2013-11-12T13:41:28-06:00 2012-12-31 ERNST & YOUNG US LLP 111 MONUMENT CIRCLE INDIANAPOLIS IN 46204 990 2012-01-01 350868132 MEMORIAL HOSPITAL OF SOUTH BEND INC % JEFFREY COSTELLO MEMO 5746473549 615 N MICHIGAN STREET Suite SOUTH BEND IN 46601 JEFFREY COSTELLO 2013-11-11 3176817000 2012 2016-02-24 21:20:13Z PHILIP NEWBOLD 615 N MICHIGAN STREET SOUTH BEND IN 46601 609537279 false X www.qualityoflife.org X 1923 IN MEMORIAL IS COMMITTED TO IMPROVING THE QUALITY OF LIFE OF THE PEOPLE IN OUR COMMUNITY. 18 14 3339 589 149057 819 2067550 1981542 403545986 517868639 6436272 9231027 26871373 16425616 438921181 545506824 1040579 1085736 0 0 149522222 165536912 0 0 0 222451606 234107909 373014407 400730557 65906774 144776267 676052791 795383229 228701300 216061786 447351491 579321443 X MEMORIAL IS COMMITTED TO IMPROVING THE QUALITY OF LIFE OF THE PEOPLE IN OUR COMMUNITY. false false 82701377 219654384 Ancillary Services offers the following services for patients and facilities: - Imaging Services - Outpatient Physical, Occupational and Speech Therapy - Infusion Treatments - Radiation Oncology Therapy - Cancer Research - Cardiac Cath Lab - Sleep Lab - Interventional Radiology - Environmental Services - Nutritional Services - Pharmacy Services - Laboratory. 2012 Statistics for this service unit include: - 476,193 Inpatient procedures - 280,202 Outpatient procedures - 1,043 Inpatient Caths - 774 Outpatient Caths - 282,463 Outpatient visits - 560,114 Meals. 77945693 154515591 Patient Care Unit Services provides a wide variety of hospital services including: - Inpatient rehabilitation CARF accredited - Medical - Post surgical - Orthopedic - Oncology - Intensive and intermediate - Heart and Vascular - Mother and Child - Special Care Obstetrics - Neonatal Intensive Care Level III - Emergency - Trauma Level II - Pediatrics - Pediatric Intensive Care - Pediatric Hematology Oncology - Medical Flight program - Pediatric Intensive Care Transports. 2012 Statistics for this service unit include: - 106,772 Patient Days - 9,741 Inpatient ER visits - 46,842 Outpatient ER visits - 2,815 Births - 5,031 Observation stays - 274 Medical flights - 849 Full time equivalent employees. 63679083 156207112 Surgical Services provides the following services: - General Surgery - Vascular Surgery - Cardiac Surgery - Orthopedic Surgery - Gynecological Surgery - Trauma Surgery - GI Labs - Pulmonary Services - Pain Center - DaVinci Robotic Surgery. 2012 Statistics for this service unit include: - 4,728 Inpatient procedures - 166 Open Heart procedures - 8,525 Outpatient procedures. 101491123 1085736 325817276 true true false true false false false false false true true true false false true false false true false false true false false false false false true true true false true true true false false false false false false true true true false false false false false true true true false false true 382 0 true 3339 true true true false false false false false false false false false X 18 14 false false false false true true true true true false false true true true true true true true true true true IN X JEFFREY COSTELLO 5746473549 615 N MICHIGAN STREET SOUTH BEND IN 46601 X Robert Yount MD 2.0 40.0 X 0 928009 18664 Keith Sherry MD 20.0 20.0 X 174529 0 10272 Gerard Duprat MD 2.0 40.0 X 0 409261 12567 Maurice Hurwich MD 4.0 40.0 X 34756 0 2148 Carlton Lyons MD 2.0 0.0 X 4053 0 0 Charles Miller 2.0 0.0 X X 2106 0 0 Etta K Nevel MD 2.0 0.0 X 1264 0 0 M Rose Meissner 2.0 0.0 X X 4053 0 0 Steven Cramer 2.0 0.0 X 6672 0 0 Tracy Graham 2.0 0.0 X 3742 0 0 John Mathis MD 2.0 0.0 X 0 0 0 Steve Anderson MD 2.0 0.0 X 0 0 0 James Schwartz Sr 2.0 0.0 X 0 0 0 Jesse Hseih MD 2.0 0.0 X 0 0 0 Maria Slager 2.0 0.0 X 0 0 0 Perry Watson III 2.0 0.0 X X 0 0 0 Thomas Burish PhD 2.0 0.0 X 0 0 0 Ray Gans 2.0 0.0 X 0 0 0 Delores Wilmoski 2.0 0.0 X 0 0 0 Peter Baranay 2.0 0.0 X 0 0 0 Thomas Cassady Jr 2.0 0.0 X X 0 0 0 Philip Newbold 2.0 40.0 X 0 1382738 163374 Jeffrey Costello 2.0 40.0 X 0 631550 82813 Kreg Gruber 40.0 2.0 X 490564 0 89025 Cheryl Wibbens-Lesh MD 40.0 2.0 X 373273 0 14451 Robert Riley MD 40.0 0.0 X 243816 0 16427 Scott Thomas MD 40.0 0.0 X 342016 0 10154 Thomas Sutula MD 40.0 0.0 X 253538 0 18986 Mark Lavallee 40.0 0.0 X 239589 0 9876 Dale Patterson 40.0 0.0 X 251887 0 15714 2425858 3351558 464471 143 false true false SOUTH BEND MEDICAL FOUNDATION 530 N Lafayette Blvd SOUTH BEND IN 46601 Lab services 7572771 SOUTH BEND EMERGENCY PHYSICIANS 615 N MICHIGAN SOUTH BEND IN 46601 PHYSICIAN SERVICES 6662292 CERNER CORPORATION 2800 Rockcreek Parkway KANSAS CITY MO 64117 IT UPGRADES 4779619 GIBSON-LEWIS LLC 1001 WEST 11TH STREET MISHAWAKA IN 46601 GENERAL CONTRACTOR 2422792 MICHIANA ANESTHESIA CARE PC 416 E MONROE STREET SUITE 200 SOUTH BEND IN 46601 ANESTHESIA 1880988 85 694548 1286994 1981542 NET PATIENT REVENUE 621110 515807259 515807259 RENTAL REVENUE 532000 1824457 1824457 MEDICAL EDUCATION 611710 66321 66321 CASH DISCOUNTS 561499 89155 89155 AMBULANCE SUPPLY 621910 81447 81447 517868639 6905638 6905638 0 0 77100 77100 0 77100 77100 66341928 13916 64030455 2311473 13916 2325389 2325389 0 0 0 EMR 561499 4056735 4056735 TEAM PHARMACY 561499 2330986 2330986 ATHLETIC CLUB 713940 1784702 1784702 8176093 6120727 149057 1906309 16348516 545506824 530377087 149057 12999138 1085736 1085736 0 0 0 2591022 2591022 8386 8386 122229789 97661602 24568187 5223219 4173352 1049867 26691106 21326194 5364912 8793390 7025919 1767471 2028919 1621106 407813 250837 250837 261908 261908 13988 11176 2812 0 1074713 1074713 42579722 34021198 8558524 82841 66190 16651 4759977 3803222 956755 64715 51707 13008 0 7274736 5812514 1462222 881465 704291 177174 0 126746 101270 25476 4144698 3311614 833084 0 23945535 19132482 4813053 2492339 1991379 500960 MEDICAL SUPPLIES 74241670 59319094 14922576 BAD DEBT EXPENSE 26651375 26651375 CORPORATE FEE 21792041 17411841 4380200 HOSPITAL ASSESSMENT FEE 16892141 16892141 4547543 3633487 914056 400730557 325817276 74913281 0 19525 19625 53275792 42696731 383473 350135 63452162 76188790 0 0 0 0 0 0 12855237 13320218 972016 1212556 607666050 305962774 300146361 301703276 125744343 155470859 103904579 175410741 636912 596272 1171474 1171474 13490917 27242552 676052791 795383229 39971562 44241736 0 0 17765 20330 135263364 131550029 0 0 0 0 1593583 1418814 0 0 51855026 38830877 228701300 216061786 X 442868269 574182603 4483222 5138840 0 0 447351491 579321443 676052791 795383229 X 144776267 15850387 -28656702 X X false true X true true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 13988 13988 false false Lobbying Detail Schedule C, Part IV MEMORIAL HOSPITAL PAID DUES TO THE FOLLOWING ORGANIZATIONS FOR WHICH THE PERCENTAGE LISTED WAS ATTRIBUTED TO LOBBYING: AAFP (AMERICAN ACADEMY OF FAMILY PHYSICIANS) - 12.5% AASM (AMERICAN ACADEMY OF SLEEP MEDICINE) - 1% ACCC (ASSOCIATION OF COMMUNITY CANCER CENTERS) - 6% AMA (AMERICAN MEDICAL ASSOCIATION) - %55 AMERICAN ACADEMY OF SLEEP MEDICINE - 1% ANA (AMERICAN NURSES ASSOCIATION) - 79.45% APTA (AMERICAN THERAPEUTIC RECREATION ASSOCIATION - 12.44% AORN (ASSOCIATION OF PERIOPERATIVE REGISTERED NURSES) - FLAT AMOUNT $15.93 AOTA (AMERICAN OCCUPATION THERAPY ASSOCIATION) - 13% ASA (AMERICAN SOCIETY OF ANESTHESIOLOGISTS) - 20% ASET, INC - FLAT AMOUNT $10.50 ASIS INTERNATIONAL, INC - 5% ANFP (ASSOCIATION OF NUTRITION AND FOODSERVICE PROFESSIONALS) - 4% BRAIN INJURY ASSOCIATION OF INDIANA - 10% INDIANA HOSPITAL ASSOCIATION - 5.26% INDIANA OSTEOPATHIC ASSOCIATION - 9% INTERNATIONAL SOCIETY FOR CLINICAL DENSITOMETRY - 11% ISMA (INDIANA STATE MEDICAL ASSOCIATION) - 24% AADE (AMERICAN ASSOCIATION OF DIABETES EDUCATORS) - 25% SOCIETY OF TEACHERS OF FAMILY MEDICINE - 10% SOCIETY OF NUCLEAR MEDICINE - 2% TRAUMA CENTER ASSOCIATION OF AMERICA - 30% 22198822 1501904 1884305 923860 24661171 21769701 2155236 -543657 1182458 22198822 22665989 1296194 1929600 4122082 21769701 20595396 1076924 3137353 2143684 22665989 28741974 1278996 -6927657 2497917 20595396 0.78390 0.20840 0.00770 false true true 20935306 20935306 338561534 118099596 220461938 722092 709760 12332 228354193 184136270 44217923 19092925 3017148 16075777 301703276 ALTERNATIVE INVESTMENTS 175410741 F 175410741 0 ASSET RETIREMENT OBLIGATION 4512616 INTEREST RATE SWAP 30017119 CAPITAL LEASE PAYABLE 274683 IBNR 4026459 38830877 Intended uses of endowment funds Part V, Line 4 The Board has discretion to utilize each year the incomes, revenues, and profits arising and accruing from the endowments in defraying costs associated with the trust and the remainder for support, betterment, improvement, upkeep, expansion, and replacement of Beacon Health System, Inc. and its corporate affiliates. Term endowments, which are the Temporarily restricted net assets, are used as designated by the donor. The permanent endowment provides income to be used for health care educational purposes and patient care. FIN 48 (ASC 740) Footnote Part X, Line 2 Memorial Hospital did not have a footnote addressing Fin 48 (ASC 740) liabilities for uncertian tax positions. Memorial Hospital does not have any uncertian tax positions recorded during fiscal year 2012. 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615 N MICHIGAN STREET SOUTH BEND IN 46545

WWW.QUALITYOFLIFE.ORG X X X X X X MEMORIAL HOSPITAL OF SOUTH BEND INC 1 true true 200. true 350. true X X X X true true X X X true false X X X X true X false false 6 MEMORIAL SLEEP DISORDER CENTER

53990 CARMICHAEL DRIVE SOUTH BEND IN 46601

OUTPATIENT CLINIC PROVIDING SLEEP RELATED DIAGNOSIS AND TREATMENT MEMORIAL HEALTH PLEX

111 W JEFFERSON ST SOUTH BEND IN 46601

OUTPATIENT REHABILITATION FACILITY AND FITNESS FACILITY MEMORIAL BREAST CARE CENTER

100 NAVARRE PLACE SOUTH BEND IN 46601

OUTPATIENT DIAGNOSIS AND TREATMENT MEMORIAL CHILDREN'S THERAPY CENTER

100 NAVARRE PLACE SOUTH BEND IN 46601

OUTPATIENT DIAGNOSIS AND TREATMENT MEMORIAL RADIOLOGY

100 NAVARRE PLACE SOUTH BEND IN 46601

OUTPATIENT DIAGNOSIS AND TREATMENT MEMORIAL LIGHTHOUSE PHYSICAL THERAPY

6913 N MAIN STREET GRANGER IN 46530

OUTPATIENT DIAGNOSIS AND TREATMENT Part I, line 3c Not applicable Part I, Line 6a Creating community health is at the core of Memorial Hospital of South Bend, Inc.'s mission. Promotion of community health is our social responsibility and a key to long-term cost effectiveness. In addition, improving the health status of a community is as much a social, economic and environmental issue, as it is a medical one. Consequently, the organization takes a broad approach to creating community health. This approach has included: ongoing education of board members, staff and local leaders through Community Plunges (experiential activities to involve the community residents with a neighborhood-based agency), Community Foundation support, strategic allocation of tithing resources, a clear statement of vision and goals, a commitment to continuous quality improvement and promotion of volunteer involvement and community partnerships. Memorial Hospital tithes 10% of the previous year's bottom line and transfers it to the Community Benefit Fund for investment in the community. This investment is in addition to the Hospital's charity care and prevention and education activities supported through its operating budget. The Community Health Enhancement Committee of the Board makes ongoing policy and oversees the administration of the fund and determines specific investment allocations based upon the assets and needs of the community. Volunteers and staff are committed to prudently investing these resources in an accountable manner. As a community not-for-profit organization, we take seriously our responsibility to invest our resources and energies into understanding and meeting the divergent health care needs of all, and ensure that everyone, regardless of their ability to pay, receives the care they need. Memorial has long been recognized for the collaboration efforts which engage individuals and organizations with diverse socio-economic religious, ethnic, race, age, and gender identity characteristics. Our team of passionate and dedicated health care professionals, along with many partners throughout the Northern Indiana and Southern Michigan (Michiana) region, helped us contribute significantly to the health and well-being of our community. Further, Memorial plays a key role in serving the community as a whole. In 2011, public health system partners of St. Joseph County convened meetings to complete an assessment process to evaluate how well they are serving the public health and healthcare needs of the county's residents. The Indiana State Department of Health, in collaboration with Purdue University's Healthcare Technical Assistance Program - Population Health Initiatives Program created this opportunity for all local public health system partners to identify existing strengths, as well as opportunities to establish and formalize public health system infrastructure improvements in Indiana counties. Hosted by the St. Joseph County Health Department, St. Joseph County partners met to complete the CDC National Public Health Performance Standards, Local Public Health System Assessment - a nationally recognized public health system assessment tool. Approximately 163 healthcare and social service agencies exist to support the residents of 9 cities and towns and 13 townships. Public health system partners across the county are committed to enhancing systemic performance by engaging partnerships, support, and input, so that together we can better serve the residents of St. Joseph County. The assessment process and results enable a greater understanding of how the county's healthcare and public health organizations relate to one another and how they provide essential public health and healthcare services to the public they serve. The assessment specifically focused on areas such as communication, partnerships, linking people to needed services, and sharing of resources. The process will serve as the foundation to formalize processes that strengthen local public health system infrastructure with the capacity and resources to improve quality and effectiveness of healthcare services in St. Joseph County. A primary component of such a process may include a focus on partnerships and collaboration to ensure sustainability. What follows is a narrative of how we touch and improve the health and the quality of lives throughout Michiana. It is a testimony to the commitment and leadership of our medical staff, volunteer board of trustees, employees, auxiliary volunteers, and community partners, whose dedication to serve, touch many lives, and make our community a better place to live, work, and play. Part I, Line 7, Column F Bad Debt Expense removed from Total Expenses $26,651,375 Part I, Line 7a and 7b Unreimbursed Medicaid and Other Means Tested Government Programs In 2012, total offsetting revenue for Line 7b, Medicaid did not include amounts that were received in 2012 that related to prior years. Those amounts are Hospital Assessment Fee (HAF) payments for 2011 in the amount of 18,556,000, along with Disproportionate share hospital (DSH) settlements of 52,953,000 that related to 2010 and 2011 settlement of an appeal, and 3,088,214 of BNA (Rural floor budget neutrality act) monies. Additionally, for 2012, HAF payments made in 2012 that related to 2011 in the amount of 5,630,714 were excluded from the computations for Worksheet 2, cost to charge ratio. Part I, Line 7g Not applicable Costing Methodology Part I, Line 7 Donations - the actual cost of the donation or departmental net contribution, whichever is appropriate, from General Ledger records and reports are included. In-Kind/Volunteer Services - When a specific person is listed as the event volunteer, the YTD hourly wage is pulled from the labor distribution report for 12/31, multiplied by the number of hours at the event or events. When a specific job class is listed (i.e. "peds rehab"), the average hourly wage is computed for all employees in that job class and department and used in the same manner. Benefits are added to each at a ratio of benefit dollars to total salaries, multiplied by total salaries calculated for the event. Part III, Line 4 The Corporation evaluates the collectability of its accounts receivable based on the length of time the receivable is outstanding, payor class, and the anticipated future uncollectible amounts based on historical experience. Accounts receivable are charged to the allowance for doubtful accounts when they are deemed uncollectible. The costing methodology is the same as the tax form 990, schedule H, worksheet 2 methodology. Patient care cost is adjusted by non-patient activity, expenses, and patient care charges. Rationale for inclusion of the Medicare shortfall as a Community Benefit Part III, Line 8 Participation in the governmental Medicare program does not provide the opportunity for a hospital to negotiate a reimbursement rate or structure that would allow the hospital to cover the cost of the medical service rendered to the program participant, as would be the case in contractual negotiations with commercial insurance companies. Nor is the hospital allowed to provide only the services for which reimbursement covers the direct cost of care. This produces the same shortfall outcome as does the participation in the Medicaid program. The Medicaid program is recognized as a community benefit on Schedule H and on community benefit reports for most states. The quality and cost of the patient care is the same regardless of payor source. Hence the acceptance of Medicare reimbursement represents a reduction or relief of the government burden to pay the full cost of care provided. Financial Assistance Policy Part III, Line 9B The collection policy and procedures related to patients who are known to qualify for charity care or financial assistance are as follows: To ensure the Hospital fulfills its mission and commitment to the poor, the Hospital shall annually plan for and provide free health care and health-related services to the poor and qualified uninsured/underinsured. A patient is considered for Financial Assistance if all other State and Federal assistance opportunities have been exhausted. The Federal Income and Poverty Guidelines serve as a guide in determining those patients that may qualify for Financial Assistance. All patients shall be treated consistently in the approval process including Medicare and non-Medicare patients. PURPOSE: To provide financial assistance to those patients who cannot afford to pay and to provide discounted care to uninsured patients receiving healthcare services from Memorial Hospital of South Bend. PROCEDURE: 1.Memorial Hospital will assist patients in making a determination regarding whether or not the patient may be able to qualify for some form of entitlement through a Federal or State Government program and complete the appropriate applications for assistance. It is required that the patient will assist in the determination and application process. If the patient does not qualify for any Federal or State Assistance we will start the Financial Assistance Approval process. 2.Identify patients potentially eligible for Financial Assistance through the pre-registration, admission, eligibility process, or through self-pay account review and collection activities. 3.Provide a Financial Evaluation form to the patient. 4.Obtain or receive a signed, completed Financial Evaluation Form from the patient. 5.Determine eligibility by obtaining the following information from the patient: a)Gross income and most recent W-2; b)Prior year's tax return (including all schedules); c)Last 3 pay stubs (if unemployed, Work One statement of earnings); d)Employment status and future earnings capacity; e)Family size; f)Medical expenses including drugs and medical supplies; g)Last three bank statements. If the patient does not have a prior year tax return, we will make our determination based on current income. A credit report may be run to substantiate documentation. There may be circumstances where a patient may not be able to provide all the above documentation needed to approve financial assistance. It will be up to the discretion of the Department Director and/or the CFO to grant approval in this circumstance. 6.Determine the amount of Financial Assistance by utilizing the Federal Poverty guidelines as a basis for qualification levels. Gross Annual income plus cash assets are used as the basis for income calculations. Financial Assistance will be granted for those patients who are homeless. If a patient is deceased and has no estate, we will grant charity on any outstanding self-pay account balances. Documentation that an estate has not been filed will be attached to the Financial Assistance approval form. Note: Approval may be made based on Medical indigence (I.E. Patients who have excessive pharmacy, oxygen, or ongoing medical expense). This amount would be deducted from their gross income. Financial Assistance will not be granted for non-medically necessary services. 7.Complete the Financial Assistance Approval form and forward to the Collection Coordinator. 8.The Collection Coordinator will review the Financial Assistance application to ensure that it is complete. The Coordinator will approve or deny the application before sending it to the Patient Account Manager for approval. Depending on the dollar amount of the financial assistance write off, approval signatures are required. The approval guidelines are as follows: $1.00 to $2,500.00 Collection Coordinator $2,501.00 to $10,000.00 Patient Account Service Manager $10,001.00 to $25,000.00 Director, Patient Account Services $25,001.00 and above Vice President, CFO 9. After all the appropriate signatures have been obtained, the Financial Assistance write-off along with the corresponding documentation will be forwarded to Cash Application for write-off. 10.Send determination letter to notify patient of the approval for Financial Assistance 11.Financial Assistance approvals will apply retroactively to all open accounts with existing balances (including accounts in collections) and will be active for 6 months following the date of approval. 12.The document will be placed in the Financial Assistance file drawer under the date the write off was posted. UNINSURED SELF PAY DISCOUNTS: For those patients who have no insurance and do not meet the above financial assistance guidelines, Memorial Hospital will provide an uninsured discount based on the following tiered structure: 30% discount if account is paid within 30 days from date of service 20% discount if account is paid within 90 days from date of service 10% discount if patient chooses to participate in the CarePayment financing Any exceptions must be approved by the Department Manager or Director. Measures to Publicize Financial Assistance Policy Part V, Line 14g WALL SIGNAGE CAN BE FOUND THROUGHTOUT THE HOSPITAL AND SPECIFICALLY IN EMERGENCY ROOMS, WAITING ROOMS, AND ADMISSION OFFICES DIRECTING PATIENTS TO THE FINANCIAL ASSTANCE POLICY ON THE HOSPITAL WEBSITE. Maximum Amount to be charged to FAP-eligible individuals Part V, Line 20d TO DETERMINE THE MAXIMUM AMOUNTS THAT CAN BE CHARGED TO FAP-ELIGIBLE INDIVIDUALS FOR EMERGENCY AND OTHER MEDICALLY NECESSARY CARE, MEMORIAL HOSPITAL USED THE AVERAGED DISCOUNT FOR THE THREE CONTRACTS THAT HAD THE HIGHEST PERCENT DISCOUNT TO CHARGES (EXCLUDING ALL PER DIEM AND CASE RATE CONTRACTS). Needs Assessment Part VI, Line 2 The Patient Protection and Affordable Care Act's mandate for non-profit hospitals to complete a Community Health Needs Assessment (CHNA) to guide the evaluation of community health priorities was a major focus of activity in 2012. Memorial Hospital, in partnership with St. Joseph County Health Department, successfully completed a CHNA that includes the elements required by the Patient Protection and Affordable Care Act; specifically: 1) Input from representatives of the broad community through a random telephone survey of 599 individuals, a Latino survey, interviews with key informants, and a number of focus groups, 2) Input from public health experts was evidenced as the St. Joseph County Health Department team members were in partnership with Memorial Hospital in both the preliminary work with the local health system conducted by Purdue University and the Behavioral Risk Factor Surveillance System based survey, 3) the CHNA is Made widely available to the public first at a press conference which was aired on two local television stations and covered in the local newspaper, the South Bend Tribune, and is posted on the Hospital's website www.qualityoflife.org/chna, as well as posted on the County Health Department's website, www.stjosephcountyindiana.com/departments/sjchd/PDFs/MemHospSouthBend.pdf, and attainable in paper-copy upon request, 4) the CHNA Forms the basis for a written implementation strategy to address identified needs, with explanation if those needs are not addressed, and 5) it Provides the foundation for the Community Health Needs Assessment as reported herein. Approval, based upon allocated budget funding, was given by way of a signed resolution by the Memorial Hospital Board on May 23, 2013. Patient Education and Eligibility for assistance Part VI, Line 3 When uninsured patients present to our hospital, they are offered the opportunity to meet with our eligibility specialists. Our eligibility specialists discuss the potential eligibility of the patient for multiple assistance programs, including our own internal financial assistance program. Our statements also include a notice that financial assistance is available to patients, and they can contact our customer service group for guidelines. Community Information Part VI, Line 4 Community Information (geography and demographics) Established in 1830, St. Joseph County, Indiana has become the fourth largest county in the state of Indiana. The county spans 467 square miles, which includes a comfortable mix of rural cultural heritage and urban amenities. St. Joseph County is also the regional center for higher education. The county is home to more than eight colleges and universities including but not limited to Notre Dame University, Indiana University, Purdue University, Holy Cross College, Bethel University and St. Mary's College. The heart of the Hospital is located within a mile of the University of Notre Dame, 10 miles south of the Michigan state line, and 40 miles east of Lake Michigan. Through the years, the environment of South Bend, the largest city in St. Joseph County, has changed from a focus on manufacturing (Studebaker, Bosch, and Uniroyal) to one of service industry. In fact, among the ten largest employers in the county, just two represent manufacturing. The University of Notre Dame is the largest employer, followed by Memorial Health System, the South Bend Community School Corporation, AM General, and St. Joseph Regional Medical Center. St. Joseph County, the five contiguous counties comprising its secondary service area and 12 counties in its tertiary service area are characterized by a mix of small to mid-size metropolitan areas and rural communities. Population mix is diverse and includes large numbers of first-generation European, African, Middle Eastern immigrants, African Americans, Asians, Hispanics, and Amish. The population for St. Joseph County in 2012 was estimated at 266,000 individuals. The racial statistics in the County are 75.1% Caucasians, 13% African America, and 7.7% Hispanic. As expected, with an area well-saturated with post-secondary educational institutions, the county has higher than would be projected educational level. 87.5 percent of the population are high school graduates, and 26.2% have a bachelor's degree or higher. The median household income was $45,183; persons below poverty level acoounted for 16% of the population. Of the primary and secondary Memorial service area, St. Joseph County is the largest, followed by Elkhart County estimated at 200,000. Elkhart County continues to have an industrial focus as a major center of the automotive, recreational vehicle, manufactured housing and musical instrument industries. Additional secondary service area counties and their estimated populations include Berrien (MI) 156,000, LaPorte (IN) 111,000, Cass (MI) 52,000 and Marshall (IN) 47,000. Our service area includes patients from St. Joseph and surrounding counties in Indiana and Michigan; a pediatric emergency transport program serving 18 counties and our MedFlight helicopter that covers communities within a 150-mile radius. We have the region's only Level 3 Newborn Intensive Care Unit, the only Pediatric Intensive Care Unit and the only Pediatric Hematology/Oncology program in the area. Memorial is also the only hospital in the region with Pediatric Hospitalist and Child Life programs. Memorial is not only recognized nationally as a leader in providing high quality care, but also as a leader in innovation, offering new approaches to patient satisfaction and customer service that set us apart from other health care providers. As the region's only designated children's hospital, Memorial Children's Hospital welcomes and treats children with a wide variety of medical and surgical diagnoses from more than 20 referral hospitals throughout Southwestern Michigan and Northern Indiana. Our world-class team includes pediatric hospitalists and intensivists, registered nurses, child life specialists, pediatric diabetic educators, pediatric dietitians, social workers, neonatologists, pediatric oncologists, respiratory therapists, clinical nurse specialists, pastoral care, and pediatric specialists in physical therapy, pulmonary medicine and infectious disease. Memorial Hospital and Health System also serves the community with Memorial Neighborhood Health Center - Southeast Clinic, and the Central Neighborhood Clinic at the Center for the Homeless. These two clinics offer primary health care services including all basic services as well as family planning and reproductive health, low-risk obstetrics, and colonoscopy services. Services are available to anyone, and our fees are within the customary range for the community. We accept Medicaid, Medicare and private insurance, and offer a sliding fee scale based on income guidelines for uninsured. We also participate in Hoosier Healthwise, the CHIP program that provides healthcare for Indiana children, pregnant women and low-income families. Other hospitals in our region include: St. Joseph Regional Medical Center, Elkhart General Hospital, Goshen Hospital and Lakeland Health Care. An affiliation with Elkhart General occured in 2010. Education and Research for a Healthy Future We consider education and research to be part of our mission. Each is vital to preparing the next generation of health care professionals to meet future health care demands. As our country ages, we will need more caregivers than ever before; at the same time, there is a shortage of new graduates in key clinical and technical positions. To ensure that we have the quality workforce we need to care for our patients in the future, we are committed to the education of current and future caregivers, and have partnered with local high schools, colleges, universities and Indiana University Medical School at Notre Dame. Preparing for tomorrow's health care needs also requires a commitment to researching new and innovative treatments that battle tomorrow's health care challenges. Clinical research is a part of programming across the Health System. Memorial Medical Group participates in a significant number of pharmaceutical trials annually; physicians in the Hospital participate in various research projects that are national in scope and are evaluated by FDA guidelines by Memorial's Institutional Review Board. Memorial is also a member of an Oncology Consortium which does cancer-related research. Our medical and health care staff are working to find tomorrow's treatments and cures today. Research also evolves from the nursing, pre-medical and social service disciplines at the local post-secondary education institutions. The University of Notre Dame is a close partner in community-based research, which includes evaluating education curricula, intervention modalities, and quantitative analysis as well as qualitative research methods. Together, we offer a comprehensive learning experience for medical students, enabling interns, residents, and fellows to utilize our state-of-the-art training facilities and integrate advanced technology learned in the classroom directly with patient care. We further the evidence of community-based research in addition to clinical research, particularly in the intersection of neuroscience and medical interventions, such as the impact of chemotherapy on the memory and cognitive functioning of breast cancer victims. Community Building Activities Part VI, Line 5 All information included in Part VI, Line 1, see "Other Information Required." Part VI, Line 6 Affiliated Health Care System Roles Memorial's Community Health Enhancement (CHE) division continued its 24 year tradition of "Plunges" by immersing attendees into a timely, health- impacting issue when it delved into the issue of cyber-bullying (using the Internet and related technologies to deliberately harm others). The following practices were established from the Plunge to create an issue-responsive product to combat cyber-bullying, 1) Launching Memorial's Anti-bullying Campaign partnership with the South Bend Community School Corporation. The campaign uses high-profile and contemporary tools such as billboards and websites to educate residents of all ages on modern bullying; 2) Commissioning the development and creation of "The Take Ten Crew vs. the Cyberbully," an animated comic book designed and created by teens through the Robinson Community Learning Center. This comic book will serve as an important curriculum resource in local schools to educate children on how they can respond to bullying; 3) Finalizing the development of the nanotechnology hands-on science kits for use in local classrooms. CHE commissioned the Elkhart-based professional science education organization Ethos to develop three standards-based kits for three different grade levels. The kits made their debut at The National Science Teachers Association conference in March 2012, attended by more than 10,000 educators, where the nanotechnology received rave reviews. HealthWorks! Kids' Museum was conceived as an innovative investment that goes to the very core of the System's Mission: "Improving the quality of life of those who live in our community." Creating a new kind of learning environment for children and families to explore why and how to make healthy decisions about his or her life may ultimately provide the most powerful long-term leverage for accomplishing Memorial's mission. With schools as primary partners, the business plan for HealthWorks! is directed at connecting and cultivating relationships with every growing family in the service area. A HealthWorks! Hummer allows interactive health education programs to be taken to schools and other learning traditional and non-traditional venues to promote healthy living. More than 70,000 children and adults participate in HealthWorks! experiences each year. Several initiatives are under way promoting the replication of HealthWorks! in other communities around the country. Education and supportive programming are key factors to healthy aging. Support groups, including Alzheimer's Services, Diabetes, Ostomy, Arthritis, Women-in-Touch, various cancer survivors, and Self-help for the Hard of Hearing (S-H-H-H), and numbering more than 3,000 people meet regularly at various locations on campus. "Aging in Place" is an innovative partnership program that enables older people to remain independent in their own homes as they are surrounded by a caring community of peers. A nurse and life skills administrator further facilitate independence and community building. The program is experiencing steady and continued growth, keeping pace with the needs within the community as the desire to remain independent becomes an increasingly relevant issue for more and more families. New developments in 2012 included opening a third location, and drawing upon Aging in Place experiences to create a gerontology component for higher education programs. Developed in partnership with Saint Mary's College, there are three modules that can be presented in a seminar format, including Communicating with the Elderly, Depression and Dementia, and Working with Seniors in Poverty. Programming at "BrainWorks" supports a platform to expand the knowledge of brain health. While the focus continues to be on holistic health, brain health as a key component to well-being, which can contribute towards the prevention of neurodegenerative disorders, improve rehabilitation and recovery from trauma, and enhance productivity and capabilities to be realized in the later years. BrainWorks and its programs and services aimed at translating advances in neuroscience into understandable and actionable steps became known to more locally, nationally, and internationally in 2012, laying the groundwork for additional collaborative opportunities. Major highlights include, 1) the expansion of awareness of BrainWorks, including a citation in the National Geographic Brain Health book, guest presenting in American Society of Aging webinars, and the creation and implementation of BrainWorks webinars. BrainWorks was also honored with the Reb Zelman Lifetime Achievement Award at the Sage-ing International Conference, for their significant contribution in the field of conscience, cognitively healthy aging. In 2012, the community's attention was focused on early brain development through the build-out and grand opening of "Little Noggins' Nook" at HealthWorks! Kids' Museum, representing a community investment of more-than $150,000. This high-level, interactive activity center builds upon previous developmental centers established in three agencies serving vulnerable women and children, including the YWCA's residence for battered and addicted women, St. Margaret's House, a day center for homeless women and children, and the Youth Services Bureau for younger women without homes and families to help nurture their infants. "Talk with Your Baby" was an initiative that mushroomed throughout the community, encouraging parents to speak with their infants and children to sponsor brain development. Dr. Art Kramer presented the 2012 Mary Morris Leighton Lecture and continuing medical education of which over 450 attended the community event, as well as nearly seventy physicians at the CME brain health program. BrainWorks continues to offer a wide variety of services with and to an expanded list of community partners, including Northern Indiana Alzheimer's and Dementia Services (Brain Games Challenge), Holy Cross Gerontology Institute (Conference sponsorship and speakers), Palmer Funeral Home, The Saint Joseph County Public Library (Science Alive), East Bank Learning Center, the University of Notre Dame (Innovation Studio and IRB approved chemo-brain research), and American Senior Communities (Community Educational Events). CHE's School Team offers evidence-based prevention programs within South Bend's middle schools. Approximately, 4,000 students are reached with programs focusing on developing the skills necessary to prevent pregnancy, HIV, and other sexually transmitted infections. It was a year of transition, change, and professional development for the team. Receiving the St. Joseph County VOICE grant, enabled programs to inspire high-school students to advocate against the tobacco industry attempts to recruit teens as new smokers. Anti-tobacco programs are held in South Bend, Mishawaka, Penn Harris Madison, and Rolling Prairie High Schools. Finally, developed a new program for South Bend Community School Corporation parents in collaboration with the Robinson Community Learning Center, titled Sex, Bullying, and Making Good Decisions. The System's innovative community outreach has received national recognition for models of involvement as well as state and federal grants to assist in the support some of these programs. Programs include: African-American Women in Touch - breast care education and screening programs, the PEDS developmental delay screening program for infants 0 to 3 years of age which is offered at the St. Joseph County WIC clinics, the YWCA, the Center for the Homeless, and health education and outreach in the Latino community, including a unique diabetes education and case management program that has had significant results. More than 300 Type II diabetics participated in the program with only one diabetes related hospitalization. The Special Populations' division experienced considerable growth in 2012, and highlights included being named a recipient of the Jackson Healthcare Charitable Service Program of Excellence Award for the culturally appropriate Diabeticos Saludables. Most exciting in 2012 was launching an ambitious pilot program that draws upon lessons learned from the successful Diabeticos Saludables program and utilizes Community Health Workers (CHWs) to assist individuals in managing their diabetes. The CHW model trains non-health professional community members to serve as a link or liaison between health and social services and clients. CHWs use relationship as well as cultural and language skills to make health and disease management more understandable and health care access less intimidating. With the pilot program, CHWs are recruiting clients for education and case management services through Memorial's Emergency/Trauma Center and patient-care units and Memorial Medical Group clinics. The Special Populations developed the Community Health Worker training curriculum in collaboration with Ivy Tech State Community College. This program will strive to meet the Indiana Health Professions Bu true GRACE COMMUNITY CENTER INC PO BOX 1671 SOUTH BEND IN 46634 351900380 501(C)(3) 25000 CONTRIBUTION HABITAT FOR HUMANITY OF ST JOSEPH COUNTY 402 E SOUTH ST SOUTH BEND IN 46601 311196894 501(C)(3) 10000 WOMEN BUILD 2012 NORTHEAST NEIGHBORHOOD REVITALIZATION ORGANIZATION 803 LINCOLNWAY WEST SOUTH BEND IN 46616 352118149 501(C)(3) 50000 CONTRIBUTION SJC BRIDGES OUT OF POVERTY INC 117 N LAFAYETTE BLVD SOUTH BEND IN 46601 263195466 501(C)(3) 47860 CONTRIBUTION BOYS & GIRLS CLUB OF ST JOSEPH COUNTY 1411 LINCOLNWAY WEST SOUTH BEND IN 46544 351329625 501(C)(3) 105000 EDUCATIONAL ENRICHMENT PROG THE CENTER FOR THE HOMELESS 813 South Michigan SOUTH BEND IN 46601 351768544 501(C)(3) 100000 PEDS PROGRAM INDIANA UNIVERSITY SCHOOL OF MEDICINE 1234 Notre Dame Ave Raclin-Carmichael HalL SOUTH BEND IN 46617 356001673 501(C)(3) 15000 2012 MEDICINE BALL SPONSOR UNIVERSITY OF NOTRE DAME MAIN BUILDING Notre Dame IN 46556 350868188 501(c)(3) 68222 CONTRIBUTION SOUTH BEND HERITAGE FOUNDATION INC 803 Lincolnway West SOUTH BEND IN 46616 237394320 501(c)(3) 21000 CONTRIBUTION UNITED WAY OF ST JOSEPH 3517 E Jefferson SOUTH BEND IN 46660 351063368 501(c)(3) 50000 CONTRIBUTION A ROSIE PLACE 53131 QUINCE ROAD SOUTH BEND IN 46628 371523448 501(C)(3) 36000 CONTRIBUTION AMERICAN HEART ASSOCIATION INC 7272 GREENVILLE AVE DALLAS TX 75231 135613797 501(C)(3) 7500 2013 SPONSORSHIP CENTER FOR HISTORY 808 w WASHINGTON SOUTH BEND IN 46601 351124156 501(C)(3) 15000 SPONSORSHIP ETHOS INC 2521 INDUSTRIAL PKWY ELKHART IN 46516 912094413 501(C)(3) 7000 CONTRIBUTION HEALTHY COMMUNITIES INITIATICE OF ST JOSEPH COUNTY 401 E COLFAX AV SOUTH BEND IN 46617 351994551 501(C)(3) 12537 CONTRIBUTION NEW GENERATIONS CHRISTIAN MINISTRY 431 SUMMIT DR SOUTH BEND IN 46619 432028706 501(C)(3) 10000 CONRIBUTION CANCER SOCIETY OF ST JOSEPH COUNTY INC 919 E JEFFERSON BLVD SOUTH BEND IN 46617 350872359 501(C)(3) 15000 2012 SPONSORSHIP SALVATION ARMY 900 W WESTERN AVE SOUTH BEND IN 46601 381359297 501(C)(3) 150000 CONTRIBUTION SOUTH BEND COMMUNITY SCHOOLS 215 S ST JOSEPH STREET SOUTH BEND IN 46601 351076622 501(C)(3) 27240 CONTRIBUTION SOUTH BEND MEDICAL FOUNDATION 530 N LAFAYETTE BLVD SOUTH BEND IN 46601 350868178 501(C)(3) 12500 2012 SPONSORSHIP 20 GRANT MONITORING PROCEDURES SCHEDULE I, PART IV Donations and grants given to organizations that improve the health and well-being of our community are monitored through Outcome Measurement Reports that are provided to Memorial by the various organizations. These reports inform us of how the donations and grants were used. false true false false false true true Philip Newbold 0 661503 0 326180 0 395055 0 152094 0 11280 0 1546112 0 0 Jeffrey Costello 0 336447 0 114704 0 180399 0 78239 0 4574 0 714363 0 0 Robert Yount MD 0 901782 0 22663 0 3564 0 10000 0 8664 0 946673 0 0 Keith Sherry MD 174529 0 0 0 0 0 4797 0 5475 0 184801 0 0 0 Gerard Duprat MD 0 353703 0 50000 0 5558 0 5051 0 7516 0 421828 0 0 Kreg Gruber 363323 0 107681 0 19560 0 73810 0 15215 0 579589 0 0 0 Cheryl Wibbens-Lesh MD 304619 0 60120 0 8534 0 8140 0 6311 0 387724 0 0 0 Robert Riley MD 217443 0 21355 0 5018 0 13452 0 2975 0 260243 0 0 0 Scott Thomas MD 341800 0 0 0 216 0 10154 0 0 0 352170 0 0 0 Thomas Sutula MD 224993 0 22162 0 6383 0 13903 0 5083 0 272524 0 0 0 Mark Lavallee 209132 0 25757 0 4700 0 5889 0 3987 0 249465 0 0 0 Dale Patterson 226234 0 25423 0 230 0 8983 0 6731 0 267601 0 0 0 HEALTH CLUB Schedule J, Part I, Line 1A MEMORIAL HEALTH SYSTEM, INC. (MHS) REIMBURSES TRUSTEES FOR THE TAX EFFECT OF THE 1099 REPORTABLE BENEFITS FOR HEALTH CLUB MEMBERSHIP, WITH MHS'S HEALTH AND LIFESTYLE CENTER, AND SPOUSAL TRAVEL. THIS REPORTING IMPACTS 6 VOTING BOARD MEMBERS. MHS ALSO REIMBURSES FOR DIRECT EXPENSES RELATED TO ANY TRAVEL ON THE ORGANIZATION'S BEHALF. SPOUSAL TRAVEL WAS INCLUDED IN TAXABLE COMPENSATION FOR 3 EMPLOYEES (PHILIP NEWBOLD, KREG GRUBER, AND JEFFREY COSTELLO). These expenses were paid by the parent org (MHS) and charged back to the MHSB and reported as an expense to the Hospital as if paid directly by the hospital in Part IX and in Part VII. EXECUTIVE RETENTION PLAN Schedule J, Part I, Line 4B Beacon Health System implemented an Executive Retention Plant to attract and retain key employees by providing additional deferred compensation. The Chief Executive Officer will participate in the plan and will select other participants pursuant to the guidelines set by the Employer's Board of Directors. The Employer may make contributions under the plan and has sole discretion over whether to make a contribution. Vesting occurs on January 1 of the fifth year for which such contributions are made for participants who have been continuously employed. COMPENSATION CONTINGENT ON NET EARNINGS Schedule J, Part I, Line 6A & 6B The related organization has 3 incentive plans (employee, management AND EXECUTIVE) which have a net operating income to budget measurement for the payout threshold. The employee plan shares the excess over budgeted net operating income with the non-management employees for Memorial Health System, Inc and the affiliated entities which includes Memorial Hospital of South Bend, Inc. The employee incentive pool has a maximum cap of $3,000,000. The management incentive plan pays a sliding percentage of base compensation if the net operating income is equal to or greater than 80% of the budgeted net operating income. The sliding scale caps when operating income reaches 120% of the budgeted operating income. EXECUTIVES ARE COVERED UNDER THE BEACON HEALTH SYSTEM EXECUTIVE SHORT-TERM INCENTIVE PLAN (ESTIP). THE ESTIP PAYS A SLIDING PERCENTAGE OF BASE COMPENSATION IF THE NET OPERATING INCOME IS EQUAL TO OR GREATER THAN 80% OF THE BUDGETED NET INCOME. THE SLIDING SCALE CAPS WHEN OPERATING INCOME REACHES 120% OF THE BUDGETED OPERATING INCOME. A HOSPITAL AUTHORITY OF SAINT JOSEPH COUNTY 356311914 79061BCQ6 2007-05-10 80000000 Health Care Capital Improvments false false false B HOSPITAL AUTHORITY OF SAINT JOSEPH COUNTY 356311914 79061BCP8 2006-03-16 38580000 REFUND BONDS ISSUED 12/12/2000 false false false C HOSPITAL AUTHORITY OF SAINT JOSEPH COUNTY 356311914 79061BCx1 2008-08-28 39915000 REFUND BONDS ISSUED 02/20/2003 false false false D HOSPITAL AUTHORITY OF SAINT JOSEPH COUNTY 356311914 000000000 2008-07-02 2147750 Health Care Equipment Financing false false false A 0 0 84814783 0 0 0 762312 0 0 84052471 0 0 2009 false false true true B 350000 0 45510172 0 0 0 467934 775830 0 44266408 0 0 2000 false true true true C 3545000 0 39915049 0 0 0 577504 0 0 39337545 0 0 2003 true false true true D 0 0 2147750 0 0 0 0 0 0 2147750 0 0 2008 false false true true A false false true true false 0.00000 0.00000 0.00000 false false 0.00000 false false B 0 C false false true true false 0.00000 0.00000 0.00000 false false 0.00000 false false D false false true true false 0.00000 0.00000 0.00000 false false 0.00000 false false A false false false true true false 0 true HYPO PUBLIC FINANCE 3.2 true false false B false false false true true true WELLS FARGO BANK NA 21.7 false false false 0 false false C false true true true true WELLS FARGO BANK NA 23.6 false false false 0 false false D false true true false false 0 false 0 false false A false B false C false D false PART II, LINE 3, Columns A, B, & C 0 THE DIFFERENCE BETWEEN THE TOTAL PROCEEDS OF THE ISSUE AND THE ISSUE PRICE IS INVESTMENT EARNINGS. PART II, LINE 11, Columns B & C 0 PRINCIPAL OF AND INTEREST ON REFUNDED BONDS. PART III, Column B 0 COLUMN B IS NOT COMPLETED BECAUSE SUCH BONDS WERE ISSUED AFTER 12/31/2002 TO REFUND BONDS ISSUED BEFORE 01/01/2003. PART III, LINE 4 0 IN AUGUST 2008, THE HOSPITAL AUTHORITY OF ST. JOSEPH COUNTY, ON BEHALF OF THE CORPORATION, ISSUED REVENUE REFUNDING BONDS IN THE PRINCIPAL AMOUNT OF $39,915,000 TO REFUND SERIES 2003 BONDS. THE SERIES 2003 BONDS WERE USED TO FINANCE VARIOUS CAPITAL PROJECTS INCLUDING THE HEART AND VASCULAR CENTER. AS PART OF THE PLANNING FOR THE SERIES 2003 BONDS, THE MEMORIAL HOSPITAL MANAGEMENT TEAM PLANNED FOR PRIVATE USE OF THE FIRST FLOOR OF THE HEART AND VASCULAR CENTER. AFTER PLANNING FOR THE PRIVATE USE OF THE FIRST FLOOR THE MEMORIAL MANAGEMENT TEAM CONSULTED BOND COUNSEL WHO ADVISED THAT THE FIRST FLOOR SHOULD BE FUNDED THROUGH EQUITY. MEMORIAL HOSPITAL FOLLOWED BOND COUNSEL'S RECOMMENDATION AND THE HEART AND VASCULAR CENTER FIRST FLOOR WAS ENTIRELY FUNDED BY EQUITY. MEMORIAL HOSPITAL USED APPROXIMATELY $22,100,000 IN EQUITY IN RELATION TO THE PROJECTS FUNDED WITH SERIES 2003 BOND DRAWS. PART III, LINE 9 0 ON 05/21/2013, THE ORGANIZATION ESTABLISHED PROCEDURES TO ENSURE THAT ALL NONQUALIFIED BONDS ARE REMEDIATED IN ACCORDANCE WITH THE REQUIMENTS OF ALL APPLICABLE REGULATIONS. PART IV, LINE 2C 0 A: VERIFICATION REPORT DATED JUNE 20, 2013, SHOWED THAT NO REBATE WOULD BE DUE. B: VERIFICATION REPORT DATED FEBRUARY 15, 2011, SHOWED THAT NO REBATE WOULD BE DUE. PART IV, LINE 7 0 ON 05/21/2013, THE ORGANIZATION ESTABLISHED WRITTEN PROCEDURES TO MONITOR SECTION 148 REQUIRMENTS. PART V 0 ON 05/21/2013, THE ORGANIZATION ESTABLISHED WRITTEN PROCEDURES TO ENSURE THAT VIOLATIONS OF FEDERAL TAX REQUIREMENTS ARE TIMELY IDENTIFIED AND CORRECTED THROUGH THE VOLUNTARY CLOSING AGREEMENTS PROGRAM IF SELF-REMEDIATION IS NOT AVAILABLE UNDER APPLICABLE REGULATIONS. South Bend Emergency Physicians Inc Keith Sherry DIR/TRUSTEE 6662292 See Part V false South Bend Clinic LLP Jesse Hseith/Trustee 369208 See Part V false Business Transactions Involving Interested Persons Schedule L, Part IV Keith sherry, MD, is a director and employed by South Bend Emergency Physicians, Inc. which provides emergency physician services to the hospital. Payments noted are paid to South Bend Emergency Physicians, Inc. Jesse Hseih, MD, is an officer with South Bend Clinic, LLP. Memorial Hospital of South Bend makes contractual payments to the South Bend Clinic for trauma call services provided. VOLUNTEERS Form 990, Part I, Line 6 Memorial Hospital of South Bend has a department called Ambassador and Customer Services. It is the responsibility of this department to recruit, orient, process and place new ambassadors in approximately 30 service areas of the hospital. It is also the responsibility of the department to follow up, schedule and recognize ambassadors. Some of the areas of service include a Major Surgery Waiting Room, Patient Escorts, Flower Delivery, Mail Delivery, Living History Program, Emergency Department Volunteers and Cookie Bakers. In 2012, Memorial had 589 volunteers in this program who served 50,867 hours. Other Program Services Form 990, Part III, Line 4d Other Program Services include Physcriatric departments, social services, community outreach programs, tithing, grants, and supporting services such as administration, finance, payroll, patient accounting, laundry services, health and lifestyle center, and medical records. Due to the non revenue generating or community investment nature of many of the programs, they operate at a loss. See Schedule H for details on the Hospitals tithing and community outreach represented in Other Program Services. Members of the Organization Form 990, Part VI, Section A, Line 6 BEACON HEALTH SYSTEM, INC. IS THE SOLE CORPORATE MEMBER OF MEMORIAL HOSPITAL OF SOUTH BEND, INC. Election of Board Members Form 990, Part VI, Section A Line 7A The Corporate Member shall appoint the Board of Directors of Memorial Hospital of South Bend and shall have such powers of advance approval regarding corporate actions as are delineated in the By-Laws of Memorial Hospital of South Bend. Decisions of The Board of Directors Form 990, Part VI, Section A, Line 7B Decisions of the Board of Directors must be approved by the Corporate Member. Review Process Form 990, Part VI, Section B, Line 11B The organization incorporates numerous parties in the production and review of the Form 990 and associated schedules. Senior accounting staff and management complete the Form 990 and schedules. The forms and schedules are reviewed by the Directors of Accounting, Controller and CFO. Subsequent to those steps, the organization engaged Ernst & Young to review the completed Form 990 and appropriate schedules. Prior to filing the return, the compensation committee of the organization and the CEO conduct a general overview of the form 990, including applicable compensation schedules. In addition, the Board of Directors and the Audit Committee receive a copy of the 990 prior to filing. Conflict of Interest Policy Form 990, Part VI, Section B, Line 12C THERE ARE THREE SEPARATE FORMS THAT ARE SENT OUT THROUGH THE INTERNAL AUDIT DEPARTMENT TO KEY EMPLOYEES OR BOARD MEMBERS REGARDING CONFLICT OF INTEREST. THEY ARE AS FOLLOWS: 1. THE FIRST IS A CONFLICT OF INTEREST STATEMENT THAT IS SENT TO SENIOR LEVEL ADMINISTRATION, MANAGEMENT, AND SELECT STAFF SUCH AS PURCHASING DEPARTMENT EMPLOYEES. THE PURPOSE OF THE STATEMENT IS TO REQUIRE THESE EMPLOYEES TO DISCLOSE ANY POTENTIAL CONFLICT OF INTERESTS THEY MAY HAVE. THE STATEMENTS ARE SENT IN JANUARY OF EACH YEAR for the previous year activities WE PURSUE THE REPLIES TO GET A 100% RESPONSE RATE. IN THE CURRENT YEAR WE SENT OUT OVER 250 STATEMENTS AND DID ACHIEVE A 100% RESPONSE RATE. EACH RESPONSE IS REVIEWED BY THE DIRECTOR OF INTERNAL AUDIT AND THE RESULTS ARE REPORTED TO THE CEO OF Beacon Health System, the Audit Committee Chairman, AS WELL AS THE AUDIT COMMITTEE OF THE BOARD OF DIRECTORS. It should be noted that in 2012 the Conflict of Interest Statement were not sent to Elkhart General Hospital Employees but will be sent for the calendar year 2013 in January, 2014. 2. THE SECOND STATEMENT IS THE BOARD DUALITY OF INTEREST STATEMENT THAT is SENT TO CURRENT BOARD MEMBERS, FORMER BOARD MEMBERS FROM THE LAST FIVE YEARS, and OTHER KEY EMPLOYEES. THE DUALITY OF INTEREST STATEMENT is sent using a web based survey tool provided by Ernst & Young. THE REPLIES ARE REVIEWED BY THE DIRECTOR OF INTERNAL AUDIT. THE RESULTS of the surveys are summarized using the web based tool, and are reviewed by Ernst & Young in completing the 990. The RESULTS ARE REPORTED TO THE CEO OF Beacon Health System, the Audit Committee Chairman, AND THE AUDIT COMMITTEE OF THE BOARD OF DIRECTORS. 3. THE THIRD STATEMENT IS ENTITLED "CODE OF ETHICS FOR SENIOR FINANCIAL OFFICERS". THE STATEMENT REQUIRES AN ACKNOWLEDGEMENT FORM TO BE SIGNED BY Beacon Health System's KEY FINANCIAL EMPLOYEES THAT Beacon's FINANCIAL INFORMATION IS TO THE BEST OF THEIR KNOWLEDGE TRUE AND ACCURATE. THIS STATEMENT WAS SENT OUT IN EARLY JANUARY, 2013 AND THE SIGNED ACKNOWLEDGEMENTS ARE KEPT BY THE DIRECTOR OF INTERNAL AUDIT. IN 2013, Seventeen DESIGNATED EMPLOYEES WERE REQUESTED TO SIGN THE FORM AND WE HAD A 100% COMPLIANCE RATE. ANY POTENTIAL CONFLICTS OF INTERESTS ARE REVIEWED BY INDEPENDENT PARTIES BOTH INTERNAL AND EXTERNAL TO THE ORGANIZATION, AND IF NECESSARY, CORRECTIVE ACTION WOULD BE TAKEN TO RESOLVE A TRUE CONFLICT. THE INDIVIDUAL WITH THE POTENTIAL CONFLICT OF INTEREST IS would be EXCLUDED FROM ALL REVIEW PROCEEDINGS. Process for Determining Compensation Form 990, Part VI, Section B, LINE 15a and 15b Vice President and higher compensation is determined after an extensive examination is conducted using comparable market data and then reviewed by an independent consultant hired by, and reporting to, the Board of Directors. Recommendations are presented to the Compensation Committee of the Beacon Health System, Inc. Board for deliberation and final decision. Deliberation and final decision are performed by the independent members of the Board. Public Availability for Documents Form 990, Part VI, Section C, Line 19 The governing documents and conflict of interest policy are not made available to the public. The financial statements are distributed quarterly to the Electronic Municipal Market Access (EMMA) website as part of the continuing disclosures for the Memorial Health System, Inc. bonds. Other Changes in the net assets of Fund Balances PART XI, LINE 9 Gain on SWAP 12,333,474 Loss on Swap termination (290,000) Transfer to Beacon Health Ventures, Inc. (3,283,714) Transfer to Elkhart General Hospital, Inc. (750,000) Transfers to Parent, Memorial Health System (41,769,378) Write off of inter company, Memorial Health Foundation 22,393 Write off of inter company, Memorial Health System 3,972,845 Write off of inter company, Elkhart General Hospital 149,409 Net Assets released from resrictions for capital items 302,651 Change in interest in recipient org 655,618 TOTAL (28,656,702) OTHER FEES FOR SERVICES FOR NON-EMPLOYEES FORM 990 PART IX LINE 11G DESCRIPTION:OTHER PURCHASED SERVICES TOTAL FEES:12216413 OTHER FEES FOR SERVICES FOR NON-EMPLOYEES FORM 990 PART IX LINE 11G DESCRIPTION:PHYSICIAN FEES TOTAL FEES:11859389 OTHER FEES FOR SERVICES FOR NON-EMPLOYEES FORM 990 PART IX LINE 11G DESCRIPTION:LAB FEES TOTAL FEES:7579915 OTHER FEES FOR SERVICES FOR NON-EMPLOYEES FORM 990 PART IX LINE 11G DESCRIPTION:SERVICE CONTRACTS TOTAL FEES:3999855 OTHER FEES FOR SERVICES FOR NON-EMPLOYEES FORM 990 PART IX LINE 11G DESCRIPTION:COLLECTION EXP TOTAL FEES:3293760 OTHER FEES FOR SERVICES FOR NON-EMPLOYEES FORM 990 PART IX LINE 11G DESCRIPTION:CONSULTING TOTAL FEES:1367473 OTHER FEES FOR SERVICES FOR NON-EMPLOYEES FORM 990 PART IX LINE 11G DESCRIPTION:REPAIRS & MAINTENANCE TOTAL FEES:1676042 OTHER FEES FOR SERVICES FOR NON-EMPLOYEES FORM 990 PART IX LINE 11G DESCRIPTION:TRANSCRIPTION, P/S MEDICAL TOTAL FEES:586875 Memorial Health System Inc 615 N Michigan Street South Bend IN 46601 351536132 Corp Svc/Clin IN 9 BEACON true Memorial Health Foundation Inc 615 N Michigan Street South Bend IN 46601 351536129 Financial Sup IN 9 BEACON true Elkhart General Hospital Inc 600 East Boulevard Elkhart IN 46514 350877574 Hospital IN 3 BEACON true MEMORIAL ENDOWMENT FUND FOR MEM HOS PO BOX 1602 SOUTH BEND IN 46634 356068581 ENDOWMENT IN 11d III-O MHSB true BEACON HEALTH SYSTEM Inc 600 East Boulevard Elkhart IN 46514 453864076 Parent Org. IN 11C III-FI NA false BEACON HEALTH VENTURES INC 615 N Michigan Street South Bend IN 46601 351901068 Home Medical IN NA C BEACON HEALTH VENTURES MICHIGAN INC 615 N MICHIGAN ST SOUTH BEND IN 46601 208259773 HOME MEDICAL MI NA C false true true false false false false false false true true true true false true true true true true Beacon Health Ventures Inc L 733636 REVIEW INVOICES Beacon Health Ventures Inc R 2110460 ACCT. ACTIVITY Beacon Health Ventures Inc R 3283714 CASH TRANSFER Elkhart General Hospital Inc C 301102 ACCT. ACTIVITY Elkhart General Hospital Inc O 322449 REVIEW INVOICES Elkhart General Hospital Inc R 750000 CASH TRANSFER Memorial Health Foundation Inc C 694548 DIST. FROM MHF Memorial Health Foundation Inc S 57559 CASH TRANSFER Memorial Health System Inc B 41769378 CASH TRANSFER Memorial Health System Inc C 3972845 ACTUAL CHARGES Memorial Health System Inc J 266950119 PHYSICIAN CHRGS Memorial Health System Inc K 280769 INTERCO CHARGES Memorial Health System Inc M 21135670 PHYSICIAN CHRGS Memorial Health System Inc P 30436726 INTERCO CHARGES Memorial Health System Inc Q 606455 INTERCO CHARGES Memorial Health System Inc Q 23000000 CASH TRANSFER Memorial Health System Inc S 30436726 INTERCO CHARGES