2013-05-06T12:58:05-05:00 2012-06-30 990 2011-07-01 351568821 SAINT JOSEPH REGIONAL MEDICAL CENTER INC SAIN 5743355000 5215 HOLY CROSS PARKWAY MISHAWAKA IN 465451469 JANICE DUNN 5744726083 2013-05-06 2011 2016-03-07 17:11:31Z (SEE SCHEDULE O FOR LIST) ALBERT GUTIERREZ 5215 HOLY CROSS PARKWAY MISHAWAKA IN 465451469 79352608 0 0928 X WWW.SJMED.COM X 1983 IN HEALTHCARE AND HEALTHCARE ADMINISTRATIVE SERVICES 18 16 588 16 209219 128575 7982 154990 70656064 73488585 -14686 -9917 2033471 4229806 72682831 77863464 581669 1193720 0 0 32866760 36284835 0 0 0 45615519 46834715 79063948 84313270 -6381117 -6449806 71322917 68530814 19195397 14739930 52127520 53790884 X SAINT JOSEPH REGIONAL MEDICAL CENTER, INC'S PURPOSE IS TO GOVERN, MANAGE AND PROVIDE ADMINISTRATIVE SERVICES TO ITS SUBSIDIARIES AND TO PROVIDE HEALTH CARE SERVICES. THE ADMINISTRATIVE SERVICES PROVIDED TO THE SUBSIDIARIES ALLOW FOR ECONOMIES OF SCALE THAT IN TURN PERMIT THE SUBSIDIARIES TO PROVIDE HEALTHCARE TO PATIENTS AT A REASONABLE COST. 0 0 45682570 1193720 77509172 GENERAL INFORMATION:SAINT JOSEPH REGIONAL MEDICAL CENTER, INC. IS A FAITH BASED HEALTHCARE PROVIDER UNITING THE REGIONAL HEALTHCARE MINISTRIES, AND HONORING THE HERITAGE OF THE SISTERS OF THE HOLY CROSS AND THE POOR HANDMAIDS OF JESUS CHRIST, WITH SPECIAL COMMITMENT TO THE POOR.SAINT JOSEPH REGIONAL MEDICAL CENTER, INC. 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. SAINT JOSEPH REGIONAL MEDICAL CENTER IS A MULTI-HOSPITAL HEALTH CARE SYSTEM LOCATED IN NORTH CENTRAL INDIANA. FOR MORE INFORMATION ON SPECIFIC SERVICES PROVIDED, PLEASE SEE THE SAINT JOSEPH REGIONAL MEDICAL CENTER SYSTEM WEBSITE AT WWW.SJMED.COM.SAINT JOSEPH REGIONAL MEDICAL CENTER, INC. IS THE PARENT OF SAINT JOSEPH REGIONAL MEDICAL CENTER-SOUTH BEND CAMPUS, INC., SAINT JOSEPH REGIONAL MEDICAL CENTER-PLYMOUTH CAMPUS, INC., AND THE FOUNDATION OF SAINT JOSEPH REGIONAL MEDICAL CENTER, INC. SAINT JOSEPH REGIONAL MEDICAL CENTER, INC. (SJRMC) ALSO OWNS AND OPERATES SAINT JOSEPH PHYSICIAN NETWORK, A NETWORK OF EIGHTEEN PRACTICES LOCATED IN NORTH CENTRAL INDIANA. COMMUNITY BENEFIT MINISTRY:CONSISTENT WITH ITS MISSION, SJRMC PROVIDES MEDICAL CARE TO ALL PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. IN ADDITION, SJRMC PROVIDES SERVICES INTENDED TO BENEFIT THE POOR AND UNDERSERVED, INCLUDING THOSE PERSONS WHO CANNOT AFFORD HEALTH INSURANCE OR OTHER PAYMENTS SUCH AS COPAYS AND DEDUCTIBLES BECAUSE OF INADEQUATE RESOURCES AND/OR ARE UNINSURED OR UNDERINSURED, AND TO IMPROVE THE HEALTH STATUS OF THE COMMUNITIES IN WHICH IT OPERATES. THE FOLLOWING SUMMARY HAS BEEN PREPARED IN ACCORDANCE WITH THE CATHOLIC HEALTH ASSOCIATION OF THE UNITED STATES' ("CHA"), A GUIDE FOR PLANNING AND REPORTING COMMUNITY BENEFIT, 2008 EDITION.THE AMOUNTS BELOW REFLECT THE QUANTIFIABLE COSTS OF SJRMC'S COMMUNITY BENEFIT MINISTRY FOR THE YEAR ENDED JUNE 30, 2012:MINISTRY FOR THE POOR AND UNDERSERVED:$ 496,639 CHARITY CARE AT COST 2,610,661 UNPAID COST OF MEDICAID AND OTHER PUBLIC PROGRAMS$ 3,107,300 MINISTRY FOR THE POOR AND UNDERSERVED SJRMC ALSO PROVIDED A SIGNIFICANT AMOUNT OF UNCOMPENSATED CARE TO ITS UNINSURED AND UNDERINSURED PATIENTS, WHICH WAS REPORTED AS BAD DEBT AT COST AND NOT INCLUDED IN THE AMOUNTS REPORTED ABOVE. DURING THE YEAR ENDED JUNE 30, 2012, SJRMC REPORTED BAD DEBT AT COST OF $394,713 (DETERMINED USING A COST TO CHARGE RATIO APPLIED TO THE PROVISION FOR BAD DEBTS).IN ADDITION TO THE AMOUNTS REPORTED ABOVE, SJRMC COMMITTED SIGNIFICANT RESOURCES IN SERVING THE MEDICARE POPULATION, ESPECIALLY IN CERTAIN COMMUNITIES. THE COST (DETERMINED USING A COST TO CHARGE RATIO) OF PROVIDING SERVICES TO PRIMARILY ELDERLY BENEFICIARIES OF THE MEDICARE PROGRAM, IN EXCESS OF GOVERNMENTAL AND MANAGED CARE CONTRACT PAYMENTS WAS $2,682,484.MINISTRY FOR THE POOR AND UNDERSERVED REPRESENTS THE FINANCIAL COMMITMENT TO SEEK OUT AND SERVE THOSE WHO NEED HELP THE MOST, ESPECIALLY THE POOR, THE UNINSURED AND THE INDIGENT. THIS IS DONE WITH THE CONVICTION THAT HEALTHCARE IS A BASIC HUMAN RIGHT. CHARITY CARE AT COST REPRESENTS THE COST OF SERVICES PROVIDED TO PATIENTS WHO CANNOT AFFORD HEALTH CARE SERVICES DUE TO INADEQUATE RESOURCES AND/OR ARE UNINSURED OR UNDERINSURED. A PATIENT IS CLASSIFIED AS A CHARITY PATIENT IN ACCORDANCE WITH SJRMC'S ESTABLISHED POLICY. THE COST OF CHARITY CARE IS CALCULATED USING A COST TO CHARGE RATIO METHODOLOGY. UNPAID COST OF MEDICAID AND OTHER PUBLIC PROGRAMS REPRESENTS THE COST (DETERMINED USING A COST TO CHARGE RATIO) OF PROVIDING SERVICES TO BENEFICIARIES OF PUBLIC PROGRAMS, INCLUDING STATE MEDICAID AND INDIGENT CARE PROGRAMS, IN EXCESS OF GOVERNMENTAL AND MANAGED CARE CONTRACT PAYMENTS. MISSION:THE MISSION STATEMENT FOR SAINT JOSEPH REGIONAL MEDICAL CENTER, INC. (SJRMC) IS AS FOLLOWS:WE SERVE TOGETHER IN TRINITY HEALTHIN THE SPIRIT OF THE GOSPELTO HEAL BODY, MIND, AND SPIRITTO IMPROVE THE HEALTH OF OUR COMMUNITIESAND TO STEWARD THE RESOURCES ENTRUSTED TO US. 45682570 1 1 0 1 0 0 0 0 0 0 1 1 1 1 1 0 0 1 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 1 1 154 0 1 588 1 1 1 0 0 0 0 0 0 0 0 0 0 X 18 16 1 1 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 0 IN X WAYNE NOETHE CONTROLLER 5744726083 837 EAST CEDAR STREET SUITE 350 SOUTH BEND IN 46617 X ALBERT GUTIERREZ 30.00 X X 0 595976 70498 FR MARK L POORMAN CSC 2.00 X X 0 0 0 ABRAHAM MARCUS 2.00 X X 0 0 0 JOHN ROSENTHAL 2.00 X X 0 0 0 CHARLES VIATER 2.00 X X 0 0 0 KATHY BEELER 2.00 X 0 0 0 BILAL ANSARI MD 2.00 X 0 0 0 ROBERT CASALOU 2.00 X 0 580342 76595 UTHMAN CAVALLO MD 2.00 X 0 1800 0 ROBERT E CLEMENCY MD 2.00 X 0 0 0 GREG CRAWFORD 2.00 X 0 0 0 RODNEY GANEY 2.00 X 0 0 0 MICHAEL R LEEP SR 2.00 X 0 0 0 SCOTT MALPASS 2.00 X 0 0 0 CAROL A MOONEY JD 2.00 X 0 0 0 JOHN OLIVER 2.00 X 0 0 0 ROBERT OPPMAN MD 2.00 X 0 0 0 SR KATHLEEN QUINN PHJC 2.00 X 0 0 0 SR AGNES A ROBERTS CSC 2.00 X 0 0 0 FR JAMES FOSTER CSC MD 2.00 X 0 0 0 MICHAEL HAMMES 2.00 X 0 0 0 JASON SCHULTZ 30.00 X 0 5577 167 ROBERT DEVEY TATUM LLC 30.00 X 110744 0 0 JANICE DUNN 30.00 X 0 118277 9507 AARON AUSTIN 30.00 X 0 316265 37975 DALE DEARDORFF MD 50.00 X 197916 0 33951 LORI PRICE 25.00 X 0 240661 39463 JOSEPH SWEDISH 2.00 X 0 5186660 576202 KEDRICK ADKINS 2.00 X 0 1405226 117120 RICHARD O'CONNELL 2.00 X 0 943237 118221 MICHAEL MURPHY 2.00 X 0 474370 75538 JOSEPHINE RANDAZZO DO 50.00 X 518593 0 26355 SHAYA MOKFI MD 50.00 X 444247 0 33355 DONALD FAULKNER MD 50.00 X 392678 0 40027 BRIAN PIAZZA MD 50.00 X 372423 0 31986 TOD STILLSON MD 50.00 X 367506 0 29240 RICHARD KORMAN 0.00 X 0 123672 20018 NANCY R HELLYER 0.00 X 0 187702 8110 TERRY L HECK 0.00 X 0 296742 68421 MARSHA KING 0.00 X 0 234417 63683 MICHAEL SLUBOWSKI 0.00 X 0 150838 1101 2404107 10861762 1477533 57 1 1 1 MICHIANA HEALTH INFORMATION 220 W COLFAX AVE STE 300 SOUTH BEND IN 46601 MEDICAL INFORMATION SERVICES 1298115 TONN AND BLANK CONSTRUCTION 1623 GREENWOOD AVE MICHIGAN CITY IN 46360 CONSTRUCTION SERVICES 684608 CONIFER HEALTH SOLUTIONS 1500 S DOUGLASS ROAD ANAHEIM CA 92806 COLLECTION SERVICES 650667 OTIS ELEVATOR 50641 PRINCESS WAY STE 1 GRANGER IN 46530 EQUIPMENT MAINTENANCE 472077 OLOGIE 447 E MAIN ST COLUMBUS OH 43215 ADVERTISING SERVICES 325404 22 154439 551 154990 INTERCOMPANY FEES 900099 50307640 50307640 NET PATIENT SVC REV 900099 23180945 23180945 73488585 74608 74608 1151512 1395399 -243887 -243887 -243887 9220 6215 87530 -6215 -78310 -84525 -84525 OTHER REVENUE 900099 3485929 3296414 189515 MEDICARE/MEDICAID HIT 900099 968060 968060 PRINTING REVENUE 900099 19704 19704 4473693 77863464 77509172 209219 -9917 1193720 1193720 1787732 1787732 581499 581499 26116877 23499491 2617386 1616020 1447272 168748 4419114 3323558 1095556 1763593 460599 1302994 147531 147531 579700 69470 510230 42696 42696 6634267 4822284 1811983 2038997 86583 1952414 884178 593659 290519 13321897 439173 12882724 1404353 1027177 377176 125921 46015 79906 177599 99567 78032 6453666 2000018 4453648 576909 248504 328405 INTERCO. PURCHASED SVCS 5490716 5051 5485665 EQUIPMENT MAINTENANCE 3145629 3118511 27118 CONTRACT LABOR 2349936 126205 2223731 UBI TAXES 158800 158800 3301920 2928182 373738 84313270 45682570 38630700 0 1802658 303499 3219835 3600789 38506 38506 864244 900142 51876158 27665089 25865165 24211069 3939006 4070666 3243751 4723185 7649285 8042467 24700467 22640491 71322917 68530814 4299326 4778231 14896071 9961699 19195397 14739930 X 52127506 53790884 14 0 52127520 53790884 71322917 68530814 X -6449806 8113170 X X 0 1 1 X 0 X X X 0 0 0 SAINT JOSEPH REGIONAL MEDICAL CENTER-SOUTH BEND CAMPUS INC 350868157 3 0 1 1 16000 SAINT JOSEPH REGIONAL MEDICAL CENTER-PLYMOUTH CAMPUS INC 351142669 3 0 1 1 4400 THE FOUNDATION OF SAINT JOSEPH REGIONAL MEDICAL CENTER INC 351654543 11 0 1 1 0 TRINITY HEALTH CORPORATION 351443425 11 1 1 1 347000 4 367400 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 2891 0 0 0 2891 0 EXPLANATION OF LOBBYING ACTIVITIES: PART II-B, LINE 1: SAINT JOSEPH REGIONAL MEDICAL CENTER, INC. HAS MADE GRANTS TO OTHER ORGANIZATIONS IN THE FORM OF MEMBERSHIP DUES PAID TO A NATIONAL HEALTH CARE ORGANIZATION. THIS ORGANIZATION HAS PROVIDED SAINT JOSEPH REGIONAL MEDICAL CENTER INC. WITH AN ESTIMATED PERCENTAGE OF DUES PAYMENTS WHICH ARE USED FOR LOBBYING ACTIVITIES. SAINT JOSEPH REGIONAL MEDICAL CENTER, INC. MADE NO CONTRIBUTIONS TO ANY LEGISLATORS OR CANDIDATES. 7624059 7624059 26733243 17510689 9222554 17020500 10154400 6866100 498356 498356 24211069 COMMINGLED FUNDS DIRECTLY HOLDING SECURITIES 2666314 F EQUITY METHOD INVESTMENTS 2056871 C 4723185 NORTHERN INDIANA MAGNETIC RESONANCE, INC. 911042 C ADVANTAGE HEALTH NETWORK 818674 C SELECT HEALTH NETWORK, INC. 3430449 C MICHIANA HEALTH INFORMATION NETWORK 441667 C ELM ROAD MOB II, LLC 731223 C EDISON LAKES ROC 316052 C EL ROC DEBT GUARANTEE 1393360 C 8042467 INTERCOMPANY OTHER LONG TERM ASSETS 14872199 INTERCOMPANY RECEIVABLES 4555150 OTHER RECEIVABLES 3095142 REFUNDABLE MEMBERSHIP DUES 118000 22640491 INTERCOMPANY ACCOUNTS PAYABLE 2357890 DEFERRED COMPENSATION LIABILITY 1175811 ASSET RETIREMENT OBLIGATION (FIN 47) 149528 SHORT TERM LEASE COMMITMENTS 545032 LONG TERM LEASE COMMITMENTS 4340078 LONG TERM GUARANTEES 1393360 9961699 0 LOGAN COMMUNITY RESOURCES INC 2505 E JEFFERSON BLVD SOUTH BEND IN 46615 350965639 501(C)(3) 10000 COMMUNITY BENEFIT NATIONAL COUNCIL OF THE UNITED STATES SOCIETY OF ST VINCENT DE PAUL INC 58 PROGRESS PARKWAY MARYLAND HEIGHTS MO 63043 135562362 501(C)(3) 10000 SPONSORSHIP DINNER - ST. CASIMIR'S PARISH UNIVERSITY OF NOTRE DAME DU LAC 731 GRACE HALL NOTRE DAME IN 46556 350868188 501(C)(3) 27700 COMMUNITY BENEFIT MICHIANA PUBLIC BROADCASTING CORPORATION DBA WNIT PUBLIC TELEVISION 300 WEST JEFFERSON SOUTH BEND IN 46601 351155594 501(C)(3) 10500 PLEDGE - CAPITAL CAMPAIGN AMERICAN HEART ASSOCIATION INC 7272 GREENVILLE AVE DALLAS TX 75231 135613797 501(C)(3) 6500 COMMUNITY BENEFIT THE CENTER FOR HOSPICE AND PALLIATIVE CARE INC 111 SUNNYBROOK COURT SOUTH BEND IN 46637 310952866 501(C)(3) 6000 COMMUNITY BENEFIT CENTER FOR THE HOMELESS INC 813 S MICHIGAN SOUTH BEND IN 46601 351768544 501(C)(3) 20000 COMMUNITY BENEFIT DIOCESE OF FORT WAYNESOUTH BEND 915 S CLINTON FORT WAYNE IN 46802 350876373 501(C)(3) 126000 ANNUAL PLEDGE HOLY CROSS COLLEGE INC PO BOX 308 NOTRE DAME IN 46556 351148835 501(C)(3) 15000 SPONSORSHIP - PRESIDENTIAL INAUGURATION CELEBRATION LA CASA DE AMISTAD 746 S MEADE STREET SOUTH BEND IN 46619 351350013 501(C)(3) 10150 COMMUNITY BENEFIT WOMEN'S CARE CENTER INC 360 N NOTRE DAVE AVE SOUTH BEND IN 46617 351609945 501(C)(3) 15000 COMMUNITY BENEFIT YWCA NORTH CENTRAL INDIANA INC 1102 S FELLOWS ST SOUTH BEND IN 46601 350868226 501(C)(3) 7500 COMMUNITY BENEFIT REAL SERVICES INC PO BOX 1835 SOUTH BEND IN 46634 351157606 501(C)(3) 15000 COMMUNITY BENEFIT ST JOSEPH HIGH SCHOOL 1441 NORTH MICHIGAN ST SOUTH BEND IN 46613 350924794 501(C)(3) 6000 SPONSORSHIP - SPRING BENEFIT AUCTION THE CHAMBER OF COMMERCE OF ST JOSEPH COUNTY INC 401 EAST COLFAX SOUTH BEND IN 46634 350153330 501(C)(6) 12100 COMMUNITY BENEFIT SOUTH BEND SYMPHONY ORCHESTRA ASSOCIATION INC 127 NORTH MICHIGAN STREET SOUTH BEND IN 46601 356042189 501(C)(3) 7000 MARTIN LUTHER KING CONCERT SPONSORSHIP SCHOOL CITY OF MISHAWAKA EDUCATION FOUNDATION INC PO BOX 1593 MISHAWAKA IN 46546 351973986 501(C)(3) 7500 COMMUNITY BENEFIT INDIANA UNIVERSITY FOUNDATION PO BOX 500 BLOOMINGTON IN 47402 356018940 501(C)(3) 15000 SCHOOL OF MEDICINE'S ANNUAL FUNDRAISER HOLTZ CHARITABLE FOUNDATION INC 9209 CROMWELL PARK PLACE ORLANDO IN 32827 352042978 501(C)(3) 10000 COMMUNITY BENEFIT HEALTHLINC INC 454 SOUTH COLLEGE AVENUE VALPARAISO IN 46383 352147791 501(C)(3) 560264 HEALTHY FAMILY CENTER OPERATIONS SUBSIDIZATION BUSY HANDS OF MICHIANA 702 CHAPIN ST 2ND FLOOR SOUTH BEND IN 46601 271654564 501(C)(3) 5110 CHAIR LIFT INSTALLATION 20 1 DONATIONS MADE BY SAINT JOSEPH REGIONAL MEDICAL CENTER TO CHARITABLE ORGANIZATIONS ARE MADE IN FURTHERANCE OF THE RECIPIENT ORGANIZATION'S EXEMPT PURPOSE AND ARE CONSIDERED UNRESTRICTED WITH REGARD TO THE USE OF THE FUNDS. 1 1 0 0 0 0 0 0 0 ALBERT GUTIERREZ 0 426838 0 101795 0 67343 0 51113 0 19385 0 666474 0 0 ROBERT CASALOU 0 401427 0 123058 0 55857 0 51578 0 25017 0 656937 0 0 ROBERT DEVEY TATUM LLC 110744 0 0 0 0 0 0 0 0 0 110744 0 0 0 AARON AUSTIN 0 217904 0 70370 0 27991 0 19276 0 18699 0 354240 0 0 DALE DEARDORFF MD 196686 0 0 0 1230 0 20000 0 13951 0 231867 0 0 0 LORI PRICE 0 240308 0 0 0 353 0 31291 0 8172 0 280124 0 0 JOSEPH SWEDISH 0 1279458 0 677642 0 3229560 0 548602 0 27600 0 5762862 0 2698342 KEDRICK ADKINS 0 743978 0 316652 0 344596 0 103857 0 13263 0 1522346 0 143708 RICHARD O'CONNELL 0 571942 0 230946 0 140349 0 85919 0 32302 0 1061458 0 0 MICHAEL MURPHY 0 402598 0 0 0 71772 0 48365 0 27173 0 549908 0 0 JOSEPHINE RANDAZZO DO 517377 0 0 0 1216 0 18037 0 8318 0 544948 0 0 0 SHAYA MOKFI MD 443436 0 0 0 811 0 19953 0 13402 0 477602 0 0 0 DONALD FAULKNER MD 392162 0 0 0 516 0 21308 0 18719 0 432705 0 0 0 BRIAN PIAZZA MD 372078 0 0 0 345 0 20818 0 11168 0 404409 0 0 0 TOD STILLSON MD 366639 0 0 0 867 0 21201 0 8039 0 396746 0 0 0 RICHARD KORMAN 0 99951 0 0 0 23721 0 10037 0 9981 0 143690 0 0 NANCY R HELLYER 0 0 0 0 0 187702 0 0 0 8110 0 195812 0 0 TERRY L HECK 0 50066 0 20000 0 226676 0 55579 0 12842 0 365163 0 0 MARSHA KING 0 79863 0 30720 0 123834 0 50463 0 13220 0 298100 0 0 MICHAEL SLUBOWSKI 0 13394 0 0 0 137444 0 500 0 601 0 151939 0 136445 PART I, LINE 3 SAINT JOSEPH REGIONAL MEDICAL CENTER, INC. IS A SUBSIDIARY IN THE TRINITY HEALTH SYSTEM. SAINT JOSEPH REGIONAL MEDICAL CENTER, INC.'S 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, INC.'S 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 2011. THESE AMOUNTS ARE INCLUDED IN COLUMN B(III): TERRY L. HECK - $198,819 NANCY R. HELLYER - $187,921 MARSHA KING - $104,409 IN ADDITION, COLUMN C OF SCHEDULE J, PART II INCLUDES THE FOLLOWING SEVERANCE AMOUNTS WHICH WERE UNPAID AS OF 12/31/11: TERRY L. HECK - $43,643 MARSHA KING - $32,403 BOTH OF THESE AMOUNTS WILL BE PAID AND INCLUDED IN TAXABLE INCOME IN 2012. THE FOLLOWING ARE PARTICIPANTS IN THE TRINITY HEALTH PENSION RESTORATION PLAN, A NONQUALIFIED PLAN, WHICH PROVIDES RETIREMENT BENEFITS FOR CERTAIN ASSOCIATES WITH EARNINGS ABOVE THE IRS PAY CAP FOR QUALIFIED PLANS ($245,000 FOR 2011). THE FOLLOWING ACCRUALS FOR 2011 FOR THIS PLAN ARE INCLUDED IN COLUMN C OF SCHEDULE J, PART II: KEDRICK ADKINS - $91,607 ROBERT CASALOU - $39,328 ALBERT GUTIERREZ - $38,863 MICHAEL MURPHY - $27,513 RICHARD O'CONNELL - $66,279 JOSEPH SWEDISH - $255,902 THE FOLLOWING IS A PARTICIPANT IN A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP). THE FOLLOWING SERP ACCRUAL FOR 2011 IS INCLUDED IN COLUMN C OF SCHEDULE J, PART II: JOSEPH SWEDISH - $265,000 PART II: THE FOLLOWING INDIVIDUALS BECAME VESTED IN A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP) DURING CALENDAR 2011. AS A RESULT, THE VESTED AMOUNTS WERE INCLUDED IN THEIR 2011 TAXABLE INCOMES. THE FOLLOWING VESTED SERP AMOUNTS ARE INCLUDED IN COLUMN B(III) OF SCHEDULE J, PART II: KEDRICK ADKINS - $220,648 JOSEPH SWEDISH - $2,740,000 COLUMN F OF SCHEDULE J INCLUDES THE PORTION OF THESE AMOUNTS THAT WERE REPORTED AS DEFERRED COMPENSATION IN PRIOR YEARS. PART II: ROBERT DEVEY - THE AMOUNT LISTED IN B(I) OF SCHEDULE J, PART II REPRESENTS THE AMOUNT PAID BY SAINT JOSEPH REGIONAL MEDICAL CENTER (SJRMC) TO TATUM, LLC FOR MR. DEVEY'S SERVICES AS INTERIM CFO OF SJRMC (MR. DEVEY IS AN EMPLOYEE OF TATUM, LLC AND RECEIVES A FORM W-2 FROM THEM). SJRMC DOES NOT KNOW HOW MUCH MR. DEVEY RECEIVED AS WAGES FROM HIS EMPLOYER, TATUM, LLC, IN CALENDAR 2011. FORM 990, PART VI, SECTION A, LINE 2 JANICE DUNN, CFO, AND ABRAHAM MARCUS, BOARD CHAIR, HAVE A BUSINESS RELATIONSHIP FORM 990, PART VI, SECTION A, LINE 3 TRINITY HEALTH AND SAINT JOSEPH REGIONAL MEDICAL CENTER HAVE CONTRACTED WITH TATUM, LLC FOR THE PROVISION OF INTERIM CFO SERVICES FOR SAINT JOSEPH REGIONAL MEDICAL CENTER AND ITS SUBSIDIARIES. SEE SCHEDULE J, PART III FOR ADDITIONAL INFORMATION. FORM 990, PART VI, SECTION A, LINE 6 THE SOLE MEMBER OF SAINT JOSEPH REGIONAL MEDICAL CENTER, INC. IS TRINITY HEALTH CORPORATION. SEE LINE 7 FOR ADDITIONAL INFORMATION. FORM 990, PART VI, SECTION A, LINE 7A TRINITY HEALTH CORPORATION IS THE SOLE MEMBER OF SAINT JOSEPH REGIONAL MEDICAL CENTER, INC. TRINITY HEALTH CORPORATION HAS THE RIGHT TO APPOINT ALL PERSONS TO THE BOARD OF TRUSTEES OF SAINT JOSEPH REGIONAL MEDICAL CENTER, INC. FORM 990, PART VI, SECTION A, LINE 7B AS SOLE MEMBER, TRINITY HEALTH CORPORATION MUST APPROVE CERTAIN DECISIONS OF THE GOVERNING BODY, INCLUDING THE STRATEGIC PLAN, ANNUAL CAPITAL PLAN, AND ANNUAL OPERATING BUDGET. TRINITY HEALTH CORPORATION 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, INC. IS REVIEWED BY SENIOR MANAGEMENT. IN ADDITION, CERTAIN KEY SECTIONS OF THE FORM ARE REVIEWED BY THE BOARD OF TRUSTEES. 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, 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, INC., WHICH INCLUDES TRUSTEES, 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, 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, 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 TRUSTEES OF SAINT JOSEPH REGIONAL MEDICAL CENTER, 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, 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 TRUSTEES OF SAINT JOSEPH REGIONAL MEDICAL CENTER, 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, 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, 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. ESTIMATE OF THE AVERAGE HOURS PER WEEK DEVOTED TO RELATED ORGANIZATIONS: FORM 990, PART VII, SECTION A, LINE 1, COLUMN B: THE HOURS LISTED IN COLUMN B OF PART VII, SECTION A, LINE 1 REFLECT ONLY THE INDIVIDUALS' AVERAGE WEEKLY HOURS SPENT DIRECTLY ON THE ACTIVITIES OF THE REPORTING ORGANIZATION. IN ADDITION, THESE ARE THE AVERAGE HOURS PER WEEK DEVOTED TO RELATED ORGANIZATIONS: AARON AUSTIN - 20 HOURS KEDRICK ADKINS - 53 HOURS ROBERT CASALOU - 48 HOURS ROBERT DEVEY - 20 HOURS JANICE DUNN - 20 HOURS ALBERT GUTIERREZ - 20 HOURS MICHAEL MURPHY - 53 HOURS RICHARD O'CONNELL - 53 HOURS LORI PRICE - 25 HOURS JASON SCHULTZ - 20 HOURS JOSEPH SWEDISH - 53 HOURS CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -314,753. EQUITY TRANSFERS FROM AFFILIATES: 4,653,000. EQUITY GAIN IN UNCONSOLIDATED AFFILIATES: 3,774,923. TOTAL TO FORM 990, PART XI, LINE 5: 8,113,170. FORM 990, PART XII, LINE 2: SAINT JOSEPH REGIONAL MEDICAL CENTER,INC.'S FINANCIAL STATEMENTS WERE INCLUDED IN THE FY12 CONSOLIDATED FINANCIAL STATEMENTS OF TRINITY HEALTH, WHICH WERE AUDITED BY AN INDEPENDENT PUBLIC ACCOUNTING FIRM. DOING BUSINESS AS NAMES: FORM 990, PAGE 1, BOX C SAINT JOSEPH'S PHYSICIAN NETWORK, BOURBON FAMILY MEDICINE, BREMEN FAMILY MEDICINE, COMMUNITY PEDIATRIC PHYSICIANS, GRANGER COMMUNITY MEDICINE, INTERNAL MEDICINE ASSOCIATES, MARSHALL COUNTY CARDIOLOGY SPECIALISTS, MARSHALL COUNTY FAMILY PRACTICE, MARSHALL COUNTY OB/GYN, MARSHALL COUNTY PEDIATRIC PHYSICIANS, NORTHWEST FAMILY MEDICINE, MARSHALL COUNTY SURGERY ASSOCIATES, PLYMOUTH FAMILY AND INTERNAL MEDICINE, RIVER PARK FAMILY MEDICINE, UNIVERSITY PARK FAMILY MEDICINE, SAINT JOSEPH OB/GYN SPECIALISTS, SAINT JOSEPH FAMILY MEDICINE AT ELM ROAD, PEDIATRIC SPECIALTY CLINIC, OCCUPATIONAL HEALTH, SAINT JOSEPH REGIONAL MEDICAL CENTER INFUSION PHARMACY, SJPN SOUTH BEND NEUROLOGY, SJPN-LAKE SHORE CLINIC ADVANTAGE HEALTHSAINT MARY'S MEDICAL GROUP 245 STATE ST SE GRAND RAPIDS MI 49503 272491974 HEALTHCARE SERVICES MI 501(C)(3) 9 TRINITY HEALTH-MICHIGAN 0 AMICARE HOSPICE SERVICES INC 20555 VICTOR PARKWAY LIVONIA MI 48152 382949053 PROVIDE HOSPICE 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