2014-05-09T11:46:42-05:00 2013-06-30 990 2012-07-01 350868157 SAINT JOSEPH REGIONAL MEDICAL CENTER- SOUTH BEND CAMPUS INC SAIN 5743355000 5215 HOLY CROSS PARKWAY MISHAWAKA IN 465451469 JANICE DUNN 5744726083 2014-05-08 2012 2015-11-30 17:44:51Z (SEE SCHEDULE O FOR LIST) ALBERT GUTIERREZ 5215 HOLY CROSS PARKWAY MISHAWAKA IN 465451469 303581946 0 0928 X WWW.SJMED.COM X 1958 IN HEALTHCARE SERVICES 18 13 2009 588 0 0 2730864 2175759 281749352 294498157 -1433671 -1027403 5540399 5289404 288586944 300935917 0 1428654 0 0 96103737 96454260 0 0 0 183485097 191281926 279588834 289164840 8998110 11771077 417539311 412920475 364032204 355064849 53507107 57855626 HEALTHCARE SERVICES - SEE SCHEDULE H FOR MORE INFORMATION 0 0 235439171 1428654 298250623 SAINT JOSEPH REGIONAL MEDICAL CENTER - SOUTH BEND CAMPUS, INC. (THE HOSPITAL), A NOT-FOR-PROFIT CORPORATION OWNS AND OPERATES A 287-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, CHE TRINITY HEALTH, SERVE TOGETHER IN THE SPIRIT OF THE GOSPEL AS A COMPASSIONATE AND TRANSFORMING HEALING PRESENCE WITHIN OUR COMMUNITIES. 235439171 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 1 230 0 1 2009 1 0 0 0 0 0 0 0 0 0 0 X 18 13 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 IN X WAYNE NOETHE CONTROLLER 5743354655 707 EAST CEDAR STREET SOUTH BEND IN 466172000 ALBERT GUTIERREZ 10.00 40.00 X X 0 663705 79538 ABRAHAM MARCUS 2.00 2.00 X X 0 0 0 JOHN ROSENTHAL 2.00 2.00 X X 0 0 0 CHARLES VIATER 2.00 2.00 X X 0 0 0 KATHY BEELER 2.00 2.00 X 0 0 0 BILAL ANSARI MD 2.00 2.00 X 0 0 0 ROBERT CASALOU 2.00 48.00 X 0 619307 97325 UTHMAN CAVALLO MD 2.00 26.00 X 0 187541 5781 ROBERT E CLEMENCY MD 2.00 2.00 X 0 0 0 GREG CRAWFORD 2.00 2.00 X 0 0 0 RODNEY GANEY 2.00 2.00 X 0 0 0 MICHAEL R LEEP SR 2.00 2.00 X 0 0 0 CAROL A MOONEY JD 2.00 2.00 X 0 0 0 JOHN OLIVER 2.00 4.00 X 0 0 0 ROBERT OPPMAN MD 2.00 2.00 X 0 0 0 SR KATHLEEN QUINN PHJC 2.00 2.00 X 0 0 0 SR AGNES ANNE ROBERTS CSC 2.00 2.00 X 0 0 0 FR JAMES FOSTER CSC MD 2.00 2.00 X 0 6600 0 SR JOY O'GRADY CSC 2.00 4.00 X 0 0 0 SR SHIRLEY BELL PHJC 2.00 2.00 X 0 0 0 JOHN ZEGLIS 2.00 4.00 X 0 0 0 JASON SCHULTZ 10.00 40.00 X 0 144481 13998 JANICE DUNN 10.00 40.00 X 0 369419 37148 JOSEPH SWEDISH 2.00 53.00 X 0 3233500 601476 KEDRICK ADKINS 2.00 53.00 X 0 1821619 126167 J RICHARD O'CONNELL 2.00 53.00 X 0 1036410 130423 KURT MEYER 10.00 40.00 X 0 262457 32717 KENNETH HALL 10.00 40.00 X 0 210311 35666 KHALEELUR REHMAN ZACKARIYA MD 50.00 0.00 X 338458 0 37257 SUNDAY OSUNNUGA MD 50.00 0.00 X 321872 0 39313 MARK MCGILLEM MD 50.00 0.00 X 319294 0 17667 THOMAS PERUMPILLYKADAN VARIED MD 50.00 0.00 X 318177 0 44293 F MONCRIEF DOBSON MD 50.00 0.00 X 296440 0 48192 LORI PRICE 0.00 50.00 X 0 276673 53524 AARON AUSTIN 0.00 0.00 X 0 248006 24501 MICHAEL MURPHY 0.00 0.00 X 0 180882 16630 CHRISTOPHER KARAM 0.00 50.00 X 0 232962 38803 1594241 9493873 1480419 67 1 1 0 SOUTH BEND MEDICAL FOUNDATION 530 N LAFAYETTE BLVD SOUTH BEND IN 46601 LABORATORY SERVICES 12541952 ST JOSEPH VALLEY ANESTHESIA P O BOX 1742 SOUTH BEND IN 46634 HEALTH CARE SERVICES 1739503 WEST MICH SHARED HOSP LAUNDRY 3003 WALKENT DR NW GRAND RAPIDS MI 49544 LAUNDRY SERVICES 724788 NATL WOUND CARE & HYPERBARIC 5220 BELFORT RD STE 200 JACKSONVILLE FL 32256 HEALTH CARE SERVICES 674734 FRESENIUS MANAGEMENT SERVICES 16343 COLLECTION CTR DR CHICAGO IL 60693 MANAGEMENT SERVICES 651251 33 2105929 69830 2175759 NET PATIENT SVC REV 900099 294498157 294498157 294498157 657584 657584 677004 942542 -265538 -265538 -265538 18500 1703487 0 -1703487 18500 -1684987 -1684987 MEDICARE/MEDICAID HIT 900099 1864824 1864824 CAFETERIA REVENUE 721000 1802476 1802476 1887642 1887642 5554942 300935917 298250623 0 509535 1428654 1428654 170539 170539 75814678 72749700 3064978 5615629 5388641 226988 9359868 8981195 378673 5493546 5267180 226366 579750 579750 23063810 22926013 137797 150623 150623 2872449 2200523 671926 31147 2575 28572 5824573 5410258 414315 120225 120225 203971 185905 18066 12992341 12992341 16993936 16993936 1762040 1762040 MEDICAL SUPPLIES 47827852 47827852 0 INTERCO. PURCHASED SVCS 47613194 1543331 46069863 BAD DEBT 13736277 13736277 0 HOSPITAL PROVIDER TAX 12991135 12991135 0 4518603 3792518 726085 289164840 235439171 53725669 0 408955 8201154 43038788 39146838 6133526 6214089 1468089 1541487 420077978 85819797 344037162 334258181 9601578 13494719 10708034 10053048 2143179 10959 417539311 412920475 19292845 18255718 150901 287686 12647406 12055782 331941052 324465663 364032204 355064849 X 53507107 57855626 0 53507107 57855626 417539311 412920475 X 11771077 577441 -8000000 X X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 3397 0 0 0 3397 0 EXPLANATION OF LOBBYING ACTIVITIES: 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. 3538880 3538880 218118433 27812452 190305981 183316684 54764021 128552663 15103981 3243324 11860657 334258181 INTERCOMPANY NOTES PAYABLE 319235437 INTERCOMPANY ACCOUNTS PAYABLE 2072253 ASSET RETIREMENT OBLIGATION (FIN 47) 126630 DEFERRED COMPENSATION LIABILITY 3031343 324465663 1 1 X 1 X 1 X 1 1 1 0 1 1 1 13321 9200002 9200002 0.03340 50 40559 44092136 32660879 11431257 0.04150 51 53880 53292138 32660879 20631259 0.07490 10 42638 1313500 78199 1235301 0.00450 5 279 4248936 2840876 1408060 0.00510 8 38616 6226510 2733854 3492656 0.01270 10 1151590 5511 1146079 0.00420 33 81533 12940536 5658440 7282096 0.02650 84 135413 66232674 38319319 27913355 0.10140 3 70459 70459 0.00030 1 10321 10321 0.00000 3 191521 2710 188811 0.00070 1 750 140 610 0.00000 8 273051 2850 270201 0.00100 0 4401279 1571257 75086091 87826572 -12740481 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 X X X X SJRMC-SOUTH BEND CAMPUS 1 1 X X X X X X X X X 11 1 1 1 X X X X X X X X X 1 0 1 1 150.000000000000 1 400.000000000000 1 X X X X X X 1 1 X X 1 0 X X X X 1 X 0 0 7 ST JOSEPH REHABILITATION INSTITUTE

60205 BODNAR BOULEVARD MISHAWAKA IN 46544

INPATIENT REHAB FACILITY ELM ROAD MEDICAL CAMPUS

60101 BODNAR BLVD MISHAWAKA IN 46544

OUTPATIENT CLINIC, MIDWIFERY & SLEEP DISORDERS CLINICS FAMILY MEDICINE CENTER

611 E DOUGLAS RD SUITE 407 MISHAWAKA IN 46545

FAMILY HEALTH CENTER 4 WEST MEDICAL PAVILION

420 W FOURTH STREET MISHAWAKA IN 46544

OUTPAT.PHYSICIAN CLINIC SAINT JOSEPH PEDIATRIC SPECIALTY CLINICS

611 EAST DOUGLAS RD SUITE 405 MISHAWAKA IN 46545

PEDIATRIC SPECIALTY CLINIC SISTER MAURA CSC BRANNICK HEALTH CENTER

326 SOUTH CHAPIN STREET SOUTH BEND IN 46601

OUTPATIENT CLINIC MEDICAL IMAGING CENTER

53940 CARMICHAEL DRIVE SOUTH BEND IN 46635

MEDICAL IMAGING CENTER 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 TO THE 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 IN ITS ANNUAL REPORT, 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, L7 COL(F): THE FOLLOWING NUMBER, $13,736,277, 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 PROVIDES SUPPORT 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:- HANSEL CENTER RENOVATION INSTITUTE FOR LATINO STUDIES UNIVERSITY OF NOTRE DAME- NORTHEAST NEIGHBORHOOD REVITALIZATION ECONOMIC DEVELOPMENT - CONTRIBUTED TO:- CHAMBER OF COMMERCE ST. JOSEPH COUNTY- CHAMBER OF COMMERCE ELKHART COUNTY - MISHAWAKA BUSINESS ASSOCIATION- GRANGER BUSINESS ASSOCIATION- ANCILLA COLLEGECOMMUNITY SUPPORT DONATIONS TO:- 100 BLACK MEN OF GREATER SOUTH BEND AREA FOR MENTORING YOUNG BLACK MEN- JUNIOR ACHIEVEMENT OF MICHIANA - NAACP SOUTH BEND BRANCH- 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 - YWCA- 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- WNIT - 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 AND ST. ANTHONY'S CHURCH- CENTER FOR THE HOMELESS - UNIVERSITY OF NOTRE DAME LATINO STUDIES AND SOCIAL SERVICES- SAINT MARY'S COLLEGE 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 17 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 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 MINISTRY ORGANIZATION 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 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. 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. 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 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 5C: LINE 5A:WWW.SJMED.COM/DOCUMENTS/COMMUNITYHEALTHNEEDSASSESSMENT.PDFLINE 5C: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 12H: 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: BASIC INFORMATION ABOUT THE FINANCIAL ASSISTANCE POLICY WAS POSTED IN ENGLISH AND SPANISH IN THE EMERGENCY AND OTHER WAITING ROOMS, PATIENT REGISTRATION BOOTHS AND PHYSICIAN OFFICES. DURING FISCAL YEAR 2013, IF AN INDIVIDUAL WANTED A SUMMARY OF THE FINANCIAL ASSISTANCE POLICY, HE/SHE COULD GET A BROCHURE OF THIS INFORMATION AT ALL POINTS OF SERVICES MENTIONED IN THE LATTER SENTENCE. BROCHURES ARE ALSO AVAILABLE FROM THE CASHIERS, FINANCIAL COUNSELORS AND ELIGIBILITY SPECIALISTS. PATIENTS WERE PROVIDED INFORMATION ABOUT OBTAINING A COPY OF THE FINANCIAL ASSISTANCE POLICY (FAP) WITH BILLING INVOICES. THE FAP SUMMARY AND APPLICATION WERE NOT ON THE SAINT JOSEPH REGIONAL MEDICAL CENTER WEBSITE DURING FISCAL YEAR 2013. SJRMC-SOUTH BEND CAMPUS PART V, SECTION B, LINE 20D: PATIENTS WITH INCOME AT OR BELOW 150% 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 151% AND 400% OF THE FPG RECEIVE A PERCENTAGE DISCOUNT OFF OF HOSPITAL CHARGES FOR MEDICALLY NECESSARY SERVICES, BASED UPON A SLIDING SCALE. PART VI, LINE 2: NEEDS ASSESSMENTSAINT JOSEPH REGIONAL MEDICAL CENTER SOUTH 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: COMMUNITY INFORMATION - SAINT JOSEPH REGIONAL MEDICAL CENTER SERVES 960,783 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 0.3% FROM 2013 THROUGH 2018. COMPARED TO THE STATE OF INDIANA, THE SYSTEM SERVICE AREA HAS A LOWER PROJECTED POPULATION GROWTH, A HIGHER MEDIAN AGE AND THE GREATEST DECLINE IN FEMALES OF CHILD BEARING AGE 15-44 AT 1.2%. THE POPULATION AGED 65 AND OLDER REPRESENTS 16.6% OF THE TOTAL POPULATION, AND IS EXPECTED TO INCREASE 11.4% OVER THE NEXT FIVE YEARS. MEDIAN HOUSEHOLD INCOME IS BELOW THE RATE FOR THE STATES OF INDIANA, MICHIGAN AND OHIO AS WELL AS THE USA. THIRTY-TWO PERCENT OF THE POPULATION IN THE SYSTEM SERVICE AREA, EARN AN ANNUAL SALARY BELOW $25,000. 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.UNEMPLOYMENT HAS DECLINED 7% IN THE SYSTEM MARKET AREA SINCE JUNE 2011. THE CURRENT RATE OF 9.4% IS HIGHER THAN THE INDIANA RATE OF 7.8% AND THE NATIONAL AVERAGE OF 8.7% FOR JUNE 2013, THE MOST RECENT DATA AVAILABLE. MOODY'S RATES INDIANA AS RECOVERING. EDUCATION, HEALTHCARE, AND GOVERNMENT ARE THE MAJOR EMPLOYERS IN THE LOCAL ECONOMY.ESTIMATES OF THE UNINSURED IN THE SEVEN INDIANA COUNTIES IN THIS SERVICE AREA IS 107,422 AND RANGES FROM 14.3% IN FULTON COUNTY TO 21% IN ELKHART COUNTY; IN THE THREE MICHIGAN COUNTIES SERVED THE ESTIMATE OF UNINSURED IS 34,503, RANGING FROM 14.4% IN CASS COUNTY TO 15.9% IN BERRIEN COUNTY. THIS IS COMPARED TO A NATIONAL AND 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, IN 2011 15.6% OF FAMILIES LIVED IN POVERTY. THE STATE OF MICHIGAN'S PERCENTAGE WAS SLIGHTLY LOWER, AT 15.0%. SJRMC 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. 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 8.2% AS COMPARED TO 17% 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. ACCORDING TO A REPORT BY TRUST FOR AMERICA'S HEALTH AND THE ROBERT WOOD JOHNSON FOUNDATION, "F AS IN FAT 2013: HOW OBESITY THREATENS AMERICA'S FUTURE", APPROXIMATELY 31.4% OF HOOSIERS WERE CONSIDERED OBESE IN 2012. 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 WOMEN'S TASK FORCE: (WOMEN SURVIVORS OF VARIOUS FORMS OF CANCER)- PROVIDES MAMMOGRAMS AND PAP TESTS FOR THOSE UNABLE TO AFFORD THEMTHE COMMUNITY HEALTH PARTNERS OF SOUTH BEND, INC.:- BENDIX FAMILY PHYSICIANS (A HEALTH CENTER JOINTLY ESTABLISHED BY SJRMC AND MEMORIAL HOSPITAL) PROVIDES CARE AND HEALTH EDUCATION IN A DECLARED MEDICALLY UNDERSERVED AREA- VOLUNTEER PHYSICIAN NETWORK - PRIMARY CARE PROVIDERS AND SPECIALISTS CARING FOR THOSE UNABLE TO PAY OR ARE ON SLIDING FEE SCALEOUTREACH PROGRAMS FOCUSING ON:- CHRONIC DISEASE- NUTRITION- EXERCISE- SMOKING CESSATION- HEALTH FAIRS- SENIORS- PRE-NATAL SERVICES- COLLABORATION WITH OTHER AREA HEALTH CARE PROVIDERS TO ASSIST AND CARE FOR THE UNDERSERVED POPULATIONSJRMC-SOUTH BEND CAMPUS PROVIDED IN-KIND DONATIONS TO MANY AGENCIES INCLUDING THE FOLLOWING:- MEDICAL SUPPLIES AND DRUGS TO MISSION TRIPS- LUNCHES TO HOPE MINISTRIES - PRINTING SERVICES FOR LOCAL NON-PROFIT AGENCIESSJRMC SOUTH MADE SIGNIFICANT CONTRIBUTIONS TO:- UNITED WAY - AMERICAN HEART ASSOCIATION- SOUTH BEND MEDICAL FOUNDATION- CODE FOR AMERICA- SUSAN G. KOMEN- UNIVERSITY OF NOTRE DAME HARPER CANCER RESEARCH - LOGAN INC. (CENTER FOR PEOPLE WITH DISABILITIES)- DIOCESE OF FORT WAYNE/SOUTH BEND- WOMEN'S CARE CENTER- MARCH OF DIMES- REAL SERVICES - HANNAH'S HOUSE (HOME FOR PREGNANT WOMEN) - IU SCHOOL OF MEDICINE- LA CASA DE AMISTAD - COMMUNITY CENTER FOR LATINO MEMBERS PART VI, LINE 6: SAINT JOSEPH REGIONAL MEDICAL CENTER - SOUTH BEND CAMPUS IS A MEMBER OF CHE TRINITY HEALTH, THE SECOND-LARGEST CATHOLIC HEALTH CARE SYSTEM IN THE COUNTRY. CHE 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, CHE 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 CHE TRINITY HEALTH, VISIT WWW.NEWHEALTHMINISTRY.ORG. REPORTS FILED WITH STATES PART VI, LINE 7 IN 0 INDIANA UNIVERSITY FOUNDATION PO BOX 500 BLOOMINGTON IN 47402 356018940 501(C)(3) 45000 COMMUNITY BENEFIT LOGAN COMMUNITY RESOURCES INC 2505 E JEFFRERSON BLVD SOUTH BEND IN 46615 350965639 501(C)(3) 31000 SUPPORT AUTISM SAINT MARYS COLLEGE PO BOX 180 NOTRE DAME IN 46556 350868158 501(C)(3) 55000 COMMUNITY BENEFIT SOUTH BEND MEDICAL FOUNDATION 530 N LAFAYETTE BLVD SOUTH BEND IN 466011098 350868178 501(C)(3) 50000 COMMUNITY BENEFIT NATIONAL COUNCIL OF THE UNITED STATES 58 PROGRESS PARKWAY MARYLAND HEIGHTS MD 63043 355562362 501(C)(3) 30000 SPONSHORSHIP DINNER UNIVERSITY OF NOTRE DAME 100 GRACE HALL NOTRE DAME IN 46556 350868188 501(C)(3) 53250 SPONSHORSHIP EDUCATION MICHIGAN PUBLIC BROADCASTING CORPORATION DBA WNIT PUBLIC TELEVISION 300 WEST JEFFERSON SOUTH BEND IN 46601 351155594 501(C)(3) 7500 PLEDGE - CAPITAL CAMPAIGN BOYS AND GIRLS CLUB 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) 16000 SUPPORT OPERATIONS DICOESE 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) 12860 COMMUNITY BENEFIT LA CASA DE AMISTAD 746 S MEADE ST SOUTH BEND IN 46619 351350013 501(C)(3) 15175 COMMUNITY BENEFIT MARIAN HIGH SCHOOL 1311 S LOGAN MISHAWAKA IN 46544 351101600 501(C)(3) 6000 COMMUNITY BENEFIT NORTHEAST NEIGHBORHOOD REVITALIZATION 803 LINCOLN WAY WEST SOUTH BEND IN 46616 352118149 501(C)(3) 50000 COMMUNITY BENEFIT WOMENS CARE CENTER 360 N NOTRE DAME AVE SOUTH BEND IN 46601 351609945 501(C)(3) 25000 SPONSORSHIP REAL SERVICES INC 1151 S MICHIGAN SOUTH BEND IN 46634 351157606 501(C)(3) 15250 SPONSORSHIP ST JOSEPH'S HIGH SCHOOL 1441 NORTH MICHIGAN ST SOUTH BEND IN 46613 350924794 501(C)(3) 15000 SPONORSHIP COMMUNITY FOUNDATION OF ST JO COUNTY PO BOX 837 SOUTH BEND IN 46624 237365930 501(C)(3) 10000 COMMUNITY BENEFIT INDIANA UNIVERSITY FOUNDATION PO BOX 7111 SOUTH BEND IN 46634 356018940 501(C)(3) 17330 COMMUNITY BENEFIT MARCH OF DIMES FOUNDATION 1275 MAMARONECK WHITE PLAINS NY 10605 131846366 501(C)(3) 20000 COMMUNITY BENEFIT PHM EDUCATIONAL FOUNDATION 55900 BITTERSWEET ROAD MISHAWAKA IN 46545 351996785 501(C)(3) 15000 COMMUNITY BENEFIT GREATER ELKHART CHAMBER OF COMMERCE INC 418 S MAIN ST ELKHART IN 46516 350290590 501(C)(6) 6096 COMMUNITY BENEFIT NORTHERN INDIANA HISTORICAL SOCIETY FOUNDATION 808 WEST WASHINGTON ST SOUTH BEND IN 46601 310906405 501(C)(3) 15000 COMMUNITY BENEFIT SCHOOL CITY OF MISHAWAKA 1402 S MAIN ST MISHAWAKA IN 46544 351973986 501(C)(3) 25000 COMMUNITY BENEFIT CODE FOR AMERICA LABS INC 155 9TH ST SAN FRANCISCO CA 94103 271067272 501(C)(3) 50000 COMMUNITY BENEFIT 24 1 SCHEDULE I, 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 0 434245 0 167275 0 62185 0 59770 0 19768 0 743243 0 0 ROBERT CASALOU 0 417993 0 143567 0 57747 0 71479 0 25846 0 716632 0 0 UTHMAN CAVALLO MD 0 187093 0 0 0 448 0 5613 0 168 0 193322 0 0 JASON SCHULTZ 0 144267 0 0 0 214 0 7464 0 6534 0 158479 0 0 JANICE DUNN 0 280828 0 63623 0 24968 0 21050 0 16098 0 406567 0 0 JOSEPH SWEDISH 0 1402192 0 786411 0 1044897 0 572762 0 28714 0 3834976 0 520902 KEDRICK ADKINS 0 784856 0 366716 0 670047 0 112792 0 13375 0 1947786 0 265335 J RICHARD O'CONNELL 0 607209 0 284428 0 144773 0 97104 0 33319 0 1166833 0 0 KURT MEYER 0 209297 0 52111 0 1049 0 15400 0 17317 0 295174 0 0 KENNETH HALL 0 162705 0 45309 0 2297 0 14430 0 21236 0 245977 0 0 KHALEELUR REHMAN ZACKARIYA MD 338141 0 0 0 317 0 15266 0 21991 0 375715 0 0 0 SUNDAY OSUNNUGA MD 321411 0 0 0 461 0 19981 0 19332 0 361185 0 0 0 MARK MCGILLEM MD 318784 0 0 0 510 0 9110 0 8557 0 336961 0 0 0 THOMAS PERUMPILLYKADAN VARIED MD 317652 0 0 0 525 0 20000 0 24293 0 362470 0 0 0 F MONCRIEF DOBSON MD 196957 0 426 0 99057 0 25918 0 22274 0 344632 0 0 0 LORI PRICE 0 247226 0 29094 0 353 0 34259 0 19265 0 330197 0 0 AARON AUSTIN 0 45182 0 0 0 202824 0 7237 0 17264 0 272507 0 0 MICHAEL MURPHY 0 139488 0 0 0 41394 0 4650 0 11980 0 197512 0 0 CHRISTOPHER KARAM 0 206603 0 26064 0 295 0 18301 0 20502 0 271765 0 0 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 INDIVIDUALS RECEIVED SEVERANCE PAYMENTS IN CALENDAR 2012. THESE AMOUNTS ARE INCLUDED IN COLUMN B(III): AARON AUSTIN - $179,577 MONCRIEF DOBSON - $97,146 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 ($250,000 FOR 2012). THE FOLLOWING ACCRUALS FOR 2012 FOR THIS PLAN ARE INCLUDED IN COLUMN C OF SCHEDULE J, PART II: KEDRICK ADKINS - $100,292 ROBERT CASALOU - $44,129 ALBERT GUTIERREZ - $47,270 RICHARD O'CONNELL - $77,104 JOSEPH SWEDISH - $543,977 PART II: THE FOLLOWING INDIVIDUALS ARE VESTED IN A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP). THE FOLLOWING VESTED SERP AMOUNTS ARE INCLUDED IN COLUMN B(III) OF SCHEDULE J, PART II: KEDRICK ADKINS - $185,540 JOSEPH SWEDISH - $530,000 COLUMN F OF SCHEDULE J INCLUDES THE PORTION OF THESE AMOUNTS THAT WERE REPORTED AS DEFERRED COMPENSATION IN PRIOR YEARS. ERICA AUSTIN FAMILY MEMBER OF AARON AUSTIN, FORMER KEY EMPLOYEE 75585 EMPLOYMENT ARRANGEMENT 0 ELM ROAD MOB II LLC ROBERT CLEMENCY, DIR., HAS A GREATER THAN 5% INDIRECT INT IN ELM ROAD MOB 1113660 SJRMC - SOUTH BEND CAMPUS LEASES SPACE FROM ELM ROAD MOB II 0 LISA AUSTIN FAMILY MEMBER OF AARON AUSTIN, FORMER KEY EMPLOYEE 16542 EMPLOYMENT ARRANGEMENT 0 ELLEN BRUNEEL FAMILY MEMBER OF JOHN ROSENTHAL, OFFICER AND DIRECTOR 24589 EMPLOYMENT ARRANGEMENT 0 JEAN LOUISE HALL FAMILY MEMBER OF KENNETH HALL, KEY EMPLOYEE 53823 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, 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 AN ANNUAL BASIS. FORM 990, PART VI, SECTION B, LINE 15 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 ANNUAL REPORT (WHICH INCLUDES COMMUNITY BENEFIT MINISTRY INFORMATION) AND 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) CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 9: EQUITY TRANSFERS TO AFFILIATES -8,000,000. FORM 990, PART XII, LINE 2: SAINT JOSEPH REGIONAL MEDICAL CENTER-SOUTH BEND CAMPUS, INC.'S FINANCIAL STATEMENTS WERE INCLUDED IN THE FY13 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. 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