2012-11-14T16:32:53-06:00 2011-12-31 ERNST & YOUNG US LLP 111 MONUMENT CIRCLE STE 2600 INDIANAPOLIS IN 46204 990 2011-01-01 351536132 MEMORIAL HEALTH SYSTEM INC % JEFFREY COSTELLO MEMO 5746473549 615 N MICHIGAN STREET SOUTH BEND IN 46601 JEFFREY COSTELLO 2012-11-14 3176817000 2011 2016-02-24 21:20:13Z PHILIP NEWBOLD 615 N MICHIGAN STREET SOUTH BEND IN 46601 90544313 false X QUALITYOFLIFE.ORG X 1981 IN MEMORIAL HEALTH SYSTEM, INC. IS COMMITTED TO IMPROVING THE QUALITY OF LIFE OF THE PEOPLE IN OUR COMMUNITY. 12 9 951 0 2071687 1966424 2628344 67793807 81205762 604115 154362 2403293 1383530 72767639 85371998 329745 248560 0 0 60258564 73826588 0 0 0 31507624 32526351 92095933 106601499 -19328294 -21229501 99994316 106397632 46648276 61570630 53346040 44827002 X MEMORIAL HEALTH SYSTEM, INC. IS COMMITTED TO IMPROVING THE QUALITY OF LIFE OF THE PEOPLE IN OUR COMMUNITY. false false 66874455 55262791 MEMORIAL HEALTH SYSTEM, INC. (THE "CORPORATION") OPERATES MEMORIAL MEDICAL GROUP. MEMORIAL MEDICAL GROUP (MMG) IS A MULTI-SPECIALTY CARE NETWORK OF PHYSICIANS AND ALSO INCLUDES THE MED-POINT IMMEDIATE CARE CENTERS AND CENTER FOR OCCUPATIONAL HEALTH. IN ADDITION TO THE PHYSICIAN PRACTICES, MMG OPERATES A HIGH COMPLEXITY CORE LABORATORY FOR THE SUPPORT OF ITS EMPLOYED PHYSICIANS. THE CENTER FOR OCCUPATIONAL HEALTH (COH) AND WORKER'S COMPENSATION SERVICES FOR 1500 CLIENT COMPANIES IN ST. JOSEPH AND LAPORTE COUNTIES. MMG ALSO OPERATES MED-POINT URGENT CARE CENTERS TO SUPPLEMENT THE SERVICES OF THE MEDICAL GROUP AND COH. MMG OPERATES MED-POINT EXPRESS, A RETAIL BASED WALK-IN CLINIC AT VARIOUS RETAIL SUPERCENTERS OR GROCERY STORES. IN ADDITION TO THE CORPORATION'S PRIMARY CARE NETWORK, MEMORIAL MEDICAL GROUP MANAGES THE OPERATION OF SEVERAL HOSPITAL BASED PRACTICES FOR THE HOSPITALISTS, TRAUMA ORTHOPEDIC SURGEON, AND PEDIATRIC INTENSIVISTS. 20431613 248560 25567367 MEMORIAL HEALTH SYSTEM, INC. (THE "CORPORATION") WAS ESTABLISHED AS THE PARENT CORPORATION OF MEMORIAL HOSPITAL OF SOUTH BEND, INC. (THE "HOSPITAL") IN 1981 TO DEVELOP A FULL SPECTRUM OF HEALTH-RELATED SERVICES FOR NORTH CENTRAL INDIANA AND SOUTHWESTERN MICHIGAN. THE CORPORATION IS COMMUNITY-OWNED AND NOT-FOR-PROFIT. ALONG WITH ITS SUBSIDIARIES, THE CORPORATION SERVES THE GREATER COMMUNITY THROUGHOUT THE CONTINUM OF CARE FROM HEALTH PROMOTION AND SICKNESS PREVENTION TO DIAGNOSIS, INPATIENT, OUTPATIENT AND HOME CARE SERVICES. IT CONTROLS MEMORIAL HEALTH FOUNDATION, THE HOSPITAL'S PHILANTHROPIC ARM, AND MEMORIAL HOME CARE, INC., COLLECTIVELY REFERRED TO AS THE "SYSTEM". THE CORPORATION PROVIDES CORPORATE SERVICES TO THE ABOVE MENTIONED AFFILIATED ORGANIZATIONS AND THE HOSPITAL. ALONG WITH ITS OWN AFFILIATED ORGANIZATIONS, MEMORIAL HEALTH SYSTEM, INC. HAS FORMED SEVERAL JOINT VENTURES WHICH FURTHERS ITS WORK IN THE CONTINUUM OF CARE. 329206 375604 MEMORIAL HEALTH SYSTEM, INC. (THE "CORPORATION") OPERATES MEMORIAL MEDICAL GROUP (MMG). ALONG WITH THE PRIMARY CARE NETWORK, MMG ALSO OPERATES THE MEMORIAL MEDICAL GROUP CLINICAL RESEARCH INSTITUTE (CLINICAL RESEARCH). CLINICAL RESEARCH IS CURRENTLY FOCUSED ON PHARMACOLOGY STUDIES. THE PHARMACOLOGY STUDIES INVOLVE PATIENTS WITH SPECIFIC CONDITIONS OR DISEASES. CLINICAL RESEARCH HAS BROUGHT THE FOLLOWING POSITIVE BENEFITS TO MMG: IMPROVED PATIENT CARE - BRINGS MMG PHYSICIANS AND NURSES CLOSER TO LEADING-EDGE MEDICINE. CORPORATE POSITIONING - CLINICAL RESEARCH CAN ENHANCE MMG'S IDENTITY AND BRAND, IT CAN PROVIDE A MEANS TO MEET PHYSICIANS' ACADEMIC NEEDS AND ENHANCE PHYSICIAN RECRUITMENT. 557692 2459 MANAGED CARE SERVICES 557692 2459 88192966 true true false true false false false false false false true false true false true false false true false false false false false false false false true true true true true false false false false false false false true false false false false false true true true false false true 221 0 true 951 true true true false false false false false false false false false X 12 9 true false true false true true true true true false false true true true true true true true true true false IN X JEFFREY COSTELLO 5746473549 615 N MICHIGAN STREET SOUTH BEND IN 46601 X JOHN HILER 2.0 X X 3407 0 0 RICHARD WARNER CSC 2.0 X 0 0 0 VIVIAN SALLIE 2.0 X X 2355 0 0 RAFAT ANSARI MD 4.0 X 0 0 0 LARRY HARDING 2.0 X X 2355 0 0 VINCENT HENDERSON MD 40.0 X 354760 0 31520 TODD SCHURZ 2.0 X X 3501 0 0 PHILIP NEWBOLD 40.0 X X 1675637 0 42358 BIPIN DOSHI 2.0 X 2607 0 0 JAMES KEENAN 2.0 X 2073 0 0 WES WILLIAMS 2.0 X 2844 0 0 RICHARD RICE 2.0 X 2844 0 0 TRACY D GRAHAM 2.0 X 1061 0 0 NAJEEB KHAN 2.0 X 0 0 0 WELLINGTON JONES III 2.0 X 2355 0 0 JEFFREY COSTELLO 40.0 X 608049 0 32936 MICHAEL O'NEIL 40.0 X 257401 0 23936 GREG CONRAD 8.0 X 42692 128075 19452 MICHAEL GORDON 40.0 X 217266 0 31287 STEPHEN SMITH 40.0 X 1207771 0 27045 ROBERT YOUNT 40.0 X 1020433 0 24501 RAMANAK MITRA 40.0 X 954618 0 28275 WALTER LANGHEINRICH 40.0 X 955839 0 24904 JOSEPH SCHNITTKER 40.0 X 805202 0 32041 8125070 128075 318255 124 false true false CERNER CORPORATION 2800 ROCKCREEK PKWY KANSAS CITY MO 46117 IS SFTWR MAINTENANCE 2043208 WOODCOX BLDG CONTRACTORS 51175 PRESCOTT AVE SOUTH BEND IN 46637 CONSTRUCTION MANAGER 1447879 MCKESSON INFORMATION SOLUTIONS LLC PO BOX 98347 CHICAGO IL 60693 IS SFTWR MAINTENANCE 1330965 BVK 250 W COVENTRY COURT MILWAUKEE WI 53217 ADVERTISING 883977 ALLSCRIPTS LLC 8529 SIX FORKS ROAD RALEIGH NC 27615 IS SFTWR MAINTENANCE 845237 40 514674 2113670 2628344 NET PATIENT REV 621110 55262791 55132043 130748 CLINICAL TRIAL REV 621500 375604 375604 MGT ADMIN SVCS 561499 24302348 22383456 1918892 JOINT VENTURES 621110 624626 619979 4647 AFFILIATE RENT 531120 640393 640393 81205762 142421 142421 0 83221 83221 2912830 1952352 960478 960478 960478 3221904 10000 3140200 79763 81704 -69763 11941 11941 0 0 0 MEDICAL DIRECTORSHIP 621110 252892 252892 PROFESSIONAL CALL VOLUME - ASK A NURSE 621300 67080 67080 ACCOUNTING SERVICES FOR JOINT VENTURE 541200 17400 17400 2459 2459 339831 85371998 78513541 2071687 2158426 69130 69130 179430 179430 0 0 3348107 254186 3093921 0 56928775 51979929 4948846 1900076 1651120 248956 8305229 6930794 1374435 3344401 2784821 559580 0 539099 539099 172921 14856 158065 5788 3356 2432 0 0 4029467 2968603 1060864 1808163 1071019 737144 7318391 4615536 2702855 38178 27479 10699 0 2619514 2136239 483275 276389 176325 100064 0 338309 307368 30941 0 0 4999329 3380512 1618817 1195884 1102158 93726 MEDICAL SUPPLIES 4188105 4188105 BAD DEBT EXPENSE 2944207 2944207 LICENSES & TAXES 1164421 789845 374576 GENERAL DUES & SUBSCRIPTIONS 524124 364949 159175 364062 252999 111063 106601499 88192966 18408533 0 5781 5781 2859523 6626725 304670 396954 5963233 8223770 0 0 0 0 106522 106522 0 0 5304783 5877805 112953244 51836403 61948591 61116841 3871168 3980513 0 0 15623397 16670770 0 0 4006648 3391951 99994316 106397632 11775949 16280847 0 0 26636 22383 0 0 0 0 0 0 0 0 0 0 34845691 45267400 46648276 61570630 X 53346040 44827002 0 0 0 0 53346040 44827002 99994316 106397632 X -21229501 12710463 X false true true X true true X 831024 1265409 1791723 1966424 2628344 8482924 63654671 62463577 66413343 67805369 81208221 341545181 64485695 63728986 68205066 69771793 83836565 350028105 0 0 0 0 29878877 22391069 20657376 19468541 20415589 112811452 29878877 22391069 20657376 19468541 20415589 112811452 237216653 2904040 3258293 2405482 4228947 3133702 15930464 4830 4867 4893 4963 17400 36953 2908870 3263160 2410375 4233910 3151102 15967417 583054 388924 395391 325266 319972 2012607 67977619 67381070 71010832 74330969 87307639 368008129 0.64460 0.60097 0.04339 0.04451 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 5788 5788 false OTHER ACTIVITIES PART II-B MEMORIAL HEALTH SYSTEM, INC PAYS FOR THE MEMBERSHIP FEES TO SEVERAL NATIONAL ORGANIZATIONS FOR ITS EMPLOYEES. THESE NATIONAL ORGANIZATIONS INDICATE A PORTION OF THE MEMBERSHIP FEES ARE USED FOR LOBBYING PURPOSES. THE MEMBERSHIP FEES PAID WERE FOR THE FOLLOWING ORGANIZATIONS: -AMERICAN INSTITUTE OF CERTIFIED PUBLIC ACCOUNTANTS -INDIANA CPA SOCIETY -AMERICA COLLEGE OF HEALTH CARE EXECUTIVES -AMERICAN DIETETIC ASSOCIATION -FINANCIAL EXECUTIVE INSTITUTE -MEDICAL GROUP MANAGEMENT ASSOCIATION -AMERICAN ACADEMY OF FAMILY PHYSICIANS -AMERICAN COLLEGE OF PHYSICIANS -AMERICAN COLLEGE OF CARDIOLOGY -AMERICAN HOSPITAL ASSOCIATION -AMERICAN ASSOCIATION OF NEUROLOGICAL SURGEONS -INDIANA STATE MEDICAL SOCIETY -SOCIETY FOR HUMAN RESOURCE MANAGMENT 16819050 16819050 50088232 16811301 33276931 1959397 1480610 478787 44086565 33544492 10542073 61116841 INVESTMENT IN HOME CARE 12366886 C INVESTMENT IN VHA 200000 C INVETMENT IN STRATUM MEDICAL 95000 C LAPORTE MEDICAL GROUP SURGICAL 15766 C MEMORIAL SPINE & NEUROSCIENCE 172699 C COMMUNITY HEALTH ALLIANCE 2235416 C MEMORIAL LIGHTHOUSE IMAGING JV 11851 C MICHIANA LINEN SERVICES JV 1573152 C 16670770 0 ACCRUED SUPPLEMENTAL BENEFITS 4122106 ACCRUED PENSION 40962596 DUE TO AFFILIATES 182698 45267400 true true true X true X true false false 260157 260157 0.00330 9027703 9027703 0.11570 9287860 9287860 0.11900 60700 60700 0.00070 60700 60700 0.00070 9348560 9348560 0.11970 false 2270346 227035 10283915 13660982 -3377067 X true true MEMORIAL SPINE & NEU SPINAL INJECTIONS & OTHER MIN 0.50000 0.50000 LAPORTE MEDICAL GROU OUTPATIENT SURGERY CENTER 0.50187 0.18023 PHYSICIAN'S HOSPITAL LONGTERM ACUTE CARE FACILITY 0.33981 0.25243 0.39320 1 1 RIVERCREST SPECIALTY HOSPITAL

1625 EAST JEFFERSON BLVD MISHAWAKA IN 46545

X LONG TERM ACUTE CARE RIVERCREST SPECIALTY HOSPITAL 1 true true 100 true 400. true X true true X true false false X X false false 35 MEMORIAL ADVANCED CARDIOVASCULAR INSTITU

610 N MICHIGAN SUITE 400 SOUTH BEND IN 46601

PHYSICIAN PRACTICE OUTPATIENT SERVICES LAPORTE MEDICAL GROUP

900 I STREET LAPORTE IN 46350

PHYSICIAN PRACTICE OUTPATIENT SERVICES MAIN STREET MEDICAL GROUP

6913 N MAIN STREET SUITE 300 GRANGER IN 46530

PHYSICIAN PRACTICE OUTPATIENT SERVICES LAPORTE LAB

900 I STREET LAPORTE IN 46350

LAB SERVICES IRELAND ROAD MEDICAL GROUP

1815 E IRELAND RD SOUTH BEND IN 46614

PHYSICIAN PRACTICE OUTPATIENT SERVICES LAPORTE SURGERY CENTER

900 I STREET LAPORTE IN 46350

OUTPATIENT SURGERY MICHIANA ARTHRITIS AND OSTEOARTHRITIS CE

707 N MICHIGAN SUITE 102 SOUTH BEND IN 46601

PHYSICIAN PRACTICE OUTPATIENT SERVICES FAMILY PRACTICE CENTER

714 SOUTH MICHIGAN STREET SOUTH BEND IN 46601

PHYSICIAN PRACTICE OUTPATIENT SERVICES NAVARRE PEDIATRIC SATELLITE

6913 N MAIN STREET SUITE 200 GRANGER IN 46530

PHYSICIAN PRACTICE OUTEPATIENT SERVICES RADIATION ONCOLOGY

615 N MICHIGAN STREET SOUTH BEND IN 46601

PHYSICIAN PRACTICE OUTPATIENT SERVICES MEMORIAL SPINE & NEUROSCIENCE CENTER

100 NAVARRE SUITE 4405 SOUTH BEND IN 46601

SPINE & OUTPATIENT SURGERY PROCEDURES WOMEN'S REPRODUCTIVE MEDICINE

100 NAVARRE SUITE 4470 SOUTH BEND IN 46601

PHYSICIAN PRACTICE OUTPATIENT SERVICES MEMORIAL HOSPITALISTS

100 NAVARRE SUITE 5500 SOUTH BEND IN 46601

PHYSICIAN PRACTICE OUTPATIENT SERVICES NAVARRE PEDIATRIC GROUP

100 NAVARRE SUITE 4400 SOUTH BEND IN 46601

PHYSICIAN PRACTICE OUTPATIENT SERVICES SCHWARTZ-WEIKAMP MEDICAL GROUP

4630 VISTULA ROAD MISHAWAKA IN 46544

PHYSICIAN PRACTICE OUTPATIENT SERVICES PORTAGE MEDICAL GROUP

3575 PORTAGE ROAD SOUTH BEND IN 46628

PHYSICIAN PRACTICE OUTPATIENT SERVICES DR BRYAN BOYER

100 NAVARRE SUITE 5500 SOUTH BEND IN 46601

PHYSICIAN PRACTICE OUTPATIENT SERVICES MATERNALFETAL MEDICINE

100 NAVARRE SUITE 4400 SOUTH BEND IN 46601

PHYSICIAN PRACTICE OUTPATIENT SERVICES SOUTHEAST CLINIC

1708 S HIGH STREET SOUTH BEND IN 46613

PHYSICIAN PRACTICE OUTPATIENT SERVICES MEMORIAL CRITICAL KIDS

615 N MICHIGAN SOUTH BEND IN 46601

PHYSICIAN PRACTICE OUTPATIENT SERVICES CENTRAL CLINIC

813 S MICHIGAN STREET SOUTH BEND IN 46601

PHYSICIAN PRACTICE OUTPATIENT SERVICES CENTER FOR OCCUPATIONAL HEALTH

2301 N BENDIX DRIVE SOUTH BEND IN 46628

PHYSICIAN PRACTIVE OUTPATIENT SERVICES SPORTS MEDICINE INSTITUTE

111 W JEFFERSON BLVD SUITE 100 SOUTH BEND IN 46601

PHYSICIAN PRACTICE OUTPATIENT SERVICES PEDIATRIC HEMATOLOGY AND ONCOLOGY

615 N MICHIGAN SOUTH BEND IN 46601

PHYSICIAN PRACTICE OUTPATIENT SERVICES MEDPOINT EXPRESS - VALPARAISO

2400 NORTHLAND DRIVE VALPARAISO IN 46383

PHYSICIAN PRACTICE OUTPATIENT SERVICES DEVELOPMENTAL PEDIATRICS

615 N MICHIGAN SOUTH BEND IN 46601

PHYSICIAN PRACTICE OUTPATIENT SERVICES MEDPOINT EXPRESS - ERSKINE

926 ERSKINE PLAZA SOUTH BEND IN 46614

PHYSICIAN PRACTICE OUTPATIENT SERVICES MEDPOINT EXPRESS - ELKHART

3900 E BRISTOL STREET ELKHART IN 46514

PHYSICIAN PRACTICE OUTPATIENT SERVICES LAKEVILLE FAMILY PRACTICE

601 N MICHIGAN LAKEVILLE IN 46536

PHYSICIAN PRACTICE OUTPATIENT SERVICES BARIATRIC SERVICES

6913 N MAIN STREET GRANGER IN 46530

PHYSICIAN PRACTICE OUTPATIENT SERVICES MEMORIAL CARDIOTHORACIC SURGERY

707 N MICHIGAN ST SUITE 501 SOUTH BEND IN 46601

PHYSICIAN PRACTICE OUTPATIENT SERVICES MEMORIAL MEDICAL GROUP BEHAVIORAL HEALTH

420 N NILES AVE 3RD FLOOR SOUTH BEND IN 46617

PHYSICIAN PRACTICE OUTPATIENT SERVICES MEMORIAL NORTHCENTRAL NEUROSURGERY

100 NAVARRE PLACE SUITE 6600 SOUTH BEND IN 46601

PHYSICIAN PRACTICE OUTPATIENT SERVICES MEMORIAL NORTHCENTRAL NEUROSURGERY

500 ARCADE BLVD SUITE 110 ELKHART IN 46601

PHYSICIAN PRACTICE OUTPATIENT SERVICES MEMORIAL PEDIATRIC SPECIALTIES

100 NAVARRE PLACE SUITE 4475 SOUTH BEND IN 46601

PHYSICIAN PRACTICE OUTPATIENT SERVICES SCHEDULE H, PART I, LINE 3c NOT APPLICABLE SCHEDULE H, PART I, LINE 6a MEMORIAL HEALTH SYSTEM, INC. IS A 33.98% OWNER IN PHYSICIAN'S HOSPITAL, LLC, WHICH IS A JOINT VENTURE PARTNERSHIP AND DOES NOT FILE A COMMUNITY BENEFIT REPORT. MEMORIAL HEALTH SYSTEM, INC., OPERATES SEVERAL PHYSICIAN CLINICS THAT PROVIDE SERVICES TO INDIVIDUALS, REGARDLESS OF THEIR ABILITY TO PAY. MEMORIAL'S CENTRAL CLINIC IS LOCATED AT THE SOUTH BEND HOMELESS SHELTER, WHILE THE SOUTHEAST CLINIC IS LOCATED IN A NEIGHBORHOOD WITH HISTORICALLY LOW INCOME LEVELS. SCHEDULE H, PART I, LINE 7, COLUMN F BAD DEBT EXPENSE REMOVED FROM TOTAL EXPENSES OF $3,016,651 SCHEDULE H, PART I, LINE 7 DONATIONS - THE ACTUAL COST OF THE DONATION OR DEPARTMENTAL NET CONTRIBUTION, WHICHEVER IS APPROPRIATE, FROM THE GENERAL LEDGER RECORDS AND REPORTS ARE INCLUDED. SCHEDULE H, 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 RECEIVABLES ARE CHARGED TO THE ALLOWANCE FOR DOUBTFUL ACCOUNTS WHEN THEY ARE DEEMED UNCOLLECTIBLE. COSTING METHODOLOGY IS THE SAME AS TAX FORM 990, SCHEDULE H, WORKSHEET 2 METHODOLOGY. PATIENT CARE COST ADJUSTED BY NON-PATIENT ACTIVITY, EXPENSES, AND PATIENT CARE CHARGES. SCHEDULE H, PART III, LINE 8 PARTICIPATION IN THE GOVERNMENTAL MEDICARE PROGRAM DOES NOT PROVIDE THE OPPORTUNITY FOR A HEALTH PROVIDER TO NEGOTIATE A REIMBURSMENT RATE OR STRUCTURE THAT WOULD ALLOW THE PROVIDER TO COVER THE COST OF THE MEDICAL SERVICE RENDERED TO THE PROGRAM PARTICIPTANT, AS WOULD BE THE CASE IN CONTRACTUAL NEGOTIATIONS WITH COMMERCIAL INSURANCE COMPANIES. NOR IS THE PROVIDER ALLOWED TO PROVIDE ONLY THE SERVICES FOR WHICH REIMBURSMENT 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 REIMBURSMENT REPRESENTS A REDUCTION OR RELIEF OF THE GOVERNMENT BURDEN TO PAY THE FULL COST OF CARE PROVIDED. SCHEDULE H, PART III, LINE 9b The collection policy and procedures are as follows related to patients who are known to qualify for charity care or financial assistance: To ensure that Memorial fulfills its mission and commitment to the poor, Memorial 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 will 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 Health System. PROCEDURE: 1.Memorial Health System 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 to the patient a Financial Evaluation form. 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 years 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. ie: 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 Health System 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. SCHEDULE H, PART V, SECTION B, LINE 19d PHYSICIANS HOSPITAL, LLC IS NOT AN EXEMPT ORGINIZATION, AND BECAUSE IT IS A LONG TERM ACUTE CARE HOSPITAL, IT DOES NOT PROVIDE EMERGENCY SERVICES. PHYSICIANS HOSPITAL DOES HAVE A FINANCIAL ASSISTANCE POLICY, HOWEVER IT HAS NOT IMPLEMENTED SECTION 501(r). SCHEDULE H, PART VI, LINE 3 PHYSICIAN'S HOSPITAL, LLC IS DEDICATED TO SERVICING THE HEALTH CARE NEEDS OF ITS PATIENTS NEEDING FINANCIAL ASSISTANCE. PATIENTS NEED ONLY REQUEST FINANCIAL ASSISTANCE, AND COMPLETE AND SIGN A FINANCIAL ASSISTANCE APPLICATION TO BE CONSIDERED. SCHDULE H, PART VI, LINE 4 ESTABLISHED IN 1830, ST JOSEPH COUNTY INDIANA HAS BECOME THE FOURTH LARGEST COUNTY IN INDIANA. THE COUNTY SPANS 467 SQUARE MILES, WHICH INCLUDES A COMFORTABLE MIX OF RURAL CULTRUAL HERITAGE AND URBAN AMENITIES. THE POPULATION FOR ST. JOSEPH COUNTY IN 2011 WAS 266,700 INDIVIDUALS. THE RACE IN THE COUNTY IS 80% CAUCASIANS, 11.8% AFRICAN AMERICAN, AND HISPANICS REPRESENT 6.6%, WITH 1.6% LISTED AS OTHER. OUR SERVICE AREA INCLUDES PATIENTS FROM ST. JOSEPH COUNTY AND SURROUNDING COUNTIES IN INDIANA AND MICHIGAN. SCHEDULE H, PART VI, LINE 6 MEMORIAL HEALTH SYSTEM, INC. IS A 33.98% OWNER IN PHYSICIAN'S HOSPITAL, LLC. PHYSICIAN'S HOSPITAL, LLC, DOING BUSINESS AS RIVERCREST SPECIALTY HOSPITAL (THE "HOSPITAL") PROVIDES INPATIENT LONG-TERM ACUTE CARE SERVICES. THE HOSPITAL OPERATES A 30 BED, FREESTANDING SPECIALTY ACUTE CARE HOSPITAL LOCATED IN MISHAWAKA, INDIANA. THE HOSPITAL PROVIDES SHORT-TERM, COMPREHENSIVE REHABILITATION SERVICES TO PATIENTS, AND ITS PROGRAMS ARE DESIGNED TO RESTORE PHYSICAL FUNCTIONS FOLLOWING AN ACUTE ILLNESS OR TRAUMA. INPATIENT THERAPY AND SUPPORT SERVICES PROVIDED BY THE HOSPITAL INCLUDE PHYSICAL, OCCUPATIONAL, SPEECH AND RECREATION THERAPY, RADIOLOGY, VENTILATORS, LABORATORY AND DIETARY SERVICES. SCHEDULE H, PART VI, LINE 7 MEMORIAL HEALTH SYSTEM, INC. IS A 33.98% OWNER IN PHYSICIAN'S HOSPITAL, LLC. PHYSICIAN'S HOSPITAL LLC, DOES NOT CURRENTLY FILE A COMMUNITY BENEFIT REPORT AS IT IS NOT AN EXEMPT ORGANIZATION. MEMORIAL HEALTH SYSTEM, INC REPORTS ITS SHARE OF THE NON-CONTROLLING INCOME (LOSS) IN PHYSICIANS HOSPITAL, LLC AS RELATED INCOME. true DOWNTOWN SOUTH BEND INC 217 S MICHIGAN ST SOUTH BEND IN 46601 351546291 501(c)(6) 50000 2011 PLEDGE 1 SCHOLARSHIPS/TUITION REIMBURSMENT 112 179430 SCHEDULE I, PART II CHARITABLE DONATIONS PART OF THE ORGANIZATION'S MISSION IS TO IMPROVE THE HEALTH OF OUR COMMUNITY. IN ORDER TO FULFILL THIS GOAL, OUR ADMINISTRATORS HAVE THE ABILITY TO MAKE DONATIONS TO ORGANIZATIONS THAT IMPROVE THE HEALTH AND WELL BEING OF OUR COMMUNITY. SCHEDULE I, PART III SCHOLARSHIPS / TUITION REIMBURSMENT FOR SCHOLARSHIPS THE INDIVIDUAL MUST MEET SEVERAL REQUIREMENTS TO QUALIFY. IN ORDER TO QUALIFY FOR A SCHOLARSHIP THE INDIVIDUAL MUST (1) APPLY ON-LINE (INTRANET) AND WITHIN THE ACCEPTABLE TIME PARAMETERS FOR THE SEMESTER OF FUNDS BEING REQUESTED, (2) MAINTAIN A GRADE OF C OR BETTER, (3) PAY FOR TUITION/BOOKS AND SUBMIT CORRESPONDING ORIGINAL RECEIPTS FOR REIMBURSEMENT. REIMBURSED UP TO THE AMOUNT AWARDED BY THE SCHOLARSHIP COMMITTEE. (4) MEET ANY ADDITIONAL REQUIREMENTS OF THE SPECIFIC SCHOLARSHIP FUND, AND (5) MEET ELIGIBILITY REQUIREMENTS WHICH INCLUDE: (A) EMPLOYED BY MEMORIAL HEALTH SYSTEM, INC. (B) ENROLLED IN A QUALIFIED PROGRAM; (C) SUBMITTED A POSITIVE RECOMMENDATION EACH SEMESTER FROM THE IMMEDIATE SUPERVISOR; AND (D) SUBMITTED A POSITIVE RECOMMENDATION EACH SEMESTER FROM THE SCHOOL. X X X X true true X X X X X false true false false false true true true false VINCENT HENDERSON MD 349614 0 0 0 5146 0 14722 0 16798 0 386280 0 0 0 JEFFREY COSTELLO 282072 0 303186 0 22791 0 17402 0 15534 0 640985 0 203250 0 MICHAEL O'NEIL 219135 0 0 38266 0 12672 0 11264 0 281337 0 0 0 PHILIP NEWBOLD 559219 0 891563 0 224855 0 22046 0 20312 0 1717995 0 448804 0 MICHAEL GORDON 211801 0 0 0 5465 0 10811 0 20476 0 248553 0 0 0 GREG CONRAD 41676 125028 0 0 1016 3047 2133 6398 2730 8191 47555 142664 0 0 STEPHEN SMITH 1182771 0 25000 0 0 0 9800 0 17245 0 1234816 0 0 0 ROBERT YOUNT 991776 0 25000 0 3657 0 9800 0 14701 0 1044934 0 0 0 RAMANAK MITRA 953928 0 0 0 690 0 9800 0 18475 0 982893 0 0 0 WALTER LANGHEINRICH 929597 0 25000 0 1242 0 9800 0 15104 0 980743 0 0 0 JOSEPH SCHNITTKER 777880 0 25000 0 2322 0 9800 0 22241 0 837243 0 0 0 PART I, LINE 1A MEMORIAL HEALTH SYSTEM, INC. REIMBURSES DIRECTORS FOR THE TAX EFFECT OF THE 1099 REPORTABLE BENEFITS FOR HEALTH CLUB MEMBERSHIP, WITH MEMORIAL HEALTH SYSTEM'S HEALTH AND LIFESTYLE CENTER AND SPOUSAL TRAVEL. THIS REPORTING IMPACTS 11 CURRENT BOARD MEMBERS. MEMORIAL HEALTH SYSTEM ALSO REIMBURSES FOR DIRECT EXPENSES RELATED TO ANY TRAVEL ON THE ORGANIZATION'S BEHALF. SOCIAL CLUB MEMBERSHIPS INCLUDED IN TAXABLE COMPENSATION - 2 EMPLOYEES (JEFFERY COSTELLO, AND MICHAEL O'NEIL) SPOUSAL TRAVEL INCLUDED IN TAXABLE COMPENSATION -1 EMPLOYEE (PHILIP NEWBOLD) CHARTER TRAVEL WAS PROVIDED FOR INVESTMENT COMMITTEE MEMBERS TO TRAVEL TO THE INVESTMENT ADVISOR, LOCATED IN MINNEAPOLIS, MN. THE CHARTER TRAVEL ALLOWED THE ORGINIZATION TO REDUCE THE OVERALL COST OF TRAVEL, BY ELIMINATING THE NEED FOR OVERNIGHT ACCOMIDATIONS. THE CHARTER TRAVEL ALSO REDUCED THE TIME UNPAID BOARD MEMBERS HAD TO COMMIT. CHARTER TRAVEL WAS PROVIDED FOR 2 INDIVIDUALS LISTED ON PART VII, SECTION LINE 1A (JEFFREY COSTELLO, JAMES KEENAN). PART I, LINE 4B SUPPLEMENTAL EXECUTIVE RETIREMENT PROGRAM (457(F)) EMPLOYEE 2011 EARNED 457(f) PHILIP NEWBOLD $191,729 MICHAEL O'NEIL $16,110 JEFFERY COSTELLO $0 MEMORIAL HEALTH SYSTEM PROVIDES A NON-QUALIFIED SUPPLEMENTAL EXECUTIVE RETIREMENT PROGRAM (SERP) TO CERTAIN EXECUTIVES. THE PLAN PROVIDES FOR AN ADDED RETIREMENT BENEFIT OVER THE QUALIFIED RETIREMENT PROGRAM. QUALIFIED INDIVIDUALS ARE ELIGIBLE TO RECEIVE A BENEFIT, IN THE FORM OF AN AFTER TAX LUMP SUM, WHICH IS THE ACTUARIAL EQUIVALENT OF AN ANNUITY, EQUAL TO 65% OF THE AVERAGE OF THEIR LAST FIVE YEARS OF PRERETIREMENT EARNINGS, OR 70% WITH MORE THAN 25 YEARS OF SERVICE, WITH OFFSETS FOR THE VALUE OF SOCIAL SECURITY AND QUALIFIED RETIREMENT PLAN BENEFITS. PARTICIPANTS VEST INTO THE SERP AFTER FIVE YEARS OF SERVICE. THE INCREASE IN VALUE OF THE BENEFIT EACH YEAR IS INCLUDED IN THE TAXABLE COMPENSATION OF VESTED SERP PARTICIPANTS. SUCH AMOUNTS ARE INCLUDED IN PART II COLUMN (B)(iii). IF A VESTED EMPLOYEE LEAVES EMPLOYMENT, THE ANNUAL VALUE OF THE BENEFIT IS CONVERTED TO A LUMP SUM AND PAID TO THE PARTICIPANT AFTER FULFILLING THE TERMS OF THEIR NON-COMPETE AGREEMENT. ON 12/31/2011 MEMORIAL HEALTH SYSTEM TERMINATED THE SUPPLEMENTAL EXECUTIVE RETIREMENT PROGRAM. PART I, LINE 6A & 6B THE ORGANIZATION HAS TWO INCENTIVE PLANS (EMPLOYEE AND MANAGEMENT) WHICH HAVE A NET OPERATING INCOME TO BUDGET MEASUREMENT FOR THE PAYOUT THRESHOLD. THE EMPLOYEE PLAN SHARES THE EXCESS OVER BUDGET NET OPERATING INCOME WITH THE NON-MANAGMENT EMPLOYEES FOR MEMORIAL HEALTH SYSTEM, INC AND THE AFFILIATED ENTITIES, WHICH INCLUDES MEMORIAL HOSPITAL OF SOUTH BEND, INC. THE EMPLOYEE INCENTIVE HAS A MAXIMUM CAP OF $2,500,00. 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. THE CEO IS COVERED UNDER A DEFERRED COMPENDATION PLAN. THE PLAN SETS ASIDE HALF OF THE CEO'S ANNUAL BONUS AWARD AS DEFERRED COMPENSATION TO BE PAID IN FUTURE YEARS AT A RATE OF 20% PER YEAR PLUS ACCRUED INTEREST. IN ORDER TO RECEIVE THE FUTURE BENEFITS UNDER THE PLAN, THE CEO MUST CONTINUE TO REMAIN EMPLOYED BY THE ORGANIZATION. THE PLAN WAS TERMINATED AND BENEFITS UNDER THE PLAN WERE PAID IN FULL ON 12/31/2011. PART I, LINE 7 BRYAN BOYER, MD IS ELIGIBLE FOR AN INCENTIVE BASED UPON EXCEEDING GROSS PROFESSIONAL BILLINGS. THE INCENTIVE IS A COMPONENT OF THE EMPLOYMENT CONTRACT WITH DR. BOYER. DAVID HORNBACK, MD IS ELIGIBLE FOR AN INCENTIVE BASED UPON NET PROFESSIONAL BILLINGS. THE INCENTIVE IS A COMPONENT OF THE EMPLOYMENT CONTRACT WITH DR HORNBACK. FACULTY INCENTIVE FOR FAMILY PRACTICE RESIDENCY CLINICS PROVIDES FOR AN INCENTIVE PAYMENT WHEN COLLECTIONS FOR PERSONALLY RENDERED SERVICES EXCEED A THRESHOLD. THESE INCENTIVE ARE CAPPED. PHYSICIAN RELATIONS INCENTIVE PLAN PROVIDES FOR AN INCENTIVE PAYMENT TO EMPLOYEES IN A PHYSICIANS RELATIONS POSITION BASED UPON ATTAINMENT OF SATISFACTION SCORES. PAID AS A PERCENTAGE OF BASE PAY UP TO 5%. RAFAT ANSARI MD DIRECTOR 259189 LEASES OFFICE SPACE false FORM 990, PART VI, SECTION A, LINE 2 BUSINESS RELATIONSHIPS - VINCENT HENDERSON & RICK RICE FORM 990, PART VI, SECTION A, LINE 4 IN MARCH 2011, MEMORIAL HEALTH SYSTEM INC (MHS) AND ELKHART GENERAL HOSPITAL INC (EGH) COMPLETED A MEMORANDUM OF UNDERSTANDING TO FORM AN AFFILIATION. EFFECTIVE DECEMBER 1, 2011, A NEWLY FORMED CORPORATION, BEACON HEALTH SYSTEM, INC (BEACON), BECAME THE SOLE CORPORATE MEMBER FOR BOTH MHS AND EGH. FORM 990, PART VI, SECTION A, LINE 6 BEACON HEALTH SYSTEM, INC. IS THE SOLE CORPORATE MEMBER OF MEMORIAL HEALTH SYSTEM, INC. FORM 990, PART VI, SECTION A, LINE 7a THE CORPORATE MEMBER SHALL APPOINT THE BOARD OF DIRECTORS OF MEMORIAL HEALTH SYSTEM AND SHALL HAVE SUCH POWERS OF ADVANCE APPROVAL REGARDING CORPORATE ACTIONS AS ARE DELINEATED IN THE BY-LAWS OF MEMORIAL HEALTH SYSTEM. FORM 990, PART VI, SECTION A, LINE 7b DECISIONS OF THE BOARD OF DIRECTORS MUST BE APPROVED BY THE CORPORATE MEMBER. 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 CONTROLLER, AND CFO. SUBSEQUENT TO THOSE STEPS, THE ORGANIZATION ENGAGED ERNST & YOUNG US, LLP TO REVIEW THE COMPLETED FORM 990 AND APPROPRIATE SCHEDULES. PRIOR TO FILING THE RETURN, THE COMPENSATION COMMITTEE OF THE ORGANIZATION AND CEO CONDUCT A GENERAL OVERVIEW OF THE FORM 990, INCLUDING APPLICABLE COMPENSATION SCHEDULES. IN ADDITION, THE BOARD OF DIRECTORS AND THE AUDIT COMMITTEE WILL RECEIVE A COPY OF THE 990 PRIOR TO FILING. 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 EMPLOYEES TO DISCLOSE ANY POTENTIAL CONFLICT OF INTERESTS THEY MAY HAVE. THE STATEMENTS ARE SENT IN JANUARY OF EACH YEAR AND WE PURSUE THE REPLIES TO GET A 100% RESPONSE RATE. IN THE CURRENT YEAR WE SENT OUT OVER 250 STATEMENTS AND ACHIEVED A 100% RESPONSE RATE. EACH RESPONSE IS REVIEWED BY THE DIRECTOR OF INTERNAL AUDIT AND THE RESULTS ARE REPORTED TO THE CEO OF MEMORIAL HEALTH SYSTEM, INC AS WELL AS THE AUDIT COMMITTEE OF THE BOARD OF DIRECTORS. 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, THE FIVE HIGHEST COMPENSATED EMPLOYEES FROM THE PREVIOUS YEAR, EMPLOYEES THAT ARE ON THE GRANT AND SCHOLARSHIP COMMITTEES, AND OTHER KEY EMPLOYEES. THE DUALITY OF INTEREST STATEMENTS WERE SENT OUT IN JUNE, 2011. THE REPLIES ARE REVIEWED BY THE DIRECTOR OF INTERNAL AUDIT WHO SUMMARIZES THE RESULTS, WHICH ARE REVIEWED BY AN INDEPENDENT PARTY. THE RESULTS ARE REPORTED TO THE CEO OF MEMORIAL HEALTH SYSTEM, INC 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 ACKNOWLEDGMENT FORM TO BE SIGNED BY MEMORIAL HEALTH SYSTEM, INC'S KEY FINANCIAL EMPLOYEES THAT MEMORIAL HEALTH SYSTEMS, INC'S FINANCIAL INFORMATION IS TO THE BEST OF THEIR KNOWLEDGE TRUE AND ACCURATE. THIS STATEMENT WAS SENT OUT IN JANUARY, 2011. SIGNED ACKNOWLEDGEMENTS ARE KEPT BY THE DIRECTOR OF INTERNAL AUDIT. IN 2011, TWELVE DESIGNATED EMPLOYEES WERE REQUESTED TO SIGN THE FORM AND 100% COMPLIED WITH THIS REQUEST. 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 EXCLUDED FROM ALL REVIEW PROCEEDINGS FORM 990, PART VI, SECTION B, LINE 15a & 15b AN EXTENSIVE EXAMINATION IS CONDUCTED USING COMPARABLE MARKET DATA AND IT IS THEN REVIEWED BY AN INDEPENDENT CONSULTANT HIRED BY, AND REPORTING TO, THE BOARD OF DIRECTORS. RECOMMENDATIONS ARE PRESENTED TO THE COMPENSATION COMMITTEE OF THE MEMORIAL HEALTH SYSTEM, INC BOARD FOR DELIBERATION AND FINAL DECISION. DELIBERATION AND FINAL DECISION ARE PERFORMED BY THE INDEPENDENT MEMBERS OF THE BOARD. 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. FORM 990, PART XI, LINE 5 CASH TRANSFERS FROM MEMORIAL HOSPITAL OF SOUTH BEND: $ 28,513,083 WRITE OFF INTER COMPANY MEMORIAL HOSPITAL OF SOUTH BEND $- 2,919,982 WRITE OFF INTER COMPANY MEMORIAL HEALTH FOUNDATION $- 1,043,051 CHANGE IN PENSION LIABILITY $-12,572,569 ACCRUED HEALTH INSURANCE LIABLILITY TRUE UP -BETWEEN MEMORIAL HOSPITAL AND MEMORIAL HEALTH SYSTEM $ 841,936 UNREALIZED GAIN\LOSS ON INVESTMENT $- 108,955 TOTAL $ 12,710,462 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:JOHN HILER TITLE:DIRECTOR - CHAIR HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:RICHARD WARNER, CSC TITLE:DIRECTOR - THRU MAR 2011 HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:VIVIAN SALLIE TITLE:DIRECTOR - SECRETARY HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:RAFAT ANSARI, MD TITLE:DIRECTOR - MED DIRECTOR HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:LARRY HARDING TITLE:DIRECTOR - TREASURER HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:VINCENT HENDERSON, MD TITLE:DIRECTOR & EMPLOYED PHYSICIAN HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:TODD SCHURZ TITLE:DIRECTOR - VICE CHAIR HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:PHILIP NEWBOLD TITLE:PRESIDENT & CEO HOURS:4 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:BIPIN DOSHI TITLE:DIRECTOR HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:JAMES KEENAN TITLE:DIRECTOR - THRU MAR 2011 HOURS:2 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:WES WILLIAMS TITLE:DIRECTOR - THRU NOV 2011 HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:RICHARD RICE TITLE:DIRECTOR HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:TRACY D GRAHAM TITLE:DIRECTOR HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:NAJEEB KHAN TITLE:DIRECTOR HOURS:2 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:WELLINGTON JONES III TITLE:DIRECTOR HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:JEFFREY COSTELLO TITLE:ASSISTANT TREASURER & CFO HOURS:4 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:MICHAEL O'NEIL TITLE:COO HOURS:2 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:GREG CONRAD TITLE:ASST SECRETARY & VP HOURS:32 MEMORIAL HOSPITAL OF SOUTH BEND INC 615 N MICHIGAN ST SOUTH BEND IN 46601 350868132 HOSPITAL IN 501(c)(3) 3 BEACON true MEMORIAL HEALTH FOUNDATION INC 615 N MICHIGAN ST SOUTH BEND IN 46601 351536129 FINANCIAL SUP IN 501(c)(3) 9 MHS true ELKHART GENERAL HOSPITAL 600 EAST BOULEVARD ELKHART IN 46514 350877574 HOSPITAL IN 501(C)(3) 3 BEACON true BEACON HEALTH SYSTEM INC 600 EAST BOULEVARD ELKHART IN 46514 PARENT ORG IN 501(C)(3) 11C-III-FI N/A false MEMORIAL ENDOWMENT FUND FOR MEMORIAL HOS PO BOX 1602 SOUTH BEND IN 46634 356068581 ENDOWMENT IN 501(C)(3) 11D III-O MEMORIAL HOS true LAPORTE MEDICAL GROUP SURGICAL CENTER 11221 ROE AVE SUITE 320 LEAWOOD KS 66211 260505795 SURGICAL CENTER KS MEMORIAL HEALTH RELATED 24739 1055717 false false 0.50187 MICHIANA LINEN SERVICES LLC 600 EAST BLVD ELKHART IN 46515 LINEN SERVICES IN MEMORIAL HEALTH UNRELATED 37397 1738299 false false 0.64000 MEMORIAL HOME CARE INC 615 N MICHIGAN ST SOUTH BEND IN 46601 351901068 HOME MEDICAL IN NA C 22286263 13742061 1.00000 true true true false false false false false true true true true true true true true true true MEMORIAL HOME CARE INC a iv 79099 ACTUAL CHARGES MEMORIAL HOSPITAL OF SOUTH BEND INC a iv 642868 ACTUAL CHARGES MEMORIAL HOME CARE INC j 114453 ACTUAL CHARGES MEMORIAL HOSPITAL OF SOUTH BEND INC j 204612 ACTUAL CHARGES MEMORIAL HEALTH FOUNDATION INC b 1043051 ACTUAL CHARGES MEMORIAL HOSPITAL OF SOUTH BEND INC c 25593094 CASH TRANSFERS MEMORIAL HEALTH FOUNDATION INC c 289280 CASH TRANSFERS MEMORIAL HOME CARE INC k 5090962 PHYSICIAN CHARG MEMORIAL HOSPITAL OF SOUTH BEND INC k 246641735 PHYSICIAN CHARG MEMORIAL HOSPITAL OF SOUTH BEND INC l 21288665 ACTUAL CHARGES MEMORIAL HOME CARE INC l 1117905 ACTUAL CHARGES MEMORIAL HEALTH FOUNDATION INC l 437365 ACTUAL CHARGES MEMORIAL HEALTH FOUNDATION INC n 522324 ACTUAL CHARGES MEMORIAL HOME CARE INC p 3760484 ACTUAL CHARGES MEMORIAL HOSPITAL OF SOUTH BEND INC p 27186057 ACTUAL CHARGES MEMORIAL HEALTH FOUNDATION INC p 155000 ACTUAL CHARGES MEMORIAL HEALTH FOUNDATION INC q 1058314 ACTUAL CHARGES MEMORIAL HOME CARE INC q 3701587 ACTUAL CHARGES MEMORIAL HOSPITAL OF SOUTH BEND INC q 41212189 ACTUAL CHARGES MEMORIAL HEALTH FOUNDATION INC r 1058314 ACTUAL CHARGES MEMORIAL HOME CARE INC r 4422440 ACTUAL CHARGES MEMORIAL HOSPITAL OF SOUTH BEND INC r 41221885 ACTUAL CHARGES