2011-05-13T13:37:37-05:00 2010-06-30 Blue & Co LLC One American Square 2200 Indianapolis IN 46282 990 2009-07-01 350985964 Little Company of Mary Hospital of Indiana Inc LITT 8124822345 800 West Ninth Street Jasper IN 47546 E Kyle Bennett 8124822345 2011-05-12 1 Carrie A Merrill CPA 3176334705 2009 2016-02-24 21:20:13Z Memorial Hospital & Health Care Cent E Kyle Bennett 800 West Ninth Street Jasper IN 47546 148062833 0 X www.mhhcc.org X 1950 IN Provide Health services consistent with the needs of the community. 16 8 1492 211 84355 52256 420682 245685 138296887 139415841 906512 1711000 2074167 2313461 141698248 143685987 182647 166819 0 74503968 72427532 0 0 65400148 65042620 140086763 137636971 1611485 6049016 181904842 185905708 77195196 78838616 104709646 107067092 We, the board, physicians, staff, volunteers and auxiliary of Memorial Hospital and Health Care Center will provide excellent health care services to the people of the communities we serve. We will pledge ourselves to care for each individual in a manner that reflects the physical, psychological and spiritual healing ministry of Jesus Christ. We will work together to create an atmosphere of mutual respect, dignity, compassion and joy. We will effectively and efficiently utilize our resources in providing health care. We will be guided by the needs of those we serve and as needs change, we will change. We will "be for others!" 0 0 124577307 166819 139879372 General primary acute care hospital Expenses incurred in providing excellent health care services consistent with the needs of the community. See Form 990, Schedule H for additional services provided to the community. 124577307 1 1 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 1 1 1 1 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 1 0 0 1 189 0 1492 1 1 1 0 0 0 0 0 0 0 0 0 16 8 1 0 0 0 1 0 1 1 1 0 0 1 1 1 1 1 1 1 1 0 IN X E Kyle Bennett 8124820506 800 West Ninth Street Jasper IN 47546 Sr Adrian Davis 30.00 X 0 0 974 Robert Disinger 1.00 X 0 0 0 Kenneth Sendelweck 1.00 X 0 0 0 Sr Renee Cunningham 1.00 X 0 0 7587 Robert Ehrhard MD 1.00 X 0 0 0 Scott Beckman MD 1.00 X 0 0 0 William Rubino 1.00 X 0 0 0 Douglas Bies MD 1.00 X 416320 0 12191 Gervase Schwenk 1.00 X 0 0 0 Michael Uebelhor 1.00 X 0 0 0 Sr Sharon Ann Walsh 1.00 X 0 0 0 Sr Kathleen McIntyre 1.00 X 0 0 0 Lisa Arvesen 40.00 X X 163064 0 18421 E Kyle Bennett 40.00 X X 259497 0 28109 John Dillon 40.00 X X 156136 0 14969 Raymond Snowden 40.00 X X 393540 0 35531 Dr Robert Mandal 40.00 X 878861 0 0 Dr Michael Ruff 40.00 X 541024 0 11537 Dr Jerry Ammon 40.00 X 417696 0 17446 Dr Stephen DeWitt 40.00 X 458877 0 25574 Dr Stephen O'Connor 40.00 X 454227 0 20479 4139242 0 192818 60 0 1 0 STREICHER CONSTRUCTION INC PO BOX 643 Jasper IN 47546 CONSTRUCTION 2043934 VANTAGE ONCOLOGY TREATMENT PO BOX 15040 IN 47716 EVANSVILLE IN 47716 ONCOLOGY SERVICES 784005 MATRIX INTEGRATION LLC 417 MAIN ST JASPER IN 47546 COMPUTER SERVICES 710147 SEUFERT CONSTRUCTION PO BOX 68 FERDINAND IN 47532 CONSTRUCTION 675824 OUTSOURCE BILLING SERVICES 1039 SHELBY ST INDIANAPOLIS IN 46203 OUTSOURCED BILLING 561399 42 245685 245685 Net Patient Service Re 900099 139415841 139415841 139415841 960300 960300 1916464 1582979 333485 333485 333485 3544567 2784970 8897 759597 -8897 750700 750700 Laboratory Services 621500 81799 81799 Clinical Engineering R 811000 1798 1798 Linen Services Revenue 812300 758 758 1895621 463531 1432090 1979976 143685987 139879372 84355 3476575 5000 5000 161819 161819 962237 962237 57855987 53230492 4625495 1621236 1467219 154017 8138706 7365529 773177 3849366 3483676 365690 61633 55778 5855 100500 90954 9546 10299393 9320951 978442 203911 184539 19372 24027314 21744719 2282595 8040762 7276890 763872 538207 487077 51130 2535545 2294668 240877 9697519 8776255 921264 1111301 1005727 105574 Bad debts 6343009 5740423 602586 Dues & Sub. 299549 271092 28457 1783977 1614499 169478 137636971 124577307 13059664 0 19777076 30820232 20847854 17790769 1938139 1686674 2413270 2370315 1550935 1649098 162392578 76565169 91391348 85827409 41782723 43679219 1788980 1696988 414517 385004 181904842 185905708 10971753 10389735 55157291 53765978 11066152 14682903 77195196 78838616 X 104709646 107067092 104709646 107067092 181904842 185905708 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 694781 694781 72039302 23900131 48139171 89658495 52665038 36993457 85827409 Third Party Payable 800000 Pension Liability 13864642 Related Party Payable 18261 14682903 Part XI, XII, and XIII are not required as the organization is part of a consolidated financial statement. The consolidated financial statements are audited by an independent accounting firm and prepared in accordance with Generally accepted accounting principles. 1 1 1 X 1 X 1 1 1 1 1 1 2797980 2797980 0.02130 6465203 6465203 0.04920 9263183 9263183 0.07050 811424 811424 0.00620 811424 811424 0.00620 10074607 10074607 0.07670 1 3191168 0 34439828 29120019 5319809 X 1 1 Memorial Hospital Seaton Health Corp Sleep Center Inc Sleep Disorder Treatment and Diagnosis center 0.60000 0.00000 0.00000 Memorial Hospital & Health Care Center

800 W 9th St Jasper IN 47546

X X X Part I, Line 3c: A patient may qualify for partial financial assistance if the patient's household income is between 200% and 400% of the federal poverty guidelines. Part I, Line 7g: The organization does not provide any subsidized health services attributable to physician clinics. Part I, Line 7f: TOTAL BAD DEBT EXPENSE OF $6,343,009 INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A) HAS BEEN EXCLUDED FROM THE DENOMINATOR FOR THE PERCENTAGE CALCULATION PER IRS INSTRUCTIONS. Part III, Line 4: Section A. Bad Debt Expense. Line 2 Footnote to organization's financial statements that describes bad debt expense: Not applicable. No footnote.Part III, Line 4: Section A. Bad Debt Expense. Line 3 Explanation for rational for including other bad debt amount in community benefit: No other bad debt amounts have been included as community benefit. The hospital has a detailed Financial Assistance Policy and educates patients with limited ability to pay regarding financial assistance. For this reason, the organization believes it accurately captures all charity care deductions provided according to the financial assistance policy and the amount of bad debt expense attributable to patients eligible under the organization's charity care policy is negligible. Part III, Line 8: The source used to determine the amount of Medicare allowable costs reported for Part III, Section B, Medicare has been provided from the year ended June 30, 2010: Hospital Statement of Reimbursable Cost. Part III, Line 9b: The organization's written debt collection policy includes provisions on the collection practices to be followed during the follow-up period after a patient is discharged and includes specific instructions for self-pay who may qualify for charity care or financial assistance. Part VI, Line 2: The organization assesses the health care needs of the community it serves through the use of hospital committees developing strategic plans for the hospital to provide quality care to the community members. Part VI, Line 3: IF DURING PATIENT FINANCIAL SERVICES' FINANCIAL COUNSELING OR COLLECTION PROCESS, IT APPEARS THAT AN INDIVIDUAL MAY NOT HAVE THE FINANCIAL RESOURCES TO PAY FOR SERVICES NOT COVERED BY A THIRD PARTY PAYOR, THEN A FINANCIAL DISCLOSURE FORM SHOULD BE COMPLETED BY THE PATIENT. IN ADDITION, OTHER MEMBERS OF THE HOSPITAL STAFF MAY IDENTIFY INDIVIDUALS WHO MAY QUALIFY FOR CHARITY CARE. THE INFORMATION IS FORWARDED TO THE PATIENT FINANCIAL SERVICES DEPARTMENT. APPROPRIATE SIGNAGE IS VISIBLE IN THE HOSPITAL AND ALL HOSPITAL-OWNED FACILITIES, SPECIFICALLY IN PATIENT ACCESS AREAS, CREATING AWARENESS FOR THE FINANCIAL ASSISTANCE PROGRAM AND THE FINANCIAL ASSISTANCE THAT IS AVAILABLE. IN ADDITION THE HOSPITAL HAS ANNOUNCED A NEW PAYMENT PLAN WHICH ALLOWS PATIENTS TO PAY FOR THEIR HOSPITAL SERVICES AT 0% INTEREST OVER A 25-MONTH PERIOD. REGARDLESS OF INSURANCE COVERAGE, CREDIT HISTORY OR EMPLOYMENT, THE HOSPITAL WILL REFER PATIENTS AUTOMATICALLY TO THE CAREPAYMENT OPTION IF THEY HAVE A BALANCE ON THEIR HOSPITAL ACCOUNT TWO MONTHS AFTER RECEIVING THEIR FIRST STATEMENT. THROUGH A PRE-APPROVED APPLICATION PROCESS, THE PATIENT WILL RECEIVE A 0% INTEREST HOSPITAL-SPONSORED LOYALTY CARD WITH A MINIMUM OF 4% OF THE BALANCE OR $25. Part VI, Line 4: As a regional health center, the staff provides a comprehensive range of medical care for residents of Dubois and surrounding counties including more than 7,700 inpatients and 172,000 outpatients. Over 1,000 babies were born at Memorial Hospital during the past year, which set the all-time record! Part VI, Line 5: PROGRAMS WERE OFFERED AT DISCOUNTED PRICES. SOME SERVICES SUCH AS SCREENING RESULT SESSIONS OR SUPPORT GROUPS ARE OFFERED FREE TO PARTICIPANTS. THE FOLLOWING IS A LIST OF SERVICES PROVIDED THROUGH THE COMMUNITY RELATIONS DEPARTMENT.HEALTH SCREENINGS INCLUDING WEIGHT, BMI, WAIST CIRCUMFERENCE, BLOOD PRESSURE, LIPID PROFILE, CHEMISTRY PANEL, GLUCOSE, PSA AND COLON KITS: 6576 PARTICIPATED AT 61 DIFFERENT LOCATIONS. 1620 PSA'S WERE PERFORMED WHICH INCLUDED THE ANNUAL PSA SCREENING FOR MEN 50 AND OLDER, 674 COLON KITS DISTRIBUTED.HEALTH RISK APPRAISALS WERE PROVIDED FOR IMED PATIENTS AND PARTICIPANTS IN HEALTH SCREENINGS WITH 2439 COMPLETED.OTHER SCREENINGS Included LIPIDS, BLOOD PRESSURES, AND CARBON MONOXIDE SCREENINGS FOR 236 PEOPLE.OVER 2962 PARTICIPANTS ATTENDED SCREENING RESULT SESSIONS TO LEARN ABOUT THE IMPORTANCE OF THEIR SCREENING RESULTS AT THE VARIOUS WORK-SITES.1374 PARTICIPATED IN VARIOUS WELLNESS CLASSES AT DISCOUNTED GROUP RATES AND THROUGH WELLNESS DISPLAYS AT LOCAL BUSINESSES. SMOKING CESSATION PROGRAMS WERE PROVIDED FOR THE COMMUNITY AND COMPANY WORK-SITES AT NO COST WITH ONE WEEK OF NICOTINE PATCHES AWARDED FOR COMPLETION THANKS TO A GRANT FROM THE DUBOIS COUNTY SUBSTANCE ABUSE COUNCIL FOR 28 PARTICIPANTS. AMERICAN CANCER SOCIETY AND THE INDIANA TOBACCO PREVENTION AND CESSATION COUNCIL ALSO PROVIDED EDUCATION MATERIALS AT NO CHARGE. MEMORIAL HOSPITAL PROVIDED STAFFING TO TEACH THE CLASSES.392 HOSPITAL EMPLOYEES PARTICIPATED IN LUNCH AND LEARN WELLNESS QUIZZES, COACHING AND OTHER WELLNESS ACTIVITIES THROUGHOUT THE YEAR AT NO CHARGE.WE PROVIDED WELLNESS COACHING FOR 335 INDUSTRY PARTICIPANTS. THE COMPANIES PAID A FEE FOR THIS SERVICE. HOSPITAL EMPLOYEES PARTICIPATED FOR FREE.CANCER EDUCATION INFORMATION AND HEALTH EDUCATION INFORMATION WAS DISTRIBUTED AT NO COST TO PARTICIPANTS AT SCREENINGS AND THROUGH EMPLOYEE WELLNESS PROGRAMS.NUTRITION AND HEALTH DISPLAYS WERE PROVIDED FOR 4 COMPANIES.MATERNITY CENTER PROGRAMS WERE OFFERED INCLUDING THE CHILDBIRTH AND CHILDBIRTH REFRESHER CLASSES, BREAST-FEEDING, GETTING READY FOR BABY BROTHER OR SISTER, PAPA PAGERS, OB BACK CLASSES FOR PARTICIPANTS AT NO CHARGE. 319 PARTICIPANTS ATTENDED THE VARIOUS CHILDBIRTH CLASSES, BREAST-FEEDING CLASSES, AND THE GETTING READY FOR BABY BROTHER AND SISTER CLASSES. 13 PARTICIPANTS WERE RECORDED AT SESSIONS CONDUCTED IN THE FERTILITY CARE (NATURAL FAMILY PLANNING) PROGRAM FOR A SMALL FEE. PROGRAMS ARE AVAILABLE AT REDUCED RATE FOR THOSE UNABLE TO PAY FOR THE SERVICES.MEDIC FIRST AID, CPR PROGRAMS, AED, AND BLOOD BORNE PATHOGENS, WERE PROVIDED FOR 1003 INDUSTRY WORKERS, SCOUT Troops, SCHOOLS AND THE GENERAL PUBLIC FOR A FEE.WE PARTICIPATED IN FREE COMMUNITY EXHIBITS AND FAIRS INCLUDING THE WBDC SENIOR FAIR, AND TEEN WELLNESS FAIRS WITH 156 PARTICIPANTS. WRIST BANDS WERE DONATED FOR RELAY PARTICIPANTS AND CANCER SURVIVOR GIFTS WERE DONATED.THE LANGE-FUHS CANCER CENTER CONDUCTED THE MAN TO MAN PROGRAM, THE LOOK GOOD, FEEL BETTER PROGRAM, MEN'S GROUP AND WOMEN'S GROUP, AND THE CELEBRATE LIFE PROGRAM TO AREA CANCER PATIENTS AT NO COST.THE MEMORIAL HOSPITAL COUNSELING CENTER PROVIDED MONTHLY SUPPORT GROUPS FOR FAMILIES WITH ALZHEIMER'S DISEASE AND DEMENTIA, HEART DISEASE, AND PARKINSON'S DISEASE. THE DIABETES EDUCATION STAFF PROVIDED FREE MONTHLY SUPPORT GROUPS FOR THOSE WITH DIABETES. THE PASTORAL CARE DEPARTMENT PROVIDED TWO 5-WEEK PROGRAMS FOR THOSE SUFFERING WITH GRIEF.SUPERSITTER (BABYSITTING) CLASSES WERE OFFERED FOR A FEE TO 43 YOUTH TO LEARN ABOUT SAFE BABYSITTING PRACTICES.ATTENDANCE OF 806 WAS RECORDED AT MONTHLY HEALTH CHECK-INS WHICH PROVIDED ONE-ON-ONE EDUCATION AND SUPPORT FOR PEOPLE CREATING HEALTHY LIFESTYLES.16 CLIENTS WERE EDUCATED IN DISEASE MANAGEMENT: HYPERTENSION AND DIABETES WITH WEEKLY PHONE CALLS FROM A DISEASE EDUCATION NURSE.1374 PARTICIPANTS ATTENDED WELLNESS CLASSES AND LUNCH AND LEARN PROGRAMS SPONSORED BY THEIR EMPLOYER OR AS A PART OF THE COMMUNITY PROGRAMS OFFERED BY THE HOSPITAL.1283 PARTICIPANTS TOOK PART IN THE WEIGHT MANAGEMENT CLASSES AND WEEKLY WEIGH-INS AT THE HOSPITAL FOR FREE OR AT A GROUP RATE. HOSPITAL EMPLOYEES PARTICIPATED FREE.234 PARTICIPATED IN THE MONTHLY FITNESS CLASSES HELD AT THE HOSPITAL.167 YOUTH ATTENDED BREAST SELF EXAM CLASSES, YOUTH FAIRS AT SCHOOLS, AND THE HEALTHY ME WELLNESS PROGRAM AT THE HOSPITAL.236 ATTENDED CARBON MONOXIDE, LIPID, OR BLOOD PRESSURE SCREENINGS.THE LIFELINE PROGRAM MAINTAINS AN AVERAGE OF 216 LIFELINE UNITS FOR AREA RESIDENTS TO PROVIDE A SAFE ENVIRONMENT FOR THE ELDERLY MAINTAINING THEIR INDEPENDENCE AT HOME.FREE MONTHLY E-MAIL WELLNESS TIPS HAVE BEEN PROVIDED FOR THE AREA CHAMBER OF COMMERCE AND 14 LOCAL BUSINESSES TO SHARE WITH THEIR MEMBERS/EMPLOYEES.COMMUNITY EDUCATION STAFF PARTICIPATED IN LOCAL COMMUNITY COMMITTEES SUCH AS THE MEMORIAL HOSPITAL FOUNDATION OUTREACH COMMITTEE, THE DUBOIS COUNTY SUBSTANCE ABUSE COUNCIL, THE HOSPITAL ERGONOMIC COMMITTEE, AND THE HOSPITAL CANCER COMMITTEE WITH OVER 36 HOURS OF STAFF TIME DONATED. FREE WELLNESS INFORMATION WAS PROVIDED QUARTERLY TO AREA INDUSTRIES ON HEALTH INFORMATION FOR THEM TO USE IN THEIR NEWSLETTERS AND ON BULLETIN BOARDS TO IMPROVE THE HEALTH OF THEIR EMPLOYEES ALONG WITH FREE WELLNESS PAYCHECK STUFFERS TO OVER 30 COMPANIES. 6 CHOOSE 8 TO LOSE WEIGHT NUTRITION PROGRAMS WERE TAUGHT AT SALEM CHURCH AND 4 AT THE GUADALUPE CENTER IN HUNTINGBURG A PART OF THE GET-WELL HUNTINGBURG PROJECT. 60 PARTICIPATED IN THE HUNTINGBURG CHOOSE 8 TO LOSE WEIGHT PROGRAM FITNESS-TRACKING PROGRAM AND AN AVERAGE OF 25 ATTENDED THE MONTHLY NUTRITION CLASSES. Part VI, Line 6: The organization furthers its exempt purpose by promoting health of the community through the following: The majority of the organization's governing body is comprised of persons who reside in the organization's primary service area who are neither employees nor independent contractors of the organization, nor are their family members. Any surplus funds are applied directly or indirectly to improve patient care services. Also, the organization operates under the premise of an open medical staff with regard to qualified physicians in the 9 county community it serves, however it does not actively pursue those physicians who have not approached the organization regarding these privileges. Part VI, Line 7: Not applicable. The organization is not part of an affiliated health care system. IN 1 Tri County Young Men's Christian Association PO BOX 171 Ferdinand IN 47532 352216734 501(C)(3) 5000 Support for child care programs in Dubois, Perry, and Spencer Counties. 1 Student loan buy back program to offset educational expenses for critically needed health care fields. 39 66950 Tuition Reimbursement program for the cost of tuition and books. 42 80071 Scholarship Program to assist staff members pursuing an undergraduate degree to work in defined critical shortage areas. 10 14798 Procedure for Monitoring Grants in the U.S.: Part I, Line 2: Schedule I, Part I, Line 2: For the Student Loan Buy-Back program applications are submitted to the Human Resource Department; and reviewed for denial or approval. For the Tuition Reimbursment program applications must be approved by the directors in charge of the employee before submitting to Human Resource Department for approval. In addition grades must be submitted to the Human Resource Department for grade verification. For the Scholarship program the scholarship committee exercises authority in the selection process and recipients must re-apply each semester. For the Grant Provided to The Tri-County Young Men's Christian association (a section 501(c)(3) organization), support for the organization is approved by the board of directors. Other Information: Part IV: See Schedule O for eligibility and procedures for Student Loan Buy-Back, Tuition Reimbursement, and Scholarship programs. X X X X 0 0 0 0 0 0 0 0 0 Douglas Bies MD 180003 0 0 0 236317 0 3600 0 8591 0 428511 0 0 0 Lisa Arvesen 163064 0 0 0 0 0 9095 0 9326 0 181485 0 0 0 E Kyle Bennett 259497 0 0 0 0 0 9332 0 18777 0 287606 0 0 0 John Dillon 156136 0 0 0 0 0 5917 0 9052 0 171105 0 0 0 Raymond Snowden 393540 0 0 0 0 0 25903 0 9628 0 429071 0 0 0 Dr Robert Mandal 878861 0 0 0 0 0 0 0 0 0 878861 0 0 0 Dr Michael Ruff 180003 0 0 0 361021 0 2916 0 8621 0 552561 0 0 0 Dr Jerry Ammon 394160 0 0 0 23536 0 3139 0 14307 0 435142 0 0 0 Dr Stephen DeWitt 324459 0 79537 0 54881 0 11461 0 14113 0 484451 0 0 0 Dr Stephen O'Connor 324459 0 59317 0 70451 0 6172 0 14307 0 474706 0 0 0 Hospital Authority of the City of Jasper 351692946 471641AA8 2008-05-20 15000000 See Sch O for purpose 0 0 15000000 284700 14715300 2008 0 0 1 1 0 0 0 0 1 0.00000 0.00000 0.00000 1 0 1 0 0 0 0 Sr R Cunningham Board members 256128 Sisters Renee Cunningham and Adrian Davis provide nursing services to the hospital and serve as board members. The hospital pays American Providence of Little Company of Mary Sisters $256,128 as a sponsorship for the sisters. The sisters do not accept compensation as they have taken a vow of poverty. The American Providence of Little Company of Mary Sisters is the corporate member for the hospital. 0 Sr A Davis Board members 256128 Sisters Renee Cunningham and Adrian Davis provide nursing services to the hospital and serve as board members. The hospital pays American Providence of Little Company of Mary Sisters $256,128 as a sponsorship for the sisters. The sisters do not accept compensation as they have taken a vow of poverty. The American Providence of Little Company of Mary Sisters is the corporate member for the hospital. 0 Scott Beckman Board member & Medical Staff President 20507 Dr. Beckman receives a stipend for medical Director and payment for purchased physician services as an independent contractor. 0 Ray Snowden CEO of Memorial Hospital and Board member of German American Bank 0 Ray Snowden is a board member for German American Bank which provides banking needs of savings and interest accounts to the hospital. 0 Ken Sendelweck Board member of Memorial Hospital & officer at German American Bank 0 Ken Sendelweck services as officer for German American Bank which provides banking needs of savings and interest accounts to the hospital. 0 Mike Uebelhor Board Member & Owner of Uebelhor Development 124687 Mike Uebelhor is a part owner of Uebelhor Developments, which is the lessor of the organization's urgent care building in Huntington, IN. The Hospital paid $107,400 in lease payments and $17,287 in property tax payments to Uebelhor Developments in the current year. 0 Form 990, Part VI, Section A, line 2 Mr. Bennett, Sister Davis, Mr. Disinger, Mr. Rubino, Mr. Sendelweck and Mr. Snowden have a businss relationship as they are all board members for the memorial hospital foundation together. Form 990, Part VI, Section A, line 6 The members of the corporation are the Providence Leader and Council Members of the American Providence of Little Company of Mary Sisters. Form 990, Part VI, Section A, line 7b The following decisions of the governing body are subject to approval by the members: To establish/approve the mission/philosophy of the Corporation; to adopt, amend or repeal the Articles of Incorporation or Bylaws of the Corporation; to fix the number of directors of the Corporation and appoint the Corporation's board of directors; to remove any member of the Board of the Corporation; to appoint and remove the President/CEO of the Corporation; To appoint and remove the Chairperson of the Board of Directors; To approve for the Corporation, the acquisition of assets, the incurrence of indebtedness or the lease, sale, transfer, assignment, or encumbering of the assets in an amount set from time to time by the Members; to approve the merger, dissolution, affiliation, or corporate restructuring of the Corporation and any subsidiary of the Corporation; To accept a gift or legacy imposing a permanent or continuing obligation on the Corporation; to approve the annual operating and capital budgets; and to appoint the auditors of the Corporation. Form 990, Part VI, Section B, line 11 A copy of the Form 990 is made available for the board of directors for review prior to filing. Form 990, Part VI, Section B, line 12c The board chairperson evaluates situations where possible conflicts may exist, and tries to discuss these situations with board members before discussions may take place at the board meeting. Form 990, Part VI, Section B, line 15 The compensation committee, composed of the Executive Committee of the Board minus the CEO, reviews external survey information provided by an independent compensation consultant, and votes on any compensation and benefit changes for the CEO and approves the same for other members of Administrative Staff. These actions are documented in meeting minutes. Form 990, Part VI, Section C, line 19 The organization does not make the governing documents, conflict of interest policy, or financial statements available to the public. Part XI, Line 2C Oversight of the Audit The board of directors assumes responsibility for oversight of the audit of the financial statements and selection of the independent accountant; no processes have changed from the prior year. Sch I Student Loan Buy-Back Program POLICY STATEMENT: MEMORIAL HOSPITAL AND HEALTH CARE CENTER STRIVES TO BE PROACTIVE IN RECRUITING, ASSISTING, AND ENCOURAGING QUALIFIED INDIVIDUALS TO ENTER INTO CRITICALLY NEEDED HEALTH CARE FIELDS. THIS PROGRAM WAS DESIGNED TO OFFSET EDUCATIONAL EXPENSES BY REIMBURSING APPROVED MONTHLY STUDENT LOAN OBLIGATIONS IN TRADE FOR TIME WORKED AT MEMORIAL HOSPITAL AND HEALTH CARE CENTER. PROCEDURE: 1. THE STUDENT LOAN BUY-BACK BENEFIT IS AVAILABLE TO EMPLOYEES RECRUITED BY MEMORIAL HOSPITAL AND HEALTH CARE CENTER FOR CRITICAL SHORTAGE AREAS WHO HAVE EXISTING LOANS. THIS BENEFIT MAY NOT BE USED IN CONJUNCTION WITH THE TUITION REIMBURSEMENT PROGRAM. 2. THE STUDENT LOAN monies mUST BE BORROWED BY THE EMPLOYEE FOR OBTAINING A FORMALIZED DEGREE IN A CRITICAL SHORTAGE AREA AS DEFINED BY THE HOSPITAL. EACH POTENTIAL EMPLOYEE MUST HAVE MADE HIS OR HER OWN ARRANGEMENTS FOR THE STUDENT LOAN FINANCING THROUGH AN APPROPRIATE LENDING INSTITUTION. THE HOSPITAL WILL IN NO WAY BE SIGNATORY OR BE HELD RESPONSIBLE FOR THE FINANCIAL CONTRACT OBTAINED THROUGH A LENDING INSTITUTION. 3. THE APPLICATION TITLED "STUDENT BUY-BACK APPLICATION" FOR QUALIFIED INDIVIDUALS MUST BE COMPLETED AND SUBMITTED TO THE HUMAN RESOURCE DEPARTMENT. IT SHALL BE THE RESPONSIBILITY OF HUMAN RESOURCES TO NOTIFY THE EMPLOYEE OF DENIAL OR APPROVAL. 4. THE ACTIVE LOAN BALANCE AT THE TIME OF APPLICATION WILL BE USED TO CALCULATE STUDENT LOAN BUY-BACK. 5. ELIGIBILITY FOR BUY-BACK PAYMENTS COMMENCES AT THE BEGINNING OF THE MONTH FOLLOWING COMPLETION OF THE 60 DAY INTRODUCTORY PERIOD. EMPLOYEES WITH A PRN STATUS ARE NOT ELIGIBLE TO PARTICIPATE IN THE STUDENT LOAN BUY-BACK PROGRAM. BUY-BACK PAYMENTS CEASE IMMEDIATELY WITH TERMINATION. 6. SHOULD AN EMPLOYEE REDUCE TO LESS THAN FULL TIME STATUS (1.0 FTE) THEN THE EMPLOYEE'S MAXIMUM REIMBURSEMENT WILL BE REDUCED PROPORTIONATELY(I.E. A .8 FTE WILL QUALIFY FOR 80% OF THE ALLOWABLE MONTHLY AND TOTAL REIMBURSEMENT AMOUNT). THE EMPLOYEE WILL BE REQUIRED TO COMPLETE A NEW APPLICATION AT THE TIME OF STATUS CHANGE. 7. IF AN INDIVIDUAL IS GIVEN ANY DISCIPLINARY ACTION, THE LOAN BUY-BACK PAYMENT WILL NOT BE MADE FOR THE MONTH IN WHICH THE DISCIPLINARY ACTION OCCURRED AND CONTINUATION OF THE BENEFIT WILL BE REVIEWED. 8. THE MAXIMUM AMOUNT FOR LOAN BUY-BACK WILL BE $250.00 PER MONTH FOR A TOTAL OF 24 MONTHS. 9. THE CRITICAL SHORTAGE AREAS WILL BE IDENTIFIED BY THE ADMINISTRATIVE STAFF OF MEMORIAL HOSPITAL AND THE HUMAN RESOURCE DEPARTMENT WILL HAVE THE LIST AVAILABLE UPON REQUEST. 10. SHOULD A POSITION BE REMOVED FROM THE CRITICAL SHORTAGE LIST, ANY APPROVED APPLICATION FOR THE STUDENT LOAN BUY-BACK SHALL CONTINUE TO BE VALID AND APPROVED EACH YEAR SO LONG AS ALL OTHER CRITERIA ARE MET. 11. STUDENT LOAN BUY-BACK PAYMENTS WILL BE MADE DIRECTLY TO THE EMPLOYEE. THE EMPLOYEE WILL CONTINUE TO BE RESPONSIBLE FOR THEIR OWN PAYMENTS TO THE LENDING INSTITUTION(S). 12. THE EMPLOYEE IS RESPONSIBLE FOR OBTAINING A LETTER STATING THE PURPOSE OF THE LOAN, AMOUNT OF THE LOAN, THE DATE OF ISSUANCE AND THE SIGNATURE OF THE LOAN OFFICER. Sch I Tuition Reimbursement Program POLICY STATEMENT: MEMORIAL HOSPITAL AND HEALTH CARE CENTER STRIVES TO PROVIDE A WORKING ENVIRONMENT DESIGNED TO ATTRACT, REWARD AND RETAIN QUALIFIED PERSONNEL. TUITION REIMBURSEMENT IS DEFINED AS THE COST OF TUITION AND BOOKS ONLY FOR CLASSES TAKEN IN PURSUANCE OF AN UNDERGRADUATE DEGREE AT AN ACCREDITED INSTITUTION OF HIGHER EDUCATION. PROCEDURE: 1. ELIGIBILITY: EMPLOYEES MUST BE EMPLOYED AS A REGULAR EMPLOYEE AUTHORIZED TO WORK WEEKEND OPTION OR AT LEAST 64 HOURS PER PAY PERIOD FOR SIX CONSECUTIVE MONTHS. THE SIX MONTH REQUIREMENT IS WAIVED FOR EMPLOYEES TAKING ACADEMIC COURSES TOWARD A DEGREE FOR A CRITICAL SHORTAGE AREA. IF ACADEMIC COURSES ARE RECOMMENDED BY THE DIRECTOR OR VICE PRESIDENT AT THE TIME OF HIRE, THE EMPLOYEE MAY ENROLL IN THE CLASS BEFORE SIX MONTHS OF EMPLOYMENT IS COMPLETED; HOWEVER, TUITION REIMBURSEMENT MAY NOT BE RECEIVED BEFORE SIX MONTHS OF EMPLOYMENT HAS BEEN COMPLETED. THE PROGRAM OF STUDY MUST: (A) BENEFIT THE HOSPITAL, AND EITHER (B) BE RELATED TO THE EMPLOYEE'S PRESENT JOB, OR (C) ENHANCE THE EMPLOYEE'S POTENTIAL FOR ADVANCEMENT TO A POSITION TO WHICH THE EMPLOYEE CAN REASONABLy BE EXPECTED TO BE PROMOTED WITHIN MEMORIAL HOSPITAL AND HEALTH CARE CENTER. TUITION REIMBURSEMENT WILL BE CONSIDERED FOR GRADUATE COURSES IF THE APPLICABLE VICE PRESIDENT OF MEMORIAL HOSPITAL AND HEALTH CARE CENTER REQUESTS THE EMPLOYEE TO CONTINUE HIS/HER EDUCATION TO MEET JOB REQUIREMENTS OF THE CURRENT JOB, TO MEET QUALIFICATIONS OF A PLANNED PROMOTION OR SERVES A BUSINESS PURPOSE OF THE HOSPITAL. INDIVIDUAL SEMINARS AND WORKSHOPS ARE NOT COVERED UNDER THIS POLICY. CERTIFICATE PROGRAMS ARE ONLY COVERED IF COLLEGE CREDIT AND LETTER GRADES ARE PROVIDED FOR CLASSES TAKEN BY THE EMPLOYEE. THE COURSE(S) MUST BE ATTENDED DURING NON-WORKING HOURS OR DIRECTOR/VICE PRESIDENT APPROVAL IS REQUIRED FOR SCHEDULE CHANGES IF NEEDED TO ATTEND CLASSES. THIS ACCOMMODATION MAY NOT BE POSSIBLE In SOME AREAS. THE HOSPITAL EXPECTS EACH EMPLOYEE INVOLVED IN THE TUITION REIMBURSEMENT PROGRAM TO CONTINUE TO FUNCTION AT AN ACCEPTABLE LEVEL OF PERFORMANCE. A LETTER GRADE OF C (OR EQUIVALENT) OR BETTER MUST BE OBTAINED FOR UNDERGRADUATE COURSES. A GRADE OF B (OR EQUIVALENT) OR BETTER MUST BE ATTAINED FOR GRADUATE CLASSES. GRADES AND CHECK REQUESTS FOR TUITION REIMBURSEMENT MUST BE RECEIVED BY THE HUMAN RESOURCES DEPARTMENT WITHIN TWO WEEKS AFTER GRADES ARE RECEIVED. 2. BENEFITS - FOR CLASSES TAKEN FOR ALL JOB TITLES THAT ARE NOT LISTED AS CRITICAL SHORTAGE: FULL TIME (72 HOURS OR MORE PER PAY PERIOD) UNDERGRADUATE - 90% WITH A MAXIMUM OF $3,000 GRADUATE - 90% WITH A MAXIMUM OF $5,000 PART TIME (WEEKEND OPTION OR MINIMUM OF 64 HOURS PER PAY PERIOD) UNDERGRADUATE - 70% WITH A MAXIMUM OF $2,000 GRADUATE - 70% WITH A MAXIMUM OF $3,000 3.BENEFITS - FOR CLASSES TAKEN FOR JOB TITLES THAT ARE LISTED AS CRITICAL SHORTAGE: FULL TIME (MINIMUM OF 72 HOURS PER PAY PERIOD) UNDERGRADUATE - 90% WITH A MAXIMUM OF $4,000 PART TIME (WEEKEND OPTION OR MINIMUM OF 64 HOURS PER PAY PERIOD) 70% WITH A MAXIMUM OF $4,000 4. APPLICATION PROCEDURE: EMPLOYEES THAT MEET ELIGIBILITY REQUIREMENTS MUST COMPLETE A TUITION REIMBURSEMENT REQUEST FORM. ALL REQUESTS MUST INCLUDE DIRECTOR RECOMMENDATIONS. THE PRESIDENT AND THE DIRECTOR OF HUMAN RESOURCES HAVE THE AUTHORITY FOR THE FINAL APPROVAL OF EACH INDIVIDUAL REQUEST FOR TUITION REIMBURSEMENT. IN CASES WHERE EMPLOYEES HAVE HAD WRITTEN COUNSELING/DISCIPLINARY ACTION WITHIN THE LAST TWELVE MONTHS, TUITION REIMBURSEMENT MAY NOT BE APPROVED. REQUESTS RECEIVED MAY BE DENIED AND THE EMPLOYEE WILL BE ADVISED TO APPLY FOR THE NEXT CLASS SESSION. AFTER CLASS COMPLETION, VERIFICATION OF A LETTER GRADE (OR EQUIVALENT)FOR EACH CLASS MUST BE SUBMITTED TO THE HUMAN RESOURCES DEPARTMENT WITHIN TWO WEEKS OF RECEIPT OF GRADES. REIMBURSEMENT WILL NOT BE OBTAINED WITHOUT GRADE VERIFICATION. IF AN EMPLOYEE WHO HAS RECEIVED TUITION REIMBURSEMENT TERMINATES EMPLOYMENT AT MEMORIAL HOSPITAL (VOLUNTARY OR INVOLUNTARY) OR IF AN EMPLOYEE REDUCES EMPLOYMENT STATUS TO BELOW .6 FTE ALL TUITION REIMBURSEMENT RECEIVED WITHIN THE LAST 24 MONTHS PRIOR TO DATE OF TERMINATION OR STATUS REDUCTION WILL BE REPAID TO MEMORIAL HOSPITAL AND HEALTH CARE CENTER. REpaymeNT IS DUE WITHIN 30 DAYS OF TERMINATION DATE OR STATUS REDUCTION. A STATEMENT AGREEING TO THIS ARRANGEMENT WILL BE SIGNED BY EACH EMPLOYEE AT THE TIME APPLICATION IS MADE. Sch I Scholarship Program POLICY STATEMENT: IN AN EFFORT TO PROMOTE PERSONAL AND PROFESSIONAL GROWTH OF STAFF, MEMORIAL HOSPITAL AND HEALTH CARE CENTER PROVIDES A SCHOLARSHIP PROGRAM TO ASSIST STAFF MEMBERS PURSUING AN UNDERGRADUATE DEGREE AT AN ACCREDITED INSTITUTION OF HIGHER EDUCATION TO WORK IN DEFINED CRITICAL SHORTAGE AREAS. PROCEDURE: 1. ELIGIBILITY: SCHOLARSHIP APPLICANTS MUST BE EMPLOYED BY MEMORIAL HOSPITAL AND HEALTH CARE CENTER PRIOR TO APPLYING FOR THE SCHOLARSHIP. WEEKEND OPTION EMPLOYEES ARE NOT ELIGIBLE TO PARTICIPATE IN THE SCHOLARSHIP PROGRAM. EMPLOYEES WITH WRITTEN COUNSELING/DISCIPLINARY ACTION WITHIN THE LAST TWELVE MONTHS WILL NOT BE ELIGIBLE FOR THE SCHOLARSHIP PROGRAM. THE HOSPITAL EXPECTS EACH EMPLOYEE INVOLVED IN THE SCHOLARSHIP PROGRAM TO CONTINUE TO FUNCTION AT AN ACCEPTABLE LEVEL OF PERFORMANCE. THE PROGRAM OF STUDY MUST BENEFIT SPECIFICALLY DEFINED CRITICAL SHORTAGE AREAS WITHIN THE HOSPITAL, AS DETERMINED BY THE SCHOLARSHIP COMMITTEE. THE NUMBER OF SCHOLARSHIPS FOR CRITICAL SHORTAGE AREAS WILL BE DETERMINED ANNUALLY. EMPLOYEES THAT MEET ELIGIBILITY REQUIREMENTS MUST COMPLETE AN APPLICATION FORM AND SUBMIT IT TO THEIR DEPARTMENT DIRECTOR. DIRECTOR RECOMMENDATIONS MUST ACCOMPANY ALL APPLICATIONS SENT TO THE HUMAN RESOURCES DEPARTMENT. THE SCHOLARSHIP COMMITTEE WILL EXERCISE AUTHORITY IN THE SELECTION PROCESS. MEMBERS OF THIS COMMITTEE INCLUDE THE PRESIDENT/CEO, TWO VICE PRESIDENTS, THE DIRECTOR OF HUMAN RESOURCES, AND A DIRECTOR FROM ALL THREE DIVISIONS. SCHOLARSHIP RECIPIENTS ARE REQUIRED TO MAINTAIN A 0.8 FTE WORK STATUS. BENEFITS WILL BE CONSISTENT WITH EMPLOYEE STATUS. CREDIT HOURS WILL BE APPLIED WEEKLY TOWARDS THE STUDENT'S WEEKLY REQUIRED HOURS. EXAMPLE: A STUDENT WITH NINE CREDIT HOURS WEEKLY WOULD BE REQUIRED TO WORK 23 HOURS PER WEEK AT THE HOSPITAL. IN THIS EXAMPLE, THE STUDENT WOULD WORK 24 HOURS AT THE HOSPITAL, AS STAFFING WILL NOT BE ADJUSTED MID-SHIFT TO RELEASE STUDENTS EARLY FROM THEIR RESPONSIBILITIES. COURSE(S) WILL BE ATTENDED DURING NON-WORKING HOURS IN COORDINATION WITH STUDENT'S DEPARTMENT DIRECTOR WHO WILL SCHEDULE THEIR HOSPITAL HOURS AS NEEDED FOR DEPARTMENTAL COVERAGE, WHILE NOT INTERFERING WITH HOURS OF CLASS. STUDENTS MUST SUPPLY A CLASS SCHEDULE TO THEIR DIRECTOR AS SOON AS AVAILABLE TO ENABLE THE SCHEDULING PROCESS. AFTER CLASS COMPLETION, VERIFICATION OF A LETTER GRADE (OR EQUIVALENT) FOR EACH CLASS MUST BE SUBMITTED TO THE HUMAN RESOURCES DEPARTMENT WITHIN TWO WEEKS OF RECEIPT OF GRADES. A GRADE POINT AVERAGE OF 2.5 OR GREATER MUST BE MAINTAINED TO REMAIN IN GOOD STANDING. IF A STUDENT'S GPA DROPS BELOW 2.5, THE INDIVIDUAL WILL NOT BE ELIGIBLE TO REMAIN IN THE SCHOLARSHIP PROGRAM AND MUST APPLY FOR AN OPEN POSITION IN THE HOSPITAL TO CONTINUE THEIR EMPLOYMENT. SCHOLARSHIP RECIPIENTS MUST RE-APPLY FOR EACH SEMESTER TO VERIFY ELIGIBILITY BASED ON GRADES AND WORK PERFORMANCE. IF A SCHOLARSHIP RECIPIENT TERMINATES EMPLOYMENT AT MEMORIAL HOSPITAL (VOLUNTARY OR INVOLUNTARY), REDUCES EMPLOYMENT STATUS TO BELOW .8 FTE, OR DOES NOT MAINTAIN SATISFACTORY PERFORMANCE, ALL SCHOLARSHIP ASSISTANCE RECEIVED WITH THE LAST 24 MONTHS PRIOR TO DATE OF TERMINATION, STATUS REDUCTION, OR DISCIPLINARY ACTION WILL BE REPAID TO MEMORIAL HOSPITAL AND HEALTH CARE CENTER. RE-PAYMENT IS DUE WITHIN 30 DAYS OF THIS DATE. STATEMENT AGREEING TO THIS ARRANGEMENT WILL BE SIGNED BY EACH EMPLOYEE EACH TIME APPLICATION IS MADE. 2. BENEFITS: SCHOLARSHIP RECIPIENTS WILL BE PAID MINIMUM WAGE PER CREDIT HOUR TO BE APPLIED TO THEIR 0.8 FTE COMMITMENT. NO ADDITIONAL HOURS WILL BE PAID TO COMPLETE HOMEWORK, CLINICAL HOURS, OR SPECIAL ASSIGNMENTS. CORRESPONDENCE COURSES WILL BE PAID AT MINIMUM WAGE PER CREDIT HOUR FOR A MAXIMUM OF 16 WEEKS. THE STUDENT WILL BE PAID AT THEIR REGULAR HOURLY RATE FOR HOURS WORKED IN THE FACILITY. SCHOLARSHIP ASSISTANCE DOES NOT APPLY WHEN SCHOOL IS NOT IN SESSION. SCHOLARSHIP RECIPIENTS ARE ALSO ELIGIBLE TO APPLY FOR TUITION Sch K Purpose of Series 2008 Bonds The proceeds of the Series 2008 bonds were used for the purpose of financing a portion of the costs of construction of and equipping of Cardiology labs, patient rooms, food and nutrition services and other ancillary spaces and to pay insurance costs of the series 2008 bonds. Barrett Healthcare Corp of SW Indiana 800 West 9th St Jasper IN 47546 352039829 Healthcare IN 3046910 N/A MEMORIAL HOSPITAL FOUNDATION Inc 800 West Ninth Street Jasper IN 47546 351359445 Benefit Memorial Hospital & Health Care Center IN 501(c)(3) Line 11a, I Memorial Hospital and Health Care Center Memorial Hospital Seton Health Corp Sleep Lab LLC 800 West 9th Street Jasper IN 47546 263635457 Management company for sleep labs IN N/A related 34399 160998 0 0 0 0 1 0 0 0 0 1 0 0 0 0 0 1 0 0 0 0 MEMORIAL HOSPITAL SETON HEALTH CORP SLEEP LAB LLC 0 MEMORIAL HOSPITAL FOUNDATION Inc 0