2015-05-06T17:07:04-05:00 2014-06-30 990 2013-07-01 350868157 SAINT JOSEPH REGIONAL MEDICAL CENTER- SOUTH BEND CAMPUS INC SAIN 5743355000 5215 HOLY CROSS PARKWAY MISHAWAKA IN 465451469 JANICE DUNN CFO 5744726083 2015-05-06 2013 2016-02-25 16:41:14Z (SEE SCHEDULE O FOR LIST) ALBERT GUTIERREZ 5215 HOLY CROSS PARKWAY MISHAWAKA IN 465451469 317074925 0 0928 X WWW.SJMED.COM X 1958 IN HEALTHCARE SERVICES 17 11 2039 574 0 0 2175759 1390233 294498157 308969791 -1027403 -816314 5289404 4853704 300935917 314397414 1428654 1526819 0 0 96454260 98018336 0 0 0 191281926 205550107 289164840 305095262 11771077 9302152 412920475 416857731 355064849 348329709 57855626 68528022 HEALTHCARE SERVICES - SEE SCHEDULE H FOR MORE INFORMATION 0 0 242630485 1526819 312364477 SAINT JOSEPH REGIONAL MEDICAL CENTER - SOUTH BEND CAMPUS, INC. (THE HOSPITAL), A NOT-FOR-PROFIT CORPORATION OWNS AND OPERATES A 294-BED ACUTE-CARE HOSPITAL IN SOUTH BEND, INDIANA. THE HOSPITAL PROVIDES SERVICES TO RESIDENTS OF THE LOCAL GEOGRAPHIC REGION. THE HOSPITAL IS A MEMBER OF TRINITY HEALTH, AN INDIANA NOT-FOR-PROFIT CORPORATION SPONSORED BY CATHOLIC HEALTH MINISTRIES, A PUBLIC JURIDIC PERSON OF THE HOLY ROMAN CATHOLIC CHURCH. FOR MORE INFORMATION ON SPECIFIC SERVICES PROVIDED, PLEASE SEE THE HOSPITAL WEBSITE AT WWW.SJMED.COM. MISSION: THE MISSION STATEMENT FOR THE HOSPITAL IS AS FOLLOWS:WE, SAINT JOSEPH REGIONAL MEDICAL CENTER- SOUTH BEND CAMPUS, INC. AND TRINITY HEALTH, SERVE TOGETHER IN THE SPIRIT OF THE GOSPEL AS A COMPASSIONATE AND TRANSFORMING HEALING PRESENCE WITHIN OUR COMMUNITIES. 242630485 1 1 0 1 0 0 0 0 0 0 1 0 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 1 0 0 0 0 0 1 1 1 0 0 1 226 0 1 2039 1 0 0 0 0 0 0 0 0 0 0 X 17 11 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 901102 95532 ABRAHAM MARCUS CHAIR 2.00 2.00 X X 0 0 0 JOHN ROSENTHAL VICE CHAIR 2.00 2.00 X X 0 0 0 CHARLES VIATER TREASURER 2.00 2.00 X X 0 0 0 BILAL ANSARI MD DIRECTOR 4.00 2.00 X 21730 0 652 ROBERT CASALOU DIRECTOR; CEO,ST JOS MERCY,ANN ARBOR 2.00 2.00 X 0 908704 90722 UTHMAN CAVALLO MD DIRECTOR; PHYSICIAN 2.00 26.00 X 0 201827 10664 ROBERT E CLEMENCY MD 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 JOHN OLIVER DIRECTOR 2.00 2.00 X 0 0 0 FR JAMES FOSTER CSC MD DIRECTOR 2.00 2.00 X 0 7200 0 SR JOY O'GRADY CSC DIRECTOR 2.00 4.00 X 0 0 0 JOHN ZEGLIS DIRECTOR 2.00 4.00 X 0 0 0 SR NORA HAHN DIRECTOR AS OF 1/14 2.00 2.00 X 0 0 0 LOUIS PIERCE DIRECTOR AS OF 1/14 2.00 2.00 X 0 0 0 KATHY BEELER DIRECTOR THR 12/13 2.00 2.00 X 0 0 0 GREG CRAWFORD DIRECTOR THR 12/13 2.00 2.00 X 0 0 0 ROBERT OPPMAN MD DIRECTOR THR 12/13 2.00 2.00 X 0 0 0 JASON SCHULTZ SECRETARY; SJRMC ASSOC. COUNSEL 10.00 40.00 X 0 150187 12863 JANICE DUNN CFO SJRMC 10.00 40.00 X 0 368730 29957 KURT MEYER CHRO SJRMC 10.00 40.00 X 0 273659 31603 KENNETH HALL CNO SJRMC 10.00 40.00 X 0 260822 21851 MARTIN WIESCHHAUS MD PHYSICIAN 50.00 0.00 X 332721 0 49943 ISMAIL M ABBASI MD PHYSICIAN 50.00 0.00 X 295635 0 39514 STEPHEN SIMONS MD PHYSICIAN 50.00 0.00 X 261694 0 57084 THEODORE NEUMANN MD PHYSICIAN 50.00 0.00 X 222025 0 46974 BRIAN M HUBER MD PHYSICIAN 50.00 0.00 X 208900 0 25321 LORI PRICE FORMER OFFICER 0.00 50.00 X 0 388666 46902 JOSEPH SWEDISH FORMER KEY EMPLOYEE 0.00 0.00 X 0 1463995 28888 KEDRICK ADKINS FORMER KEY EMPLOYEE 0.00 0.00 X 0 1808589 1739236 J RICHARD O'CONNELL FORMER KEY EMPLOYEE 0.00 55.00 X 0 1673574 145485 MICHAEL SLUBOWSKI FORMER KEY EMPLOYEE 0.00 0.00 X 0 231799 0 1342705 8638854 2473191 42 1 1 0 SOUTH BEND MEDICAL FOUNDATION 530 N LAFAYETTE BLVD SOUTH BEND IN 466011098 LABORATORY SERVICES 13097632 SOUND INPATIENT PHYS OF OH LLC 1123 PACIFIC AVENUE TACOMA WA 98402 HEALTH CARE SERVICES 3771647 ST JOSEPH VALLEY ANESTHESIA PO BOX 1742 SOUTH BEND IN 46634 HEALTH CARE SERVICES 1876367 ALLIED PHYSICIANS OF MICHIANA 6301 UNIVERSITY COMMONS SUIT 100 SOUTH BEND IN 45635 HEALTH CARE SERVICES 1616247 AMERICAN HEALTHCARE SERVICES ASSOCIATION 10126 E CHERRY BEND RD TRAVERSE CITY MI 49684 STAFFING SERVICES 909631 37 1248407 72826 69000 1390233 NET PATIENT SVC REV 622110 308969791 308969791 308969791 475228 475228 670785 1326769 -655984 -655984 -655984 59200 798279 552463 -798279 -493263 -1291542 -1291542 CAFETERIA REVENUE 722514 2115002 2115002 GOV'T SUBSIDY- EHR 622110 1164550 1164550 PROVIDER INCENTIVE REVENUE 622110 523604 523604 1706532 1706532 5509688 314397414 312364477 0 642704 1526819 1526819 21730 21730 94208 94208 76515562 73448960 3066602 4332184 4180850 151334 11522916 10937993 584923 5531736 5301997 229739 443679 443679 45265 45265 27179569 26943375 236194 43350 42865 485 3245074 2587391 657683 20703 20703 6132444 5815588 316856 156361 153054 3307 270483 244644 25839 12623195 12623195 17132945 8514614 8618331 2499000 2499000 MEDICAL SUPPLIES 47597130 47597130 INTERCO. PURCHASED SVCS 46283334 1264397 45018937 BAD DEBT 22703783 22703783 HOSPITAL PROVIDER TAX 14732117 14732117 4441675 3431393 1010282 305095262 242630485 62464777 0 8201154 7756363 39146838 44376984 6214089 5235109 1541487 1668299 418699187 96065675 334258181 322633512 13494719 19530582 10053048 14767903 10959 888979 412920475 416857731 18255718 19475234 287686 12055782 11405874 324465663 317448601 355064849 348329709 X 57855626 68528022 57855626 68528022 412920475 416857731 9302152 1370244 0 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 3450 0 0 0 3450 0 PART II-B, LINE 1: SAINT JOSEPH REGIONAL MEDICAL CENTER - SOUTH BEND CAMPUS INC. HAS MADE GRANTS TO OTHER ORGANIZATIONS FOR LOBBYING PURPOSES. THESE GRANTS HAVE BEEN IN THE FORM OF MEMBERSHIP DUES PAID TO REGIONAL AND NATIONAL HEALTH CARE ORGANIZATIONS, WHERE THE ORGANIZATIONS HAVE PROVIDED SAINT JOSEPH REGIONAL MEDICAL CENTER - SOUTH BEND CAMPUS INC. WITH AN ESTIMATED PERCENTAGE OF DUES PAYMENTS WHICH ARE USED FOR LOBBYING ACTIVITIES. SAINT JOSEPH REGIONAL MEDICAL CENTER - SOUTH BEND CAMPUS INC. MADE NO CONTRIBUTIONS TO ANY LEGISLATORS OR CANDIDATES. 1553389 1553389 211916862 28280832 183636030 203365748 67784843 135580905 1863188 1863188 322633512 INTERCOMPANY NOTES PAYABLE 313482066 DEFERRED COMPENSATION LIABILITY 2877414 INTERCOMPANY ACCOUNTS PAYABLES 962491 ASSET RETIREMENT OBLIGATION (FIN 47 126630 317448601 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 0 1 1 1 21600 8845807 8845807 0.03130 50 40053 47532106 31034970 16497136 0.05840 51 61653 56377913 31034970 25342943 0.08970 8 71399 1072874 354497 718377 0.00250 5 276 4700457 3253770 1446687 0.00510 8 40737 6259379 3148001 3111378 0.01100 8 3600 1074897 3135 1071762 0.00380 29 116012 13107607 6759403 6348204 0.02240 80 177665 69485520 37794373 31691147 0.11210 3 85340 85340 0.00030 1 53086 490 52596 0.00020 4 302246 3480 298766 0.00110 0 1 6000 6000 0.00000 0 1 2000 280 1720 0.00000 0 0 10 448672 4250 444422 0.00160 0 7092110 73513227 78815745 -5302518 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 #14 X X X X SJRMC-SOUTH BEND CAMPUS 1 1 X X X X X X X X X 11 1 1 1 X SEE SCHEDULE H, PART V, SECTION C X X X X X X X X 1 0 1 1 200.000000000000 1 300.000000000000 1 X X X X X X X 1 1 X X 1 0 X X X X 1 X 0 0 SJRMC-SOUTH BEND CAMPUS PART V, SECTION B, LINE 3: PRIOR ANALYSIS BY THE COMMUNITY BENEFIT COUNCIL IDENTIFIED THREE IMPORTANT COMMUNITY-RELATED ISSUES: DIABETES, SENIOR SERVICES AND PRENATAL CARE. THE METHODOLOGY FOR CONDUCTING THE CHNA INVOLVED DEPLOYMENT OF A COMMUNITY SURVEY, BOTH ON PAPER AND ONLINE, DURING THE MONTHS OF AUGUST THROUGH OCTOBER 2011. THE SURVEY TAKERS WERE ASKED WHAT THREE AREAS SHOULD SAINT JOSEPH REGIONAL MEDICAL CENTER (SJRMC) MOST IMPROVE. THEY WERE GIVEN A LIST OF OPTIONS FROM WHICH TO SELECT MULTIPLE ANSWERS. THE IMPORTANT ISSUES IDENTIFIED BY THE SURVEY TAKERS WERE: AWARENESS, EDUCATION AND ACCESSIBILITY.THE COUNCIL THEN BROUGHT TOGETHER DIFFERENT GROUPS INCLUDING: LEADERSHIP ALUMNI, YOUNG PROFESSIONALS, SENIORS, CLINICS, BUSINESS LEADERS IN PLYMOUTH, EXPECTANT & NEW MOTHERS, AND LATINO COMMUNITY LEADERS. THE FOCUS GROUPS WERE ASKED TO DISCUSS ISSUES THAT HAD BEEN IDENTIFIED AS IMPORTANT BY SJRMC AND BY THE SURVEY RESULTS.COMMUNITY BENEFIT COUNCIL SUBCOMMITTEES OF SENIOR SERVICES, DIABETES AND PRE-NATAL CARE WERE FORMED AND MET TO DISCUSS HOW TO IMPROVE THE AREAS THEY WERE ASSIGNED. AFTER DISCUSSION, ACTION PLANS WERE DEVELOPED AND APPROVED AND BUDGETED. SJRMC-SOUTH BEND CAMPUS PART V, SECTION B, LINE 4: SAINT JOSEPH REGIONAL MEDICAL CENTER - PLYMOUTH CAMPUS SJRMC-SOUTH BEND CAMPUS PART V, SECTION B, LINE 5D: ALL FOCUS GROUPS 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 12I: 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 14G: DUE TO THE COMPLEXITY OF THE POLICY, COPIES OF THE FULL POLICY ARE ONLY PROVIDED ON REQUEST.BROCHURE AND SIGNAGE ARE USED TO PROVIDE SIMPLE PLAIN LANGUAGE OVERVIEW OF THE POLICY REQUIREMENTS. FAP SUMMARY INFORMATION AND APPLICATION AVAILABLE ON WEBSITE: HTTP://WWW.SJMED.COM/FINANCIAL-ASSISTANCE SJRMC-SOUTH BEND CAMPUS PART V, SECTION B, LINE 20D: 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. PATIENTS WITH INCOME BETWEEN 201% AND 300% OF THE FPG RECEIVE A WRITE OFF OF HOSPITAL CHARGES FOR MEDICALLY NECESSARY SERVICES EQUAL TO THE HOSPITAL'S AVERAGE COMMERCIAL CONTRACTUAL ADJUSTMENT FOR ALL COMMERCIAL PAYERS. SAINT JOSEPH REGIONAL MEDICAL CENTER SOUTH BEND- PART V, SECTION B, LINE 5A: WWW.SJMED.COM/DOCUMENTS/COMMUNITYHEALTHNEEDSASSESSMENT.PDF 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, $22,703,783, 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 JOSEPH HIGH SCHOOLECONOMIC DEVELOPMENT - CONTRIBUTED TO:- CHAMBER OF COMMERCE - ST. JOSEPH COUNTY- CHAMBER OF COMMERCE - ELKHART COUNTY - MISHAWAKA BUSINESS ASSOCIATION- GRANGER BUSINESS ASSOCIATION- ENFOCUS, INC.COMMUNITY SUPPORT DONATIONS TO:- 100 BLACK MEN OF GREATER SOUTH BEND AREA FOR MENTORING YOUNG BLACK MEN- JUNIOR ACHIEVEMENT OF MICHIANA - MISHAWAKA EDUCATION FOUNDATION- PENN HARRIS MADISON 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- BOYS AND GIRLS CLUB- TUITION ASSISTANCE TO STUDENTS OF THE DIOCESE OF FORT WAYNE/SOUTH BEND - CENTER FOR THE HOMELESS - UNIVERSITY OF NOTRE DAME LATINO STUDIES AND SOCIAL SERVICES- SAINT MARY'S COLLEGE- UNITED HEALTH SERVICES- LA CASA DE AMISTAD PART III, LINE 2: METHODOLOGY USED FOR LINE 2 - BAD DEBT EXPENSE REPORTED ON LINE 2 IS SHOWN AT COST AND WAS CALCULATED USING A COST TO CHARGE RATIO METHODOLOGY.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. FY13 WAS THE FIRST YEAR SAINT JOSEPH REGIONAL MEDICAL CENTER - SOUTH BEND CAMPUS UTILIZED THE PREDICTIVE MODEL WITH RESULTS USED FOR ANALYSIS ONLY. STARTING IN FY14, 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 THEORECTICALLY 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 14 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 REGIONAL HEALTH MINISTRY 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: PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE - SJRMC-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 COMMUNITY.IN ACCORDANCE WITH AMERICAN HOSPITAL ASSOCIATION RECOMMENDATIONS, SJRMC-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 OBLIGATIONSSJRMC-SOUTH BEND CAMPUS PROVIDES EFFECTIVE COMMUNICATIONS 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. SJRMC-SOUTH BEND CAMPUS RECOGNIZES THE MANY CHALLENGES THAT FACE ITS UNINSURED AND UNDERINSURED PATIENTS WHEN APPLYING FOR STATE AND FEDERAL PROGRAMS TO HELP WITH HEALTHCARE EXPENSES. THEREFORE, SJRMC-SOUTH BEND CAMPUS ESTABLISHED THE ELIGIBILITY ASSISTANCE DEPARTMENT THAT UTILIZES A SOCIAL SERVICE APPROACH WITH A COMMITMENT TO PATIENT DIGNITY, COMPASSION, INTEGRITY AND PATIENT-CENTERED CARE. HIGHLY TRAINED SPECIALISTS WHO KNOW AND UNDERSTAND THE DIFFERENT REQUIREMENTS FOR MANY LOCAL, STATE AND FEDERAL PROGRAMS STAFF THE ELIGIBILITY ASSISTANCE DEPARTMENT. ONCE IT IS DETERMINED THAT A PATIENT QUALIFIES FOR A PROGRAM, AN ELIGIBILITY SPECIALIST IS ASSIGNED TO THE PATIENT'S CASE. THE ELIGIBILITY SPECIALIST WORKS WITH THE PATIENT'S PROVIDERS, DEPARTMENT OF CARE MANAGEMENT, AND ALL APPROPRIATE STATE AND FEDERAL AGENCIES WHILE NAVIGATING THE PATIENT THROUGH PROCESSES. FINANCIAL COUNSELORS, IN CONJUNCTION WITH THE ELIGIBILITY ASSISTANCE DEPARTMENT, 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. HOWEVER, DETERMINATION FOR FINANCIAL SUPPORT CAN BE MADE DURING ANY STAGE OF THE PATIENT'S STAY AFTER STABILIZATION OR COLLECTION CYCLE.SJRMC-SOUTH BEND CAMPUS OFFERS FINANCIAL SUPPORT TO PATIENTS WITH LIMITED MEANS. THIS SUPPORT IS AVAILABLE TO UNINSURED AND UNDERINSURED INDIVIDUALS WHO DO NOT QUALIFY FOR PUBLIC PROGRAMS OR OTHER ASSISTANCE. NOTIFICATION ABOUT FINANCIAL ASSISTANCE, INCLUDING CONTACT INFORMATION, IS AVAILABLE THROUGH VARIOUS MEANS, WHICH INCLUDE, BUT ARE NOT LIMITED TO, PATIENT BROCHURES, MESSAGES INCLUDED ON PATIENT BILLS, NOTICES IN PUBLIC REGISTRATION AREAS INCLUDING EMERGENCY ROOMS, URGENT CARE CENTERS, ADMITTING AND REGISTRATION DEPARTMENTS, HOSPITAL PATIENT ACCOUNTING DEPARTMENTS, AND OTHER PATIENT FINANCIAL SERVICES OFFICES THAT ARE LOCATED ON FACILITY CAMPUSES. SUMMARIES OF HOSPITAL PROGRAMS ARE MADE AVAILABLE TO THE INDIANA DIVISION OF FAMILY RESOURCES, UNITED WAY, THE LOCAL CHAPTER OF THE AMERICAN RED CROSS, THE AREA COUNCIL ON AGING, LOCAL PRIVATE AND PUBLIC SCHOOLS AND OTHER COMMUNITY HEALTH AND HUMAN SERVICES AGENCIES THAT ASSIST PEOPLE IN NEED. INFORMATION REGARDING FINANCIAL ASSISTANCE PROGRAMS IS ALSO AVAILABLE ON THE HOSPITAL WEBSITE AND IN THE DEPARTMENT ADMISSION PACKAGES. IN ADDITION TO ENGLISH, THIS INFORMATION IS ALSO AVAILABLE IN SPANISH, REFLECTING THE OTHER PRIMARY LANGUAGE SPOKEN BY THE POPULATION SERVICED BY THE HOSPITAL. SJRMC-SOUTH BEND CAMPUS HAS ESTABLISHED A WRITTEN POLICY FOR THE BILLING, COLLECTION AND SUPPORT FOR PATIENTS WITH PAYMENT OBLIGATIONS. SJRMC-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. SJRMC-SOUTH BEND CAMPUS EDUCATES STAFF MEMBERS WHO WORK CLOSELY WITH PATIENTS (INCLUDING THOSE WORKING IN PATIENT REGISTRATION AND ADMITTING, FINANCIAL ASSISTANCE, CUSTOMER SERVICE, BILLING AND COLLECTIONS) ABOUT THESE POLICIES WITH AN EMPHASIS ON TREATING ALL PATIENTS WITH DIGNITY AND RESPECT REGARDLESS OF THEIR INSURANCE STATUS OR THEIR ABILITY TO PAY FOR SERVICES. ALL OF THE AFOREMENTIONED STAFF RECEIVE TRAINING ON TRINITY HEALTH'S MISSION, VISION AND CORE VALUES. THIS ALLOWS THE ASSOCIATES TO OFFER FINANCIAL ASSISTANCE TO PATIENTS WITH COMPASSION AND INTEGRITY, WHILE MAINTAINING THE PATIENT'S DIGNITY. PART VI, LINE 4: SAINT JOSEPH REGIONAL MEDICAL CENTER-SOUTH BEND CAMPUS SERVES 899,381 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 HOSPITALS IN THE PRIMARY SERVICE AREA INCLUDE MEMORIAL HOSPITAL OF SOUTH BEND, ELKHART GENERAL HOSPITAL AND GOSHEN GENERAL HOSPITAL TO THE EAST, IN ELKHART COUNTY. HOSPITALS LOCATED IN THE SECONDARY SERVICE AREA INCLUDE LAPORTE HOSPITAL AND SAINT ANTHONY MEMORIAL HOSPITAL TO THE WEST IN LAPORTE COUNTY, AND TO THE SOUTH, WOODLAWN HOSPITAL IN ROCHESTER, STARKE MEMORIAL IN STARKE COUNTY, AND PULASKI MEMORIAL IN WINAMAC. TOTAL POPULATION FOR THE SYSTEM SERVICE AREA IS ONLY EXPECTED TO GROW 0.2% FROM 2014 THROUGH 2019. COMPARED TO THE STATE OF INDIANA, THE SYSTEM SERVICE AREA HAS A LOWER PROJECTED POPULATION GROWTH, A HIGHER MEDIAN AGE AND THE A DECLINE IN FEMALES OF CHILD BEARING AGE 15-44 AT 0.5%. THE POPULATION AGED 65 AND OLDER REPRESENTS 15.2% OF THE TOTAL POPULATION, AND IS EXPECTED TO INCREASE 13% OVER THE NEXT FIVE YEARS. AVERAGE HOUSEHOLD INCOME ($56,584) IS BELOW THE RATE FOR THE STATES OF INDIANA, MICHIGAN AND OHIO AS WELL AS THE USA. TWENTY-EIGHT PERCENT OF THE POPULATION IN THE SYSTEM SERVICE AREA EARNS AN ANNUAL SALARY $25,000 OR BELOW. BOTH THE PRIMARY AND SECONDARY SERVICES AREAS HAVE EXPERIENCED STAGNANT POPULATION GROWTH OVER THE PAST DECADE. THE ONLY POCKET OF GROWTH IN ST. JOSEPH COUNTY IS IN THE SOUTHEAST QUADRANT. MEDIAN HOUSEHOLD INCOME IS FAIRLY STABLE ACROSS THE REGION, WITH AREAS OF HIGHEST AFFLUENCE IN THE GRANGER ZIP CODE AND PORTIONS OF ELKHART COUNTY.THE CURRENT UNEMPLOYMENT RATE OF 5.9% IS HIGHER THAN THE INDIANA RATE OF 5.5% AND LOWER THAN THE NATIONAL AVERAGE OF 6.3% FOR AUGUST 2014, THE MOST RECENT DATA AVAILABLE. MOODY'S RATES INDIANA AS RECOVERING. EDUCATION, HEALTHCARE, AND GOVERNMENT ARE THE MAJOR EMPLOYERS IN THE LOCAL ECONOMY.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%.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. 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 SYSTEM 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. THE SYSTEM SERVICE AREA POPULATION TENDS TO SUFFER FROM THE SAME CHRONIC HEALTH PROBLEMS AS THE REST OF THE NATION. DISEASES WITH THE HIGHEST INCIDENCE RATES TEND TO BE HEART DISEASE, CANCER AND DIABETES IN VARIOUS DEGREES. SMOKING PREVALENCE IN INDIANA IS QUITE HIGH COMPARED TO THE NATIONAL RATES BUT HAS SEEN SOME IMPROVEMENT IN RECENT YEARS. 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 ARE 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 MADE SIGNIFICANT CONTRIBUTIONS TO UNITED WAY, AMERICAN HEART ASSOCIATION, SOUTH BEND MEDICAL FOUNDATION, CODE FOR AMERICA, UNIVERSITY OF NOTRE DAME HARPER CANCER RESEARCH, LOGAN INC. (CENTER FOR PEOPLE WITH DISABILITIES), WOMEN'S CARE CENTER, MARCH OF DIMES, REAL 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 MEMBER ORGANIZATIONS 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. OVERALL, 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 A ROSIE PLACE 53131 QUINCE ROAD SOUTH BEND IN 46628 371523448 501(C)(3) 11000 COMMUNITY BENEFIT AMERICAN HEART ASSOCIATION 7272 GREENVILLE AVE DALLAS TX 75231 135613797 501(C)(3) 20000 COMMUNITY BENEFIT BOYS & GIRLS CLUB AFTER SCHOOL PROG 502 E SAMPLE ST SOUTH BEND IN 46601 351329625 501(C)(3) 25000 COMMUNITY BENEFIT CENTER FOR THE HOMELESS 813 S MAIN STREET SOUTH BEND IN 466013102 351768544 501(C)(3) 16476 SUPPORT OPERATIONS CHAMBER OF COMMERCE OF ST JOSEPH COUNTY 401 E COLFAX AVE SUITE 310 SOUTH BEND IN 46617 350153330 501(C)(6) 17500 COMMUNITY BENEFIT CODE FOR AMERICA 155 9TH STREET SAN FRANCISCO CA 94103 271067272 501(C)(3) 29169 COMMUNITY BENEFIT COMMUNITY FOUNDATION OF SAINT JOSEPH COUNTY PO BOX 837 SOUTH BEND IN 46624 237365930 501(C)(3) 66250 COMMUNITY BENEFIT COMMUNITY HEALTH PARTNERS OF SOUTH BEND 1010 N BENDIX AVE SOUTH BEND IN 46628 263051440 501(C)(3) 190600 COMMUNITY BENEFIT DIOCESE OF FORT WAYNESOUTH BEND 915 S CLINTON ST FORT WAYNE IN 46801 350876373 501(C)(3) 139999 ANNUAL PLEDGE ENFOCUS INC 506 SOUTH STREET SOUTH BEND IN 46601 455638209 501(C)(3) 27500 COMMUNITY BENEFIT GREATER ELKHART CHAMBER OF COMMERCE INC 418 S MAIN ST ELKHART IN 46516 350290590 501(C)(6) 6661 COMMUNITY BENEFIT HABITAT FOR HUMANITY OF ST JOSEPH COUNTY INC 402 EAST SOUTH STREET SOUTH BEND IN 46601 311196894 501(C)(3) 10000 PHYISCAL IMPROVEMENTS HANNAHS HOUSE INC 518 W 4TH ST MISHAWAKA IN 46544 351871289 501(C)(3) 12500 UNDERSERVED INDIANA UNIVERSITY FOUNDATION PO BOX 7111 SOUTH BEND IN 46634 356018940 501(C)(3) 16360 COMMUNITY BENEFIT JUNIOR LEAGUE OF SOUTH BEND INC 130 PARK LANE SOUTH BEND IN 46601 356001729 501(C)(3) 0 6632 PRINTING COMMUNITY BENEFIT LA CASA DE AMISTAD 746 S MEADE ST SOUTH BEND IN 46619 351350013 501(C)(3) 60929 COMMUNITY BENEFIT LOGAN COMMUNITY RESOURCES INC 2205 EAST JEFFRERSON BLVD SOUTH BEND IN 46624 350965639 501(C)(3) 30000 SUPPORT AUTISM MARCH OF DIMES FOUNDATION 1275 MAMARONECK WHITE PLAINS NY 10605 131846366 501(C)(3) 22000 COMMUNITY BENEFIT NATIONAL COUNCIL OF THE UNITED STATES SOCIETY OF ST VINCENT DE PAUL INC 58 PROGRESS PARKWAY MARYLAND HEIGHTS MO 63043 135562362 501(C)(3) 10000 UNDERSERVED NORTHEAST NEIGHBORHOOD REVIT 803 LINCOLN WAY WEST SOUTH BEND IN 46616 352118149 501(C)(3) 50340 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 RESUE INCORPORATED AKA HOPE MINISTRIES PO BOX 4488 SOUTH BEND IN 466344488 351038532 501(C)(3) 0 20200 LUNCHES UNDERSERVED SAINT ADALBERT PARISH 2420 W HURON ST SOUTH BEND IN 46619 351095958 501(C)(3) 15000 UNDERSERVED SAINT MARY'S COLLEGE PO BOX 180 NOTRE DAME IN 46556 350868158 501(C)(3) 33336 1702 COST BEDS COMMUNITY BENEFIT SCHOOL CITY OF MISHAWAKA EDUCATION FOUNDATION INC PO BOX 1593 MISHAWAKA IN 46546 351973986 501(C)(3) 5750 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) 25000 OPERATIONS ST MARGARET'S HOUSE 117 N LAFAYETTE BLVD SOUTH BEND IN 46601 351913328 501(C)(3) 9896 9896 COST PRINTING UNDERSERVED THE FOUNDATION FOR THE CENTER FOR HOSPICE AND PALLIATIVE CARE INC 111 SUNNYBROOK CT SOUTH BEND IN 46637 300433147 501(C)(3) 7000 COMMUNITY BENEFIT UNITED WAY OF ST JOSEPH COUNTY INC 3517 E JEFFERSON BLVD SOUTH BEND IN 46615 351063368 501(C)(3) 22000 COMMUNITY BENEFIT UNIVERSITY OF NOTRE DAME ECK INST GLOBAL 100 GRACE HALL NOTRE DAME IN 46556 350868188 501(C)(3) 107333 COMMUNITY BENEFIT VIETNAM VETERANS OF AMERICA PO BOX 4 SOUTH BEND IN 46624 943481672 501(C)(6) 0 9876 COST PRINTING COMMUNITY BENEFIT WOMENS CARE CTR 360 N NOTRE DAME AVE SOUTH BEND IN 46601 351609945 501(C)(3) 35000 SPONSORSHIP SYRIAN AMERICAN MEDICAL SOCIETY FOUNDATION 254 HOOD DRIVE CANFIELD OH 44406 161717058 501(C)(3) 250717 COST SURGICAL SUPPLIES SUPPORT HOSPITAL OVERSEAS MISSION THE FOUNDATION OF SJRMC INC 707 EAST CEDAR STREET SUITE 350 SOUTH BEND IN 46617 351654543 501(C)(3) 93842 COST PRINTING COMMUNITY BENEFIT 33 3 PART I, LINE 2: DONATIONS MADE BY SAINT JOSEPH REGIONAL MEDICAL CENTER- SOUTH BEND CAMPUS, INC. 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 451616 0 377170 0 72316 0 64603 0 30929 0 996634 0 0 ROBERT CASALOU DIRECTOR; CEO,ST JOS MERCY,ANN ARBOR 0 471479 0 373619 0 63606 0 65277 0 25445 0 999426 0 0 UTHMAN CAVALLO MD DIRECTOR; PHYSICIAN 0 201575 0 0 0 252 0 10079 0 585 0 212491 0 0 JASON SCHULTZ SECRETARY; SJRMC ASSOC. COUNSEL 0 147106 0 0 0 3081 0 5654 0 7209 0 163050 0 0 JANICE DUNN CFO SJRMC 0 287030 0 80233 0 1467 0 14002 0 15955 0 398687 0 0 KURT MEYER CHRO SJRMC 0 213513 0 58136 0 2010 0 14500 0 17103 0 305262 0 0 KENNETH HALL CNO SJRMC 0 173287 0 85192 0 2343 0 17398 0 4453 0 282673 0 0 MARTIN WIESCHHAUS MD PHYSICIAN 291029 0 41073 0 619 0 29010 0 20933 0 382664 0 0 0 ISMAIL M ABBASI MD PHYSICIAN 273830 0 17000 0 4805 0 17850 0 21664 0 335149 0 0 0 STEPHEN SIMONS MD PHYSICIAN 245657 0 15000 0 1037 0 40094 0 16990 0 318778 0 0 0 THEODORE NEUMANN MD PHYSICIAN 220711 0 0 0 1314 0 26129 0 20845 0 268999 0 0 0 BRIAN M HUBER MD PHYSICIAN 158743 0 50000 0 157 0 6258 0 19063 0 234221 0 0 0 LORI PRICE FORMER OFFICER 0 299792 0 37005 0 51869 0 26640 0 20262 0 435568 0 0 JOSEPH SWEDISH FORMER KEY EMPLOYEE 0 344758 0 0 0 1119237 0 21706 0 7182 0 1492883 0 0 KEDRICK ADKINS FORMER KEY EMPLOYEE 0 504488 0 873685 0 430416 0 1730702 0 8534 0 3547825 0 45090 J RICHARD O'CONNELL FORMER KEY EMPLOYEE 0 731422 0 769386 0 172766 0 111806 0 33679 0 1819059 0 0 MICHAEL SLUBOWSKI FORMER KEY EMPLOYEE 0 0 0 0 0 231799 0 0 0 0 0 231799 0 231799 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 A SEVERANCE PAYMENT IN CALENDAR 2013. THIS AMOUNT IS INCLUDED IN COLUMN B(III): KEDRICK ADKINS - $310,298 IN ADDITION, COLUMN C OF SCHEDULE J, PART II INCLUDES THE FOLLOWING SEVERANCE AMOUNTS, WHICH WERE UNPAID AS OF 12/31/13: KEDRICK ADKINS - $1,347,759 ($814,924 PAID IN 2014 AND $532,835 TO BE PAID IN 2015) 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 ($255,000 FOR 2013). THE FOLLOWING ACCRUALS FOR 2013 FOR THIS PLAN ARE INCLUDED IN COLUMN C OF SCHEDULE J, PART II: KEDRICK ADKINS - $106,281 ALBERT GUTIERREZ - $51,853 J. RICHARD O'CONNELL - $99,056 ROBERT CASALOU - $52,527 THE FOLLOWING IS A PARTICIPANT IN A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP). THE FOLLOWING SERP ACCRUAL FOR 2013 IS INCLUDED IN COLUMN C OF SCHEDULE J, PART II: KEDRICK ADKINS - $258,812 PART II, COLUMN B (II): THE FOLLOWING INDIVIDUALS RECEIVED AMOUNTS IN 2013 FROM A LONG-TERM INCENTIVE PLAN (LTIP). PARTICIPANTS IN THE LTIP (CEO'S AND CERTAIN TRINITY EXECUTIVES) WERE ELIGIBLE TO RECEIVE A PAYMENT UNDER THE PLAN ONLY IF CERTAIN CULTURE OF SAFETY SURVEY SCORE TARGETS WERE ACHIEVED AT THE END OF A THREE-YEAR PERIOD (FY11 THROUGH FY13). THE FOLLOWING LTIP AMOUNTS ARE INCLUDED IN SCHEDULE J, PART II, COLUMN B(II): KEDRICK ADKINS - $372,833 ALBERT GUTIERREZ - $189,804 KENNETH HALL - $37,580 J. RICHARD O'CONNELL - $294,870 ROBERT CASALOU - $205,450 PART II: THE FOLLOWING INDIVIDUALS WERE VESTED IN A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP). THE FOLLOWING VESTED SERP AMOUNTS ARE INCLUDED IN COLUMN B(III) OF SCHEDULE J, PART II: JOSEPH SWEDISH - $543,977 MICHAEL SLUBOWSKI - $231,799 COLUMN F OF SCHEDULE J 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 23998 EMPLOYMENT ARRANGEMENT 0 JEAN LOUISE HALL FAMILY MEMBER OF KENNETH HALL, KEY EMPLOYEE 70210 EMPLOYMENT ARRANGEMENT 0 ELM ROAD MOB IILLC ROBERT CLEMENCY, DIR., HAS A GREATER THAN 5% INDIRECT INT IN ELM ROAD MOB 476192 SJRMC - SOUTH BEND CAMPUS LEASES SPACE FROM ELM ROAD MOB II 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, A MATERIAL CHANGE IN MISSION, 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, INC. HAS ADOPTED A CONFLICT OF INTEREST POLICY WHICH CONTAINS THE ELEMENTS IN THE MODEL CONFLICT OF INTEREST POLICY ISSUED BY THE IRS. IT APPLIES TO ALL "INTERESTED PERSONS" OF SAINT JOSEPH REGIONAL MEDICAL CENTER-SOUTH BEND CAMPUS, INC., WHICH INCLUDES DIRECTORS, PRINCIPAL OFFICERS AND EXECUTIVES, AND MEMBERS OF COMMITTEES WITH BOARD DESIGNATED POWERS. INTERESTED PERSONS ARE REQUIRED TO ACT AT ALL TIMES IN A MANNER CONSISTENT WITH SAINT JOSEPH REGIONAL MEDICAL CENTER-SOUTH BEND CAMPUS, INC.'S CHARITABLE PURPOSE AND SERVICE TO THE COMMUNITY AND TO AVOID CONFLICTS OF INTEREST. INTERESTED PERSONS ARE REQUIRED TO MAKE FULL DISCLOSURE TO SAINT JOSEPH REGIONAL MEDICAL CENTER-SOUTH BEND CAMPUS, INC. OF ANY FINANCIAL OR BUSINESS INTERESTS THAT MIGHT RESULT IN OR HAVE THE APPEARANCE OF A CONFLICT OF INTEREST. INTERESTED PERSONS ARE REQUIRED TO RECUSE THEMSELVES FROM DISCUSSION AND VOTING ON MATTERS INVOLVING A CONFLICT OF INTEREST. THE BOARD OF DIRECTORS OF SAINT JOSEPH REGIONAL MEDICAL CENTER-SOUTH BEND CAMPUS, INC. IS RESPONSIBLE FOR THE REVIEW AND APPROVAL OF TRANSACTIONS WITH INTERESTED PERSONS, INCLUDING DETERMINING THAT SUCH TRANSACTIONS ARE FAIR AND REASONABLE TO SAINT JOSEPH REGIONAL MEDICAL CENTER-SOUTH BEND CAMPUS, INC. 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 REVIEWED WITH THE BOARD OF DIRECTORS OF SAINT JOSEPH REGIONAL MEDICAL CENTER-SOUTH BEND CAMPUS, INC. ON A YEARLY BASIS. FORM 990, PART VI, SECTION B, LINE 15 QUESTIONS 15A AND 15B ARE ANSWERED "NO" BECAUSE THE COMPENSATION FOR SAINT JOSEPH REGIONAL MEDICAL CENTER-SOUTH BEND CAMPUS, INC.'S CEO, OFFICERS, AND KEY MANAGEMENT OFFICIALS IS ESTABLISHED AND PAID BY TRINITY HEALTH, A RELATED ORGANIZATION. 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 CERTAIN OFFICERS AND KEY MANAGEMENT OFFICIALS OF SAINT JOSEPH REGIONAL MEDICAL CENTER-SOUTH BEND CAMPUS, INC. 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 AS WELL AS SAINT JOSEPH REGIONAL MEDICAL CENTER'S WEBSITE (WWW.SJMED.COM). SAINT JOSEPH REGIONAL MEDICAL CENTER-SOUTH BEND CAMPUS, INC.'S GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE AVAILABLE UPON REQUEST. FORM 990, PART XII, LINE 2: SAINT JOSEPH REGIONAL MEDICAL CENTER-SOUTH BEND CAMPUS, INC.'S FINANCIAL STATEMENTS WERE INCLUDED IN THE FY14 CONSOLIDATED FINANCIAL STATEMENTS OF TRINITY HEALTH, WHICH WERE AUDITED BY AN INDEPENDENT PUBLIC ACCOUNTING FIRM. 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 ALLEGANY FRANCISCAN MINISTRIES INC 33920 US HIGHWAY 19 NORTH SUITE 269 PALM HARBOR FL 34684 581492325 MANAGEMENT & SUPPORT SERVICES FL 501(C)(3) LINE 11A, I CATHOLIC HEALTH EAST 1 AMICARE HOSPICE SERVICES INC 20555 VICTOR PARKWAY LIVONIA MI 48152 382949053 PROVIDE 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 SUPPORTS SERVICES OF RELATED HOSPITAL OR 501(C)(3) LINE 9 SAINT ALPHONSUS MEDICAL CENTER-ONTARIO 1 BAUM HARMON MERCY HOSPITAL 255 NORTH WELCH AVENUE PRIMGHAR IA 51245 421500277 ACUTE/AMBULATORY HEALTHCARE SERVICES IA 501(C)(3) LINE 3 MERCY HEALTH SERVICES-IOWA CORP 1 BAUM HARMON MERCY HOSPITAL & CLINICS FOUNDATION 255 NORTH WELCH AVENUE PRIMGHAR IA 51245 262973307 SUPPORT THE SERVICES OF RELATED HOSPITAL IA 501(C)(3) LINE 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