2012-05-04T09:36:28-05:00 2011-06-30 990 2010-07-01 350868157 SAINT JOSEPH REGIONAL MEDICAL CENTER- SOUTH BEND CAMPUS INC SAIN 5743355000 5215 HOLY CROSS PARKWAY MISHAWAKA IN 465451469 JANICE DUNN 5744726083 2012-05-04 2010 2016-02-24 21:20:13Z (SEE SCHEDULE O FOR LIST) ALBERT GUTIERREZ 5215 HOLY CROSS PARKWAY MISHAWAKA IN 465451469 262586199 0 0928 X WWW.SJMED.COM X 1958 IN HEALTHCARE SERVICES 20 16 1986 733 0 0 1967690 3356058 249600027 254984369 -2760625 -943566 3238415 2143364 252045507 259540225 4500 2700000 0 0 97248093 95353654 0 0 0 156684978 164232825 253937571 262286479 -1892064 -2746254 433516881 426009401 376362590 375976278 57154291 50033123 HEALTHCARE SERVICES - SEE SCHEDULE H FOR MORE INFORMATION 0 0 213413151 2700000 256245150 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. THE MISSION STATEMENT FOR THE HOSPITAL IS AS FOLLOWS:WE SERVE TOGETHER IN TRINITY HEALTHIN THE SPIRIT OF THE GOSPEL TO HEAL BODY, MIND AND SPIRITTO IMPROVE THE HEALTH OF OUR COMMUNITIESAND TO STEWARD THE RESOURCES ENTRUSTED TO US. 213413151 1 1 0 1 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 1 145 0 1 1986 1 0 0 0 0 0 0 0 0 0 0 X 20 16 0 1 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 IN X ROBERT SINK 5742377444 837 EAST CEDAR ST STE 350 SOUTH BEND IN 466172000 X ABRAHAM MARCUS 2.00 X X 0 0 0 CHARLES VIATER 2.00 X X 0 0 0 RODNEY GANEY 2.00 X 0 0 0 KATHY BEELER 2.00 X 0 0 0 JOHN ROSENTHAL 2.00 X 0 0 0 UTHMAN CAVALLO MD 2.00 X 0 0 0 ROBERT E CLEMENCY MD 2.00 X 0 0 0 MICHAEL J HAMMES 2.00 X X 0 0 0 ROBERT S OPPMAN MD 2.00 X 0 0 0 THOMAS REITINGERHURON CONSULTING GR 10.00 X 0 714166 0 BILAL ANSARI MD 2.00 X 0 0 0 ROBERT CASALOU 2.00 X 0 561874 75510 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 REV MARK L POORMAN CSC PHD 2.00 X X 0 0 0 SISTER KATHLEEN QUINN PHJC 2.00 X 0 0 0 SISTER AGNES ANNE ROBERTS CSC 2.00 X 0 0 0 WILLIAM SEXTON 2.00 X 0 0 0 ALBERT GUTIERREZ 10.00 X X 0 55347 4769 GREG CRAWFORD 2.00 X 0 0 0 TERRY L HECK 10.00 X 0 306741 43062 RICHARD KORMAN 10.00 X 0 186871 34364 ROBERT DEVEY 10.00 X 0 0 0 MARSHA KING 10.00 X 0 228608 41428 AARON AUSTIN 10.00 X 0 254881 43824 JOSEPH SWEDISH 2.00 X 0 2853932 791453 KEDRICK ADKINS 2.00 X 0 1160870 198248 MICHAEL SLUBOWSKI 2.00 X 0 1153164 271732 RICHARD O'CONNELL 2.00 X 0 761373 137960 MICHAEL MURPHY 2.00 X 0 539823 68542 THOMAS PERUMPILLYKADAN VARIED MD 50.00 X 341971 0 34998 PAUL E MILLER MD 50.00 X 332922 0 43798 F MONCRIEF DOBSON MD 50.00 X 311469 0 52786 MATOUS PRADNY MD 50.00 X 305210 0 29255 RAJA SINGH MD 50.00 X 301119 0 11953 NANCY HELLYER 0.00 X 0 420308 204780 LORI PRICE 0.00 X 0 232867 40741 BRUCE E PAYTON 0.00 X 0 229039 4957 1592691 9659864 2134160 48 1 1 1 SOUTH BEND MEDICAL FOUNDATION 530 N LAFAYETTE BLVD SOUTH BEND IN 46601 LABORATORY SERVICES 11708641 SODEXO MARRIOT MGMT INC 4880 PAYSPHERE CIRCLE CHICAGO IL 60674 DIETARY MANAGEMENT 2455571 ST JOSEPH VALLEY ANESTHESIA PO BOX 1742 SOUTH BEND IN 46634 ANESTHESIA SERVICES 1670986 NATL WOUNDCARE AND HYPERBARIC PO BOX 933430 ATLANTA GA 31193 HEALTHCARE SERVICES 843310 FMS NEPHROLOGY NORTH CENTRAL 5228 RELIABLE PKWY CHICAGO IL 60686 HEALTHCARE SERVICES 826574 34 3053974 302084 3356058 NET PATIENT SVC REV 900099 254984369 254984369 254984369 479868 479868 387634 1071035 -683401 -683401 -683401 551505 1287407 687532 -1287407 -136027 -1423434 -1423434 CAFETERIA 900099 1565984 1565984 1260781 1260781 2826765 259540225 256245150 0 -60983 2700000 2700000 87025 87025 74126345 71069698 3056647 6812834 6531964 280870 8835765 8471271 364494 5491685 5332323 159362 555639 555639 22906001 22618825 287176 39581 24406 15175 1904944 1159587 745357 32638 17783 14855 5399154 5272475 126679 166763 151649 15114 140289 121456 18833 13504865 13504865 16350264 16350264 1890620 1890620 MEDICAL SUPPLIES 42940212 42494490 445722 INTERCO. PURCHASED SVCS 41715231 675994 41039237 BAD DEBT EXPENSE 14569408 14569408 EQUIPMENT MAINTENANCE 1162358 892566 269792 CONTRACT LABOR EXPENSE 424354 424354 530504 387109 143395 262286479 213413151 48873328 0 9597040 3501115 29780653 34030378 978391 559814 5888338 6103509 1262395 875397 413351577 56767600 368037898 356583977 5591167 12160093 1262204 10544204 11118795 1650914 433516881 426009401 20034069 21556060 119442 175039 13669687 13184269 342539392 341060910 376362590 375976278 X 57154291 50033123 57154291 50033123 433516881 426009401 X -2746254 -4374914 X X 0 1 1 X 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 7391 0 0 0 7391 0 EXPLANATION OF OTHER LOBBYING ACTIVITIES: PART II-B, LINE 1I: SAINT JOSEPH REGIONAL MEDICAL CENTER - SOUTH BEND CAMPUS INC. (THE HOSPITAL) HAS MADE GRANTS TO OTHER ORGANIZATIONS FOR LOBBYING PURPOSES IN THE FORM OF MEMBERSHIP DUES PAID TO REGIONAL AND NATIONAL HEALTH CARE ORGANIZATIONS. THESE ORGANIZATIONS HAVE PROVIDED SAINT JOSEPH REGIONAL MEDICAL CENTER - SOUTH BEND CAMPUS, INC. WITH AN ESTIMATED PERCENTAGE OF DUES PAYMENTS WHICH ARE USED FOR LOBBYING PURPOSES. SAINT JOSEPH REGIONAL MEDICAL CENTER - SOUTH BEND CAMPUS, INC. MADE NO CONTRIBUTIONS TO ANY LEGISLATORS OR CANDIDATES. 3538880 3538880 216191100 17804090 198387010 176808663 37573514 139235149 16812934 1389996 15422938 356583977 DEFERRED COMPENSATION PAYABLE 3177994 ASSET RETIREMENT OBLIGATION (FIN 47) 125354 INTERCOMPANY PAYABLES 6807086 INTERCOMPANY NOTES PAYABLE 330950476 341060910 1 1 X 1 X 1 X 1 1 1 0 1 1 1 12352 7853296 7853296 0.03170 50 45487 31720160 17226852 14493308 0.05850 3 457 217292 58345 158947 0.00060 54 58296 39790748 17285197 22505551 0.09080 9 9468 1468712 6179 1462533 0.00590 5 64 4291772 2542999 1748773 0.00710 11 46311 8485663 3539460 4946203 0.02000 7 3840 698244 11970 686274 0.00280 32 59683 14944391 6100608 8843783 0.03580 86 117979 54735139 23385805 31349334 0.12660 1 2700000 2700000 0.01090 2 62555 260 62295 0.00030 1 40005 1590 38415 0.00020 1 7840 560 7280 0.00000 1 1000 1000 0.00000 6 2811400 2410 2808990 0.01140 0 4981543 498154 78772953 88520201 -9747248 X 1 1 1 1 ST JOSEPH REG MED CTR-SOUTH BEND CAMPUS

5215 HOLY CROSS PARKWAY MISHAWAKA IN 46544

X X X X NOT REQUIRED 1 6 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 MEDICAL OFFICE PAVILION III

837 E CEDAR STREET SOUTH BEND IN 46617

FAMILY HEALTH CTR 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 PART I, LINE 6A: 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.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 INCLUDES A COPY OF ITS MOST RECENTLY FILED SCHEDULE H ON BOTH TRINITY HEALTH'S WEBSITE AS WELL AS SAINT JOSEPH REGIONAL MEDICAL CENTER'S WEBSITE (WWW.SJMED.COM) 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, $14,569,408, 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 - SAINT JOSEPH REGIONAL MEDICAL CENTER STRIVES TO LIVE ITS MISSION OF SERVING THE POOR AND UNDERSERVED BY ASSISTING LOCAL ORGANIZATIONS IN THEIR EFFORTS TO MAKE THE CITIZENS OF OUR COMMUNITY MORE PRODUCTIVE, HEALTHY MEMBERS OF SOCIETY. THROUGH OUR COMMUNITY NEEDS ASSESSMENT, WE LEARNED THAT CERTAIN TYPES OF AGENCIES COULD BENEFIT FROM OUR SUPPORT, INCLUDING THOSE THAT 1) PROVIDE MEDICAL CARE FOR THE MEDICALLY UNDER-SERVED AND/OR HOMELESS, 2) PROMOTE DIVERSITY, 3) SERVE WOMEN AND CHILDREN AND KEEP THEM SAFE, CLOTHED, FED AND EDUCATED, AND 4) WORK WITH OTHER HEALTH AND HUMAN SERVICES AGENCIES IN THE COMMUNITY TO FIND COMMON WAYS OF MEETING SOCIAL NEEDS.MOST OF THE COMMUNITY BUILDING PROGRAMS AND ORGANIZATIONS THAT SJRMC SUPPORTS SERVE 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 INCLUDED:- PHYSICAL IMPROVEMENT -- DONATED LAND VALUED AT $2.7 MILLION TO THE CATHOLIC DIOCESE OF FORT WAYNE-SOUTH BEND FOR CONSTRUCTION OF A NEW CATHOLIC HIGH SCHOOL. THIS LAND WAS THE SITE OF THE FORMER SJRMC.- ECONOMIC DEVELOPMENT -- CONTRIBUTED TO:O PROJECT FUTURE (INITIATIVE OF ST. JOSEPH COUNTY, IND.)O WNIT PUBLIC TELEVISIONO CITY OF SOUTH BEND ALL AMERICAN CITY DELEGATION OF FIVE PARTICIPANTSO SABOR LATINO RADIO STATION- LEADERSHIP DEVELOPMENT -- PROVIDED FINANCIAL SUPPORT TO:O 100 BLACK MEN OF GREATER SOUTH BEND AREA FOR MENTORING YOUNG BLACK MENO SAINT MARY'S COLLEGE CIVIC ENGAGEMENT PROGRAMO SOUTH BEND PUBLIC EDUCATION FOUNDATIONO EDUCATION TO MEMBERS OF THE HEALTH CARE PROFESSIONALS GROUP- COMMUNITY SUPPORT DONATIONS TO:O MISHAWAKA EDUCATION FOUNDATIONO MISHAWAKA SUMMERFEST - FESTIVAL HIGHLIGHTING THE CITY OF MISHAWAKA, SJRMC SPONSORS THE 5K RUN PORTION OF THIS EVENT. O GIRLS ON THE RUN - EDUCATION PROGRAM FOR 3RD - 5TH GRADE GIRLS ON SELF RESPECT AND HEALTHY LIVING O REINS OF LIFE -- OFFERS DISABLED CHILDREN OPPORTUNITY TO PARTICIPATE IN THERAPEUTIC HORSEBACK RIDINGO BIG BROTHERS BIG SISTERS SPONSORSHIPO MARTIN LUTHER KING FOUNDATION -- EDUCATE THE COMMUNITY ABOUT DIVERSITY, WORKING TOGETHER, CREATING COMMON GOALS AND DEVELOPING A STRONG PATH TO POSITIVE OUTCOMES AND ONGOING VITALITYO FOREVER LEARNING INSTITUTE-PROVIDES LEARNING OPPORTUNITIES FOR SENIORS FOCUSING ON SPIRITUAL REFLECTION AND SOCIAL INTERACTIONO ST. MARGARET'S HOUSE - SAFE DAY HOUSE FOR HOMELESS WOMEN AND CHILDRENO ST. VINCENT DEPAUL SOCIETYO HOPE MINISTRIES - FAMILY LIFE CENTER FOR HOMELESS FAMILIES/INDIVIDUALSO BOYS AND GIRLS CLUBO TUITION ASSISTANCE TO STUDENTS OF THE DIOCESE OF FORT WAYNE/SOUTH BEND AND ST. ANTHONY'S CHURCHO CENTER FOR THE HOMELESS O HISPANIC LEADERSHIP COALITION 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 THOSE STATEMENTS: "SUBSTANTIALLY ALL OF THE CORPORATION'S RECEIVABLES ARE RELATED TO PROVIDING HEALTHCARE SERVICES TO PATIENTS. ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR AMOUNTS THAT COULD BECOME UNCOLLECTIBLE IN THE FUTURE. THE CORPORATION'S ESTIMATE FOR ITS ALLOWANCE FOR DOUBTFUL ACCOUNTS IS BASED UPON MANAGEMENT'S ASSESSMENT OF HISTORICAL AND EXPECTED NET COLLECTIONS BY PAYOR."COSTING METHODOLOGY FOR LINES 2 AND 3: AMOUNTS ARE CALCULATED ON LINE 2 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.A BAD DEBT TO CHARITY RECLASS WAS CONDUCTED AT TWO RELATED TRINITY ORGANIZATIONS. BASED ON DATA RETURNED FROM COLLECTION AGENCIES, WHICH WAS VALIDATED THROUGH ELECTRONIC MEANS (ISOLUTIONS), AMOUNTS THAT HAD BEEN WRITTEN OFF TO BAD DEBT WERE RE-CLASSED TO CHARITY DUE TO PATIENT'S INABILITY TO PAY THAT WOULD MEET PRESUMPTIVE CHARITY CRITERIA. SELECTED RETURNED ACCOUNTS WERE CASES WHERE THERE WAS NO PAYMENT WITHIN 90 DAYS OF PLACEMENT WITH THE AGENCY.AS ISOLUTIONS DATA WAS NOT AVAILABLE FOR THE SJRMC FACILITIES, WE ASSUME APPROXIMATELY 10% OF THE AMOUNTS WRITTEN-OFF TO BAD DEBT WOULD HAVE QUALIFIED FOR CHARITY BASED ON SIMILAR FINDINGS WITHIN THE REGION. WHILE CURRENT OPERATIONS ATTEMPT TO IDENTIFY THOSE CASES THAT WILL QUALIFY FOR CHARITY OR UNCOMPENSATED CARE, IT IS ASSUMED THAT APPROXIMATELY 10% OF THE REMAINING BAD DEBT AMOUNT MAY ALSO QUALIFY AS CHARITY. 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 ORGANIZATION'S COLLECTION POLICY CONTAINS THE CRITERIA FOR FINANCIAL ASSISTANCE, AND CONTAINS THE FOLLOWING VERBIAGE FOR ARRANGEMENTS WITH OUTSIDE COLLECTION AGENCIES: THE AGREEMENT MUST DEFINE THE STANDARDS AND SCOPE OF PRACTICES TO BE USED BY OUTSIDE COLLECTION AGENTS ACTING ON BEHALF OF THE MINISTRY ORGANIZATION, ALL OF WHICH MUST BE IN COMPLIANCE WITH THIS POLICY. PART VI, LINE 2: NEEDS ASSESSMENT - SAINT JOSEPH REGIONAL MEDICAL CENTER/SOUTH BEND COMPLETED THE INITIAL PHASE OF THE COMMUNITY NEEDS ASSESSMENTS THAT IS REQUIRED EVERY THREE YEARS. A COMMUNITY NEEDS ASSESSMENT IS A POINT-IN-TIME EFFORT TO MEASURE THE HEALTH AND WELL BEING OF THE COMMUNITY. IT SERVES AS THE BASIS FOR SAINT JOSEPH REGIONAL MEDICAL CENTER'S (SJRMC) STRATEGIC AND SUBSEQUENT ACTION PLANNING TO DEVELOP HEALTH POLICY, ALLOCATE RESOURCES, IMPROVE OR EXPAND EXISTING SERVICES, IMPLEMENT NEW PROGRAMS AND COLLABORATE WITH OTHER COMMUNITY HEALTHCARE PROVIDERS. A COMMUNITY NEEDS ASSESSMENT ALSO SERVES AS A BENCHMARK FOR FUTURE ASSESSMENT OF RELATIVE PROGRESS TOWARD ESTABLISHED COMMUNITY HEALTH OBJECTIVES.THE SJRMC COMMUNITY NEEDS ASSESSMENT PROVIDES THE OPPORTUNITY TO:- GAIN INSIGHTS INTO THE NEEDS AND ASSETS OF THE COMMUNITIES SERVED - IDENTIFY AND ADDRESS THE NEEDS OF VULNERABLE POPULATIONS WITHIN THE COMMUNITY- ENHANCE HOSPITAL/COMMUNITY RELATIONSHIPS AND THE OPPORTUNITY FOR COLLABORATIVE COMMUNITY ACTION, INCLUDING INVOLVEMENT WITH COALITIONS, PARTNERSHIPS, BOARDS, COMMITTEES, COMMISSIONS, ADVISORY GROUPS AND PANELS- PROVIDE THE INFORMATION REQUIRED FOR COMMUNITY OUTREACH PLANNINGTHE SJRMC CHNA PROCESS INVOLVES THE GATHERING OF TWO TYPES OF DATA: QUANTITATIVE (DEMOGRAPHICS, HEALTH INDICATORS, ETC.) AND QUALITATIVE (PUBLIC SURVEYS, FORUMS, FOCUS GROUPS). THE DATA HELP SUPPORT SHORT-TERM AND LONG-TERM DECISIONS ABOUT ALLOCATION OF COMMUNITY HUMAN AND CAPITAL RESOURCES. AS OF DECEMBER 2, 2011, 2026 SURVEYS - TAKEN ELECTRONICALLY, IN-PERSON, AND ON PAPER - HAVE BEEN RECEIVED AND PROCESSED, AND TEN (10) FOCUS GROUPS HAVE BEEN CONDUCTED, WHICH CONCLUDES THE DATA COLLECTION PHASE OF OUR CHNA, SO AS TO SURFACE CRITICAL INFORMATION LEADING TO THE DEVELOPMENT OF ACTION PLANS BASED ON COMMUNITY INPUT. THESE ACTION PLANS WILL SERVE AS AN UNDERPINNING OF SJRMC'S STRATEGIC PLAN THROUGH 2015. THE ACTION PLANS WILL BE MONITORED AND EVALUATED BY THE SJRMC BOARD OF TRUSTEES, THE SJRMC COMMUNITY BENEFITS COUNCIL AND AD HOC COMMITTEES WITH FINAL REPORTED ESTIMATED TO BE COMPLETED MAY, 2012. PART VI, LINE 3: PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE - SJRMC 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 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 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 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 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 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 HAS ESTABLISHED A WRITTEN POLICY FOR THE BILLING, COLLECTION AND SUPPORT FOR PATIENTS WITH PAYMENT OBLIGATIONS. SJRMC 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 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 RECEIVES 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 APPROXIMATELY 910,000 PEOPLE IN A DIVERSE NINE-COUNTY 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 NINE COUNTY SERVICE AREAS IS ONLY EXPECTED TO GROW 0.6% FROM 2010 THROUGH 2015. COMPARED TO THE STATE OF INDIANA, THE NINE-COUNTY AREA HAS A LOWER PROJECTED POPULATION GROWTH, A HIGHER MEDIAN AGE AND THE GREATEST DECLINE IN FEMALES OF CHILD BEARING AGE 15-44 AT 2.5%. THE POPULATION AGED 65 AND OLDER REPRESENTS 13.2% OF THE TOTAL POPULATION, AND IS EXPECTED TO INCREASE 10% 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. WHILE MEDIAN HOUSEHOLD WEALTH IS HIGHER IN THE NINE COUNTY AREA THAN THE USA AND NEARBY STATES, UNEMPLOYMENT RATES IN THE PAST NINE MONTHS HAVE ALTERED THE ESTIMATION OF WEALTH IN THIS AREA. 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 DRAMATICALLY FLUCTUATED IN THE NINE COUNTY MARKETS OVER THE PAST NINE MONTHS. BY COMPARISON, FROM 7.5% IN 2008 TO A HIGH OF 13% IN MAY 2009 TO THE CURRENT RATE OF 11.3% IN SEPTEMBER 2010. THE CURRENT RATE IS HIGHER THAN THE INDIANA RATE OF 9.5% AND THE NATIONAL AVERAGE OF 9.2%. ANECDOTALLY, THE NUMBER OF LOCAL UNDERINSURED AND UNINSURED RESIDENTS HAS LEVELED OFF WITH THE RATES OF JOB LOSS. MOODY'S.COM STILL RATES INDIANA AS IN RECESSION. EDUCATION, HEALTH CARE, AND GOVERNMENT ARE THE MAJOR EMPLOYERS IN THE LOCAL ECONOMY.ESTIMATES OF THE UNINSURED IN THE SEVEN INDIANA COUNTIES IN THIS SERVICE AREA IS 91,759, RANGING FROM 14.5% IN FULTON COUNTY TO 16.5% IN ELKHART COUNTY; IN THE THREE MICHIGAN COUNTIES SERVED THE ESTIMATE OF UNINSURED IS 232,203, RANGING FROM 10.3% IN CASS COUNTY TO 14.4% IN BERRIEN COUNTY.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 2007 10.1% OF FAMILIES LIVED IN POVERTY. THE STATE OF MICHIGAN'S PERCENTAGE WAS LOWER, AT 8.2%. 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 MISHAWAKA CAMPUS EQUALS 20% OF THE HOSPITAL'S TOTAL OVERALL. WHEN SPECIFIC SERVICES LIKE OBSTETRICS AND NEONATOLOGY ARE CONSIDERED, THE PERCENTAGE INCREASES TO 56-72% OF THE TOTAL DISCHARGES FOR THE RESPECTIVE SERVICE LINE. AS IN MOST MIDWESTERN COMMUNITIES, THE NINE COUNTY 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 LIKELY TO BE UNDERSTATED. THE NINE COUNTY 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. PART VI, LINE 6: OTHER INFORMATION - SJRMC 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 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 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 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 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 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 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. ONE OF THE AREAS IS COMPOSED OF ONE OF THE COUNTRY'S LARGEST AMISH POPULATIONS.ADVOCACY FOR VARIOUS HEALTH-RELATED ISSUES IS AT THE FOREFRONT AT SJRMC, INCLUDING EFFORTS RELATED TO OBTAINING HEALTH CARE FOR ALL, ELIMINATING THE HEALTH CARE DISPARITIES AMONG DIVERSE POPULATIONS AND OBTAINING AFFORDABLE PHARMACEUTICALS. SJRMC 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 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 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 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 PARTICIPATES IN MANY OUTREACH COMMUNITY PROGRAMS AND SERVICES:- THE WOMEN'S TASK FORCE (WOMEN SURVIVORS OF VARIOUS FORMS OF CANCER)O PROVIDES MAMMOGRAMS AND PAP TESTS FOR THOSE UNABLE TO AFFORD THEM- THE COMMUNITY HEALTH PARTNERS OF SOUTH BEND, INC.O BENDIX FAMILY PHYSICIANS (A HEALTH CENTER JOINTLY ESTABLISHED BY SJRMC AND MEMORIAL HOSPITAL) PROVIDES CARE AND HEALTH EDUCATION IN A DECLARED MEDICALLY UNDERSERVED AREAO VOLUNTEER PHYSICIAN NETWORK - PRIMARY CARE PROVIDERS AND SPECIALISTS CARING FOR THOSE UNABLE TO PAY OR ARE ON SLIDING FEE SCALE- OUTREACH PROGRAMS FOCUSING ON:O CHRONIC DISEASEO NUTRITIONO EXERCISEO SMOKING CESSATIONO HEALTH FAIRSO COLLABORATION WITH OTHER AREA HEALTH CARE PROVIDERS TO ASSIST AND CARE FOR THE UNDERSERVED POPULATIONSJRMC PROVIDED IN-KIND DONATIONS TO MANY AGENCIES INCLUDING THE FOLLOWING:- COMPUTERS TO LOCAL YOUTH CENTERS- MEDICAL SUPPLIES AND DRUGS TO MISSION TRIPS- LUNCHES TO HOPE MINISTRIES - COMPUTERS AND PRINTERS TO SIERRA LEONE, AFRICASJRMC MADE SIGNIFICANT CONTRIBUTIONS TO:- UNITED WAY - AMERICAN HEART ASSOCIATION- RIVERBEND CANCER SERVICES- SUSAN G. KOMEN- MICHIANA CANCER SURVIVORS - LOGAN INC. (CENTER FOR PEOPLE WITH DISABILITIES)- DIOCESE OF FORT WAYNE/SOUTH BEND- FOOD BANK OF NORTHERN INDIANA- MARCH OF DIMES- NORTHEAST NEIGHBORHOOD REVITALIZATION PROGRAM (NEIGHBORHOOD WHERE OUR FORMER CAMPUS WAS LOCATED)- HANNAH'S HOUSE (HOME FOR PREGNANT WOMEN) - ARTHRITIS FOUNDATION- LA CASA DE AMISTAD - COMMUNITY CENTER FOR LATINO MEMBERS PART VI, LINE 7: SAINT JOSEPH REGIONAL MEDICAL CENTER - SOUTH BEND CAMPUS IS A MEMBER ORGANIZATION OF TRINITY HEALTH, ONE OF THE LARGEST CATHOLIC HEALTH CARE SYSTEMS IN THE COUNTRY. BASED IN NOVI, MICHIGAN, TRINITY HEALTH ANNUALLY REQUIRES THAT ALL MEMBER ORGANIZATIONS DEVELOP, AND ARE HELD ACCOUNTABLE FOR ACHIEVING, COMMUNITY BENEFIT GOALS THAT INCLUDE DEVELOPING NEEDED SERVICES OR EXPANDING ACCESS TO SERVICES FOR LOW-INCOME INDIVIDUALS. AS A NOT-FOR-PROFIT HEALTH SYSTEM, TRINITY HEALTH REINVESTS ITS PROFITS BACK INTO THE COMMUNITY THROUGH PROGRAMS TO SERVE THE POOR AND UNINSURED, MANAGE CHRONIC CONDITIONS LIKE DIABETES, HEALTH EDUCATION AND PROMOTION INITIATIVES, AND OUTREACH FOR THE ELDERLY. IN FY 2011, THIS INCLUDED NEARLY $453 MILLION IN SUCH COMMUNITY BENEFITS. THEREFORE, TRINITY HEALTH TAKES A SYSTEMS APPROACH IN ITS COMMUNITY BENEFIT PLANNING AND IMPLEMENTATION, AND IS CONSEQUENTLY ABLE TO ENSURE THAT ITS MEMBER HOSPITALS AND OTHER ENTITIES/AFFILIATES ARE HELPING PROMOTE AND ADDRESS THE HEALTH NEEDS OF THEIR RESPECTIVE COMMUNITIES. FOR MORE INFORMATION ABOUT TRINITY HEALTH, VISIT WWW.TRINITY-HEALTH.ORG. REPORTS FILED WITH STATES PART VI, LINE 7 IN 1 CATHOLIC DIOCESE OF FORT WAYNE 915 SOUTH CLINTON STREET FORT WAYNE IN 46802 350876373 501(C)(3) 2700000 APPRAISAL DONATION OF VACANT LAND USED BY FORMER HOSPITAL COMMUNITY SUPPORT 1 0 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: DONATIONS MADE BY SAINT JOSEPH REGIONAL MEDICAL CENTER - SOUTH BEND CAMPUS TO CHARITABLE ORGANIZATIONS ARE MADE IN FURTHERANCE OF THE RECIPIENT ORGANIZATION'S EXEMPT PURPOSE AND ARE CONSIDERED UNRESTRICTED WITH REGARD TO THE USE OF THE FUNDS. X X X X X X 1 1 0 0 0 0 0 0 0 THOMAS REITINGERHURON CONSULTING GR 0 714166 0 0 0 0 0 0 0 0 0 714166 0 0 ROBERT CASALOU 0 377993 0 128803 0 55078 0 51463 0 24047 0 637384 0 0 TERRY L HECK 0 247248 0 57140 0 2353 0 26677 0 16385 0 349803 0 0 RICHARD KORMAN 0 186469 0 0 0 402 0 15027 0 19337 0 221235 0 0 MARSHA KING 0 184503 0 42423 0 1682 0 27758 0 13670 0 270036 0 0 AARON AUSTIN 0 206071 0 47783 0 1027 0 22918 0 20906 0 298705 0 0 JOSEPH SWEDISH 0 1240774 0 645161 0 967997 0 763945 0 27508 0 3645385 0 690161 KEDRICK ADKINS 0 717356 0 326029 0 117485 0 184461 0 13787 0 1359118 0 0 MICHAEL SLUBOWSKI 0 701008 0 291561 0 160595 0 246925 0 24807 0 1424896 0 42832 RICHARD O'CONNELL 0 533392 0 113794 0 114187 0 116680 0 21280 0 899333 0 0 MICHAEL MURPHY 0 343184 0 68618 0 128021 0 47238 0 21304 0 608365 0 0 THOMAS PERUMPILLYKADAN VARIED MD 339841 0 0 0 2130 0 16839 0 18159 0 376969 0 0 0 PAUL E MILLER MD 332242 0 0 0 680 0 16293 0 27505 0 376720 0 0 0 F MONCRIEF DOBSON MD 310174 0 0 0 1295 0 30275 0 22511 0 364255 0 0 0 MATOUS PRADNY MD 305042 0 0 0 168 0 6622 0 22633 0 334465 0 0 0 RAJA SINGH MD 300561 0 0 0 558 0 7202 0 4751 0 313072 0 0 0 NANCY HELLYER 0 0 0 0 0 420308 0 189809 0 14971 0 625088 0 420070 LORI PRICE 0 232541 0 0 0 326 0 25121 0 15620 0 273608 0 0 BRUCE E PAYTON 0 0 0 46092 0 182947 0 0 0 4957 0 233996 0 180480 PART I, LINES 4A-B THE FOLLOWING INDIVIDUALS RECEIVED SEVERANCE PAYMENTS IN CALENDAR 2010. THESE AMOUNTS ARE INCLUDED IN COLUMN B(III): BRUCE PAYTON - $180,480 NANCY HELLYER - $390,875 IN ADDITION, COLUMN C OF SCHEDULE J, PART II INCLUDES $189,809 OF SEVERANCE FOR NANCY R. HELLYER WHICH WAS UNPAID AS OF 12/31/2010. THE $189,809 WAS PAID AND INCLUDED IN NANCY R. HELLYER'S TAXABLE INCOME IN 2011. PART I, LINE 4B: THE FOLLOWING ARE PARTICIPANTS IN A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP). THE FOLLOWING SERP ACCRUALS FOR 2010 ARE INCLUDED IN COLUMN C OF SCHEDULE J, PART II: KEDRICK ADKINS - $49,977 MICHAEL SLUBOWKSI - $77,185 JOSEPH SWEDISH - $511,613 PART I, LINE 4B: 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 2010). THE FOLLOWING ACCRUALS FOR 2010 FOR THIS PLAN ARE INCLUDED IN COLUMN C OF SCHEDULE J, PART II: KEDRICK ADKINS - $113,498 ROBERT CASALOU - $35,149 ALBERT GUTIERREZ - $2,259 MICHAEL MURPHY - $26,316 J. RICHARD O'CONNELL - $83,058 MICHAEL SLUBOWSKI - $136,445 JOSEPH SWEDISH - $223,342 SUPPLEMENTAL INFORMATION PART III PART II: TOM REITINGER - THE AMOUNT LISTED IN B(I) OF SCHEDULE J, PART II REPRESENTS THE AMOUNT PAID BY SAINT JOSEPH REGIONAL MEDICAL CENTER (SJRMC) TO HURON CONSULTING GROUP FOR MR. REITINGER'S SERVICES AS INTERIM PRESIDENT OF SJRMC (MR. REITINGER IS AN EMPLOYEE OF HURON CONSULTING GROUP AND RECEIVES A FORM W-2 FROM THEM). SJRMC DOES NOT KNOW HOW MUCH MR. REITINGER RECEIVED AS WAGES FROM HIS EMPLOYER, HURON CONSULTING GROUP, IN CALENDAR 2010. ERICA AUSTIN FAMILY MEMBER OF AARON AUSTIN, KEY EMPLOYEE 56487 EMPLOYMENT ARRANGEMENT 0 ELM ROAD MOB II LLC ROBERT CLEMENCY, DIR., HAS A GREATER THAN 5% INDIRECT INT IN ELM ROAD MOB 1327083 SJRMC - SOUTH BEND CAMPUS LEASES SPACE FROM ELM ROAD MOB II 0 ADVANTAGE HEALTH SOLUTIONS TERRY HECK, CFO 5300000 SJRMC - SOUTH BEND CAMPUS PROVIDES MEDICAL SERVICES TO ADVANTAGE HEALTH MEMBERS 0 LISA AUSTIN FAMILY MEMBER OF AARON AUSTIN, KEY EMPLOYEE 12394 EMPLOYMENT ARRANGEMENT 0 ELLEN BRUNEEL FAMILY MEMBER OF JOHN ROSENTHAL, DIRECTOR 18145 EMPLOYMENT ARRANGEMENT 0 FORM 990, PART VI, SECTION A, LINE 3 TRINITY HEALTH AND SAINT JOSEPH REGIONAL MEDICAL CENTER (THE PARENT OF SAINT JOSEPH REGIONAL MEDICAL CENTER - SOUTH BEND CAMPUS) HAVE CONTRACTED WITH HURON CONSULTING GROUP FOR THE PROVISION OF INTERIM PRESIDENT SERVICES FOR SAINT JOSEPH REGIONAL MEDICAL CENTER AND ITS SUBSIDIARIES. SEE SCHEDULE J, PART III FOR ADDITIONAL INFORMATION. TRINITY HEALTH AND SAINT JOSEPH REGIONAL MEDICAL CENTER (THE PARENT OF SAINT JOSEPH REGIONAL MEDICAL CENTER - SOUTH BEND CAMPUS) HAVE CONTRACTED WITH TATUM LLC FOR THE PROVISION OF INTERIM CFO SERVICES FOR SAINT JOSEPH REGIONAL MEDICAL CENTER AND ITS SUBSIDIARIES. 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) ESTIMATE OF THE AVERAGE HOURS PER WEEK DEVOTED TO RELATED ORGANIZATIONS: CORE FORM, 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: KEDRICK ADKINS - 53 HOURS AARON AUSTIN - 40 HOURS ROBERT CASALOU - 48 HOURS ROBERT DEVEY - 40 HOURS ALBERT GUTIERREZ - 40 HOURS TERRY L. HECK - 40 HOURS MARSHA KING - 40 HOURS RICHARD KORMAN - 40 HOURS MICHAEL MURPHY - 53 HOURS RICHARD O'CONNELL - 53 HOURS LORI PRICE - 50 HOURS THOMAS REITINGER - 40 HOURS MICHAEL SLUBOWSKI - 53 HOURS JOSEPH SWEDISH - 53 HOURS CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 625,086. EQUITY TRANSFERS TO AFFILIATES: -5,000,000. TOTAL TO FORM 990, PART XI, LINE 5: -4,374,914. CORE FORM, PART XII, LINE 2: SAINT JOSEPH REGIONAL MEDICAL CENTER-SOUTH BEND CAMPUS, INC.'S FINANCIAL STATEMENTS WERE INCLUDED IN THE FY11 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, ASSOCIATES IN FAMILY MEDICINE, SAINT JOSEPH PODIATRIC RESIDENCY CLINIC, FAMILY MEDICINE CENTER OF SJRMC, SAINT JOSEPH REGIONAL MEDICAL CENTER SPORTS MEDICINE INSTITUTE, SR. MAURA BRANNICK DENTAL CENTER. 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