2022-05-12T10:13:45-05:00 2021-06-30 990 2020-07-01 351568821 SAINT JOSEPH REGIONAL MEDICAL CENTER INC SAIN 5743355000 5215 HOLY CROSS PARKWAY MISHAWAKA IN 465451469 ROBERT SINK CFO 5743355000 2022-05-12 ROBERT SINK 999009999 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z (SEE SCHEDULE O FOR LIST) SHAWN VINCENT 5215 HOLY CROSS PARKWAY MISHAWAKA IN 465451469 105118984 0 0928 X WWW.SJMED.COM X 1983 IN TO PROVIDE HEALTH CARE SYSTEM MANAGEMENT AND SUPPORT 13 10 3592 11 629736 580309 1245150 191200 92442855 97001053 442549 935555 6555572 6991176 100686126 105118984 0 100 0 0 61173656 67492583 0 0 0 72721698 72947867 133895354 140440550 -33209228 -35321566 164545623 310696031 163782377 355508730 763246 -44812699 X WE, SAINT JOSEPH REGIONAL MEDICAL CENTER (SJRMC) AND TRINITY HEALTH, SERVE TOGETHER IN THE SPIRIT OF THE GOSPEL AS A COMPASSIONATE AND TRANSFORMING HEALING PRESENCE WITHIN OUR COMMUNITIES.SJRMC IS A MEMBER OF TRINITY HEALTH. 0 0 127995418 100 103362493 SJRMC IS A NOT-FOR-PROFIT, MULTI-HOSPITAL HEALTH SYSTEM LOCATED IN NORTH CENTRAL INDIANA IN MISHAWAKA, INDIANA. SJRMC IS THE PARENT OF SAINT JOSEPH REGIONAL MEDICAL CENTER-SOUTH BEND CAMPUS (A 254-BED ACUTE CARE HOSPITAL AT THE MISHAWAKA CAMPUS), SAINT JOSEPH REGIONAL MEDICAL CENTER-PLYMOUTH CAMPUS (A 45-BED ACUTE CARE HOSPITAL), AND THE FOUNDATION OF SAINT JOSEPH REGIONAL MEDICAL CENTER. SJRMC GOVERNS, MANAGES AND PROVIDES LONG-RANGE PLANNING, FINANCIAL, LEGAL, AND OTHER EXPERTISE AND SUPPORT SERVICES TO THESE AFFILIATES.SJRMC ALSO OWNS AND OPERATES SAINT JOSEPH PHYSICIAN NETWORK, A NETWORK OF 44 PHYSICIAN PRACTICE SITES. THE NETWORK INCLUDES MORE THAN 96 PRIMARY CARE PHYSICIANS AND SPECIALISTS. ALL OF THE DOCTORS ARE CONNECTED TO THE ENTIRE HEALTH SYSTEM, MAKING IT EASY TO COORDINATE CARE. IN FY21, THE PHYSICIAN NETWORK HAD 225,237 OUTPATIENT VISITS FROM PATIENTS.PLEASE VISIT OUR WEBSITE FOR ADDITIONAL INFORMATION: HTTP://WWW.SJMED.COM 127995418 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 120 0 1 3592 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 13 10 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 1 1 IN X REBECCA MULLINS 5743354661 707 EAST CEDAR STREET SUITE 350 SOUTH BEND IN 46617 BENJAMIN CARTER DIRECTOR AT 1/21; TRINITY EVP & COO 1.00 54.00 X 0 1555234 83280 SACHIN RAJENDRA PATEL MD PHYSICIAN 50.00 0.00 X 1000900 0 51403 ASHFAQ AHMED TURK MD PHYSICIAN 50.00 0.00 X 946170 0 44934 ANAND SINGLA MD PHYSICIAN 50.00 0.00 X 897046 0 41722 TAMMY LUNDSTROM MD DIRECTOR THR 12/20; TRINITY SVP, CMO 1.00 54.00 X 0 662460 154091 ZACHARY LESHEN MD PHYSICIAN 50.00 0.00 X 756012 0 46936 ERIC KNAPP DO PHYSICIAN 48.00 2.00 X 670210 0 46550 CHAD TOWNER DIRECTOR; PRESIDENT & CEO SJHS 33.00 22.00 X X 0 583750 127902 GENEVIEVE LANKOWICZ MD SJHS REGIONAL CHIEF MEDICAL OFFICER 10.00 40.00 X 0 335648 48959 JANICE DUNN FORMER OFFICER; CFO ST MARYS HEALTH 0.00 50.00 X 0 332846 40470 KEVIN HIGDON CFO SJHS THROUGH 2/21 28.00 22.00 X 0 316166 50609 JASON SCHULTZ SECRETARY;VP STRATEGY & BUS DEV SJHS 30.00 20.00 X 0 231003 21025 ROBERT SINK INT CFO THR 3/21; CFO SJHS AT 4/21 28.00 22.00 X 173666 0 29656 BRIAN MOLONEY MD DIRECTOR; MED. DIR. SELECT HEALTH 50.00 0.00 X 97997 0 19779 JOHN ZEGLIS DIRECTOR; CHAIR 2.00 0.00 X X 0 0 0 MARIANNE CORR DIRECTOR; VICE CHAIR AS OF 1/21 2.00 0.00 X X 0 0 0 J SPIKE ABERNETHY DIRECTOR; TREASURER 2.00 0.00 X X 0 0 0 THE VERY REV EDWARD BEAUCHAMP CSC, DIRECTOR THROUGH 12/20 2.00 0.00 X 0 0 0 ANN COMBS DIRECTOR AS OF 1/21 2.00 0.00 X 0 0 0 MARION FULCE DIRECTOR 2.00 0.00 X 0 0 0 THOMAS GATEWOOD DIRECTOR AS OF 1/21 2.00 2.00 X 0 0 0 NORA HAHN PHJC DIRECTOR 2.00 2.00 X 0 0 0 ABRAHAM MARCUS DIRECTOR 2.00 2.00 X 0 0 0 RODOLFO MONTERROSA JR DIRECTOR 2.00 0.00 X 0 0 0 BEN ZIOLKOWSKI DIRECTOR 2.00 0.50 X 0 0 0 4542001 4017107 807316 220 1 1 0 CARDIAC SURGERY ASSOC SC PO BOX 153 CHANNAHON IL 60410 STAFFING SERVICES 2164692 WEATHERBY LOCUMS INC 6451 NORTH FEDERAL HIGHWAY STE 800 FORT LAUDERDALE FL 33208 STAFFING SERVICES 2162299 MICHIANA HEALTH INFORMATION NETWORK 220 W COLFAX ST 300 SOUTH BEND IN 46624 PCO MEDICAL INFORMATION SERVICES 2067149 COMPHEALTH PO BOX 972651 DALLAS TX 75397 STAFFING SERVICES 830701 TOD STILLSON MD PC 328 S MICHIGAN ST PLYMOUTH IN 46563 HEALTH INFORMATION SERVICES 713083 26 191200 191200 INTERCOMPANY FEES 551114 59922628 59922628 NET PATIENT SERVICE REVENUE 621111 37078425 37078425 97001053 345300 345300 758264 0 758264 758264 758264 590255 0 590255 590255 590255 SUPPORT SERVICES REVENUE 551114 3224638 3224638 PROVIDER INCENTIVE REVENUE 621111 2033769 2033769 OTHER OPERATING REVENUE 551114 974505 344769 629736 6232912 105118984 103362493 629736 935555 100 100 1951884 117776 1834108 56361849 52761751 3600098 4886014 4562465 323549 4292836 3901741 391095 50910 46272 4638 138999 138999 309437 309437 19476 19476 11733194 10996162 737032 1292017 1174309 117708 3976064 3613828 362236 19309216 17550068 1759148 4266797 3878074 388723 72572 65960 6612 48826 44378 4448 1205 1205 6949780 6316627 633153 399881 363450 36431 UBI TAXES 35442 32213 3229 INTERCO. PURCHASED SVCS 12994654 11810788 1183866 EQUIPMENT MAINTENANCE 5093744 4629683 464061 MEDICAL SUPPLIES 3566320 3566320 2689333 2562248 127085 140440550 127995418 12445132 0 243237 319598 3677216 4463674 671687 662900 35771 29936 720253 670274 58529674 37384030 19128561 21145644 15746198 11041405 4806232 2746997 124066 714855 119392402 268900748 164545623 310696031 10755239 14488888 241195 216795 90719 73234 152695224 340729813 163782377 355508730 X 765745 -44810200 -2499 -2499 763246 -44812699 164545623 310696031 X -35321566 1365366 -11619745 X X 0 1 X 1 1 1 X X 2 SJRMC-SB CAMPUS 350868157 3 0 0 0 SJRMC-PLYMOUTH CAMPUS 351142669 3 0 0 0 2 0 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 1 1 1 X 1 1 PART I, LINE 12G(VI) SAINT JOSEPH REGIONAL MEDICAL CENTER (SJRMC) PROVIDES HEALTH CARE SYSTEM MANAGEMENT AND SUPPORT TO ITS SUPPORTED ORGANIZATION. PART IV, SECTION A, LINE 1 SJRMC'S SUPPORTED ORGANIZATIONS ARE NOT LISTED BY NAME IN THE GOVERNING DOCUMENTS, BUT THERE EXISTS A HISTORIC AND CONTINUING RELATIONSHIP WITH EACH SUPPORTED ORGANIZATION. SJRMC HAS BEEN THE SOLE MEMBER OF SAINT JOSEPH REGIONAL MEDICAL CENTER-SOUTH BEND CAMPUS (SJRMC-SOUTH BEND) SINCE 1983, AND OF SAINT JOSEPH REGIONAL MEDICAL CENTER-PLYMOUTH CAMPUS (SJRMC-PLYMOUTH) SINCE 1998. SJRMC AND ITS SUPPORTED ORGANIZATIONS SHARE THE SAME EXEMPT PURPOSE, AS STATED IN THE GOVERNING DOCUMENTS OF EACH. THEIR SHARED PURPOSE IS TO ADVANCE, PROMOTE, SUPPORT, AND CARRY OUT THE PURPOSES OF CATHOLIC HEALTH MINISTRIES AND TRINITY HEALTH. THE ORGANIZATIONS' SPECIFIC PURPOSES ARE TO ENGAGE IN THE DELIVERY OF AND TO CARRY ON, SPONSOR OR PARTICIPATE, DIRECTLY OR THROUGH ONE OR MORE AFFILIATES, IN ANY ACTIVITIES RELATED TO THE DELIVERY OF HEALTH CARE AND HEALTH CARE RELATED SERVICES AS APPROPRIATE IN CARRYING OUT THE HEALTH CARE MISSION OF CATHOLIC HEALTH MINISTRIES AND TRINITY HEALTH. SUCH ACTIVITIES INCLUDE THE SUPPORT AND ASSISTANCE OF AFFILIATES TO ACCOMPLISH THE FOREGOING PURPOSES. SJRMC PROVIDES SUCH SUPPORT AND ASSISTANCE TO SJRMC-SOUTH BEND AND SJRMC-PLYMOUTH IN CARRYING OUT THEIR SHARED PURPOSES. THE CHAIR OF EACH SUPPORTED ORGANIZATION'S BOARD OF DIRECTORS SITS ON SJRMC'S BOARD OF DIRECTORS, AND THE KEY OFFICERS (CEO, CHIEF FINANCIAL OFFICER AND SECRETARY) OF THE SUPPORTED ORGANIZATIONS EQUALLY SERVE SJRMC; THESE FACTORS ENSURE COMMON CONTROL AND MANAGEMENT OF SJRMC AND ITS SUPPORTED ORGANIZATIONS. IN ADDITION, THE COMMONALITY OF THE NAMES OF SJRMC, SJRMC-SOUTH BEND AND SJRMC-PLYMOUTH ENSURES THE CLOSE IDENTIFICATION BETWEEN THE SUPPORTED AND SUPPORTING ORGANIZATIONS. PART IV, SECTION A, LINE 2 SJRMC-SOUTH BEND AND SJRMC-PLYMOUTH DO NOT HAVE IRS DETERMINATIONS OF STATUS UNDER SECTION 509(A)(1); BOTH HAVE BEEN RECOGNIZED AS EXEMPT UNDER SECTION 501(C)(3) UNDER GROUP EXEMPTION NO. 0928 AND ARE LISTED IN THE OFFICIAL CATHOLIC DIRECTORY AS HOSPITALS. SJRMC SOUTH-BEND AND SJRMC-PLYMOUTH ARE EACH A PUBLIC CHARITY AS DESCRIBED IN SECTION 509(A)(1) BECAUSE EACH IS A HOSPITAL AS DESCRIBED UNDER SECTION 170(B)(1)(A)(III). PART IV, SECTION A, LINE 6 SJRMC PROVIDED HEALTH CARE MANAGEMENT AND SUPPORT TO RELATED ORGANIZATIONS THAT ARE PART OF TRINITY HEALTH AND SHARE THE CHARITABLE PURPOSES OF ITS SUPPORTED ORGANIZATIONS AND TRINITY HEALTH. PART IV, SECTION E, LINE 3A SJRMC HAS THE AUTHORITY TO APPOINT AND REMOVE MEMBERS OF THE BOARD OF DIRECTORS OF EACH OF ITS SUPPORTED ORGANIZATIONS. PART IV, SECTION E, LINE 3B AS THE SOLE MEMBER OF ITS SUPPORTED ORGANIZATIONS, SJRMC MUST APPROVE CERTAIN DECISIONS OF EACH SUPPORTED ORGANIZATION'S GOVERNING BODY, INCLUDING THE STRATEGIC PLAN, ANNUAL CAPITAL PLAN, AND ANNUAL OPERATING BUDGET. SJRMC MUST ALSO APPROVE SIGNIFICANT CHANGES SUCH AS A MERGER, DISSOLUTION, SALE OF ASSETS IN EXCESS OF CERTAIN LIMITS, AND MODIFICATIONS TO GOVERNING DOCUMENTS. PART IV, SECTION D, LINE 3 SJRMC'S CEO AND PRESIDENT IS AN OFFICER OF EACH OF ITS SUPPORTED ORGANIZATIONS, AND THE CHAIR OF EACH SUPPORTED ORGANIZATION'S BOARD OF DIRECTORS IS ON SJRMC'S BOARD OF DIRECTORS. IN ADDITION, THE CHIEF FINANCIAL OFFICER AND SECRETARY EQUALLY SERVE ALL ORGANIZATIONS. THIS COMBINATION OF OVERLAPPING CONTROL AND MANAGEMENT ALLOWS EACH SUPPORTED ORGANIZATION TO HAVE A SIGNIFICANT VOICE IN THE INVESTMENT POLICIES AND IN DIRECTING THE USE OF THE INCOME AND ASSETS OF SJRMC. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 10395 0 0 0 10395 0 PART II-B, LINE 1: SAINT JOSEPH REGIONAL MEDICAL CENTER (SJRMC) HAS MADE GRANTS TO OTHER ORGANIZATIONS FOR LOBBYING PURPOSES. THESE GRANTS HAVE BEEN IN THE FORM OF MEMBERSHIP DUES PAID TO REGIONAL AND NATIONAL HEALTH CARE ORGANIZATIONS, WHERE THE ORGANIZATIONS HAVE PROVIDED SJRMC WITH AN ESTIMATED PERCENTAGE OF DUES PAYMENTS WHICH ARE USED FOR LOBBYING ACTIVITIES. 9549323 9549323 22032917 17639918 4392999 1857459 1814031 43428 20184783 17930081 2254702 4905192 4905192 21145644 MISCELLANEOUS RECEIVABLES 1804236 INTERCOMPANY OTHER LT ASSETS 27103906 OTHER LONG-TERM ASSETS 290892 INTERCOMPANY ACCOUNTS RECEIVABLE 226351448 INVESTMENT IN UNCONSOLIDATED AFFILIATES 7380261 OPERATING LEASE RIGHT-OF-USE ASSETS 5970005 268900748 DEFERRED COMPENSATION LIABILITY 5939841 INTERCOMPANY ACCOUNTS PAYABLE 326526624 OTHER LONG-TERM LIABILITIES 60686 OPERATING LEASE LIABILITIES 8202662 340729813 0 1 0 0 0 0 0 0 0 BENJAMIN CARTER DIRECTOR AT 1/21; TRINITY EVP & COO 0 1254721 0 0 0 300513 0 12825 0 70455 0 1638514 0 0 SACHIN RAJENDRA PATEL MD PHYSICIAN 988384 0 10000 0 2516 0 17100 0 34303 0 1052303 0 0 0 ASHFAQ AHMED TURK MD PHYSICIAN 917352 0 22150 0 6668 0 21375 0 23559 0 991104 0 0 0 ANAND SINGLA MD PHYSICIAN 896385 0 0 0 661 0 12825 0 28897 0 938768 0 0 0 TAMMY LUNDSTROM MD DIRECTOR THR 12/20; TRINITY SVP, CMO 0 637295 0 0 0 25165 0 125481 0 28610 0 816551 0 0 ZACHARY LESHEN MD PHYSICIAN 745280 0 10000 0 732 0 12825 0 34111 0 802948 0 0 0 ERIC KNAPP DO PHYSICIAN 529228 0 0 0 140982 0 12825 0 33725 0 716760 0 0 0 CHAD TOWNER DIRECTOR; PRESIDENT & CEO SJHS 0 452844 0 0 0 130906 0 93367 0 34535 0 711652 0 111206 GENEVIEVE LANKOWICZ MD SJHS REGIONAL CHIEF MEDICAL OFFICER 0 333129 0 0 0 2519 0 14596 0 34363 0 384607 0 0 JANICE DUNN FORMER OFFICER; CFO ST MARYS HEALTH 0 327905 0 0 0 4941 0 12825 0 27645 0 373316 0 0 KEVIN HIGDON CFO SJHS THROUGH 2/21 0 305197 0 0 0 10969 0 12825 0 37784 0 366775 0 2462 JASON SCHULTZ SECRETARY;VP STRATEGY & BUS DEV SJHS 0 230670 0 0 0 333 0 10432 0 10593 0 252028 0 0 ROBERT SINK INT CFO THR 3/21; CFO SJHS AT 4/21 172975 0 0 0 691 0 11928 0 17728 0 203322 0 0 0 PART I, LINE 3 SAINT JOSEPH REGIONAL MEDICAL CENTER (SJRMC) IS A SUBSIDIARY IN THE TRINITY HEALTH SYSTEM. SJRMC'S CEO IS PAID DIRECTLY BY THE SYSTEM'S PARENT ENTITY, TRINITY HEALTH CORPORATION. TRINITY HEALTH CORPORATION USED THE FOLLOWING METHODS TO ESTABLISH THE COMPENSATION OF SJRMC'S CEO: - COMPENSATION COMMITTEE - INDEPENDENT COMPENSATION CONSULTANT - FORM 990 OF OTHER ORGANIZATIONS - WRITTEN EMPLOYMENT CONTRACT - COMPENSATION SURVEY OR STUDY, AND - APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE PART I, LINE 4B THE FOLLOWING ARE PARTICIPANTS IN A TRINITY HEALTH SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP) IN 2020. THE PLAN PROVIDES RETIREMENT BENEFITS TO CERTAIN TRINITY HEALTH EXECUTIVES SUBJECT TO MEETING SPECIFIED VESTING AND EMPLOYMENT DATE REQUIREMENTS. BENEFITS FOR PARTICIPANTS VESTED IN A PLAN WERE PAID OUT IN 2020, AND BENEFITS FOR PARTICIPANTS NOT YET VESTED IN A PLAN WERE ACCRUED IN 2020. THE FOLLOWING PAYOUTS FOR 2020 FOR THE PLAN ARE INCLUDED IN COLUMN B(III) OF SCHEDULE J, PART II: BENJAMIN CARTER - $260,058 CHAD TOWNER - $116,707 COLUMN F OF SCHEDULE J, PART II INCLUDES THE PORTION OF THIS AMOUNT THAT WAS REPORTED AS DEFERRED COMPENSATION IN PRIOR YEARS. THE FOLLOWING ACCRUALS FOR 2020 ARE INCLUDED IN COLUMN C OF FORM 990, PART VII: TAMMY LUNDSTROM, MD - $112,656 CHAD TOWNER - $82,505 THE FOLLOWING ARE PARTICIPANTS IN A TRINITY HEALTH RESTORATION PLAN. THE RESTORATION PLAN PROVIDES RETIREMENT BENEFITS FOR CERTAIN TRINITY HEALTH SYSTEM OFFICE EXECUTIVES WITH EARNINGS ABOVE THE IRS PAY CAP FOR QUALIFIED PLANS ($285,000 FOR 2020). JANICE DUNN - $0 KEVIN HIGDON - $4,813 GENEVIEVE LANKOWICZ, MD - $0 COLUMN F OF SCHEDULE J, PART II INCLUDES THE PORTION OF THESE AMOUNTS THAT WERE REPORTED AS DEFERRED COMPENSATION IN PRIOR YEARS. THE FOLLOWING INDIVIDUAL IS A PARTICIPANT IN A NON-QUALIFIED DEFERRED COMPENSATION PLAN UNDER SECTION 451. NO AMOUNTS WERE DEFERRED OR VESTED FOR 2020. BRIAN MOLONEY, MD - $0 FORM 990, PART VI, SECTION A, LINE 6 THE SOLE MEMBER OF SAINT JOSEPH REGIONAL MEDICAL CENTER (SJRMC) IS TRINITY HEALTH CORPORATION. SEE LINE 7 FOR ADDITIONAL INFORMATION. FORM 990, PART VI, SECTION A, LINE 7A TRINITY HEALTH CORPORATION IS THE SOLE MEMBER OF SJRMC. TRINITY HEALTH CORPORATION HAS THE RIGHT TO APPOINT ALL PERSONS TO THE BOARD OF DIRECTORS OF SJRMC. FORM 990, PART VI, SECTION A, LINE 7B AS SOLE MEMBER, TRINITY HEALTH CORPORATION MUST APPROVE CERTAIN DECISIONS OF THE GOVERNING BODY, INCLUDING THE STRATEGIC PLAN, ANNUAL CAPITAL PLAN, AND ANNUAL OPERATING BUDGET. TRINITY HEALTH CORPORATION MUST ALSO APPROVE SIGNIFICANT CHANGES SUCH AS A MERGER, DISSOLUTION, SALE OF ASSETS IN EXCESS OF CERTAIN LIMITS, AND MODIFICATIONS TO GOVERNING DOCUMENTS. FORM 990, PART VI, SECTION B, LINE 11B PRIOR TO FILING, THE FORM 990 FOR SJRMC IS REVIEWED BY SENIOR MANAGEMENT. IN ADDITION, CERTAIN KEY SECTIONS OF THE FORM ARE REVIEWED BY THE BOARD OF DIRECTORS. THE BOARD RECEIVES A COPY OF THE RETURN IN ITS FINAL FORM BEFORE IT IS FILED WITH THE INTERNAL REVENUE SERVICE. FORM 990, PART VI, SECTION B, LINE 12C SJRMC HAS ADOPTED TRINITY HEALTH'S GOVERNANCE POLICY NO. 1, WHICH SETS FORTH THE ORGANIZATION'S CONFLICT OF INTEREST POLICY AND PROCESSES. IT APPLIES TO ALL "INTERESTED PERSONS" OF SJRMC, WHICH INCLUDES DIRECTORS, PRINCIPAL OFFICERS, KEY EMPLOYEES, AND MEMBERS OF COMMITTEES WITH BOARD-DELEGATED POWERS. INTERESTED PERSONS ARE EXPECTED TO DISCHARGE THEIR DUTIES IN A MANNER THE PERSON REASONABLY BELIEVES TO BE IN THE BEST INTERESTS OF SJRMC AND TO AVOID SITUATIONS INVOLVING A CONFLICT OF INTEREST. ON AN ANNUAL BASIS, INTERESTED PERSONS ARE REQUIRED TO COMPLETE A CONFLICT OF INTEREST DISCLOSURE STATEMENT AND TO AFFIRM THEIR RECEIPT OF THE CONFLICT OF INTEREST POLICY, COMPLIANCE WITH ITS REQUIREMENTS, AND AGREE TO NOTIFY THE ORGANIZATION OF CHANGES IMPACTING THEIR ANNUAL DISCLOSURE IN ACCORDANCE WITH THE POLICY. THE ANNUAL DISCLOSURES ARE PROVIDED TO THE INTEGRITY AND COMPLIANCE OFFICER. IF A POTENTIAL CONFLICT IS IDENTIFIED, THE INTEGRITY AND COMPLIANCE OFFICER SHARES THE DISCLOSURES WITH INTERNAL LEGAL COUNSEL, FROM WHICH LEGAL COUNSEL PREPARES A REPORT FOR THE BOARD CHAIR AND CEO. A SUMMARY OF POTENTIAL CONFLICTS IS REVIEWED WITH THE BOARD OF DIRECTORS OF SJRMC (OR A DELEGATED COMMITTEE OF THE BOARD) ON A YEARLY BASIS. INTERESTED PERSONS ARE REQUIRED TO MAKE FULL DISCLOSURE TO SJRMC OF ANY FINANCIAL OR BUSINESS INTERESTS THAT MIGHT RESULT IN OR HAVE THE APPEARANCE OF A CONFLICT OF INTEREST. THE BOARD OF DIRECTORS OF SJRMC. (OR A DELEGATED COMMITTEE OF THE BOARD) IS RESPONSIBLE FOR THE REVIEW OF TRANSACTIONS TO DETERMINE WHETHER AN ACTUAL CONFLICT OF INTEREST EXISTS. IN THE EVENT OF AN ACTUAL CONFLICT, THE BOARD (OR A DELEGATED COMMITTEE OF THE BOARD) WILL EITHER AVOID THE CONFLICT OR APPROPRIATELY SCRUTINIZE THE TRANSACTION TO ENSURE IT IS IN THE BEST INTERESTS OF SJRMC. INTERESTED PERSONS ARE REQUIRED TO RECUSE THEMSELVES FROM DISCUSSION AND VOTING ON MATTERS INVOLVING A CONFLICT OF INTEREST. THE POLICY FURTHER ADDRESSES THE PROPER DOCUMENTATION OF THE PROCEEDINGS AND POTENTIAL DISCIPLINARY AND CORRECTIVE ACTION FOR VIOLATIONS OF THE POLICY. THE POLICY IS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART VI, SECTION B, LINE 15 QUESTIONS 15A AND 15B ARE ANSWERED "NO" BECAUSE THE COMPENSATION FOR CERTAIN OFFICERS AND KEY MANAGEMENT OFFICIALS OF SJRMC IS ESTABLISHED AND PAID BY TRINITY HEALTH, A RELATED ORGANIZATION. IN ESTABLISHING CEO AND CFO COMPENSATION, TRINITY HEALTH FOLLOWS A PROCESS AND POLICY THAT IS INTENDED TO MIRROR THE IRC SECTION 4958 GUIDELINES FOR OBTAINING A "REBUTTABLE PRESUMPTION OF REASONABLENESS" WITH REGARD TO COMPENSATION AND BENEFITS. AS PART OF THAT PROCESS, THE COMPENSATION AND BENEFITS OF THE CEO AND CFO OF SJRMC ARE REVIEWED AT LEAST ANNUALLY BY THE TRINITY HEALTH BOARD OR THE TRINITY HEALTH HUMAN RESOURCES AND COMPENSATION COMMITTEE (HRCC) OF THE BOARD, AUTHORIZED TO ACT ON BEHALF OF THE BOARD WITH RESPECT TO CERTAIN COMPENSATION MATTERS. AS PART OF ITS REVIEW PROCESS, THE HRCC RETAINS AN INDEPENDENT FIRM EXPERIENCED IN COMPENSATION AND BENEFIT MATTERS FOR NOT-FOR-PROFIT HEALTH CARE ORGANIZATIONS TO ADVISE IT IN THE DETERMINATIONS IT MAKES ON THE REASONABLENESS OF PROPOSED COMPENSATION AND BENEFITS ARRANGEMENTS. FOR OTHER EXECUTIVES WHO ARE NOT PART OF THE REBUTTABLE PRESUMPTION PROCESS, TRINITY HEALTH USES A MARKET ANALYSIS TO DETERMINE THE APPROPRIATENESS OF THE EXECUTIVE'S COMPENSATION. FORM 990, PART VI, SECTION C, LINE 19 SJRMC IS A SUBSIDIARY ORGANIZATION IN THE TRINITY HEALTH SYSTEM. TRINITY HEALTH MAKES CERTAIN OF ITS KEY DOCUMENTS AVAILABLE TO THE PUBLIC ON ITS WEBSITE, WWW.TRINITY-HEALTH.ORG, IN THE "ABOUT US" SECTION. IN THIS SECTION, THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS ARE PUBLICLY AVAILABLE. SJRMC'S GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE AVAILABLE UPON REQUEST. FORM 990, PART XI, LINE 9: EQUITY TRANSFERS FROM AFFILIATES -13,719,941. EQUITY GAIN IN UNCONSOLIDATED AFFILIATES 2,128,119. ASSET IMPAIRMENT -27,923. FORM 990, PART XII, LINE 2: SJRMC'S FINANCIAL STATEMENTS WERE INCLUDED IN THE FY21 CONSOLIDATED FINANCIAL STATEMENTS OF TRINITY HEALTH, WHICH WERE AUDITED BY AN INDEPENDENT PUBLIC ACCOUNTING FIRM. FORM 990, PAGE 1, BOX C BOURBON FAMILY MEDICINE, BREMEN FAMILY MEDICINE, COMMUNITY PEDIATRIC PHYSICIANS, GRANGER COMMUNITY MEDICINE, INTERNAL MEDICINE ASSOCIATES, MARSHALL COUNTY CARDIOLOGY SPECIALISTS, MARSHALL COUNTY FAMILY PRACTICE, MARSHALL COUNTY OB/GYN, MARSHALL COUNTY PEDIATRIC PHYSICIANS, NORTHWEST FAMILY MEDICINE, MARSHALL COUNTY SURGERY ASSOCIATES, PLYMOUTH FAMILY AND INTERNAL MEDICINE, RIVER PARK FAMILY MEDICINE, UNIVERSITY PARK FAMILY MEDICINE, SAINT JOSEPH OB/GYN SPECIALISTS, SAINT JOSEPH FAMILY MEDICINE AT ELM ROAD, SAINT JOSEPH REGIONAL MEDICAL CENTER INFUSION PHARMACY, SJPN SOUTH BEND NEUROLOGY, SJPN-LAKE SHORE CLINIC, SAINT JOSEPH CARDIOTHORACIC SURGERY, SJPN - MIDWEST CARDIOLOGY, SAINT JOSEPH PHYSICIAN NETWORK PEOPLES CLINIC, SAINT JOSEPH PHYSICIAN NETWORK DERMATOLOGY, MARSHALL COUNTY PULMONOLOGY, SAINT JOSEPH MATERNAL FETAL MEDICINE, SAINT JOSEPH INFECTIOUS DISEASES, SAINT JOSEPH HEALTH SYSTEM, SAINT JOSEPH PHYSICIAN NETWORK, SAINT JOSEPH FAMILY MEDICINE AT MIAMI ROAD, PLYMOUTH FAMILY AND INTERNAL MEDICINE DOWNTOWN, MARSHALL COUNTY UROLOGY, MARSHALL COUNTY MULTISPECIALTY CLINIC, SAINT JOSEPH FAMILY MEDICINE AT AUTEN ROAD, SAINT JOSEPH WELLNESS AND WEIGHT MANAGEMENT, SAINT JOSEPH SURGICAL SPECIALISTS, SAINT JOSEPH UROLOGY - MISHWAKA, SAINT JOSEPH UROLOGY - PLYMOUTH, SAINT JOSEPH FAMILY MEDICINE - SIX SPAN, SAINT JOSEPH FAMILY MEDICINE - WOODLAND, SAINT JOSEPH MISHAWAKA CLINIC, SAINT JOSEPH BEHAVIORAL HEALTH, SAINT JOSEPH PULMONOLOGY - MISHAWAKA, SAINT JOSEPH SURGICAL SPECIALISTS - PLYMOUTH, SAINT JOSEPH PULMONOLOGY - PLYMOUTH, SAINT JOSEPH LIFEPLEX MEDICAL ADVANTAGE HEALTHSAINT MARY'S MEDICAL GROUP 245 STATE ST SE GRAND RAPIDS MI 49503 272491974 HEALTH CARE SERVICES MI 501(C)(3) LINE 10 TRINITY HEALTH-MICHIGAN 1 ALLEGANY FRANCISCAN MINISTRIES INC 33920 US HIGHWAY 19 NORTH SUITE 269 PALM HARBOR FL 34684 581492325 GRANT MAKING FL 501(C)(3) LINE 12A, I TRINITY HEALTH CORPORATION 1 ASYLUM HILL FAMILY MEDICINE CENTER INC 114 WOODLAND STREET HARTFORD CT 06105 061450170 HEALTH CARE SERVICES CT 501(C)(3) LINE 3 TRINITY HEALTH OF NEW ENGLAND CORP INC 1 BAUM HARMON MERCY HOSPITAL 255 NORTH WELCH AVENUE PRIMGHAR IA 51245 421500277 HEALTH CARE AND HOSPITAL SERVICES IA 501(C)(3) LINE 3 MERCY HEALTH SERVICES-IOWA CORP 1 BAUM HARMON MERCY HOSPITAL AND CLINICS FOUNDATION 255 NORTH WELCH AVENUE PRIMGHAR IA 51245 262973307 FOUNDATION IA 501(C)(3) LINE 12A, I BAUM HARMON MERCY HOSPITAL 1 BEECHWOOD INC 2212 BURDETT AVE TROY NY 12180 141651563 TITLE HOLDING COMPANY NY 501(C)(2) N/A LTC (EDDY) INC 1 BETHLEHEM HAVEN OF PITTSBURGH 905 WATSON STREET PITTSBURGH PA 15219 251436685 HOMELESS SHELTER PA 501(C)(3) LINE 7 PITTSBURGH MERCY HEALTH SYSTEM INC 1 BEVERWYCK INC 40 AUTUMN DRIVE SLINGERLANDS NY 12159 141717028 SENIOR LIVING COMMUNITY NY 501(C)(3) LINE 10 LTC (EDDY) INC 1 BRIGHTSIDE INC 114 WOODLAND STREET HARTFORD CT 06105 042182395 HEALTH CARE SERVICES MA 501(C)(3) LINE 10 THE MERCY HOSPITAL INC 1 CAPITAL REGION GERIATRIC CENTER INC 421 WEST 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