2012-11-14T16:17:49-06:00 2011-12-31 ERNST & YOUNG US LLP 111 MONUMENT CIRCLE INDIANAPOLIS IN 46204 990 2011-01-01 350868132 MEMORIAL HOSPITAL OF SOUTH BEND 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 490558303 false X www.qualityoflife.org X 1923 IN MEMORIAL IS COMMITTED TO IMPROVING THE QUALITY OF LIFE OF THE PEOPLE IN OUR COMMUNITY. 17 13 3338 625 8865 5006001 2067550 372173020 403545986 4909387 6436272 12921446 26871373 395009854 438921181 1222556 1040579 0 0 148393083 149522222 0 0 0 210491302 222451606 360106941 373014407 34902913 65906774 638068406 676052791 219938003 228701300 418130403 447351491 X MEMORIAL IS COMMITTED TO IMPROVING THE QUALITY OF LIFE OF THE PEOPLE IN OUR COMMUNITY. false false 66131246 161423032 Ancillary Services offers the following services for patients and facilities: - Imaging Services - Outpatient Physical, Occupational and Speech Therapy - Infusion Treatments - Radiation Oncology Therapy - Cancer Research - Cardiac Cath Lab - Sleep Lab - Interventional Radiology - Environmental Services - Nutritional Services - Pharmacy Services - Laboratory 2011 Statistics for this service unit include: - 483,110 Inpatient procedures - 292,322 Outpatient procedures - 1,308 Inpatient Caths - 1,682 Outpatient Caths - 294,812 Outpatient visits - 567,644 Meals 54935002 86936946 Patient Care Unit Services provides a wide variety of hospital services including: - Inpatient rehabilitation CARF accredited - Medical - Post surgical - Orthopedic - Oncology - Intensive and intermediate - Heart and Vascular - Mother and Child - Special Care Obstetrics - Neonatal Intensive Care Level III - Emergency - Trauma Level II - Pediatrics - Pediatric Intensive Care - Pediatric Hematology Oncology - Medical Flight program - Pediatric Intensive Care Transports 2011 Statistics for this service unit include: - 86,322 Patient Days - 19,086 Inpatient ER visits - 93,544 Outpatient ER visits - 2,916 Births - 5,908 Observation stays - 242 Medical flights - 817 Full time equivalent employees 45375659 109839351 Surgical Services provides the following services: - General Surgery - Vascular Surgery - Cardiac Surgery - Orthopedic Surgery - Gynecological Surgery - Trauma Surgery - GI Labs - Pulmonary Services - Pain Center - DaVinci Robotic Surgery 2011 Statistics for this service unit include: - 4,804 Inpatient procedures - 366 Open Heart procedures - 10,353 Outpatient procedures 128737107 1040579 52430851 295179014 true true false true false false false false false false true true false false true false true true false false true false false false false false true true true false true true true false false false false false false true true true false false false false false true true true false false true X 363 0 true 3338 true true true false false false false false false false false false X 17 13 false false true false true true true true true false false true true true true true true true true true true IN X JEFFREY COSTELLO 5746473549 615 N MICHIGAN STREET SOUTH BEND IN 46601 X Charles Miller 2.0 X X 2073 0 0 Etta Nevel MD 2.0 X 1277 0 0 Robert Yount MD 2.0 X 0 1020433 24501 Keith Sherry MD 20.0 X 156601 0 23894 Faye Magneson MD 2.0 X 2073 0 0 James Schwartz Sr 2.0 X 0 0 0 Gerard Duprat MD 2.0 X 3990 0 0 Thomas Cassady Jr 2.0 X X 5595 0 0 Jesse Hseih MD 2.0 X 4460 0 0 Maurice Hurwich MD 4.0 X 33801 0 0 M Rose Meissner 2.0 X X 0 0 0 Margaret King 2.0 X 0 0 0 Thomas Burish PhD 2.0 X 0 0 0 Thomas Hauch MD 2.0 X 0 0 0 Maria Slager 2.0 X 0 0 0 Perry Watson III 2.0 X X 0 0 0 Steven Cramer PhD 2.0 X 0 0 0 Melvin Hall 2.0 X 0 0 0 Delores Wilmoski 2.0 X 0 0 0 Peter Baranay 2.0 X 0 0 0 Carlton Lyons MD 2.0 X 0 0 0 Philip Newbold 2.0 X 0 1675637 42358 George Soper 2.0 X 0 143060 15980 Jeffrey Costello 2.0 X 0 608049 32936 Kreg Gruber 40.0 X 603145 0 35965 Cheryl Wibbens-Lesh MD 40.0 X 298846 0 31337 Robert Riley MD 40.0 X 216416 0 26088 Scott Thomas MD 40.0 X 247313 0 9977 Thomas Sutula MD 40.0 X 220508 0 32903 Mark Lavallee 40.0 X 208104 0 28025 Dale Patterson 40.0 X 223814 0 22977 2228016 3447179 326941 68 false true false SOUTH BEND EMERGENCY PHYSICIANS 615 N Michigan SOUTH BEND IN 46601 Physician services 6827829 SOUTH BEND MEDICAL FOUNDATION 530 N Lafayette Blvd SOUTH BEND IN 46601 Lab services 5960212 INDIANA BLOOD CENTER 3450 N Meridian Street INDIANAPOLIS IN 46208 Blood Processing Svc 2994815 WOODCOX BLDG CONTRACTORS 51175 PRESCOTT AVE SOUTH BEND IN 46637 CONSTRUCTION MANAGER 2552703 GIBSON-LEWIS LLC 1001 WEST 11TH STREET MISHAWAKA IN 46601 General Contractor 2304427 87 647887 1419663 8600 2067550 NET PATIENT REVENUE 621110 401863103 401863103 RENTAL REVENUE 532000 1501508 1501508 MEDICAL EDUCATION 611710 35054 35054 CASH DISCOUNTS 561499 68399 68399 AMBULANCE SUPPLY 621910 77922 77922 403545986 5347564 0 0 79230 79230 79230 79230 52549691 176139 51528919 108203 1020772 67936 1088708 1088708 0 0 0 GAIN ON ACQUSITION 561499 16409996 16409996 ATHLETIC CLUB 713940 1744624 1744624 MRI (JOINT VENTURE) INCOME 561499 1454128 1454128 7183395 5630065 8865 1544465 26792143 438921181 410630179 8865 20867023 X 1040579 1040579 0 0 0 1183589 1183589 30317 30317 116755148 90018219 26736929 4643049 3579791 1063258 18513389 14273823 4239566 8396730 6473879 1922851 0 341231 341231 233159 233159 14954 11530 3424 0 1109128 1109128 41223443 31783275 9440168 54444 41976 12468 6320301 4872952 1447349 49179 37917 11262 0 6057554 4670374 1387180 733981 565899 168082 0 170486 131445 39041 4008747 3090744 918003 0 22995849 17729800 5266049 1841240 1419596 421644 MEDICAL SUPPLIES 68369537 52712913 15656624 0 CORPORATE FEE 23252099 17927368 5324731 0 UNCOLLECTIBLE ACCOUNTS 41703970 41703970 0 0 DUES & SUBSCRIPTIONS 1031362 795180 236182 0 2940942 2267467 673475 373014407 295179014 77835393 0 19325 19525 50012044 53275792 539700 383473 61880211 63452162 0 0 0 0 12376 0 13706162 12855237 1083100 972016 582683390 282537029 279912299 300146361 123873292 125744343 99517740 103904579 765284 636912 1171474 1171474 5575399 13490917 638068406 676052791 34064199 39971562 0 0 14027 17765 138791700 135263364 0 0 0 0 1780830 1593583 0 0 45287247 51855026 219938003 228701300 X 414391549 442868269 3738854 4483222 0 0 418130403 447351491 638068406 676052791 X 65906774 -36685686 X X false true true X true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 14954 14954 false false Lobbying Detail Schedule C, Part IV MEMORIAL HOSPITAL PAID DUES TO THE FOLLOWING ORGANIZATIONS FOR WHICH THE PERCENTAGE LISTED WAS ATTRIBUTED TO LOBBYING: AAFP (AMERICAN ACADEMY OF FAMILY PHYSICIANS) - 20% AASM (AMERICAN ACADEMY OF SLEEP MEDICINE) - 1% ACADEMY OF NUTRITION AND DIETETICS - 15% AMA (AMERICAN MEDICAL ASSOCIATION) - %60 AORN (ASSOCIATION OF PERIOPERATIVE REGISTERED NURSES) - FLAT AMOUNT $19.90 AOTA (AMERICAN OCCUPATION THERAPY ASSOCIATION) - 13% APTA (AMERICAN PHYSICAL THERAPY ASSOCIATION) - 22% ASA (AMERICAN SOCIETY OF ANESTHESIOLOGISTS) - 20% CHAMBER OF COMMERCE OF SAINT JOSEPH COUNTY - 5% DIETARY MANAGERS ASSOCIATION - 5% INDIANA HOSPITAL ASSOCIATION - 5.29% INDIANA PSYCHOLOGICAL ASSOCIATION - 40% INFUSION NURSES SOCIETY - 1% IONE (INDIANA HOSPITAL AND HEALTH ASSOCIATION) - 5.29% ISMA (INDIANA STATE MEDICAL ASSOCIATION) - 24% SOCIETY OF TEACHERS OF FAMILY MEDICINE - 10% SOCIETY OF NUCLEAR MEDICINE - 2% TRAUMA CENTER ASSOCIATION OF AMERICA - 29% 20604861 20604861 333197772 107453920 225743852 722092 704719 17373 216374540 171550424 44824116 11784125 2827966 8956159 300146361 0 0 ASSET RETIREMENT OBLIGATION 4321024 INTEREST RATE SWAP 42184088 CAPITAL LEASE PAYABLE 805644 DUE TO AFFILIATES 527627 IBNR 4016643 51855026 438921181 373014407 65906774 -5293966 -31391720 -36685686 29221088 427882700 -5293966 -5744515 -11038481 438921181 438921181 373014407 373014407 373014407 Change in Net Assets Part XI Reconciliaton of Change in Net Assets from 990 to Audited Fin Stmt Unrealized Loss on Swap Transactions (5,744,515) Cash Transfers to Memorial Health System (28,513,083) Write off of Intercompany to Memorial Health System 2,919,990 Write off of Intercompany to Memorial Health Foundation 43,495 Accrued Health Insurance True up between Memorial Health System and Memorial Hospital (841,936) Change in Interest in Recipient Org 744,329 Total (31,391,720) Reconciliation of Revenue Part XII Reconciliation of Revenue per Audited Fin Stmt w Revenue per 990 Unrealized Loss on Swap Transactions (5,744,515) Central America and the Caribbean 0 0 Investments 85499722 Canada 0 0 Program Services Training Facilitator 872 0 0 0 0 85500594 85500594 true false true false false false Program Services Sch F Part 1 3e BrainWorks collaborated with a woman in Calgary to host two back to back Sage-ing Circle Facilitators training programs. All expenses in Canada were paid by the customer other than Handout related material purchased onsite for distribution during the program. true true true X true X true true true false true true 5317511 5317511 0.01600 42635672 16817806 25817866 0.07790 47953183 16817806 31135377 0.09390 11879033 5784781 6094252 0.01840 5861821 1622417 4239404 0.01280 891108 553077 338031 0.00100 1275877 332689 943188 0.00280 19907839 8292964 11614875 0.03500 67861022 25110770 42750252 0.12890 true 12440567 6220284 77132686 90435892 -13303206 X true true 1 1 Memorial Hospital of South Bend

615 N Michigan Street South Bend IN 46601

X X X X X X Memorial Hospital of South Bend 1 true true 200. true 350. true X X X X X true true X X X X X X true false true X false false 6 MEMORIAL SLEEP DISORDER CENTER

53990 CARMICHAEL DRIVE SOUTH BEND IN 46601

OUTPATIENT CLINIC PROVIDING SLEEP RELATED DIAGNOSIS AND TREATMENT MEMORIAL HEALTH PLEX

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OUTPATIENT REHABILITATION FACILITY AND FITNESS FACILITY MEMORIAL BREAST CARE CENTER

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OUTPATIENT DIAGNOSIS AND TREATMENT MEMORIAL CHILDREN'S THERAPY CENTER

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OUTPATIENT DIAGNOSIS AND TREATMENT MEMORIAL RADIOLOGY

100 NAVARRE PLACE SOUTH BEND IN 46601

OUTPATIENT DIAGNOSIS AND TREATMENT MEMORIAL LIGHTHOUSE PHYSICAL THERAPY

6913 N MAIN STREET GRANGER IN 46530

OUTPATIENT DIAGNOSIS AND TREATMENT Part I, line 3c Not applicable Part I, Line 6a Community Collaboration Introduction Creating community health is at the core of Memorial Hospital of South Bend, Inc.'s mission. Promotion of community health is our social responsiblity and a key to long-term cost effectiveness. In addition, improving the health status of a community is as much a social, economic and environmental issue, as it is a medical one. Consequently, the organization takes a broad approach to creating community health. This approach has included: ongoing education of board members, staff and local leaders through Community Plunges (experiential activities to involve the community residents with a neighborhood-based agency), Community Foundation support, strategic allocation of tithing resources, a clear statement of vision and goals, a commitment to continuous quality improvement and promotion of volunteer involvement and community partnerships. Memorial Hospital tithes 10% of the previous year's bottom line and transfers it to the Community Benefit Fund for investment in the community. This investment is in addition to the Hospital's charity care and prevention, and education activities supported through its operating budget. The Community Health Enhancement Committee of the Board makes ongoing policy and oversees the administration of the fund and determines specific investment allocations based upon the assets and needs of the community. Volunteers and staff are committed to prudently investing these resources in an accountable manner. As a community not-for-profit organization, we take seriously our responsibility to invest our resources and energies into understanding and meeting the divergent health care needs of all, and ensure that everyone, regardless of their ability to pay, receives the care they need. Memorial has long been recognized for the collaboration efforts which engage individuals and organization with diverse socio-economic religious, ethnic, race, age, and gender identity characteristics. Our team of passionate and dedicated health care professionals, along with many partners throughout the Northern Indiana and Southern Michigan (Michiana) region, helped us contribute significantly to the health and well-being of our community. Further, Memorial plays a key role in serving the community as a whole. In 2011, public health system partners of St. Joseph County convened meetings to complete an assessment process to evaluate how well they are serving the public health and healthcare needs of the county's residents. The Indiana State Department of Health, in collaboration with Purdue University's Healthcare Technical Assistance Program - Population Health Initiatives Program, worked together to create this opportunity for all local public health system partners to identify existing strengths, as well as opportunities to establish and formalize public health system infrastructure improvements in Indiana counties. Hosted by the St. Joseph County Health Department, St. Joseph County partners met to complete the CDC National Public Health Performance Standards, Local Public Health System Assessment - a nationally recognized public health system assessment tool. Approximately 163 healthcare and social service agencies exist to support the residents of 9 cities and towns and 13 townships. Public health system partners across the county are committed to enhancing systemic performance by engaging partnerships, support, and input, so that together we can better serve the residents of St. Joseph County. The assessment process and results enable a greater understanding of how the county's healthcare and public health organizations relate to one another and how they provide essential public health and healthcare services to the public they serve. The assessment specifically focused on areas such as communication, partnerships, linking people to needed services, and sharing of resources. The process will serve as the foundation to formalize processes that strengthen local public health system infrastructure with the capacity and resources to improve quality and effectiveness of healthcare services in St. Joseph County. A primary component of such a process may include a focus on partnerships and collaboration to ensure sustainability. What follows is a narrative of how we touch and improve the health and the quality of lives throughout Michiana. It is a testimony to the commitment and leadership of our medical staff, volunteer board of trustees, employees, auxiliary volunteers, and community partners, whose dedication to serve, touch many lives and make our community a better place to live, work, and play. Part I, Line 7, Column F Bad Debt Expense removed from Total Expenses $41,703,970. Part I, Line 7g Not applicable Costing Methodology Part I, Line 7 Donations - the actual cost of the donation or departmental net contribution, whichever is appropriate, from General Ledger records and reports are included In-Kind/Volunteer Services - When a specific person is listed as the event volunteer, the YTD hourly wage is pulled from the labor distribution report for 12/31, multiplied by the number of hours at the event or events. When a specific job class is listed (i.e. "peds rehab"), the average hourly wage is computed for all employees in that job class and department and used in the same manner. Benefits are added to each at a ratio of benefit dollars to total salaries, multiplied by total salaries calculated for the event. Part III, Line 4 The Corporation evaluates the collectability of its accounts receivable based on the length of time the receivable is outstanding, payor class, and the anticipated future uncollectible amounts based on historical experience. Accounts receivable are charged to the allowance for doubtful accounts when they are deemed uncollectible. 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. Rationale for inclusion of the Medicare shortfall as a Community Benefit Part III, Line 8 Participation in the governmental Medicare program does not provide the opportunity for a hospital to negotiate a reimbursement rate or structure that would allow the hospital to cover the cost of the medical service rendered to the program participant, as would be the case in contractual negotiations with commercial insurance companies. Nor is the hospital allowed to provide only the services for which reimbursement covers the direct cost of care. This produces the same shortfall outcome as does the participation in the Medicaid program. The Medicaid program is recognized as a community benefit on Schedule H and on community benefit reports for most states. The quality and cost of the patient care is the same regardless of payor source. Hence the acceptance of Medicare reimbursement represents a reduction or relief of the government burden to pay the full cost of care provided. Financial Assistance Policy Part III, Line 9b The collection policy and procedures are as follows related to patients who are known to qualify for charity care or financial assistance: To ensure the Hospital fulfills its mission and commitment to the poor, the Hospital shall annually plan for and provide free health care and health-related services to the poor and qualified uninsured/underinsured. A patient is considered for Financial Assistance if all other State and Federal assistance opportunities have been exhausted. The Federal Income and Poverty Guidelines 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 Hospital of South Bend. PROCEDURE: 1.Memorial Hospital will assist patients in making a determination regarding whether or not the patient may be able to qualify for some form of entitlement through a Federal or State Government program and complete the appropriate applications for assistance. It is required that the patient will assist in the determination and application process. If the patient does not qualify for any Federal or State Assistance, we will start the Financial Assistance Approval process. 2.Identify patients potentially eligible for Financial Assistance through the pre-registration, admission, eligibility process, or through self pay account review and collection activities. 3.Provide 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 Hospital will provide an uninsured discount based on the following tiered structure: 30% discount if account is paid within 30 days from date of service 20% discount if account is paid within 90 days from date of service 10% discount if patient chooses to participate in the CarePayment financing Any exceptions must be approved by the Department Manager or Director. Facility Information Part V, Line 19d TO DETERMINE THE MAXIMUM AMOUNTS THAT CAN BE CHARGED TO FAP-ELIGIBLE INDIVIDUALS FOR EMERGENCY AND OTHER MEDICALLY NECESSARY CARE, MEMORIAL HOSPITAL USED THE AVERAGED DISCOUNT FOR THE THREE CONTRACTS THAT HAD THE HIGHEST PERCENT DISCOUNT TO CHARGES (EXCLUDING ALL PER DIEM AND CASE RATE CONTRACTS). Needs Assessment Part VI, Line 2 At Memorial Hospital and Health System, our goal is to strengthen the health and well-being of our individual patients and neighbors, as well as the broader community. Community Health Enhancement grant dollars totaling $2,286,369 were received and blended with Memorial tithing dollars to deliver services and programs that impacted the physical health, mental health and quality of life of tens of thousands of individuals and families. Memorial invested $2,153,154 of tithing funds in community benefit, which in a time of economic upheaval is more important to building the vitality of our community than ever before. Assessment of unmet community health needs is gathered through participation in community collations, partnerships, boards, committees and task forces. Local needs assessments and reports, such as the most recent St. Joseph County Department of Health's report, United Way of St. Joseph County, as well as the County Health Rankings (a product of Robert Wood Johnson Foundation and the University of Wisconsin's Population Health Institute), provide valuable information and data used to collaboratively determine our short- and long-term priorities as well as strategies for improving the overall population health. Our community is becoming increasingly diverse. The health risks associated with chronic diseases like diabetes, hypertension, and obesity, are particularly high among our growing, and often medically underserved, Hispanic and African American populations. We reach out to these groups through churches, local community organizations, and grassroots efforts. Our goal is to help all residents access the care they need, to help them learn to manage their health responsibly and live healthier lives. In the past year, we collaborated with a number of organizations to gather information about the needs and strengths of our community residents in the form of Community Plunges. Community Plunges provide opportunities for community and hospital leadership to spend time in the neighborhoods meeting with grassroots leaders and neighbors; getting acquainted with the reality that many of us never see, and do not understand. Community Plunges have become a mainstay of Memorial's research into health and social ills as well as assets and strengths that influence and shape our community. A committee of the Board of Trustees provides input and oversight into the decision-making of partnership opportunities, addressing the needs, building on the strengths of the community, and setting priorities for resource allocation. The Board Committee is composed of community members who serve on the System-wide Boards of Directors. In addition, the division of Community Health Enhancement staff and employees of the Hospital and Health System are seated on most of the social service and health agencies boards and task forces in the community. This involvement provides a vehicle for ongoing communication, which flows continuously between the hospital and the community. The St. Joseph County Health Department Board is chaired by Memorial's Executive Director of Safety, in addition, serving in a leadership role in emergency preparation for the entire county. In 2011 the Hospital participated with the Health Department to develop the St. Joseph County Local Public Health System Performance Assessment. This process allowed for the development of infrastructure built through the identification and partnership of key stakeholders. The collaborative helped to design the Community Health Needs Assessment which was executed between March 1 and June 15, 2012. The projected timeline continues into the spring of 2013 through the strategic identification and planning stage to the implementation of activities to support the objectives based upon the priorities evidenced by the data. Patient Education and Eligibility for assistance Part VI, Line 3 When uninsured patients present to our hospital, they are offered the opportunity to meet with our eligibility specialists. Our eligibility specialists discuss the potential eligibility of the patient for multiple assistance programs, including our own internal financial assistance program. Our statements also include a notice that financial assistance is available to patients, and they can contact our customer service group for guidelines. Community Information Part VI, Line 4 Community Information (geography and demographics) Established in 1830, St. Joseph County, Indiana has become the fourth largest county in the state of Indiana. The county spans 467 square miles, which includes a comfortable mix of rural cultural heritage and urban amenities. St. Joseph County is also the regional center for higher education. The county is home to more than eight colleges and universities including but not limited to Notre Dame University, Indiana University, Purdue University, Holy Cross College, Bethel University and St. Mary's College. The heart of the Hospital is located within a mile of the University of Notre Dame, 10 miles south of the Michigan state line, and 40 miles east of Lake Michigan. Through the years, the environment of South Bend, the largest city in St. Joseph County, has changed from a focus on manufacturing (Studebaker, Bosch, and Uniroyal) to one of service industry. In fact, among the ten largest employers in the county, just two represent manufacturing. The University of Notre Dame is the largest employer, followed by Memorial Health System, the South Bend Community School Corporation, AM General, and St. Joseph Regional Medical Center. St. Joseph County, the five contiguous counties comprising its secondary service area and 12 counties in its tertiary service area are characterized by a mix of small to mid-size metropolitan areas and rural communities. Population mix is diverse and includes large numbers of first-generation European, African, Middle Eastern immigrants, African Americans, Asians, Hispanics, and Amish. The population for St. Joseph County in 2011 was 274,372 individuals. The racial statistics in the County are 82% Caucasians, 13% African America, and Hispanics represent 7.5, with 2.5 listed as Other. As expected, with an area well-saturated with post-secondary educational institutions, the county has higher than would be projected educational level. Eighty-six percent of the population are high school graduates, and 25.6% have a bachelor's degree or higher. The average household income was $44,644; persons below poverty level acoounted for 14.6% of the population. Of the primary and secondary Memorial service area, St. Joseph County is the largest, followed by Elkhart County with just over 197,098. Elkhart County continues to have an industrial focus as a major center of the automotive, recreational vehicle, manufactured housing and musical instrument industries. Additional secondary service area counties and their populations include Berrien (MI) 174,642, LaPorte (IN) 109,124, Cass (MI) 43,701 and Marshall (IN) 50,099. Our service area includes patients from St. Joseph and surrounding counties in Indiana and Michigan; a pediatric emergency transport program serving 18 counties and our MedFlight helicopter that covers communities within a 150-mile radius. We have the region's only Level 3 Newborn Intensive Care Unit, the only Pediatric Intensive Care Unit and the only Pediatric Hematology/Oncology program in the area. Memorial is also the only hospital in the region with Pediatric Hospitalist and Child Life programs. Memorial is not only recognized nationally as a leader in providing high quality care, but also as a leader in innovation, offering new approaches to patient satisfaction and customer service that set us apart from other health care providers. As the region's only designated children's hospital, Memorial Children's Hospital welcomes and treats children with a wide variety of medical and surgical diagnoses from more than 20 referral hospitals throughout Southwestern Michigan and Northern Indiana. Our world-class team includes pediatric hospitalists and intensivists, registered nurses, child life specialists, pediatric diabetic educators, pediatric dietitians, social workers, neonatologists, pediatric oncologists, respiratory therapists, clinical nurse specialists, pastoral care, and pediatric specialists in physical therapy, pulmonary medicine and infectious disease. Memorial Hospital and Health System also serves the community with Memorial Neighborhood Health Center - Southeast Clinic, and the Central Neighborhood Clinic at the Center for the Homeless. These two clinics offer primary health care services including all basic services as well as family planning and reproductive health, low-risk obstetrics, and colonoscopy services. Services are available to anyone, and our fees are within the customary range for the community. We accept Medicaid, Medicare and private insurance, and offer a sliding fee scale based on income guidelines for uninsured. We also participate in Hoosier Healthwise, the CHIP program that provides healthcare for Indiana children, pregnant women and low-income families. Other hospitals in our region include: St. Joseph Regional Medical Center, Elkhart General Hospital, Goshen Hospital and Lakeland Health Care. An affiliation with Elkhart General Hospital was announced in 2011. Education and Research for a Healthy Future We consider education and research to be part of our mission. Each is vital to preparing the next generation of health care professionals to meet future health care demands. As our country ages, we will need more caregivers than ever before; at the same time, there is a shortage of new graduates in key clinical and technical positions. To ensure that we have the quality workforce we need to care for our patients in the future, we are committed to the education of current and future caregivers, and have partnered with local high schools, colleges, universities and Indiana University Medical School at Notre Dame. Preparing for tomorrow's health care needs also requires a commitment to researching new and innovative treatments that battle tomorrow's health care challenges. Clinical research is a part of programming across the Health System. Memorial Medical Group participates in a significant number of pharmaceutical trials annually; physicians in the Hospital participate in various research projects that are national in scope and are evaluated by FDA guidelines by Memorial's Institutional Review Board. Memorial is also a member of an Oncology Consortium which does cancer-related research costing in excess of $409,347. Our medical and health care staff are working to find tomorrow's treatments and cures today. Research also evolves from the nursing, pre-medical and social service disciplines at the local post-secondary education institutions. The University of Notre Dame is a close partner in community-based research, which includes evaluating education curricula, intervention modalities, and quantitative analysis as well as qualitative research methods. Together, we offer a comprehensive learning experience for medical students, enabling interns, residents, and fellows to utilize our state-of-the-art training facilities and integrate advanced technology learned in the classroom directly with patient care. We further the evidence of community-based research in addition to clinical research, particularly in the intersection of neuroscience and medical interventions, such as the impact of chemotherapy on the memory and cognitive functioning of breast cancer victims. Community Building Activities Part VI, Line 5 All information included in Part I, see 'Other Information Required'. Part VI, Line 6 Community Building Activities Community Plunges were developed at Memorial 23 years ago. The first was the Aging Plunge, which looked at the plight of an aging society, living independently as long as possible, often isolated, suffering from depression, had little opportunities for socialization, and was mismanaging their health with polypharmacy resulting in contra-indications, and dangerous interactions, from seeing different physicians to treat many different diseases and ailments. Board members, staff, and community leaders spend a few hours together delving into the problems confronting our society; personally interacting with an Alzheimer's victim, a gang member, a cocaine addict, a child in the midst of family and neighborhood violence, a mother whose two-year-old had suffered a Sickle Cell stroke, homeless children with developmental delays, bright children of immigrants without legal residence in dead-in jobs, rural communities without sufficient access to medical care, pregnant teens, high school drop-outs and this year's Nanotechnology Plunge. In 2011, CHE enabled community members to "plunge" into the exciting world of nanotechnology though "Nanotechnology: The Power of Small". This plunge was presented in conjunction with the University of Notre Dame and sponsored by First Source Bank and Project Future. Over 60 business leaders, educators, and community members visited the University of Notre Dame, where they were introduced to local nanotechnology 'Rock Stars' - people who are leading the field through research and discoveries taking place at the university. Participants were given a glimpse into the world of those who spend their days looking at things very, very small and a vision of the endless possibilities enabled by this technology. The day ended with an interactive discussion on how to welcome and prepare South Bend for the new opportunities created by nanotechnology. As a result of the plunge, CHE is creating nanotechnology activity kits and teacher trainings that will be provided to local schools. These kits were presented at the National Science Teachers Association conference to rave reviews. Quality of Life Programs Memorial's Community Health Enhancement team innovatively served Michiana with a wide range of effective, evidence-based and fiscally-responsible programs and initiatives in 2011. Community Health Enhancement's programs reached across the life span, ensuring healthy pregnancies, productive senior years, and proactive disease management now and wise investment in our community's future. Pre-Natal Programs Community Health Enhancement's team provided a variety of programs for expectant mothers with two common goals: helping the women stay healthy and helping their babies be born healthy - and one common denominator: caring staff skillful at building trusting relationships. -Foundations for Alcohol Cessation, Education, and Support is keeping pregnant women alcohol free throughout pregnancy. Educators teach expectant women about alcohol's harmful effects on fetal brain development and screen for alcohol use during pregnancy. 22% of women were screened and participated in an alcohol intervention, and 98% of the women who were followed remained alcohol-free throughout their pregnancy. Numbers Served: 1056 -The establishment of Black American Mothers Breastfeeding Awareness Initiative is a local initiative to increase awareness of the benefits of breastfeeding throughout the African American Community. This group is also studying reasons African American women are less inclined to breastfeed than their white and Latina peers. -Pre-natal Care Coordination educators work with clients to reduce barriers to receiving prenatal care and connect them with resources such as breastfeeding classes, medical and mental health care providers and insurance programs, programs teaching parenting and childcare skills, immunization resources, and the BABE store. 275 Pregnant women were served. -As the county's Women-Infant-Children nutritional program sponsor, Memorial serves an average of 8,565 woman and children every month. Memorial collaborates with the Elkhart County WIC; the most-recent activity was to produce a training video for WIC clients in both English and Spanish about healthy nutrition for infants and children. All nutritional services are provided in English and Spanish. -In collaboration with the St. Joseph County Health Department, WIC hosts Super Shot immunization programs; Memorial also collaborates on a Lead poisoning program with the Health Department and the South Bend Housing Authority. -BABE coupon store developed an educational component, where clients can come in and learn something new to earn BABE coupons. Project Impact volunteers (former prisoners) received job skills training through the Department of Family and Children to work at the BABE store. Neuroscience and Brain Development Programs Science has shown that many of the issues faced by our community can be addressed and improved through a focus on the brain. Now in its fourth year, BrainWorks is leading the call to action for our community to understand and adopt important and cutting-edge insights from neuroscience that have a direct bearing on quality of life. BrainWorks is one of the only programs in the nation who has redefined brain health from an "old people" issue into a lifespan based issue, and teaches people how their brain (or their child's brain) works at its best and what it needs for optimum development and maintenance at all ages. In 2011, the BrainWorks team brought more brain health information and practice into the lives of community members through a variety of individually hosted events and innovative collaborative relationships. Highlights included: -Bringing national brain health speakers to the community. BrainWorks collaborated with the Public Education Foundation to present New York Times bestselling author and developmental molecular biologist Dr. John Medina (Brain Rules, Brain Rules for Baby) to three different South Bend audiences, including a training and educational event for early childhood development providers in the community. BrainWorks' annual Mary Morris Leighton Lecture featured Dr. Norman Doidge, internationally known expert on neuroplasticity, and author of The Brain That Changes Itself. In addition to speaking to a large and diverse audience of community members, Dr. Doidge presented a continuing education program to the physician community. -Presenting the televised special Brain Games. Messages about brain health were brought to up to 3.1 million viewers through the production of Brain Games, an original, BrainWorks' hosted 4-part game show on PBS station WNIT. Each episode focused on a different period of the lifespan and challenged participants' (who were members of the local business community) knowledge of brain health. Brain Games also featured interviews with several national experts, including Dr. Norman Doidge, Dr. John Medina, Dr. Jessica Payne, Dr. Paul Nussbaum, Dr. Cynthia Green, Dr. Kevin Ladd and Dawn Matthews. Episodes of Brain Games are available at www.wnit.org/braingames. -Partnering with Junior League of South Bend. In 2011, BrainWorks was awarded The Junior League of South Bend's Presidents Award and partnered with Junior League volunteers on two 'Done in a Day' projects. Each project converted an existing child's play space into a play space that promoted brain-based play. Locations included the YWCA and the main branch of the St. Joseph County Public Library. Expanding Wisdom School and Sage-ing Facilitator's Training to an international audience. In its tenth year of Sage-ing Circles Facilitators Training, BrainWorks was contracted to bring sage-ing philosophy, integrative learning theory, and group facilitation skills training to two events in Calgary, Alberta, Canada. -Hosting the BrainGames Challenge. BrainWorks partnered with the Northern Indiana Alzheimer's and Dementia Services to teach participants how to support and extend a healthy mind and memory through games and lectures. -Supporting research projects. In 2011, BrainWorks launched 'Chemo Brain', a research collaboration with the Northern Indiana Cancer Research Consortium and Dr. Tom Merluzzi of the University of Notre Dame. Chemo Brain explores the impact of brain health intervention on those experiencing cognitive side effects from chemotherapy treatment. BrainWorks also continued researching the varying impacts of sleep on cognitive variability in a partnership with Dr. Matthew Costello of Indiana University and Dr. Gary Fromm of Memorial Hospital. -Educating the general public. BrainWorks continued to provide workshops, classes, lectures, lunch and learn sessions, and corporate programs both locally and nationally, including presentations for The Gerontological Society of America and The ManKind Project. Disease Management Initiatives Memorial team members continuously teach individuals living wit Affiliated Health Care System Roles See 'Other Information Required'. true 100 BLACK MEN OF GREATER SOUTH BEND INC 2043 South Bend Ave PMB345 SOUTH BEND IN 46637 270295842 501(c)(3) 5587 Contribution COMMUNITY COORDINATED CHILD CARE OF ST JOSEPH CNTY 401 E COLFAX AVE SUITE 210 SOUTH BEND IN 46624 351389028 501(C)(3) 92000 SPONSORSHIP GRACE COMMUNITY CENTER INC PO BOX 1671 SOUTH BEND IN 46634 351900380 501(C)(3) 25000 CONTRIBUTION HABITAT FOR HUMANITY OF ST JOSEPH COUNTY 402 E SOUTH ST SOUTH BEND IN 46601 311196894 501(C)(3) 10000 WOMEN BUILD 2011 INNOVATION PARK AT NOTRE DAME INC 1400 E ANGELA BLVD SOUTH BEND IN 46634 943445005 501(C)(3) 10000 Contribution NEAR NORTHWEST NEIGHBORHOOD PO BOX 1132 SOUTH BEND IN 46624 237414729 501(C)(3) 35000 CONTRIBUTION NORTHEAST NEIGHBORHOOD REVITALIZATION ORGANIZATION 803 LINCOLNWAY WEST SOUTH BEND IN 46616 352118149 501(C)(3) 50000 CONTRIBUTION O'HANA HERITAGE FOUNDATION INC PO BOX 186 SOUTH BEND IN 46624 371523448 501(C)(3) 36000 CONTRIBUTION PENN-HARRIS-MADISON EDUC FOUNDATION INC 55900 BITTERSWEET RD MISHAWAKA IN 46545 351996785 501(C)(3) 10000 CONTRIBUTION SJC BRIDGES OUT OF POVERTY INC 117 N LAFAYETTE BLVD SOUTH BEND IN 46601 263195466 501(C)(3) 25000 CONTRIBUTION BOYS & GIRLS CLUB OF ST JOSEPH COUNTY 1411 LINCOLNWAY WEST SOUTH BEND IN 46544 351329625 501(C)(3) 41000 EDUCATIONAL ENRICHMENT PROG SOUTH BEND SYMPHONY 127 N MICHIGAN ST SOUTH BEND IN 46601 356042189 501(C)(3) 5500 SPONSERSHIP THE NATIONAL FOOTBALL FOUNDATION & COLLEGE HALL OF 1105 CLERMONTH DR SOUTH BEND IN 46617 351436531 501(C)(3) 9000 2011 ENSHRINEMENT MICHIANA PUBLIC BROADCASTING CORPORATION 300 W JEFFERSON SOUTH BEND IN 46601 351155594 501(C)(3) 40000 SPONSORSHIP TOWN HALL SERIES 2011 COMMUNITY HEALTH PARTNERS OF SOUTH BEND 1010 N Bendix Drive SOUTH BEND IN 46628 263051440 501(C)(3) 242689 Bendix Family Physicians salaries THE CENTER FOR THE HOMELESS 813 South Michigan SOUTH BEND IN 46601 351768544 501(C)(3) 97500 PEDS PROGRAM HOPE RESCURE MISSION PO Box 4488 SOUTH BEND IN 46634 351038532 501(C)(3) 25000 HOPE 4 KIDS INDIANA UNIVERSITY SCHOOL OF MEDICINE 1234 Notre Dame Ave Raclin-Carmichael HalL SOUTH BEND IN 46617 356001673 501(C)(3) 15000 2011 MEDICINE BALL SPONSOR MARCH OF DIMES 6045 Eddy St Suite A SOUTH BEND IN 46615 131846366 501(C)(3) 5250 SILVER BABY 2011, GOLD SPONSOR CHEFS 2011 ROBINSON COMMUNITY LEARNING CENTER 921 North Eddy St SOUTH BEND IN 46617 350868188 501(c)(3) 10000 CONTRIBUTION SOUTH BEND HERITAGE FOUNDATION INC 803 Lincolnway West SOUTH BEND IN 46616 237394320 501(c)(3) 77015 CONTRIBUTION THE GEORGINA JOSHI FOUNDATION INC 4201 Linden Ave SOUTH BEND IN 46619 208791238 501(c)(3) 6000 BIKE THE BEND SPONSORSHIP UNITED WAY OF ST JOSEPH 3517 E Jefferson SOUTH BEND IN 46660 351063368 501(c)(3) 55000 CONTRIBUTION UNITY GARDEN PO Box 10022 South Bend IN 46628 270901122 501(c) (3) 10000 CONTRIBUTION 24 GRANT MONITORING PROCEDURES SCHEDULE I, PART IV Donations and grants given to organizations that improve the health and well being of our community are monitored through Outcome Measurement Reports, provided to Memorial by the various organizations. These reports inform us of how the donations and grants were used. X X X X true true X X X X X false true false false false true true false false Philip Newbold 0 559219 0 891563 0 224855 0 22046 0 20312 0 1717995 0 448804 George Soper 0 104537 0 0 38523 0 4854 0 11126 0 159040 0 Jeffrey Costello 0 282072 0 303186 0 22791 0 17402 0 15534 0 640985 0 203250 Robert Yount MD 0 991776 0 25000 0 3657 0 9800 0 14701 0 1044934 0 Keith Sherry MD 156551 0 0 50 0 6748 0 17146 0 180495 0 0 Kreg Gruber 300628 0 131954 0 170563 0 9800 0 26165 0 639110 0 0 Cheryl Wibbens-Lesh MD 297416 0 0 0 1430 0 11722 0 19615 0 330183 0 0 0 Robert Riley MD 211607 0 0 0 4809 0 13851 0 12237 0 242504 0 0 0 Scott Thomas MD 247020 0 0 293 0 9977 0 0 257290 0 0 Thomas Sutula MD 218528 0 0 1980 0 13365 0 19538 0 253411 0 0 Mark Lavallee 203699 0 0 4405 0 10264 0 17761 0 236129 0 0 Dale Patterson 223274 0 0 540 0 9125 0 13852 0 246791 0 0 Health Club and Spousal Travel Schedule J, Part I, Line 1A MEMORIAL HEALTH SYSTEM, INC. (MHS) REIMBURSES TRUSTEES FOR THE TAX EFFECT OF THE 1099 REPORTABLE BENEFITS FOR HEALTH CLUB MEMBERSHIP, WITH MHS'S HEALTH AND LIFESTYLE CENTER, AND SPOUSAL TRAVEL. THIS REPORTING IMPACTS 14 CURRENT BOARD MEMBERS. MHS ALSO REIMBURSES FOR DIRECT EXPENSES RELATED TO ANY TRAVEL ON THE ORGANIZATION'S BEHALF. SPOUSAL TRAVEL WAS INCLUDED IN TAXABLE COMPENSATION FOR 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 5 INDIVIDUALS LISTED ON PART VII, SECTION LINE 1A (JEFFREY COSTELLO, JAMES KEENAN, JOHN KERR, LEIGH MORRIS, AND KELLIE PORTER). SUPPLEMENTAL EXECUTIVE RETIREMENT PROGRAM (457(F)) Schedule J, Part I, Line 4B RELATED ORGANIZATION (MEMORIAL HEALTH SYSTEM, INC.) EMPLOYEE 2011 EARNED VESTED 457(f): Phillip Newbold $191,729 Kreg Gruber $153,308 MEMORIAL HEALTH SYSTEM PROVIDED A NON-QUALIFIED SUPPLEMENTAL EXECUTIVE RETIREMENT PROGRAM (SERP) TO CERTAIN EXECUTIVES. THE PURPOSE OF THE PLAN WAS TO PROVIDE AN ADDED RETIREMENT BENEFIT OVER THE QUALIFIED RETIREMENT PROGRAM. QUALIFIED INDIVIDUALS WERE ELIGIBLE TO RECEIVE A BENEFIT, IN THE FORM OF AN AFTER TAX LUMP SUM WHICH WAS 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 WERE VESTED INTO THE SERP AFTER FIVE YEARS OF SERVICE. THE INCREASE IN VALUE OF THE BENEFIT EACH YEAR WAS INCLUDED IN THE TAXABLE COMPENSATION OF VESTED SERP PARTICIPANTS. SUCH AMOUNTS WERE 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. THE PLAN WAS TERMINATED ON 12/31/2011. Compensation Contingent on Net Earnings Schedule J, Part I, Line 6A & 6B The related organization has 2 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 budgeted net operating income with the non-management employees for Memorial Health System, Inc and the affiliated entities which includes Memorial Hospital of South Bend, Inc. The employee incentive pool has a maximum cap of $2,500,000. The management incentive plan pays a sliding percentage of base compensation if the net operating income is equal to or greater than 80% of the budgeted net operating income. The sliding scale caps when operating income reaches 120% of the budgeted operating income. The CEO is covered under a deferred compensation 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 12/31/11. HOSPITAL AUTHORITY OF SAINT JOSEPH COUNTY 356311914 79061BCQ6 2007-05-01 80000000 Health Care Capital Improvments false false false HOSPITAL AUTHORITY OF SAINT JOSEPH COUNTY 356311914 79061BCP8 2006-03-16 38580000 Refunding Series 2000 Bonds false false false HOSPITAL AUTHORITY OF SAINT JOSEPH COUNTY 356311914 79061BCX1 2008-08-28 39915000 Refunding Series 2003 Bonds false false false HOSPITAL AUTHORITY OF SAINT JOSEPH COUNTY 356311914 000000000 2008-07-01 2147750 Health Care Equipment Financing false false false 0 0 84814783 0 0 0 762312 0 0 79201600 4850871 0 2009 false false true true 0 0 38580000 0 0 0 467934 775830 0 0 0 0 2000 false true true true 0 0 39915049 0 0 0 577204 0 0 0 0 0 2003 true false true true 0 0 2147750 0 0 0 0 0 0 2147750 0 0 2008 false false true true false false true true false true 0 true 0.00000 0.00000 0.00000 false false true true false true 0 true false false true true false true 0 true false true false 0 false false true HYPO PUBLIC FINANCE 3.91 true false false false true true WELLS FARGO BANK NA 21.7 false false false 0 false true true true WELLS FARGO BANK NA 23.6 false false false 0 false true false false false 0 false false false 0 false true Procedures to undertake corrective action Part V Management is in the process of developing written procedures for formalizing the post issuance compliance. Jesse Hseih MD Trustee/Director 349163 See Part V false Keith sherry MD Trustee 6827829 See Part V false Candace Hurwich SPOUSE OF TRUSTEE 30317 See Part V false Business Transactions Involving Interested Persons Schedule L, Part IV Jesse Hseih, MD, is an officer with South Bend Clinic, LLP. Memorial Hospital of South Bend makes contractual payments to the South Bend Clinic for trauma call services provided. Keith sherry, MD, is a director and employed by South Bend Emergency Physicians, Inc. which provides emergency physician services to the hospital. Payments noted are paid to South Bend Emergency Physicians, Inc. Candace Hurwich, wife of Maurice Hurwich, MD (Trustee and Medical Director) was compensated for services as a Staff RN on the Emergency Response Team. VOLUNTEERS Form 990, Part I, Line 6 Memorial Hospital of South Bend has a department called Ambassador and Customer Services. It is the responsibilty of this department to recruit, orient, process and place new ambassadors in approximately 30 service areas of the hospital. It is also the responsibility of the department to follow up, schedule and recognize ambassadors. Some of the areas of service include Major Surgery Waiting Room, Escort Service, Flower Delivery, Mail Delivery, Living History Program, Emergency Department Volunteers and Cookie Bakers. In 2011, Memorial had 625 volunteers in this program who served 48,189 hours. Other Program Services Form 990, Part III, Line 4d 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 continuum of care from health promotion and sickness prevention to diagnosis, inpatient, outpatient and home health services. It controls the Hospital, Memorial Health Foundation, the Hospital's philanthropic arm, and Memorial Home Care, Inc., collectively referred to as the "System". The Hospital with 673 licensed adult beds and 80 bassinets, a staff of approx. 3,338, a medical staff of more than 620, and a volunteer Auxiliary of 594, is the largest hospital in the primary and secondary service areas. The Corporation owns and operates the acute care Hospital facility and Family Practice Residency Program. The Hospital's purpose is to provide hospital care and enhance wellness for the community. The Hospital has its own Board of Trustees (the "Hospital Board") elected by the persons serving on the Board of Directors of the Corporation. The Hospital Board has responsibility for the operation of the Hospital as defined in its bylaws. Memorial Hospital of South Bend is the largest and most comprehensive tertiary care medical center in Northern Indiana. Services are delivered through service divisions and professional ancillary services: Adult Patient Services, Cardiovascular & Critical Care Services, Women's and Children's Services, Surgical Services, Oncology Services and Professional Services. Key utilization Statistics for the Hospital for 2011 include: Admissions 19,821 Total Patient Days 98,338 Births 2,916 Inpatient Surgical Procedures 4,947 Outpatient Surgical Procedures 8,650 Emergency Department visits 56,315 Creating community health is at the core of Memorial Hospital of South Bend, Inc's mission. Promotion of community health is the right thing to do and a key to long term cost effectiveness. In addition, improving the health status of a community is as much a social, economic and environmental issue, as it is a medical one. Consequently, the System takes a broad approach to creating community health. This approach has included ongoing education of board members, staff and local leaders through community plunges (experiential activities to involve the community residents with a neighborhood-based agency), Community Foundation support, ongoing allocation of tithing resources, a clear statement of vision and goals, a commitment to continuous quality improvement and promotion of volunteer involvement and community partnerships. In the early 1990s, the System made a dramatic shift from a disease-focused medical model to a prevention-focused model. Its vision is to continue the journey to be among the nation's healthiest communities. Memorial's health enhancement plan focuses on five priorities: schools, neighborhoods, congregations, seniors and mother/child concerns. Its methods include building partnerships, investing dollars, listening and communicating, nurturing leadership, and continuous evaluation backed by sound outcome and impact measurement. The Community Benefit Fund is the System's mechanism for re-investing funds to improve the health status of communities it serves. The System, which includes Memorial Hospital of South Bend Inc, tithes 10% of the previous year's excess operating revenue and transfers it to the Community Benefit Fund. This investment is in addition to the Hospital's charity care and prevention and education activities supported through its operating budget. The Community Health Enhancement Committee of the Board began the fund in 1993 and makes ongoing policy and oversees the administration of the fund and determines specific investment allocations. Volunteers and staff are committed to prudently investing these resources in an accountable manner. BrainWorks at Memorial Hospital is housed within the Leighton Center, located on the Hospital campus. The programs sponsored at the Leighton Center promote a holistic understanding and approach to brain health across the lifespan, emphasizing the importance of a healthy brain to enhance the quality of life at every age. Education and physical movement are important aspects of aging well for all of us. Programming at the Leighton Center supports a platform to expand the knowledge of brain health. While the focus continues to be on holistic health, brain health as a key component to well-being which can contribute to the prevention of neurodegenerative disorders, improve rehabilitation and recovery from trauma, and enhance productivity and capabilities to be realized in the later years. As a part of senior programming, Memorial's Sage-ing Center contributes to spiritually Eldering and socially responsible aging. The System's innovative community outreach has received national recognition for models of involvement as well as state and federal grants to assist in the support of some of these programs. Programs include: African American Women in Touch - breast care education and screening programs, the PEDS developmental delay screening program for infants 0 to 3 years of age which is offered at the St. Joseph County WIC clinics, the YWCA, and the Center for the Homeless, and health education and outreach into the Latino community, including an innovative diabetes education and case management program that has had significant results. More than 320 Type II diabetics have participated in the program and reported no hospitalizations in 2011. The most popular addition continues to be the Zumba exercise classes, which have approximately 60 individuals of all ages participating in each session. More than 45 women were referred to the gestational diabetes program; of the deliveries, there were a few minor complications, however the overall birth outcomes were positive, and 100% of the mothers returned to normal glucose readings six-week post-partum. Two programs, which received continued grant funding were the Fetal Alcohol screening, intervention, and education programming for pregnant women, 1056 women participated, and the HUD affiliated program working with Healthy Homes. More than 6,000 youth enrolled in South Bend Community Schools during the 2011-2012 school year participated in the evidenced-based program, "Draw the Line, Respect the Line" targeting middle school aged students in making and practicing good choices. The "Healthy Babies Program" focused on proper prenatal care and reducing infant mortality. A program for African American men was held at three local barbershops during one weekend, to increase awareness and encourage men to make behavioral changes to monitor their blood pressure and take steps to control high blood pressure received additional support. This was a partnership with the Minority Health Coalition of St. Joseph County and the Indiana Minority Health Coalition. The Sickle Cell Initiative now serves 28 counties in Northern Indiana with screening, education, and counseling. In 2011, high school athlete screening, regular educational newsletters, and public service announcements continue. The St. Joseph County Sickle Cell conference was attended by over 250 health professionals and students. The "Domestic Violence Ends ("DOVE") project, and the Health Professionals -- a free service for residents needing physician referral or health information have proven their value to the community, while the partnership with South Bend Community School's magnet schools finds Memorial's evolving role in building a high school program intended to prepare students for future careers in health care and scientific research. As a supporter of the St. Joseph County Volunteer Provider Network, providing care for the uninsured adults in our community, with 373 physicians, diagnostic service providers, and two hospitals has, since its inception, served more than 19,000 patients and provided over $36 million in donated care. A demonstration project in partnership with South Bend Heritage Foundation provides health and social service case management to 49 low-income elderly living independently in the converted Robertson's Department Store. The results of the intervention have shown a decrease in depression and increases in eight indices of health in those elderly residents participating in the program. This project received funding from a local foundation to expand to 41 seniors living in public housing. housing. Changes to Governing Documents FORM 990, PART VI, SECTION A, LINE4 IN MARCH 2011, MEMORIAL HEALTH SYSTEM, INC, THE PARENT COMPANY OF MEMORIAL HOSPITAL OF SOUTH BEND, INC., AND ELKHART GENERAL HOSPITAL, INC. COMPLETED A MEMORANDUM OF UNDERSTANDING TO FORM AN AFFILIATION. EFFECTIVE DECEMBER 1, 2011, A NEWLY FORMED CORPORATION, BEACON HEALTH SYSTEM, INC. BECAME THE SOLE CORPORATE MEMBER FOR BOTH MEMORIAL HEALTH SYSTEM AND ELKHART GENERAL HOSPITAL. Members of the Organization Form 990, Part VI, Section A, Line 6 BEACON HEALTH SYSTEM, INC. IS THE SOLE CORPORATE MEMBER OF MEMORIAL HOSPITAL OF SOUTH BEND, INC. Election of Board Members Form 990, Part VI, Section A Line 7A The Corporate Member shall appoint the Board of Directors of Memorial Hospital of South Bend and shall have such powers of advance approval regarding corporate actions as are delineated in the By-Laws of Memorial Hospital of South Bend. Decisions of The Board of Directors Form 990, Part VI, Section A, Line 7B Decisions of the Board of Directors must be approved by the Corporate Member. Review Process Form 990, Part VI, Section B, Line 11B The organization incorporates numerous parties in the production and review of the Form 990 and associated schedules. Senior accounting staff and management complete the Form 990 and schedules. The forms and schedules are reviewed by the Controller and CFO. Subsequent to those steps, the organization engaged Ernst & Young to review the completed Form 990 and appropriate schedules. Prior to filing the return, the compensation committee of the organization and the CEO conduct a general overview of the form 990, including applicable compensation schedules. In addition, the Board of Directors and the Audit Committee will receive a copy of the 990 prior to filing. Conflict of Interest Policy Form 990, Part VI, Section B, Line 12 There are three separate forms that are sent out through the Internal Audit Department to Key Employees or Board Members regarding Conflict of Interest. They are as follows 1. The first is a Conflict of Interest Statement that is sent to Senior level Administration, Management, and select staff such as Purchasing Department employees. The purpose of the Statement is to require these Employees to disclose any potential conflict of interests they may have. The Statements are sent in January of each year and we pursue the replies to get a 100% response rate. In the current year we sent out over 250 Statements and achieved a 98% response rate. Each response is reviewed by the Director of Internal Audit and the results are reported to the CEO of Memorial 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 May, 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 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's Key Financial Employees that Memorial's financial information is to the best of their knowledge true and accurate. This Statement was sent out in January, 2011 and the signed acknowledgements are kept by the Director of Internal Audit. In 2011, twelve designated employees were requested to sign the form and we had a 100% compliance rate. Any potential Conflicts of Interest 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. Process for Determining Compensation Form 990, Part VI, Section B, Line 15 An extensive examination is conducted using comparable market data and 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. Public Availability for Documents Form 990, Part VI, Section C, Line 19 The governing documents and conflict of interest policy are not made available to the public. The financial statements are distributed quarterly to the Electronic Municipal Market Access (EMMA) website as part of the continuing disclosures for the Memorial Health System, Inc. bonds. Other Changes in Net Assets of Fund Balances Part XI, Line 5 Unrealized Loss on Swap Transactions (5,744,515) Unrealized Gain on Investments (5,293,966) Cash Transfers to Memorial Health System (28,513,083) Write off of Intercompany to Memorial Health System 2,919,990 Write off of Intercompany to Memorial Health Foundation 43,495 Accrued Health Insurance True up between Memorial Health System and Memorial Hospital (841,936) Change in Interest in Recipient Org 744,329 Total (36,685,686) Private Business Use for Schedule K Schedule K, Part III, Line 5 In August 2008, the Hospital Authority of St. Joseph County, on behalf of the Corporation, issued revenue refunding bonds in the principal amount of $39,915,000 to refund Series 2003 Bonds. The Series 2003 Bonds were used to finance various capital projects including the Heart and Vascular Center. As part of the planning for the Series 2003 Bonds, the Memorial Hospital management team planned for private use of the first floor of the Heart and Vascular Center. After planning for the private use of the first floor the Memorial management team consulted bond counsel at that time. Bond counsel advised that the first floor should be funded through equity. Memorial Hospital followed bond counsels recommendations and the Heart and Vascular Center first floor was entirely funded by equity. Memorial Hospital had used approximately $22,100,000 in equity in relation to the projects funded with Series 2003 bond draws. Arbitrage for Schedule K Schedule K, Part IV Part IV is not completed for the Series 2008A Bonds because such bonds indirectly refunded new money bonds issued in 2000. Voluntary Closing Agreement Schedule K, Part V Memorial Hospital of South Bend anticipates implementing written procedures to ensure that violations of Federal tax requirements are timely identified and corrected through the voluntary closing agreement program if self remediation is not available under applicable regulations. HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Charles Miller TITLE:Secretary HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Etta Nevel MD TITLE:Trustee HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Robert Yount MD TITLE:Trustee; Employed Physician HOURS:40 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Keith Sherry MD TITLE:Trustee and medical director HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Faye Magneson MD TITLE:Trustee thru APR 11 HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:James Schwartz Sr TITLE:Trustee HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Gerard Duprat MD TITLE:Trustee HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Thomas Cassady Jr TITLE:Chair HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Jesse Hseih MD TITLE:Trustee HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Maurice Hurwich MD TITLE:Trustee and medical director HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:M Rose Meissner TITLE:Vice Chair HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Margaret King TITLE:Trustee thru Mar 11 HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Thomas Burish PhD TITLE:Trustee HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Thomas Hauch MD TITLE:Trustee thru Mar 11 HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Maria Slager TITLE:Trustee HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Perry Watson III TITLE:Treasurer HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Steven Cramer PhD TITLE:Trustee HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Melvin Hall TITLE:Trustee Thru MAR 11 HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Delores Wilmoski TITLE:Trustee HOURS:2 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Peter Baranay TITLE:Trustee HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Carlton Lyons MD TITLE:Trustee HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Philip Newbold TITLE:CEO/President HOURS:42 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:George Soper TITLE:Asst. Secretary thru Mar 11 HOURS:40 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Jeffrey Costello TITLE:Asst. Treasurer/CFO HOURS:42 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Kreg Gruber TITLE:COO HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Cheryl Wibbens-Lesh MD TITLE:Asst. Secr./VP HOURS:1 Memorial Health System Inc 615 N Michigan Street South Bend IN 46601 351536132 Corp Svc/Clin IN 501C(3) 9 BEACON true Memorial Health Foundation Inc 615 N Michigan Street South Bend IN 46601 351536129 Financial Sup IN 501C(3) 9 MHS true Elkhart General Hospital Inc 600 East Boulevard Elkhart IN 46514 350877574 Hospital IN 501C(3) 3 BEACON true MEMORIAL ENDOWMENT FUND FOR MEMORIAL HOS PO BOX 1602 SOUTH BEND IN 46634 356068581 ENDOWMENT IN 501C(3) 11d III-O MHSB true BEACON HEALTH SYSTEM Inc 600 East Boulevard Elkhart IN 46514 453864076 Parent Org. IN 501C(3) 11C III-FI NA false Memorial Home Care Inc 615 N Michigan Street South Bend IN 46601 351901068 Home Medical IN NA C false true true false false false false false false false true true true true true true true true Memorial Health Foundation Inc L 647887 CASH TRANSFERS Memorial Health Foundation Inc Q 62479 CASH TRANSFERS Memorial Home Care Inc L 699554 REVIEW INVOICES Memorial Home Care Inc R 1513814 ACCT. ACTIVITY Memorial Home Care Inc Q 168599 ACCT. ACTIVITY Elkhart General Hospital Inc 85730 REVIEW INVOICES