECEMBER 2013] INPATIENT MEDICAID POPULATION SERVED BY SJRMC-SOUTH BEND CAMPUS EQUALS 14% OF THE HOSPITAL'S TOTAL OVERALL INPATIENT POPULATION. WHEN SPECIFIC SERVICES LIKE OBSTETRICS AND NEONATOLOGY ARE CONSIDERED, THE PERCENTAGE INCREASES TO 45-60% OF THE TOTAL DISCHARGES FOR THE RESPECTIVE SERVICE LINE. AS IN MOST MIDWESTERN COMMUNITIES, THE SERVICE AREA POPULATION IS LARGELY MADE UP OF WHITE NON-HISPANIC INDIVIDUALS OF NORTHERN EUROPEAN DESCENT. HOWEVER, THE REGION OF NORTHERN INDIANA AND SOUTHWESTERN MICHIGAN HAS SEEN AN INCREASE IN THE HISPANIC POPULATION OVER THE PAST TEN YEARS. THE REPRESENTATION OF HISPANIC POPULATION IN THIS AREA IS 8.6% AS COMPARED TO 17.6% NATION-WIDE; HOWEVER, THIS IS LIKELY TO BE UNDERSTATED. ALL COUNTIES IN THE REGION HAVE HIGHER SMOKING RATES, A SIGNIFICANTLY HIGHER ADULT OBESITY RATE AND HIGHER ALCOHOL CONSUMPTION THAN THE US BENCHMARK. UNFORTUNATELY, WITH FEW EXCEPTIONS, THE DEATH RATES FROM CHRONIC CONDITIONS SUCH AS HEART DISEASE, CANCER, STROKE AND DIABETES IN THE SERVICE AREA ARE HIGHER THAN THE STATES OF INDIANA OR MICHIGAN. THE POPULATION HAS A LOWER INCOME AND IS LESS EDUCATED, ON AVERAGE, THAN THE NATION, THE STATE OF INDIANA OR MICHIGAN. INDIANA RANKS 8TH LOWEST IN HIGHER EDUCATION LEVELS IN THE U.S. THIS EQUATES WITH A HIGHER PERCENTAGE OF CHILDREN IN POVERTY AND A LOWER HOUSEHOLD INCOME THAN STATE AVERAGES IN MOST OF THE SERVICE AREA. PART VI, LINE 5: OTHER INFORMATION - SJRMC-SOUTH BEND CAMPUS EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS. BY DOING SO, IT IS ABLE TO ENSURE THAT HIGH QUALITY AND EASILY ACCESSIBLE CARE IS AVAILABLE IN A VARIETY OF PRIMARY AND SPECIALTY CARE AREAS.SJRMC-SOUTH BEND CAMPUS PRIDES ITSELF ON HAVING A NEW, STATE-OF-THE-ART MEDICAL CENTER THAT UTILIZES THE LATEST TECHNOLOGY, ELECTRONIC MEDICAL RECORDS, FULLY INTEGRATED MEDICAL TEAMS AND HIGHLY TRAINED STAFF TO PROVIDE CARE THAT IS SECOND TO NONE. RESIDENCY PROGRAMS IN FAMILY PRACTICE, PODIATRY, AND PHARMACY, AS WELL AS CLINICAL EDUCATION FOR NURSES AND ANCILLARY STAFF, PROVIDE ONGOING EDUCATION AND A "LABORATORY FOR LEARNING." SEVERAL NURSING SCHOOLS UTILIZE SJRMC FOR THE CLINICAL COMPONENT OF THEIR NURSING EDUCATION. PARTICIPATING IN BOTH AN INTERNAL AND EXTERNAL INTERNAL REVIEW BOARD, SJRMC-SOUTH BEND CAMPUS KEEPS PACE WITH THE EVER-GROWING COMPLEXITY OF HEALTH CARE AND PROVIDES LEADERSHIP IN AREAS SPECIFIC TO THE NEEDS OF ITS PATIENTS.WHILE NOT CONSIDERED "THE" TRAUMA CENTER FOR THE AREAS IT SERVES, SJRMC-SOUTH BEND CAMPUS DOES HAVE AN EXCELLENT GROUP OF EMERGENCY DEPARTMENT PHYSICIANS AND STAFF TRAINED IN TREATING PERSONS SUFFERING FROM EMERGENT AND NON-EMERGENT CONDITIONS. SERVING ALL PEOPLE REGARDLESS OF ETHNICITY, GENDER, RELIGION, ABILITY TO PAY, ETC., THE EMERGENCY DEPARTMENT HAS OVER 30 TREATMENT ROOMS AS WELL AS TRAUMA ROOMS AND HIGH-INTENSITY TREATMENT ROOMS.SJRMC-SOUTH BEND CAMPUS PARTICIPATES IN MEDICARE, MEDICAID, CHAMPUS/ TRICARE AND OTHER GOVERNMENT-SPONSORED HEALTH CARE PROGRAMS, AND OFFERS CHARITY CARE AND CARE ON A SLIDING FEE SCALE. IN KEEPING WITH ITS MISSION STATEMENT AND VALUES, SJRMC-SOUTH BEND CAMPUS ASSURES UNINSURED PATIENTS THAT THEY RECEIVE THE SAME HIGH QUALITY MEDICAL CARE AS THOSE WHO HAVE THE ABILITY TO PAY. FINANCIAL ASSISTANCE IS PROVIDED TO ALL WHO ARE ELIGIBLE TO RECEIVE IT. POLICIES GOVERNING SUCH ASSISTANCE ARE READILY AVAILABLE FOR STAFF AND PATIENTS ALIKE. SJRMC-SOUTH BEND CAMPUS SPONSORS A HEALTH CENTER THAT PROVIDES CARE TO ALL INSURED, UNDER-INSURED, AND UNINSURED PATIENTS. IT ALSO FULLY SUBSIDIZES A HEALTH CENTER SPECIFICALLY FOR THE UNINSURED. STAFFED BY DOCTORS WHO VOLUNTEER THEIR TIME AND SKILLS, THIS HEALTH CENTER SERVES A HIGHLY DIVERSE POPULATION AND OFFERS SPECIALIZED CLINICS IN CHRONIC DISEASE MANAGEMENT, COUMADIN CARE, SMOKING CESSATION, HIV/AIDS, AND SUBSTANCE ABUSE. A MOBILE MEDICAL UNIT PROVIDES DIGITAL MAMMOGRAPHY IN OUTLYING AREAS WHERE SERVICES ARE DIFFICULT TO OBTAIN. ADVOCACY FOR VARIOUS HEALTH-RELATED ISSUES IS AT THE FOREFRONT AT SJRMC-SOUTH BEND CAMPUS, INCLUDING EFFORTS RELATED TO OBTAINING HEALTH CARE FOR ALL, ELIMINATING THE HEALTH CARE DISPARITIES AMONG DIVERSE POPULATIONS AND OBTAINING AFFORDABLE PHARMACEUTICALS. SJRMC-SOUTH BEND CAMPUS CONTINUES TO BE THE LEADER IN FOUNDING AND FUNDING PROGRAMS THAT IMPACT THE HEALTH OF ITS COMMUNITIES, PROVIDING LOCAL SCHOOLS WITH ATHLETIC TRAINERS, AND SCHOOL HEALTH NURSES.VOLUNTEERS WITHIN THE SJRMC-SOUTH BEND CAMPUS HOSPITAL TESTIFY TO THE REPUTATION AND IMPACT OF THE HOSPITAL. WOMEN, MEN, AND YOUTH BELIEVE IN THE MISSION OF THE HOSPITAL AND ATTEST TO IT BY PROVIDING HUNDREDS OF HOURS OF SERVICE EACH YEAR. VOLUNTEERS WITH SPECIAL NEEDS ARE ALSO WELCOME TO SERVE THE HOSPITAL, ITS PHYSICIANS, STAFF AND THE PUBLIC. AS A FAITH-BASED HEALTH INSTITUTION, SJRMC-SOUTH BEND CAMPUS OFFERS PATIENTS, THEIR FAMILIES, AND THE BROADER COMMUNITY THE OPPORTUNITY TO ADDRESS THE SPIRITUAL NEEDS THAT ARISE AS ONE EXPERIENCES ILLNESS, CHRONIC HEALTH CONDITIONS, OR THE DYING PROCESS. THIS EXPERIENCE OF FAITH, THE PRESENCE OF CHRISTIAN, JEWISH AND MUSLIM PRAYER/REFLECTION ROOMS, AND FULL-TIME CERTIFIED CHAPLAINS AFFORD EVERYONE WITH THE CERTITUDE THAT THE WHOLE PERSON AND HIS/HER CARE IS ADDRESSED.SJRMC-SOUTH BEND CAMPUS HAS A NUMBER OF CRITICAL OUTREACH PROGRAMS THAT FURTHER ASSIST IN THE ENHANCEMENT OF THE HEALTH STATUS OF THE POPULATIONS IT SERVES. THROUGH THE GENEROSITY OF BENEFACTORS AND THE SAINT JOSEPH FOUNDATION, SJRMC-SOUTH BEND CAMPUS PARTICIPATES IN MANY OUTREACH COMMUNITY PROGRAMS AND SERVICES:THE COMMUNITY HEALTH PARTNERS OF SOUTH BEND, INC., INCLUDING BENDIX FAMILY PHYSICIANS, A HEALTH CENTER JOINTLY ESTABLISHED BY SJRMC AND MEMORIAL HOSPITAL. THEY PROVIDE CARE AND HEALTH EDUCATION IN A DECLARED MEDICALLY UNDERSERVED AREA. ALSO, A VOLUNTEER PHYSICIAN NETWORK MADE UP OF PRIMARY CARE PROVIDERS AND SPECIALISTS CARING FOR THOSE UNABLE TO PAY OR ON SLIDING FEE SCALE.OUTREACH PROGRAMS FOCUSING ON: CHRONIC DISEASE, NUTRITION, EXERCISE, SMOKING CESSATION, HEALTH FAIRS, SENIORS, PRE-NATAL SERVICES, AND COLLABORATION WITH OTHER AREA HEALTH CARE PROVIDERS TO ASSIST AND CARE FOR THE UNDERSERVED POPULATION.SJRMC-SOUTH BEND CAMPUS PROVIDED IN-KIND DONATIONS TO MANY AGENCIES, INCLUDING MEDICAL SUPPLIES AND DRUGS TO MISSION TRIPS, LUNCHES TO HOPE MINISTRIES, AND PRINTING SERVICES FOR LOCAL NON-PROFIT AGENCIES.SJRMC-SOUTH BEND CAMPUS MADE SIGNIFICANT CONTRIBUTIONS TO THE DIOCESE OF FT WAYNE/SOUTH BEND, CENTER FOR THE HOMELESS, UNITED WAY, AMERICAN HEART ASSOCIATION, UNIVERSITY OF NOTRE DAME HARPER CANCER RESEARCH, LOGAN INC. (CENTER FOR PEOPLE WITH DISABILITIES), WOMEN'S CARE CENTER, MARCH OF DIMES, RIVERBEND CANCER SERVICES, HANNAH'S HOUSE (HOME FOR PREGNANT WOMEN), AND THE IU SCHOOL OF MEDICINE. PART VI, LINE 6: SAINT JOSEPH REGIONAL MEDICAL CENTER - SOUTH BEND CAMPUS IS A MEMBER OF TRINITY HEALTH, ONE OF THE LARGEST CATHOLIC HEALTH CARE DELIVERY SYSTEMS IN THE COUNTRY. TRINITY HEALTH ANNUALLY REQUIRES THAT ALL REGIONAL HEALTH MINISTRIES DEFINE - AND ACHIEVE - COMMUNITY BENEFIT GOALS THAT INCLUDE IMPLEMENTING NEEDED SERVICES OR EXPANDING ACCESS TO SERVICES FOR LOW-INCOME INDIVIDUALS. AS A NOT-FOR-PROFIT HEALTH SYSTEM, TRINITY HEALTH REINVESTS ITS PROFITS BACK INTO THE COMMUNITY THROUGH PROGRAMS SERVING THOSE WHO ARE POOR AND UNINSURED, HELPING MANAGE CHRONIC CONDITIONS LIKE DIABETES, PROVIDING HEALTH EDUCATION, PROMOTING WELLNESS AND REACHING OUT TO UNDERSERVED POPULATIONS. ANNUALLY, THE ORGANIZATION INVESTS MORE THAN $800 MILLION IN SUCH COMMUNITY BENEFITS AND WORKS TO ENSURE THAT ITS MEMBER HOSPITALS AND OTHER ENTITIES/AFFILIATES ENHANCE THE OVERALL HEALTH OF THE COMMUNITIES THEY SERVE BY ADDRESSING EACH COMMUNITY'S SPECIFIC NEEDS. FOR MORE INFORMATION ABOUT TRINITY HEALTH, VISIT WWW.TRINITY-HEALTH.ORG. PART VI, LINE 7, REPORTS FILED WITH STATES IN 0 AMERICAN HEART ASSOCIATION 7272 GREENVILLE AVE DALLAS TX 75231 135613797 501(C)(3) 15000 COMMUNITY BENEFIT CENTER FOR THE HOMELESS 813 S MAIN STREET SOUTH BEND IN 466013102 351768544 501(C)(3) 35000 SUPPORT OPERATIONS CHAMBER OF COMMERCE OF ST JOSEPH COUNTY 401 E COLFAX AVE SUITE 310 SOUTH BEND IN 46617 350153330 501(C)(6) 10000 COMMUNITY BENEFIT COMMUNITY FOUNDATION OF SAINT JOSEPH COUNTY PO BOX 837 SOUTH BEND IN 46624 237365930 501(C)(3) 57500 COMMUNITY BENEFIT COMMUNITY HEALTH PARTNERS OF SOUTH BEND 1010 N BENDIX AVE SOUTH BEND IN 46628 263051440 501(C)(3) 209053 COMMUNITY BENEFIT DIOCESE OF FORT WAYNESOUTH BEND 915 S CLINTON ST FORT WAYNE IN 46801 350876373 501(C)(3) 135000 ANNUAL PLEDGE HANNAHS HOUSE INC 518 W 4TH ST MISHAWAKA IN 46544 351871289 501(C)(3) 12680 UNDERSERVED HOLY CROSS COLLEGE INC 5415 STATE ROAD 933 NORTH NOTRE DAME IN 465560308 351148835 501(C)(3) 95219 COMMUNITY BENEFIT THE FOUNDATION FOR THE CENTER FOR HOSPICE AND PALLIATIVE CARE INC 111 SUNNYBROOK CT SOUTH BEND IN 46637 300433147 501(C)(3) 10500 COMMUNITY BENEFIT INDIANA UNIVERSITY FOUNDATION PO BOX 7111 SOUTH BEND IN 46634 356018940 501(C)(3) 10000 COMMUNITY BENEFIT INDIANA UNIVERSITY FOUNDATION PO BOX 7111 SOUTH BEND IN 46634 356018940 501(C)(3) 11360 COMMUNITY BENEFIT JUNIOR LEAGUE OF SOUTH BEND INC 130 PARK LANE SOUTH BEND IN 46601 356001729 501(C)(3) 6836 COST PRINTING COMMUNITY BENEFIT KELLY CARES FOUNDATION PO BOX 853 NOTRE DAME IN 46556 263591070 501(C)(3) 10120 COMMUNITY BENEFIT LA CASA DE AMISTAD 746 S MEADE ST SOUTH BEND IN 46619 351350013 501(C)(3) 60500 COMMUNITY BENEFIT LOGAN COMMUNITY RESOURCES INC 2205 EAST JEFFRERSON BLVD SOUTH BEND IN 46624 350965639 501(C)(3) 30000 SUPPORT AUTISM NORTHEAST NEIGHBORHOOD REVIT 803 LINCOLN WAY WEST SOUTH BEND IN 46616 352118149 501(C)(3) 50000 COMMUNITY BENEFIT PHM EDUCATIONAL FOUNDATION 55900 BITTERSWEET ROAD MISHAWAKA IN 46545 351996785 501(C)(3) 15000 COMMUNITY BENEFIT REAL SERVICES INC 1151 S MICHIGAN SOUTH BEND IN 46634 351157606 501(C)(3) 15000 COMMUNITY BENEFIT RIVERBEND CANCER SERVICES 3516 E JEFFERSON BLVD SOUTH BEND IN 46615 350872359 501(C)(3) 21000 COMMUNITY BENEFIT SAINT ADALBERT PARISH 2420 W HURON ST SOUTH BEND IN 46619 351095958 501(C)(3) 43300 UNDERSERVED SAINT MARY'S COLLEGE PO BOX 180 NOTRE DAME IN 46556 350868158 501(C)(3) 50000 COST BEDS COMMUNITY BENEFIT SCHOOL CITY OF MISHAWAKA EDUCATION FOUNDATION INC PO BOX 1593 MISHAWAKA IN 46546 351973986 501(C)(3) 35000 COMMUNITY BENEFIT SOUTH BEND MUSEUM OF ART 120 SOUTH ST JOSEPH ST SOUTH BEND IN 46601 350844563 501(C)(3) 9000 COMMUNITY BENEFIT SOUTH BEND SYMPHONY ASSOCIATION INC 127 N MICHIGAN ST SOUTH BEND IN 466011603 356042189 501(C)(3) 6000 COMMUNITY BENEFIT ST JOSEPH HIGH SCHOOL 453 NORTH NOTRE DAME AV SOUTH BEND IN 46617 350924794 501(C)(3) 16500 OPERATIONS ST MARGARET'S HOUSE 117 N LAFAYETTE BLVD SOUTH BEND IN 46601 351913328 501(C)(3) 1000 11442 COST PRINTING UNDERSERVED NORTHERN INDIANA HISTORICAL SOCIETY 808 W WASHINGTON ST SOUTH BEND IN 46601 351124156 501(C)(3) 20000 COMMUNITY BENEFIT UNITED WAY OF ST JOSEPH COUNTY INC 3517 E JEFFERSON BLVD SOUTH BEND IN 46615 351063368 501(C)(3) 16000 COMMUNITY BENEFIT UNIVERSITY OF NOTRE DAME 100 GRACE HALL NOTRE DAME IN 46556 350868188 501(C)(3) 75000 COMMUNITY BENEFIT WOMENS CARE CTR 360 N NOTRE DAME AVE SOUTH BEND IN 46601 351609945 501(C)(3) 12500 SPONSORSHIP CAMP EBERHART ALUMNI ASSOCIATION 316 S EDDY ST SOUTH BEND IN 46617 311021547 501(C)(3) 6000 COMMUNITY BENEFIT SYRIAN AMERICAN MEDICAL SOCIETY FOUNDATION 254 HOOD DRIVE CANFIELD OH 44406 161717058 501(C)(3) 276279 COST MEDICAL SUPPLIES UNDERSERVED THE CASIE CENTER 533 N NILES AVE SOUTH BEND IN 46617 351899479 501(C)(3) 9600 COST PRINTING COMMUNITY BENEFIT 32 1 PART I, LINE 2: DONATIONS MADE BY SAINT JOSEPH REGIONAL MEDICAL CENTER - SOUTH BEND CAMPUS TO CHARITABLE ORGANIZATIONS ARE MADE IN FURTHERANCE OF THE RECIPIENT ORGANIZATION'S EXEMPT PURPOSE. DONATIONS ARE INCLUDED IN COMMUNITY BENEFITS IN SCHEDULE H IF THE CONTRIBUTION HAS BEEN FORMALLY RESTRICTED TO A COMMUNITY BENEFIT ACTIVITY THAT MEETS THE CRITERIA TO BE REPORTED ON SCHEDULE H. 1 1 0 0 0 0 0 0 0 ALBERT GUTIERREZ DIRECTOR; PRES & CEO SJRMC 0 467563 0 160002 0 104797 0 17277 0 33745 0 783384 0 0 MICHAEL FINEGAN DIRECTOR AS OF 10/14 0 309671 0 114370 0 63311 0 13707 0 25858 0 526917 0 0 ROBERT CASALOU DIRECTOR THR 09/14; SE MICH REG CEO 0 497485 0 217796 0 189034 0 13000 0 26120 0 943435 0 84582 UTHMAN CAVALLO MD DIRECTOR THROUGH 03/15;PHYSICIAN 0 200000 0 0 0 273 0 10000 0 641 0 210914 0 0 JASON SCHULTZ SECRETARY; SJRMC GENERAL COUNSEL 0 163584 0 0 0 253 0 4682 0 6946 0 175465 0 0 JANICE DUNN CFO SJRMC 0 293717 0 57316 0 1501 0 13000 0 17207 0 382741 0 0 STEPHEN ANDERSON MD RHM CMO 0 296061 0 33826 0 7789 0 18200 0 16418 0 372294 0 0 CHRIS KARAM COO 214699 0 21612 0 312 0 12207 0 21418 0 270248 0 0 0 KURT MEYER CHRO SJRMC 0 220223 0 43238 0 2055 0 13000 0 14132 0 292648 0 0 KENNETH HALL CNO SJRMC 0 168967 0 34013 0 4644 0 14869 0 23941 0 246434 0 0 MARTIN F WIESCHHAUS MD PHYSICIAN 286362 0 37958 0 1214 0 25354 0 22729 0 373617 0 0 0 KRISTEN T HOUGLAND MD PHYSICIAN 293827 0 0 0 452 0 13000 0 17174 0 324453 0 0 0 STEPHEN SIMONS MD PHYSICIAN 257158 0 0 0 1756 0 35523 0 18948 0 313385 0 0 0 THEODORE R NEUMANN MD PHYSICIAN 221355 0 0 0 1476 0 27754 0 22656 0 273241 0 0 0 DAVID T WYNCOTT MD PHYSICIAN 208110 0 10000 0 141 0 6771 0 9571 0 234593 0 0 0 KEDRICK ADKINS FORMER KEY EMPLOYEE 0 0 0 0 0 1069394 0 0 0 1656 0 1071050 0 1056681 J RICHARD O'CONNELL FORMER KEY EMPLOYEE 0 791024 0 532372 0 425006 0 18200 0 36377 0 1802979 0 174337 LORI PRICE FORMER OFFICER 0 329059 0 90135 0 69549 0 25011 0 23232 0 536986 0 4367 PART I, LINE 3 SAINT JOSEPH REGIONAL MEDICAL CENTER-SOUTH BEND CAMPUS IS A SUBSIDIARY IN THE TRINITY HEALTH SYSTEM. SAINT JOSEPH REGIONAL MEDICAL CENTER-SOUTH BEND CAMPUS' CEO IS PAID DIRECTLY BY THE SYSTEM'S PARENT ENTITY, TRINITY HEALTH CORPORATION. TRINITY HEALTH CORPORATION USED THE FOLLOWING METHODS TO ESTABLISH THE COMPENSATION OF SAINT JOSEPH REGIONAL MEDICAL CENTER-SOUTH BEND CAMPUS' CEO: - COMPENSATION COMMITTEE - INDEPENDENT COMPENSATION CONSULTANT - FORM 990 OF OTHER ORGANIZATIONS - WRITTEN EMPLOYMENT CONTRACT - COMPENSATION SURVEY OR STUDY, AND - APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE PART I, LINES 4A-B THE FOLLOWING INDIVIDUAL RECEIVED SEVERANCE PAYMENTS IN CALENDAR 2014. THESE AMOUNTS ARE INCLUDED IN COLUMN B(III): KEDRICK ADKINS - $814,924 COLUMN F OF SCHEDULE J, PART II INCLUDES THE PORTION OF THESE AMOUNTS THAT WERE REPORTED AS DEFERRED COMPENSATION IN PRIOR YEARS. THE FOLLOWING IS A PARTICIPANT IN AN INDIVIDUAL SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP). HE DID NOT RECEIVE A SERP PAYOUT IN 2014. KEDRICK ADKINS THE FOLLOWING ARE PARTICIPANTS IN THE NEW TRINITY HEALTH SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP) EFFECTIVE JANUARY 1, 2014. THE PLAN WILL PROVIDE RETIREMENT BENEFITS TO CERTAIN TRINITY HEALTH EXECUTIVES SUBJECT TO MEETING SPECIFIED VESTING AND EMPLOYMENT DATE REQUIREMENTS. THERE WERE NO PAYOUTS IN 2014. ROBERT CASALOU MICHAEL FINEGAN ALBERT GUTIERREZ J. RICHARD O'CONNELL LORI PRICE PART I LINE 4B: THE FOLLOWING ARE PARTICIPANTS IN THE TRINITY HEALTH CASH BALANCE RESTORATION AND RETENTION PLAN, A NONQUALIFIED PLAN, WHICH PROVIDES RETENTION BENEFITS PLUS RETIREMENT BENEFITS FOR CERTAIN ASSOCIATES WITH EARNINGS ABOVE THE IRS PAY CAP FOR QUALIFIED PLANS ($260,000 FOR 2014). THE PLAN WAS FROZEN DECEMBER 31, 2013. THE FOLLOWING PAYOUTS FOR 2014 FOR THIS PLAN ARE INCLUDED IN COLUMN B(III) OF SCHEDULE J, PART II: KEDRICK ADKINS - $242,986 ROBERT CASALOU - $92,801 J. RICHARD O'CONNELL - $185,824 LORI PRICE - $4,389 COLUMN F OF SCHEDULE J, PART II INCLUDES THE PORTION OF THESE AMOUNTS THAT WERE REPORTED AS DEFERRED COMPENSATION IN PRIOR YEARS. ELLEN BRUNEEL FAMILY MEMBER OF JOHN ROSENTHAL, OFFICER AND DIRECTOR 39727 EMPLOYMENT ARRANGEMENT 0 JEAN LOUISE HALL FAMILY MEMBER OF KENNETH HALL, FORMER KEY EMPLOYEE 34336 EMPLOYMENT ARRANGEMENT 0 FORM 990, PART VI, SECTION A, LINE 6 THE SOLE MEMBER OF SAINT JOSEPH REGIONAL MEDICAL CENTER - SOUTH BEND CAMPUS, INC. IS SAINT JOSEPH REGIONAL MEDICAL CENTER, INC. SEE LINE 7 FOR ADDITIONAL INFORMATION. FORM 990, PART VI, SECTION A, LINE 7A SAINT JOSEPH REGIONAL MEDICAL CENTER, INC. IS THE SOLE MEMBER OF SAINT JOSEPH REGIONAL MEDICAL CENTER - SOUTH BEND CAMPUS, INC. SAINT JOSEPH REGIONAL MEDICAL CENTER, INC. HAS THE RIGHT TO APPOINT ALL PERSONS TO THE BOARD OF DIRECTORS OF SAINT JOSEPH REGIONAL MEDICAL CENTER - SOUTH BEND CAMPUS, INC. FORM 990, PART VI, SECTION A, LINE 7B AS SOLE MEMBER, SAINT JOSEPH REGIONAL MEDICAL CENTER, INC. MUST APPROVE CERTAIN DECISIONS OF THE GOVERNING BODY, INCLUDING THE STRATEGIC PLAN, ANNUAL CAPITAL PLAN, AND ANNUAL OPERATING BUDGET. SAINT JOSEPH REGIONAL MEDICAL CENTER, INC. MUST ALSO APPROVE SIGNIFICANT CHANGES SUCH AS A MERGER, DISSOLUTION, SALE OF ASSETS IN EXCESS OF CERTAIN LIMITS, AND MODIFICATIONS TO GOVERNING DOCUMENTS. FORM 990, PART VI, SECTION B, LINE 11 PRIOR TO FILING, THE FORM 990 FOR SAINT JOSEPH REGIONAL MEDICAL CENTER-SOUTH BEND CAMPUS, INC. IS REVIEWED BY SENIOR MANAGEMENT. IN ADDITION, CERTAIN KEY SECTIONS OF THE FORM ARE REVIEWED BY THE BOARD OF DIRECTORS. THE BOARD RECEIVES A COPY OF THE RETURN IN ITS FINAL FORM BEFORE IT IS FILED WITH THE INTERNAL REVENUE SERVICE. FORM 990, PART VI, SECTION B, LINE 12C SAINT JOSEPH REGIONAL MEDICAL CENTER - SOUTH BEND CAMPUS HAS ADOPTED TRINITY HEALTH'S GOVERNANCE POLICY NO. 1, WHICH SETS FORTH THE ORGANIZATION'S CONFLICT OF INTEREST POLICY AND PROCESSES. IT APPLIES TO ALL "INTERESTED PERSONS" OF SAINT JOSEPH REGIONAL MEDICAL CENTER - SOUTH BEND CAMPUS, WHICH INCLUDES DIRECTORS, PRINCIPAL OFFICERS, KEY EMPLOYEES, AND MEMBERS OF COMMITTEES WITH BOARD-DELEGATED POWERS. INTERESTED PERSONS ARE EXPECTED TO DISCHARGE THEIR DUTIES IN A MANNER THE PERSON REASONABLY BELIEVES TO BE IN THE BEST INTERESTS OF SAINT JOSEPH REGIONAL MEDICAL CENTER - SOUTH BEND CAMPUS AND TO AVOID SITUATIONS INVOLVING A CONFLICT OF INTEREST. ON AN ANNUAL BASIS, INTERESTED PERSONS ARE REQUIRED TO COMPLETE A CONFLICT OF INTEREST DISCLOSURE STATEMENT AND TO AFFIRM THEIR RECEIPT OF THE CONFLICT OF INTEREST POLICY, COMPLIANCE WITH ITS REQUIREMENTS, AND AGREE TO NOTIFY THE ORGANIZATION OF CHANGES IMPACTING THEIR ANNUAL DISCLOSURE IN ACCORDANCE WITH THE POLICY. THE ANNUAL DISCLOSURES ARE PROVIDED TO INTERNAL LEGAL COUNSEL AND THE INTEGRITY AND COMPLIANCE OFFICER, FROM WHICH LEGAL COUNSEL PREPARES A REPORT FOR THE BOARD CHAIR AND CEO. A SUMMARY OF POTENTIAL CONFLICTS IS REVIEWED WITH THE BOARD OF DIRECTORS OF SAINT JOSEPH REGIONAL MEDICAL CENTER - SOUTH BEND CAMPUS (OR A DELEGATED COMMITTEE OF THE BOARD) ON A YEARLY BASIS. INTERESTED PERSONS ARE REQUIRED TO MAKE FULL DISCLOSURE TO SAINT JOSEPH REGIONAL MEDICAL CENTER - SOUTH BEND CAMPUS OF ANY FINANCIAL OR BUSINESS INTERESTS THAT MIGHT RESULT IN OR HAVE THE APPEARANCE OF A CONFLICT OF INTEREST. THE BOARD OF DIRECTORS OF SAINT JOSEPH REGIONAL MEDICAL CENTER - SOUTH BEND CAMPUS (OR A DELEGATED COMMITTEE OF THE BOARD) IS RESPONSIBLE FOR THE REVIEW OF TRANSACTIONS TO DETERMINE WHETHER AN ACTUAL CONFLICT OF INTEREST EXISTS. IN THE EVENT OF AN ACTUAL CONFLICT, THE BOARD (OR A DELEGATED COMMITTEE OF THE BOARD) WILL EITHER AVOID THE CONFLICT OR APPROPRIATELY SCRUTINIZE THE TRANSACTION TO ENSURE IT IS IN THE BEST INTERESTS OF SAINT JOSEPH REGIONAL MEDICAL CENTER - SOUTH BEND CAMPUS. INTERESTED PERSONS ARE REQUIRED TO RECUSE THEMSELVES FROM DISCUSSION AND VOTING ON MATTERS INVOLVING A CONFLICT OF INTEREST. THE POLICY FURTHER ADDRESSES THE PROPER DOCUMENTATION OF THE PROCEEDINGS AND POTENTIAL DISCIPLINARY AND CORRECTIVE ACTION FOR VIOLATIONS OF THE POLICY. THE POLICY IS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART VI, SECTION B, LINE 15 QUESTIONS 15A AND 15B ARE ANSWERED "NO" BECAUSE THE COMPENSATION FOR CERTAIN OFFICERS AND KEY MANAGEMENT OFFICIALS OF SAINT JOSEPH REGIONAL MEDICAL CENTER - SOUTH BEND CAMPUS IS ESTABLISHED AND PAID BY TRINITY HEALTH, A RELATED ORGANIZATION. IN ESTABLISHING CEO AND CFO COMPENSATION, TRINITY HEALTH FOLLOWS A PROCESS AND POLICY THAT IS INTENDED TO MIRROR THE IRC SECTION 4958 GUIDELINES FOR OBTAINING A "REBUTTABLE PRESUMPTION OF REASONABLENESS" WITH REGARD TO COMPENSATION AND BENEFITS. AS PART OF THAT PROCESS, THE COMPENSATION AND BENEFITS OF THE CEO AND CFO OF SAINT JOSEPH REGIONAL MEDICAL CENTER - SOUTH BEND CAMPUS ARE REVIEWED AT LEAST ANNUALLY BY THE TRINITY HEALTH BOARD OR THE TRINITY HEALTH HUMAN RESOURCES AND COMPENSATION COMMITTEE (HRCC) OF THE BOARD, AUTHORIZED TO ACT ON BEHALF OF THE BOARD WITH RESPECT TO CERTAIN COMPENSATION MATTERS. AS PART OF ITS REVIEW PROCESS, THE HRCC RETAINS AN INDEPENDENT FIRM EXPERIENCED IN COMPENSATION AND BENEFIT MATTERS FOR NOT-FOR-PROFIT HEALTHCARE ORGANIZATIONS TO ADVISE IT IN THE DETERMINATIONS IT MAKES ON THE REASONABLENESS OF PROPOSED COMPENSATION AND BENEFITS ARRANGEMENTS. FORM 990, PART VI, SECTION C, LINE 19 SAINT JOSEPH REGIONAL MEDICAL CENTER-SOUTH BEND CAMPUS, INC. IS A SUBSIDIARY ORGANIZATION IN THE TRINITY HEALTH SYSTEM. TRINITY HEALTH MAKES CERTAIN OF ITS KEY DOCUMENTS AVAILABLE TO THE PUBLIC ON ITS WEBSITE, WWW.TRINITY-HEALTH.ORG, IN THE "ABOUT US" SECTION. IN THIS SECTION, THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS ARE PUBLICLY AVAILABLE. IN ADDITION, SAINT JOSEPH REGIONAL MEDICAL CENTER - SOUTH BEND CAMPUS, INC. INCLUDES A COPY OF ITS MOST RECENTLY FILED SCHEDULE H ON TRINITY HEALTH'S WEBSITE. SAINT JOSEPH REGIONAL MEDICAL CENTER-SOUTH BEND CAMPUS, INC.'S GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE AVAILABLE UPON REQUEST. FORM 990, PART XI, LINE 9: EQUITY TRANSFERS TO AFFILIATES -20,025,087. FORM 990, PART I, DOING BUSINESS AS: ELM ROAD OCCUPATIONAL HEALTH, ELM ROAD SLEEP DISORDER CENTER, ELM ROAD OUTPATIENT THERAPY/INDUSTRIAL REHABILITATION, HEALTHY FAMILY CENTER, MIDWIFERY OF MICHIANA, MOBILE MEDICAL UNIT, OCCUPATIONAL HEALTH, SR. MAURA BRANNICK HEALTH CENTER, SAINT JOSEPH REGIONAL MEDICAL CENTER, SJRMC REHABILITATION INSTITUTE, SAINT JOSEPH REGIONAL MEDICAL CENTER REHABILITATION INSTITUTE, SAINT JOSEPH REHABILITATION INSTITUTE, SAINT JOSEPH PODIATRIC RESIDENCY CLINIC, FAMILY MEDICINE CENTER OF SJRMC, SAINT JOSEPH REGIONAL MEDICAL CENTER SPORTS MEDICINE INSTITUTE, SR. MAURA BRANNICK DENTAL CENTER, FAMILY MEDICINE FACULTY PHYSICIANS, OUR LADY OF THE ROSARY HEALTH CENTER. ADVANTAGE HEALTHSAINT MARY'S MEDICAL GROUP 245 STATE ST SE GRAND RAPIDS MI 49503 272491974 HEALTHCARE SERVICES MI 501(C)(3) LINE 9 TRINITY HEALTH-MICHIGAN 1 ALBANY MEMORIAL HOSPITAL 600 NORTHERN BLVD ALBANY NY 12204 141338457 HEALTHCARE AND HOSPITAL SERVICES NY 501(C)(3) LINE 3 NORTHEAST HEALTH INC 1 ALLEGANY FRANCISCAN MINISTRIES INC 33920 US HIGHWAY 19 NORTH SUITE 269 PALM HARBOR FL 34684 581492325 HEALTHCARE SYSTEM MANAGEMENT AND SUPPORT FL 501(C)(3) LINE 11A, I TRINITY HEALTH CORPORATION 1 AMICARE HOSPICE SERVICES INC 20555 VICTOR PARKWAY LIVONIA MI 48152 382949053 HOSPICE SERVICES MI 501(C)(3) LINE 9 TRINITY HOME HEALTH SERVICES INC 1 AUXILIARY OF HOLY ROSARY HOSPITAL 351 SW 9TH STREET ONTARIO OR 97914 943059469 VOLUNTEER SERVICE AUXILIARY OR 501(C)(3) LINE 9 SAINT ALPHONSUS MEDICAL CENTER-ONTARIO 1 BAUM HARMON MERCY HOSPITAL 255 NORTH WELCH AVENUE PRIMGHAR IA 51245 421500277 HEALTHCARE AND HOSPITAL SERVICES IA 501(C)(3) LINE 3 MERCY HEALTH SERVICES-IOWA CORP 1 BAUM HARMON MERCY 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501(C)(3) LINE 3 MERCY PHYSICIAN NETWORK 1 EDDY LICENSED HOME CARE AGENCY 433 RIVER ST SUITE 3000 TROY NY 12180 141818568 HOME HEALTH SERVICES NY 501(C)(3) LINE 3 LTC (EDDY) INC 1 EMPIRE HOME INFUSION SERVICE INC 10 BLACKSMITH DRIVE MALTA NY 12020 141795732 HOME HEALTH SERVICES NY 501(C)(3) LINE 9 HOME AIDE SERVICE OF EASTERN NEW YORK INC 1 FARREN CARE CENTER INC C/O SPHS 1221 MAIN STREET SUITE 213 HOLYOKE MA 01040 042501711 LONG TERM CARE MA 501(C)(3) LINE 3 SISTERS OF PROVIDENCE HEALTH SYSTEM INC 1 FRANCISCAN ELDERCARE CORPORATION PO BOX 2500 WILMINGTON DE 19805 223008680 LONG TERM CARE (INACTIVE) DE 501(C)(3) LINE 9 ST FRANCIS HOSPITAL 1 GLEN EDDY INC ONE GLEN EDDY DRIVE NISKAYUNA NY 12309 141794150 SENIOR LIVING COMMUNITY NY 501(C)(3) LINE 9 LTC (EDDY) INC 1 GLOBAL HEALTH MINISTRY 3805 WEST CHESTER PIKE SUITE 100 NEWTOWN SQUARE PA 19073 233068656 HEALTHCARE SERVICES PA 501(C)(3) LINE 7 TRINITY HEALTH CORPORATION 1 GLOBAL HEALTH MINISTRY (FKA TRINITY HEALTH INTERNATIONAL) 20555 VICTOR PARKWAY LIVONIA MI 48152 421253527 HEALTHCARE SERVICES MI 501(C)(3) LINE 11A, I TRINITY HEALTH CORPORATION 1 GOOD SAMARITAN HOSPITAL INC 5401 LAKE OCONEE PARKWAY GREENSBORO GA 30642 261720984 HEALTHCARE AND HOSPITAL SERVICES GA 501(C)(3) LINE 3 ST MARY'S HEALTH CARE SYSTEM INC 1 GOTTLIEB COMMUNITY HEALTH SERVICES CORPORATION 701 W NORTH AVE MELROSE PARK IL 60160 363332852 COMMUNITY OUTREACH IL 501(C)(3) LINE 9 GOTTLIEB MEMORIAL HOSPITAL 1 GOTTLIEB MEMORIAL FOUNDATION 701 W NORTH AVE MELROSE PARK IL 60160 743260011 FOUNDATION IL 501(C)(3) LINE 11C, III-FI N/A 0 GOTTLIEB MEMORIAL HOSPITAL 701 W NORTH AVE MELROSE PARK IL 60160 362379649 HEALTHCARE AND HOSPITAL SERVICES IL 501(C)(3) LINE 3 LOYOLA UNIVERSITY HEALTH SYSTEM 1 GRAND RAPIDS MEDICAL EDUCATION PARTNERS INC 1000 MONROE AVENUE NW GRAND RAPIDS MI 49503 237270669 MEDICAL EDUCATION TRAINING PROGRAMS MI 501(C)(3) LINE 11A, I TRINITY HEALTH-MICHIGAN 1 HACKLEY HOSPITAL SELF INSURANCE PROFESSIONAL LIABILITY TRUST PO BOX 3302 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