2018-05-03T10:08:04-05:00 2017-06-30 990 2016-07-01 350868157 SAINT JOSEPH REGIONAL MEDICAL CENTER- SOUTH BEND CAMPUS INC SAIN 5743355000 5215 HOLY CROSS PARKWAY MISHAWAKA IN 465451469 KEVIN HIGDON CFO 5744726083 2018-05-03 170.232.227.252 2018-05-03 10:07:41 ED P 29E163B212FF32246D5C7FFF8D40785F24745F20 18E15B76DD68E3E95DA4CEAEDBAE9AF3AFA56F71 2016 2021-01-29 14:40:06Z (SEE SCHEDULE O FOR LIST) CHAD TOWNER 5215 HOLY CROSS PARKWAY MISHAWAKA IN 465451469 365725897 0 X WWW.SJMED.COM X 1958 IN TO PROVIDE HEALTH CARE AND HOSPITAL SERVICES 15 10 2230 546 0 0 2093047 2349192 336534336 357393296 -1050637 -521027 5002353 5501076 342579099 364722537 1203311 1140646 0 0 103925568 109351939 0 0 0 207379143 226392760 312508022 336885345 30071077 27837192 408259144 395162343 348860951 332162767 59398193 62999576 X WE, SAINT JOSEPH REGIONAL MEDICAL CENTER AND TRINITY HEALTH, SERVE TOGETHER IN THE SPIRIT OF THE GOSPEL AS A COMPASSIONATE AND TRANSFORMING HEALING PRESENCE WITHIN OUR COMMUNITIES.SJRMC-SOUTH BEND IS A MEMBER OF SAINT JOSEPH REGIONAL MEDICAL CENTER AND TRINITY HEALTH. 0 0 271289259 1140646 359687565 SAINT JOSEPH REGIONAL MEDICAL CENTER - SOUTH BEND CAMPUS (SJRMC-SOUTH BEND), REFERRED TO AS "MISHAWAKA MEDICAL CENTER", HAS BEEN DELIVERING QUALITY HEALTH CARE TO THE SOUTH BEND/MISHAWAKA, INDIANA AREA SINCE 1958. SJRMC-SOUTH BEND PROVIDES FREE CARE, SUBSIDIZES THE CARE OF MEDICARE AND MEDICAID PATIENTS WHERE THE GOVERNMENT REIMBURSEMENT IS BELOW COST, AND SPONSORS HEALTH PROGRAMS AND ACTIVITIES FOR THE COMMUNITY. THESE PROGRAMS INCLUDE WELLNESS PROGRAMS, COMMUNITY EDUCATION PROGRAMS, SPECIAL PROGRAMS FOR THE ELDERLY, HANDICAPPED, MEDICALLY UNDERSERVED AND A VARIETY OF BROAD COMMUNITY SUPPORT ACTIVITIES. SJRMC-SOUTH BEND OFFERS A FULL RANGE OF SERVICES IN AN INPATIENT AND OUTPATIENT SETTING AS WELL AS 24-HOUR EMERGENCY CARE, SURGICAL SERVICES, CANCER CARE, HEART AND STROKE CARE, REHABILITATION SERVICES, SENIOR BEHAVIORAL HEALTH CARE, AMONG MANY OTHER HEALTH CARE SERVICES. THE MISHAWAKA MEDICAL CENTER HOSPITAL OFFERS 268 PRIVATE INPATIENT ROOMS AND PROVIDED 62,683 PATIENT DAYS OF HEALTH CARE SERVICES IN FY17. THE SAINT JOSEPH REHABILITATION INSTITUTE OFFERS 40 PRIVATE INPATIENT BEDS AND PROVIDED 3,501 PATIENT DAYS OF REHABILITATION SERVICES TO THE COMMUNITY IN FY17.PLEASE VISIT SCHEDULE H AND OUR WEBSITE FOR ADDITIONAL INFORMATION ABOUT OUR SERVICES, RECOGNITION AND AWARDS: WWW.SJMED.COM/MISHAWAKA-MEDICAL-CENTER 271289259 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 1 1 1 0 0 1 266 0 1 2230 1 0 0 0 0 0 0 0 0 0 0 X 15 10 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 IN X WAYNE NOETHE CONTROLLER 5743354655 707 EAST CEDAR STREET SOUTH BEND IN 466172000 CHAD TOWNER DIR; PRES & CEO SJHS AS OF 10/16 10.00 45.00 X X 0 94996 19547 ALBERT GUTIERREZ DIR; PRES & CEO SJHS THR 9/16 10.00 45.00 X X 0 856706 48133 ABRAHAM MARCUS DIR; CHR THR 12/16; V CHR AT 1/17 2.00 2.00 X X 0 0 0 JOHN ROSENTHAL DIR; V CHR THR 12/16; CHR AT 1/17 2.00 2.00 X X 0 0 0 CHARLES VIATER DIRECTOR; TREASURER 2.00 2.00 X X 0 0 0 CHRISTOPHER KARAM PRES SJRMC-SB;PRES SJRMC-PLY AT 3/17 35.00 20.00 X X 0 304791 40455 BILAL ANSARI MD DIRECTOR THROUGH 12/16 2.00 2.00 X 0 0 0 MARIANNE CORR DIRECTOR 2.00 2.00 X 0 0 0 MICHAEL FINEGAN DIRECTOR; TH SVP OPERATIONAL PERF. 2.00 48.00 X 0 506181 38170 THE VERY REV JAMES FOSTER MD DIRECTOR 2.00 2.00 X 0 10800 0 NORA HAHN PHJC DIRECTOR 2.00 2.00 X 0 0 0 JOY O'GRADY CSC DIRECTOR 2.00 4.00 X 0 0 0 LOUIS PIERCE DIRECTOR 2.00 2.00 X 0 0 0 JOHN ZEGLIS DIRECTOR 2.00 4.00 X 0 0 0 DANIELLE GREEN MA LCPC DIRECTOR 2.00 2.00 X 0 0 0 LOUISE MASON DIRECTOR THROUGH 3/17 2.00 2.00 X 0 0 0 SALVADOR MOYA DIRECTOR 2.00 2.00 X 0 0 0 PAULA TOTH-RUSSELL DIRECTOR AS OF 1/17 2.00 2.00 X 0 0 0 JASON SCHULTZ SECRETARY; SJRMC GEN COUNSEL 10.00 40.00 X 0 192450 17149 JANICE DUNN CFO SJHS THROUGH 1/17 10.00 40.00 X 0 357731 31178 KEVIN HIGDON CFO SJHS AS OF 5/17 10.00 40.00 X 0 0 0 ROBERT SINK INTERIM CFO SJHS 1/17-4/17; VP FIN 10.00 40.00 X 0 180947 26048 STEPHEN ANDERSON MD CMO SJHS 20.00 30.00 X 0 369940 32452 JULIE WEST MD PHYSICIAN 50.00 0.00 X 355096 0 27655 MARTIN WIESCHHAUS MD PHYSICIAN 50.00 0.00 X 329274 0 43514 STEPHEN SIMONS MD PHYSICIAN 50.00 0.00 X 286478 0 38003 THEODORE NEUMANN MD PHYSICIAN 50.00 0.00 X 251449 0 36178 KEVIN ERICSON MD PHYSICIAN 50.00 0.00 X 238262 0 17100 KURT MEYER FORMER KEY EMPLOYEE; CHRO SJRMC 29.00 21.00 X 0 271834 28502 KENNETH HALL FORMER KEY EMPLOYEE; CNO THR 10/16 30.00 20.00 X 0 226697 41611 RICHARD O'CONNELL FORMER KE; TRINITY EVP THR 10/16 0.00 55.00 X 0 1545409 47362 1460559 4918482 533057 65 1 1 0 SOUTH BEND MEDICAL FOUNDATION 530 N LAFAYETTE BLVD SOUTH BEND IN 466011098 LABORATORY SERVICES 12196661 SOUND PHYSICIANS OF INDIANA 215 W 4TH ST 200 MISHAWAKA IN 46544 HEALTH CARE SERVICES 3096238 ALLIED PHYSICIANS OF MICHIANA 6301 UNIVERSITY COMMONS SUIT 100 SOUTH BEND IN 45635 HEALTH CARE SERVICES 2415125 ST JOSEPH VALLEY ANESTHESIA PO BOX 1742 SOUTH BEND IN 46634 HEALTH CARE SERVICES 2357483 STRATEGIC STAFFING SOLUTIONS 645 GRISWOLD ST STE 2900 DETROIT MI 48226 STAFFING SERVICES 1655196 35 2349192 2349192 NET PATIENT SERVICE REVENUE 622110 357393296 357393296 357393296 482333 482333 735194 0 735194 735194 735194 578263 425097 -578263 -425097 -1003360 -1003360 CAFETERIA REVENUE 722514 2471613 2471613 OTHER RELATED REVENUE 622110 2051174 2051174 PROVIDER INCENTIVE REVENUE 622110 243095 243095 4765882 364722537 359687565 0 2685780 1140646 1140646 345246 345246 51720 51720 89547339 86567876 2979463 3337006 3230959 106047 9654132 9324485 329647 6416496 6182091 234405 1252485 1206730 45755 63891 63891 32683673 32467833 215840 120381 115983 4398 1786154 1211374 574780 192090 87922 104168 8565523 6317508 2248015 115735 111507 4228 344587 331999 12588 11001165 11001165 17527868 9643881 7883987 2412927 2412927 MEDICAL SUPPLIES 61584167 61584167 INTERCO. PURCHASED SVCS 48400138 435601 47964537 BAD DEBT 24449984 24449984 HOSPITAL PROVIDER TAX 14080871 14080871 1811121 1744957 66164 336885345 271289259 65596086 0 4658608 4709136 43396929 48496132 119009 4425 6270385 6449082 565724 655615 431798740 139306326 301115034 292492414 26149764 18381170 22452885 13466832 3530806 10507537 408259144 395162343 24154890 19323766 1267504 134952 9916098 10902410 313522459 301801639 348860951 332162767 X 59398193 62999576 59398193 62999576 408259144 395162343 X 27837192 3560192 -27796001 X X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1 6441 6441 0 406021 406021 213318926 39827427 173491499 213189892 99478899 113710993 4883901 4883901 292492414 INTERCOMPANY NOTES PAYABLE 295035930 DEFERRED COMPENSATION LIABILITY 3195168 INTERCOMPANY ACCOUNTS PAYABLE 3334272 ASSET RETIREMENT OBLIGATION (FIN 47) 126630 OTHER LONG-TERM LIABILITIES 109639 301801639 PART V, LINE 4: ENDOWMENTS HELD BY THE FOUNDATION OF SAINT JOSEPH REGIONAL MEDICAL CENTER, INC. FOR THE BENEFIT OF SJRMC-SOUTH BEND ARE REPORTED ON THE FORM 990 OF THE FOUNDATION OF SAINT JOSEPH REGIONAL MEDICAL CENTER. 1 1 X 1 X 1 X 1 1 0 1 1 1 3549 6562078 6562078 0.02100 3 34509 61957699 45588640 16369059 0.05240 4 38058 68519777 45588640 22931137 0.07340 8 90054 1237297 257834 979463 0.00310 3 268 4731154 3048314 1682840 0.00540 9 38180 7669218 3636580 4032638 0.01290 7 1800 747268 14352 732916 0.00230 27 130302 14384937 6957080 7427857 0.02370 31 168360 82904714 52545720 30358994 0.09710 4 131100 131100 0.00040 1 878 200 678 0.00000 4 141392 2760 138632 0.00040 2 20155 280 19875 0.00010 2 10300 600 9700 0.00000 3 15039 400 14639 0.00000 16 318864 4240 314624 0.00090 1 24449984 0 81961422 103752104 -21790682 X 1 1 1 1 ST JOSEPH REG MED CTR-SOUTH BEND CAMPUS 5215 HOLY CROSS PARKWAY MISHAWAKA IN 46544 WWW.SJMED.COM/MISHAWAKA-MEDICAL-CENTER LICENSE #17-005012-1 X X X X SJRMC-SOUTH BEND CAMPUS 1 0 0 1 X X X X X X X X 14 1 1 1 1 X SEE SCHEDULE H, PART V, SECTION C X X 1 14 1 SEE SCHEDULE H, PART V, SECTION C 0 1 X 200.000000000000 400.000000000000 X X X X X X 1 1 X X X X 1 X HTTP://WWW.SJMED.COM/FINANCIAL-ASSISTANCE X HTTP://WWW.SJMED.COM/FINANCIAL-ASSISTANCE X HTTP://WWW.SJMED.COM/FINANCIAL-ASSISTANCE X X X X X X 1 X 0 X X X X 1 X 0 0 SJRMC-SOUTH BEND CAMPUS PART V, SECTION B, LINE 5: DURING THE MONTHS OF SEPTEMBER THROUGH NOVEMBER OF 2014, COMMUNITY FOCUS GROUPS WERE USED TO GATHER INPUT FROM PEOPLE REPRESENTING THE COMMUNITY SERVED FOR THE RECENT CHNA. THE FOCUS GROUP PARTICIPANTS WERE ASKED A SERIES OF QUESTIONS ABOUT TOPICS CONSIDERED TO BE CRITICAL TO THE VARIOUS MEMBERS OF THE COMMUNITY. THE IMPORTANT ISSUES IDENTIFIED BY THE SURVEY TAKERS WERE: MENTAL HEALTH, TRANSPORTATION AND ACCESS.EXAMPLES OF THE PARTICIPANTS INCLUDED: YOUNG PROFESSIONALS, SENIORS, CLINICS, BUSINESS LEADERS, EXPECTANT AND NEW MOTHERS, VETERANS, COLLEGE STUDENTS AND LATINO COMMUNITY LEADERS. THE FOCUS GROUPS WERE ASKED TO DISCUSS ISSUES THAT HAD BEEN IDENTIFIED AS IMPORTANT BY SAINT JOSEPH HEALTH SYSTEM.COMMUNITY BENEFIT COUNCIL MET TO DISCUSS HOW TO IMPROVE THE THREE DEFINED AREAS. AFTER DISCUSSION, ACTION PLANS WERE DEVELOPED, APPROVED AND BUDGETED. SJRMC-SOUTH BEND CAMPUS PART V, SECTION B, LINE 6A: THE CHNA WAS CONDUCTED IN COLLABORATION WITH SAINT JOSEPH REGIONAL MEDICAL CENTER - PLYMOUTH CAMPUS. SJRMC-SOUTH BEND CAMPUS PART V, SECTION B, LINE 6B: THE CHNA WAS CONDUCTED WITH THE FOLLOWING COLLABORATING ORGANIZATIONS: ST. JOSEPH COUNTY HEALTH DEPARTMENT, OAKLAWN, LA CASA DE AMISTAD, MHIN, SCHOOL CITY OF MISHAWAKA, PENN-HARRIS-MADISON SCHOOLS, TRANSPO, NOTRE DAME CENTER, ENFOCUS, UNITED WAY OF ST. JOSEPH COUNTY, DR. ANGIE'S DENTAL HEALTH EXCHANGE, NORTHERN INDIANA FOOD BANK, AND UNITY GARDENS. SJRMC-SOUTH BEND CAMPUS PART V, SECTION B, LINE 7D: ALL FOCUS GROUP MEMBERS AND COMMUNITY BENEFIT COUNCIL MEMBERS RECEIVED A PRINTED OR E-MAILED COPY OF THE COMPLETE CHNA. SJRMC-SOUTH BEND CAMPUS PART V, SECTION B, LINE 11: THERE IS A THREE-YEAR STRATEGIC PLAN TO ADDRESS THE THREE SIGNIFICANT NEEDS IDENTIFIED IN THE CHNA. IT IS OUR INTENTION TO ADDRESS ALL THREE NEEDS: MENTAL HEALTH, TRANSPORTATION AND PROVIDER ACCESS. THE VIRTUAL UNDER ONE ROOF CONCEPT WAS ESTABLISHED TO ADDRESS ALL THREE. MENTAL HEALTH ACTION PLANS INCLUDE SUPPORTING OAKLAWN MENTAL HEALTH AWARENESS WEEK, AS WELL AS PROMOTING SERVICES OFFERED AT THEIR FACILITIES. HEALTH AND WELLNESS EDUCATOR HOURS WERE INCREASED TO FULL TIME TO CONTINUE TO ADDRESS MULTIPLE CONCERNS FOR OUR LATINO COMMUNITY, INCLUDING MENTAL HEALTH. TRANSPORTATION ACTION PLANS INCLUDE PARTICIPATING IN LOCAL ALLIANCE AND SUBCOMMITTEE WHICH WILL ADDRESS TRANSPORTATION NEEDS FOR THE COUNTY. THE HOSPITAL COLLABORATES WITH HOPE MINISTRIES, TRANSPO AND OTHER AGENCIES TO ADDRESS TRANSPORTATION TO DOCTOR APPOINTMENTS. SAINT JOSEPH REGIONAL MEDICAL CENTER-SOUTH BEND CAMPUS (SJRMC-SOUTH BEND ) ADDED TRANSPO BUS ROUTES TO OUR WEBSITE TO SHOW THEIR RELATIONSHIP TO OUR PHYSICIAN NETWORK OFFICES, AND THEY WERE GIVEN EDUCATION AT HEALTH FAIRS. PROVIDER ACCESS ACTION PLANS INCLUDE PARTICIPATING IN LOCAL HEALTH ALLIANCE SUBCOMMITTEE ON DIABETES PREVENTION AND EDUCATION, STARTING DIABETES PREVENTION PROGRAM FOR LATINOS, EXPANDING WELLNESS INITIATIVE THIS COUNTS, SUPPORTING AND PROMOTING DR. ANGIE'S DENTAL HEALTH EXCHANGE PAY IT FORWARD DENTAL PROGRAM, AND EXPANDING FOOD BANK HEALTHY FOODS PROGRAM.WHILE BUDGETS FOR SJRMC-SOUTH BEND HAVE BEEN APPROVED, FINANCIAL CONSTRAINTS MAY LIMIT SOME OF THE ACTIONABLE ITEMS FOR STRATEGIES. POVERTY AS A COMMUNITY NEED COULD NOT BE COMPLETELY ADDRESSED AS IT IS VAST. ALSO, DAY CARE, JOBLESSNESS AND HOMELESSNESS WERE MENTIONED AS NEEDS BUT NOT ADDRESSED. CREATION OF A COMMUNITY HUB WHERE MANY UNDERSERVED NEEDS COULD BE ADDRESSED AT ONCE DID NOT COME TO FRUITION AND IS THEREFORE AN UNMET NEED IN THE COMMUNITY. THE FOCUS WAS CHANGED TO HELP THE UNDERSERVED NAVIGATE COMMUNITY ASSISTANCE CENTERS. SJRMC-SOUTH BEND CAMPUS PART V, SECTION B, LINE 13H: THE HOSPITAL RECOGNIZES THAT NOT ALL PATIENTS ARE ABLE TO PROVIDE COMPLETE FINANCIAL AND/OR SOCIAL INFORMATION. THEREFORE, APPROVAL FOR FINANCIAL SUPPORT MAY BE DETERMINED BASED ON AVAILABLE INFORMATION. EXAMPLES OF PRESUMPTIVE CASES INCLUDE: DECEASED PATIENTS WITH NO KNOWN ESTATE, THE HOMELESS, UNEMPLOYED PATIENTS, NON-COVERED MEDICALLY NECESSARY SERVICES PROVIDED TO PATIENTS QUALIFYING FOR PUBLIC ASSISTANCE PROGRAMS, PATIENT BANKRUPTCIES, AND MEMBERS OF RELIGIOUS ORGANIZATIONS WHO HAVE TAKEN A VOW OF POVERTY AND HAVE NO RESOURCES INDIVIDUALLY OR THROUGH THE RELIGIOUS ORDER.FOR THE PURPOSE OF HELPING FINANCIALLY NEEDY PATIENTS, A THIRD PARTY IS UTILIZED TO CONDUCT A REVIEW OF PATIENT INFORMATION TO ASSESS FINANCIAL NEED. THIS REVIEW UTILIZES A HEALTH CARE INDUSTRY-RECOGNIZED, PREDICTIVE MODEL THAT IS BASED ON PUBLIC RECORD DATABASES. THESE PUBLIC RECORDS ENABLE THE HOSPITAL TO ASSESS WHETHER THE PATIENT IS CHARACTERISTIC OF OTHER PATIENTS WHO HAVE HISTORICALLY QUALIFIED FOR FINANCIAL ASSISTANCE UNDER THE TRADITIONAL APPLICATION PROCESS. IN CASES WHERE THERE IS AN ABSENCE OF INFORMATION PROVIDED DIRECTLY BY THE PATIENT, AND AFTER EFFORTS TO CONFIRM COVERAGE AVAILABILITY, THE PREDICTIVE MODEL PROVIDES A SYSTEMATIC METHOD TO GRANT PRESUMPTIVE ELIGIBILITY TO FINANCIALLY NEEDY PATIENTS. PART V, SECTION B, LINE 7A: HTTP://WWW.SJMED.COM/ABOUT-US-COMMUNITY-HEALTH-NEEDS-ASSESSMENT-2015 PART V, SECTION B, LINE 10A: HTTP://WWW.SJMED.COM/ABOUT-US-COMMUNITY-HEALTH-NEEDS-ASSESSMENT-2015 2 1 - FAMILY MEDICINE CENTER 611 E DOUGLAS RD SUITE 407 MISHAWAKA IN 46545 FAMILY HEALTH CENTER 2 - SPORTS MEDICINE INSTITUTE 611 E DOUGLAS RD SUITE 137 MISHAWAKA IN 46545 SPORTS MEDICINE CLINIC PART I, LINE 3C: IN ADDITION TO LOOKING AT A MULTIPLE OF THE FEDERAL POVERTY GUIDELINES, OTHER FACTORS ARE CONSIDERED SUCH AS THE PATIENT'S FINANCIAL STATUS AND/OR ABILITY TO PAY AS DETERMINED THROUGH THE ASSESSMENT PROCESS. PART I, LINE 6A: SJRMC-SOUTH BEND PREPARES AN ANNUAL COMMUNITY BENEFIT REPORT, WHICH IT SUBMITS TO THE STATE OF INDIANA. IN ADDITION, SJRMC-SOUTH BEND REPORTS ITS COMMUNITY BENEFIT INFORMATION AS PART OF THE CONSOLIDATED COMMUNITY BENEFIT INFORMATION REPORTED BY TRINITY HEALTH (EIN 35-1443425) IN ITS AUDITED FINANCIAL STATEMENTS, AVAILABLE AT WWW.TRINITY-HEALTH.ORG.IN ADDITION, SJRMC-SOUTH BEND INCLUDES A COPY OF ITS MOST RECENTLY FILED SCHEDULE H ON BOTH ITS OWN WEBSITE AND TRINITY HEALTH'S WEBSITE. PART I, LINE 7: THE BEST AVAILABLE DATA WAS USED TO CALCULATE THE COST AMOUNTS REPORTED IN ITEM 7. FOR CERTAIN CATEGORIES, PRIMARILY TOTAL CHARITY CARE AND MEANS-TESTED GOVERNMENT PROGRAMS, SPECIFIC COST-TO-CHARGE RATIOS WERE CALCULATED AND APPLIED TO THOSE CATEGORIES. THE COST-TO-CHARGE RATIO WAS DERIVED FROM WORKSHEET 2, RATIO OF PATIENT CARE COST-TO-CHARGES. IN OTHER CATEGORIES, THE BEST AVAILABLE DATA WAS DERIVED FROM THE HOSPITAL'S COST ACCOUNTING SYSTEM. PART I, LN 7 COL(F): THE FOLLOWING NUMBER, $24,449,984, REPRESENTS THE AMOUNT OF BAD DEBT EXPENSE INCLUDED IN TOTAL FUNCTIONAL EXPENSES IN FORM 990, PART IX, LINE 25. PER IRS INSTRUCTIONS, THIS AMOUNT WAS EXCLUDED FROM THE DENOMINATOR WHEN CALCULATING THE PERCENT OF TOTAL EXPENSE FOR SCHEDULE H, PART I, LINE 7, COLUMN (F). PART II, COMMUNITY BUILDING ACTIVITIES: MOST OF THE COMMUNITY BUILDING PROGRAMS AND ORGANIZATIONS THAT SJRMC -SOUTH BEND SUPPORTS PROVIDE ASSISTANCE TO LOW-INCOME OR VULNERABLE POPULATIONS OR OFFER EDUCATION TO MEMBERS OF THE COMMUNITY WHO HELP THOSE POPULATIONS.OVER THE COURSE OF THE PAST YEAR, KEY CONTRIBUTIONS BY SJRMC-SOUTH BEND INCLUDED:PHYSICAL IMPROVEMENT - CONTRIBUTED TO:- NORTHEAST NEIGHBORHOOD REVITALIZATION- UNIVERSITY OF NOTRE DAME CENTER FOR ARTS AND CULTURE- RIVERBEND CANCER SERVICES- HABITAT FOR HUMANITY OF ST. JOSEPH COUNTYECONOMIC DEVELOPMENT - CONTRIBUTED TO:- CHAMBER OF COMMERCE - ST. JOSEPH COUNTY- MISHAWAKA BUSINESS ASSOCIATIONCOMMUNITY SUPPORT DONATIONS TO:- HOLY CROSS COLLEGE - COMMUNITY FOUNDATION OF ST. JOSEPH COUNTY- BIG BROTHERS BIG SISTERS SPONSORSHIP- ST. MARGARET'S HOUSE - SAFE DAY HOUSE FOR HOMELESS WOMEN AND CHILDREN- HOPE MINISTRIES- UNITED WAY OF ST. JOSEPH COUNTY- LA CASA DE AMISTADLEADERSHIP DEVELOPMENT DONATIONS TO:- HOLY CROSS COLLEGE- SAINT MARY'S COLLEGEWORKFORCE DEVELOPMENT DONATIONS TO:- ST. VINCENT DE PAUL- INDIANA UNIVERSITY SOUTH BEND (IUSB) PART III, LINE 2: METHODOLOGY USED FOR LINE 2 - ANY DISCOUNTS PROVIDED OR PAYMENTS MADE TO A PARTICULAR PATIENT ACCOUNT ARE APPLIED TO THAT PATIENT ACCOUNT PRIOR TO ANY BAD DEBT WRITE-OFF AND ARE THUS NOT INCLUDED IN BAD DEBT EXPENSE. AS A RESULT OF THE PAYMENT AND ADJUSTMENT ACTIVITY BEING POSTED TO BAD DEBT ACCOUNTS, WE ARE ABLE TO REPORT BAD DEBT EXPENSE NET OF THESE TRANSACTIONS. PART III, LINE 3: SJRMC-SOUTH BEND USES A PREDICTIVE MODEL THAT INCORPORATES THREE DISTINCT VARIABLES IN COMBINATION TO PREDICT WHETHER A PATIENT QUALIFIES FOR FINANCIAL ASSISTANCE: (1) SOCIO-ECONOMIC SCORE, (2) ESTIMATED FEDERAL POVERTY LEVEL (FPL), AND (3) HOMEOWNERSHIP. BASED ON THE MODEL, CHARITY CARE CAN STILL BE EXTENDED TO PATIENTS EVEN IF THEY HAVE NOT RESPONDED TO FINANCIAL COUNSELING EFFORTS AND ALL OTHER FUNDING SOURCES HAVE BEEN EXHAUSTED. FOR FINANCIAL STATEMENT PURPOSES, SJRMC-SOUTH BEND IS RECORDING AMOUNTS AS CHARITY CARE (INSTEAD OF BAD DEBT EXPENSE) BASED ON THE RESULTS OF THE PREDICTIVE MODEL. THEREFORE, SJRMC-SOUTH BEND IS REPORTING ZERO ON LINE 3, SINCE THEORETICALLY ANY POTENTIAL CHARITY CARE SHOULD HAVE BEEN IDENTIFIED THROUGH THE PREDICTIVE MODEL. PART III, LINE 4: SJRMC-SOUTH BEND IS INCLUDED IN THE CONSOLIDATED FINANCIAL STATEMENTS OF TRINITY HEALTH. THE FOLLOWING IS THE TEXT OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS FOOTNOTE FROM PAGE 14 OF THOSE STATEMENTS: "THE CORPORATION RECOGNIZES A SIGNIFICANT AMOUNT OF PATIENT SERVICE REVENUE AT THE TIME THE SERVICES ARE RENDERED EVEN THOUGH THE CORPORATION DOES NOT ASSESS THE PATIENT'S ABILITY TO PAY AT THAT TIME. AS A RESULT, THE PROVISION FOR BAD DEBTS IS PRESENTED AS A DEDUCTION FROM PATIENT SERVICE REVENUE (NET OF CONTRACTUAL PROVISIONS AND DISCOUNTS). FOR UNINSURED AND UNDERINSURED PATIENTS THAT DO NOT QUALIFY FOR CHARITY CARE, THE CORPORATION ESTABLISHES AN ALLOWANCE TO REDUCE THE CARRYING VALUE OF SUCH RECEIVABLES TO THEIR ESTIMATED NET REALIZABLE VALUE. THIS ALLOWANCE IS ESTABLISHED BASED ON THE AGING OF ACCOUNTS RECEIVABLE AND THE HISTORICAL COLLECTION EXPERIENCE BY THE HEALTH MINISTRIES AND FOR EACH TYPE OF PAYOR. A SIGNIFICANT PORTION OF THE CORPORATION'S PROVISION FOR DOUBTFUL ACCOUNTS RELATES TO SELF-PAY PATIENTS, AS WELL AS CO-PAYMENTS AND DEDUCTIBLES OWED TO THE CORPORATION BY PATIENTS WITH INSURANCE."PART III, LINE 5:TOTAL MEDICARE REVENUE REPORTED IN PART III, LINE 5 HAS BEEN REDUCED BY THE TWO PERCENT SEQUESTRATION REDUCTION. PART III, LINE 8: SJRMC-SOUTH BEND DOES NOT BELIEVE ANY MEDICARE SHORTFALL SHOULD BE TREATED AS COMMUNITY BENEFIT. THIS IS SIMILAR TO CHA RECOMMENDATIONS, WHICH STATE THAT SERVING MEDICARE PATIENTS IS NOT A DIFFERENTIATING FEATURE OF TAX-EXEMPT HEALTH CARE ORGANIZATIONS AND THAT THE EXISTING COMMUNITY BENEFIT FRAMEWORK ALLOWS COMMUNITY BENEFIT PROGRAMS THAT SERVE THE MEDICARE POPULATION TO BE COUNTED IN OTHER COMMUNITY BENEFIT CATEGORIES.PART III, LINE 8: COSTING METHODOLOGY FOR LINE 6 - MEDICARE COSTS WERE OBTAINED FROM THE FILED MEDICARE COST REPORT. THE COSTS ARE BASED ON MEDICARE ALLOWABLE COSTS AS REPORTED ON WORKSHEET B, COLUMN 27, WHICH EXCLUDE DIRECT MEDICAL EDUCATION COSTS. INPATIENT MEDICARE COSTS ARE CALCULATED BASED ON A COMBINATION OF ALLOWABLE COST PER DAY TIMES MEDICARE DAYS FOR ROUTINE SERVICES AND COST TO CHARGE RATIO TIMES MEDICARE CHARGES FOR ANCILLARY SERVICES. OUTPATIENT MEDICARE COSTS ARE CALCULATED BASED ON COST TO CHARGE RATIO TIMES MEDICARE CHARGES BY ANCILLARY DEPARTMENT. PART III, LINE 9B: THE HOSPITAL'S COLLECTION POLICY CONTAINS PROVISIONS ON THE COLLECTION PRACTICES TO BE FOLLOWED FOR PATIENTS WHO ARE KNOWN TO QUALIFY FOR FINANCIAL ASSISTANCE. CHARITY DISCOUNTS ARE APPLIED TO THE AMOUNTS THAT QUALIFY FOR FINANCIAL ASSISTANCE. COLLECTION PRACTICES FOR THE REMAINING BALANCES ARE CLEARLY OUTLINED IN THE ORGANIZATION'S COLLECTION POLICY. THE HOSPITAL HAS IMPLEMENTED BILLING AND COLLECTION PRACTICES FOR PATIENT PAYMENT OBLIGATIONS THAT ARE FAIR, CONSISTENT AND COMPLIANT WITH STATE AND FEDERAL REGULATIONS. PART VI, LINE 2: NEEDS ASSESSMENT - SJRMC-SOUTH BEND ASSESSES THE HEALTH STATUS OF ITS COMMUNITY, IN PARTNERSHIP WITH COMMUNITY COALITIONS, AS PART OF THE NORMAL COURSE OF OPERATIONS AND IN THE CONTINUOUS EFFORTS TO IMPROVE PATIENT CARE AND THE HEALTH OF THE OVERALL COMMUNITY. TO ASSESS THE HEALTH OF THE COMMUNITY, THE HOSPITAL MAY USE PATIENT DATA, PUBLIC HEALTH DATA, ANNUAL COUNTY HEALTH RANKINGS, MARKET STUDIES AND GEOGRAPHICAL MAPS SHOWING AREAS OF HIGH UTILIZATION FOR EMERGENCY SERVICES AND INPATIENT CARE, WHICH MAY INDICATE POPULATIONS OF INDIVIDUALS WHO DO NOT HAVE ACCESS TO PREVENTATIVE SERVICES OR ARE UNINSURED. PART VI, LINE 3: SJRMC-SOUTH BEND IS COMMITTED TO:-PROVIDING ACCESS TO QUALITY HEALTH CARE SERVICES WITH COMPASSION, DIGNITY AND RESPECT FOR THOSE WE SERVE, PARTICULARLY THE POOR AND THE UNDERSERVED IN OUR COMMUNITIES-CARING FOR ALL PERSONS, REGARDLESS OF THEIR ABILITY TO PAY FOR SERVICES-ASSISTING PATIENTS WHO CANNOT PAY FOR PART OR ALL OF THE CARE THEY RECEIVE -BALANCING NEEDED FINANCIAL ASSISTANCE FOR SOME PATIENTS WITH BROADER FISCAL RESPONSIBILITIES IN ORDER TO SUSTAIN VIABILITY AND PROVIDE THE QUALITY AND QUANTITY OF SERVICES FOR ALL WHO MAY NEED CARE IN A COMMUNITYIN ACCORDANCE WITH AMERICAN HOSPITAL ASSOCIATION RECOMMENDATIONS, SJRMC-SOUTH BEND HAS ADOPTED THE FOLLOWING GUIDING PRINCIPLES WHEN HANDLING THE BILLING, COLLECTION AND FINANCIAL SUPPORT FUNCTIONS FOR OUR PATIENTS: -PROVIDE EFFECTIVE COMMUNICATIONS WITH PATIENTS REGARDING HOSPITAL BILLS-MAKE AFFIRMATIVE EFFORTS TO HELP PATIENTS APPLY FOR PUBLIC AND PRIVATE FINANCIAL SUPPORT PROGRAMS-OFFER FINANCIAL SUPPORT TO PATIENTS WITH LIMITED MEANS-IMPLEMENT POLICIES FOR ASSISTING LOW-INCOME PATIENTS IN A CONSISTENT MANNER-IMPLEMENT FAIR AND CONSISTENT BILLING AND COLLECTION PRACTICES FOR ALL PATIENTS WITH PATIENT PAYMENT OBLIGATIONSSJRMC-SOUTH BEND COMMUNICATES EFFECTIVELY WITH PATIENTS REGARDING PATIENT PAYMENT OBLIGATIONS. FINANCIAL COUNSELING IS PROVIDED TO PATIENTS ABOUT THEIR PAYMENT OBLIGATIONS AND HOSPITAL BILLS. INFORMATION ON HOSPITAL-BASED FINANCIAL SUPPORT POLICIES AND EXTERNAL PROGRAMS THAT PROVIDE COVERAGE FOR SERVICES ARE MADE AVAILABLE TO PATIENTS DURING THE PRE-REGISTRATION AND REGISTRATION PROCESSES AND/OR THROUGH COMMUNICATIONS WITH PATIENTS SEEKING FINANCIAL ASSISTANCE. FINANCIAL COUNSELORS MAKE AFFIRMATIVE EFFORTS TO HELP PATIENTS APPLY FOR PUBLIC AND PRIVATE PROGRAMS FOR WHICH THEY MAY QUALIFY AND THAT MAY ASSIST THEM IN OBTAINING AND PAYING FOR HEALTH CARE SERVICES. EVERY EFFORT IS MADE TO DETERMINE A PATIENT'S ELIGIBILITY PRIOR TO OR AT THE TIME OF ADMISSION OR SERVICE. FINANCIAL ASSISTANCE APPLICATIONS WILL BE ACCEPTED UNTIL ONE YEAR AFTER THE FIRST BILLING STATEMENT TO THE PATIENT. SJRMC-SOUTH BEND OFFERS FINANCIAL SUPPORT TO PATIENTS WITH LIMITED MEANS. THIS SUPPORT IS AVAILABLE TO UNINSURED AND UNDERINSURED PATIENTS WHO DO NOT QUALIFY FOR PUBLIC PROGRAMS OR OTHER ASSISTANCE. NOTIFICATION ABOUT FINANCIAL ASSISTANCE, INCLUDING CONTACT INFORMATION, IS AVAILABLE THROUGH PATIENT BROCHURES, MESSAGES ON PATIENT BILLS, POSTED NOTICES IN PUBLIC REGISTRATION AREAS INCLUDING EMERGENCY ROOMS, ADMITTING AND REGISTRATION DEPARTMENTS, AND OTHER PATIENT FINANCIAL SERVICES OFFICES. SUMMARIES OF HOSPITAL PROGRAMS ARE MADE AVAILABLE TO APPROPRIATE COMMUNITY HEALTH AND HUMAN SERVICES AGENCIES AND OTHER ORGANIZATIONS THAT ASSIST PEOPLE IN NEED. INFORMATION REGARDING FINANCIAL ASSISTANCE PROGRAMS IS ALSO AVAILABLE ON HOSPITAL WEBSITES. IN ADDITION TO ENGLISH, THIS INFORMATION IS ALSO AVAILABLE IN OTHER LANGUAGES AS REQUIRED BY INTERNAL REVENUE CODE SECTION 501(R), REFLECTING OTHER PRIMARY LANGUAGES SPOKEN BY THE POPULATION SERVICED BY OUR HOSPITAL. SJRMC-SOUTH BEND HAS ESTABLISHED A WRITTEN POLICY FOR THE BILLING, COLLECTION AND SUPPORT FOR PATIENTS WITH PAYMENT OBLIGATIONS. SJRMC-SOUTH BEND MAKES EVERY EFFORT TO ADHERE TO THE POLICY AND IS COMMITTED TO IMPLEMENTING AND APPLYING THE POLICY FOR ASSISTING PATIENTS WITH LIMITED MEANS IN A PROFESSIONAL, CONSISTENT MANNER. PART VI, LINE 4: COMMUNITY INFORMATION - SJRMC-SOUTH BEND SERVES 901,167 PEOPLE IN A DIVERSE NINE-COUNTY SYSTEM MARKET IN INDIANA AND MICHIGAN AT TWO HOSPITAL CAMPUSES, ONE IN MISHAWAKA AND ONE IN PLYMOUTH. THE PRIMARY SERVICE AREA INCLUDES ST. JOSEPH, MARSHALL, AND ELKHART COUNTIES IN INDIANA, WHILE THE SECONDARY SERVICE AREA ENCOMPASSES FULTON, LAPORTE, PULASKI AND STARKE COUNTIES IN INDIANA, AND BERRIEN AND CASS COUNTIES IN MICHIGAN.COUNTIES ARE GENERALLY SUBURBAN OR RURAL IN NATURE, WITH THE EXCEPTION OF URBAN CITY-CENTERS IN ELKHART AND SOUTH BEND, THE FOURTH LARGEST CITY IN INDIANA. THE REGION OFFERS DIVERSITY, A STABLE ECONOMY AND A FAMILY-FRIENDLY ENVIRONMENT, ALL WITHIN CLOSE PROXIMITY TO CHICAGO. OUR REGION INCLUDES A VARIETY OF QUALITY EDUCATION OPPORTUNITIES, INCLUDING BOTH PUBLIC AND PRIVATE SCHOOLS FROM PRESCHOOL THROUGH HIGH SCHOOL. THOSE PURSUING A HIGHER LEVEL OF EDUCATION HAVE SEVERAL OPTIONS, INCLUDING THE UNIVERSITY OF NOTRE DAME, INDIANA UNIVERSITY AT SOUTH BEND, ST. MARY'S COLLEGE, HOLY CROSS COLLEGE, ANCILLA COLLEGE, BETHEL COLLEGE, INDIANA TECH, AND IVY TECH STATE COLLEGE. OTHER COMMUNITY HOSPITALS IN THE PRIMARY SERVICE AREA INCLUDE MEMORIAL HOSPITAL OF SOUTH BEND, ELKHART GENERAL HOSPITAL, AND INDIANA UNIVERSITY GOSHEN TO THE EAST, IN ELKHART COUNTY. HOSPITALS LOCATED IN THE SECONDARY SERVICE AREA INCLUDE INDIANA UNIVERSITY LAPORTE HOSPITAL AND SAINT ANTHONY MEMORIAL HOSPITAL TO THE WEST IN LAPORTE COUNTY, AND TO THE SOUTH, WOODLAWN HOSPITAL IN ROCHESTER, INDIANA UNIVERSITY STARKE MEMORIAL IN STARKE COUNTY, AND PULASKI MEMORIAL IN WINAMAC. TOTAL POPULATION FOR THE SYSTEM SERVICE AREA IS EXPECTED TO GROW 1% FROM 2017 THROUGH 2022. COMPARED TO THE STATE OF INDIANA, THE SERVICE AREA HAS A LOWER PROJECTED POPULATION GROWTH, A HIGHER MEDIAN AGE, AND A LOWER MEDIAN HOME VALUE. TREND OF FEMALES OF CHILDBEARING AGE IN THE SYSTEM SERVICE AREA ARE PROJECTED TO INCREASE LESS THAN 1%. HOWEVER, THE STATES THAT BORDER NORTHERN INDIANA, OHIO, MICHIGAN AND ILLINOIS, ALL HAVE DECLINING NUMBERS OF FEMALES OF CHILDBEARING AGE 15-44. THE POPULATION AGED 65 AND OLDER REPRESENTS 16.5% OF THE TOTAL POPULATION AND IS EXPECTED TO INCREASE 13.3% OVER THE NEXT FIVE YEARS. AVERAGE HOUSEHOLD INCOME FOR THE AREA IS $65,643; THIS REFLECTS A SUBSTANTIAL INCREASE FROM PRIOR YEARS. MEDIAN HOUSEHOLD INCOME OF $50,386 IS BELOW THE RATE FOR THE STATES OF INDIANA, ILLINOIS, MICHIGAN AND OHIO, AS WELL AS THE U.S. TWENTY-THREE PERCENT OF THE POPULATION IN THE SYSTEM SERVICE AREA EARNS AN ANNUAL SALARY $25,000 OR BELOW.THE AUGUST 2017 UNEMPLOYMENT RATE IN THE SOUTH BEND/MISHAWAKA MSA WAS 4.2%, THE ELKHART/GOSHEN MSA WAS 3.0%, AND MARSHALL COUNTY WAS 3.6%. THE SOUTH BEND/MISHAWAKA MSA EXCEEDS THE INDIANA STATE WIDE RATE OF 4.0% BUT IS BELOW THE NATIONAL RATE OF 4.5%. AN ESTIMATE OF THE UNINSURED IN THE SYSTEM SERVICE AREA RANGES FROM 16.2% IN ELKHART COUNTY, IN, TO 13.8% IN FULTON COUNTY, IN. THIS IS COMPARED TO AN INDIANA RATE OF 11.3%. [U.S. CENSUS BUREAU/SMALL AREA HEALTH INSURANCE (SAHIE) PROGRAM/MARCH 2015]THE TARGETED SERVICE AREA INCLUDES SEVERAL MEDICALLY UNDERSERVED AREAS (MUA) AND MEDICALLY UNDERSERVED POPULATIONS (MUP). IN INDIANA, THESE INCLUDE PORTIONS OF ELKHART COUNTY, LAPORTE COUNTY, AND ST. JOSEPH COUNTY. IN MICHIGAN, THEY INCLUDE PORTIONS OF BERRIEN COUNTY, CASS COUNTY, AND ST. JOSEPH COUNTY.THERE ARE ALSO THREE CRITICAL ACCESS HOSPITALS (CAH)- COMMUNITY HOSPITAL OF BREMEN, PULASKI MEMORIAL HOSPITAL, AND WOODLAWN HOSPITAL, AT WHICH PRIMARY CARE PROFESSIONALS WITH PRESCRIPTIVE PRIVILEGES FURNISH OUTPATIENT PRIMARY CARE SERVICES.IN THE STATE OF INDIANA, ACCORDING TO THE U.S. CENSUS BUREAU'S SMALL AREA INCOME AND POVERTY ESTIMATES (SAIPE), IN 2013 15.5% OF FAMILIES LIVED IN POVERTY. THE STATE OF MICHIGAN'S PERCENTAGE WAS HIGHER, AT 17.4%. SJRMC- SOUTH BEND SERVES A LARGE MEDICAID POPULATION ACROSS MANY DELIVERY SITES, MOST OF WHICH ARE LOCATED IN ST. JOSEPH COUNTY. [U.S. CENSUS BUREAU, SMALL AREA INCOME AND POVERTY ESTIMATES (SAIPE) PROGRAM, DECEMBER 2013]THE INPATIENT MEDICAID POPULATION SERVED BY SJRMC-SOUTH BEND EQUALS 13% OF THE HOSPITAL'S TOTAL OVERALL INPATIENT POPULATION. WHEN SPECIFIC SERVICES LIKE OBSTETRICS AND NEONATOLOGY ARE CONSIDERED, THE PERCENTAGE INCREASES TO 45-60% OF THE TOTAL DISCHARGES FOR THE RESPECTIVE SERVICE LINE. AS IN MOST MIDWESTERN COMMUNITIES, THE SERVICE AREA POPULATION IS LARGELY MADE UP OF WHITE NON-HISPANIC INDIVIDUALS OF NORTHERN EUROPEAN DESCENT. HOWEVER, THE REGION OF NORTHERN INDIANA AND SOUTHWESTERN MICHIGAN HAS SEEN AN INCREASE IN THE HISPANIC POPULATION OVER THE PAST TEN YEARS. THE REPRESENTATION OF HISPANIC POPULATION IN THIS AREA IS 9% AS COMPARED TO 18% NATIONWIDE; HOWEVER, THIS IS LIKELY TO BE UNDERSTATED. ALL COUNTIES IN THE REGION HAVE HIGHER SMOKING RATES, A SIGNIFICANTLY HIGHER ADULT OBESITY RATE, AND HIGHER ALCOHOL CONSUMPTION THAN THE U.S. BENCHMARK. UNFORTUNATELY, WITH FEW EXCEPTIONS, THE DEATH RATES FROM CHRONIC CONDITIONS SUCH AS HEART DISEASE, CANCER, STROKE AND DIABETES IN THE SERVICE AREA ARE HIGHER THAN THE STATES OF INDIANA OR MICHIGAN. THE POPULATION HAS A LOWER INCOME AND IS LESS EDUCATED, ON AVERAGE, THAN THE NATION, THE STATE OF INDIANA OR MICHIGAN. INDIANA RANKS EIGHTH LOWEST IN HIGHER EDUCATION LEVELS IN THE U.S. THIS EQUATES WITH A HIGHER PERCENTAGE OF CHILDREN IN POVERTY AND A LOWER HOUSEHOLD INCOME THAN STATE AVERAGES IN MOST OF THE SERVICE AREA. PART VI, LINE 5: OTHER INFORMATION - SJRMC-SOUTH BEND EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS. BY DOING SO, IT IS ABLE TO ENSURE THAT HIGH QUALITY AND EASILY ACCESSIBLE CARE IS AVAILABLE IN A VARIETY OF PRIMARY AND SPECIALTY CARE AREAS.SJRMC-SOUTH BEND PRIDES ITSELF ON HAVING A NEW, STATE-OF-THE-ART MEDICAL CENTER THAT UTILIZES THE LATEST TECHNOLOGY, ELECTRONIC MEDICAL RECORDS, FULLY INTEGRATED MEDICAL TEAMS AND HIGHLY TRAINED STAFF TO PROVIDE CARE THAT IS SECOND TO NONE. RESIDENCY PROGRAMS IN FAMILY PRACTICE, PODIATRY, AND PHARMACY, AS WELL AS CLINICAL EDUCATION FOR NURSES AND ANCILLARY STAFF, PROVIDE ONGOING EDUCATION AND A "LABORATORY FOR LEARNING." SEVERAL NURSING SCHOOLS UTILIZE SJRMC-SOUTH BEND FOR THE CLINICAL COMPONENT OF THEIR NURSING EDUCATION. PARTICIPATING IN BOTH AN INTERNAL AND EXTERNAL "INTERNAL REVIEW BOARD", SJRMC-SOUTH BEND KEEPS PACE WITH THE EVER-GROWING COMPLEXITY OF HEALTH CARE AND PROVIDES LEADERSHIP IN AREAS SPECIFIC TO THE NEEDS OF ITS PATIENTS.WHILE NOT CONSIDERED "THE" TRAUMA CENTER FOR THE AREAS IT SERVES, SJRMC-SOUTH BEND DOES HAVE AN EXCELLENT GROUP OF EMERGENCY DEPARTMENT PHYSICIANS AND STAFF TRAINED IN TREATING PERSONS SUFFERING FROM EMERGENT AND NON-EMERGENT CONDITIONS. SERVING ALL PEOPLE REGARDLESS OF ETHNICITY, GENDER, RELIGION, ABILITY TO PAY, ETC., THE EMERGENCY DEPARTMENT HAS OVER 30 TREATMENT ROOMS AS WELL AS TRAUMA ROOMS AND HIGH-INTENSITY TREATMENT ROOMS.SJRMC-SOUTH BEND, AS A PART OF SMOKE FREE SOUTH BEND COALITION, WAS INSTRUMENTAL IN GETTING THE CITY OF SOUTH BEND TO PASS THE MOST COMPREHENSIVE CLEAN AIR ORDINANCE IN INDIANA EFFECTIVE JANUARY 1, 2017. SJRMC-SOUTH BEND IS ALSO ACTIVELY PURSUING "BABY-FRIENDLY STATUS". BABY-FRIENDLY HOSPITALS ARE HOSPITALS THAT ARE RECOGNIZED FOR ENCOURAGING BREASTFEEDING AND MOTHER/BABY BONDING, WHICH IS KNOWN TO PROVIDE HEALTH BENEFITS FOR INFANTS, CHILDREN, AND MOTHERS.SJRMC-SOUTH BEND PARTICIPATES IN MEDICARE, MEDICAID, CHAMPUS/TRICARE AND OTHER GOVERNMENT-SPONSORED HEALTH CARE PROGRAMS, AND OFFERS CHARITY CARE AND CARE ON A SLIDING FEE SCALE. IN KEEPING WITH ITS MISSION STATEMENT AND VALUES, SJRMC-SOUTH BEND ASSURES UNINSURED PATIENTS THAT THEY RECEIVE THE SAME HIGH QUALITY MEDICAL CARE AS THOSE WHO HAVE THE ABILITY TO PAY. FINANCIAL ASSISTANCE IS PROVIDED TO ALL WHO ARE ELIGIBLE TO RECEIVE IT. POLICIES GOVERNING SUCH ASSISTANCE ARE READILY AVAILABLE FOR STAFF AND PATIENTS ALIKE. SJRMC-SOUTH BEND SPONSORS A HEALTH CENTER THAT PROVIDES CARE TO ALL INSURED, UNDER-INSURED, AND UNINSURED PATIENTS. IT ALSO FULLY SUBSIDIZES A HEALTH CENTER SPECIFICALLY FOR THE UNINSURED. STAFFED BY DOCTORS WHO VOLUNTEER THEIR TIME AND SKILLS, THIS HEALTH CENTER SERVES A HIGHLY DIVERSE POPULATION AND OFFERS SPECIALIZED CLINICS IN CHRONIC DISEASE MANAGEMENT, COUMADIN CARE, SMOKING CESSATION, HIV/AIDS, AND SUBSTANCE ABUSE. A NEW MOBILE MEDICAL UNIT PROVIDES 3D MAMMOGRAPHY IN OUTLYING AREAS WHERE SERVICES ARE DIFFICULT TO OBTAIN. ADVOCACY FOR VARIOUS HEALTH-RELATED ISSUES IS AT THE FOREFRONT AT SJRMC-SOUTH BEND, INCLUDING EFFORTS RELATED TO OBTAINING HEALTH CARE FOR ALL, ELIMINATING THE HEALTH CARE DISPARITIES AMONG DIVERSE POPULATIONS, AND OBTAINING AFFORDABLE PHARMACEUTICALS. SJRMC-SOUTH BEND CONTINUES TO BE THE LEADER IN FOUNDING AND FUNDING PROGRAMS THAT IMPACT THE HEALTH OF ITS COMMUNITIES, SUCH AS PROVIDING LOCAL SCHOOLS WITH ATHLETIC TRAINERS AND SCHOOL HEALTH NURSES.VOLUNTEERS WITHIN THE SJRMC-SOUTH BEND HOSPITAL TESTIFY TO THE REPUTATION AND IMPACT OF THE HOSPITAL. WOMEN, MEN, AND YOUTH BELIEVE IN THE MISSION OF THE HOSPITAL AND ATTEST TO IT BY PROVIDING HUNDREDS OF HOURS OF SERVICE EACH YEAR. VOLUNTEERS WITH SPECIAL NEEDS ARE ALSO WELCOME TO SERVE THE HOSPITAL, ITS PHYSICIANS, STAFF AND THE PUBLIC. AS A FAITH-BASED HEALTH INSTITUTION, SJRMC-SOUTH BEND OFFERS PATIENTS, THEIR FAMILIES, AND THE BROADER COMMUNITY THE OPPORTUNITY TO ADDRESS THE SPIRITUAL NEEDS THAT ARISE AS ONE EXPERIENCES ILLNESS, CHRONIC HEALTH CONDITIONS, OR THE DYING PROCESS. THIS EXPERIENCE OF FAITH, THE PRESENCE OF CHRISTIAN, JEWISH AND MUSLIM PRAYER/REFLECTION ROOMS, AND FULL-TIME CERTIFIED CHAPLAINS AFFORD EVERYONE WITH THE CERTITUDE THAT THE WHOLE PERSON AND HIS/HER CARE IS ADDRESSED.SJRMC-SOUTH BEND HAS A NUMBER OF CRITICAL OUTREACH PROGRAMS THAT FURTHER ASSIST IN THE ENHANCEMENT OF THE HEALTH STATUS OF THE POPULATIONS IT SERVES. THROUGH THE GENEROSITY OF BENEFACTORS AND THE SAINT JOSEPH FOUNDATION, SJRMC-SOUTH BEND PARTICIPATES IN MANY OUTREACH COMMUNITY PROGRAMS AND SERVICES:THE HOSPITAL PARTICIPATES IN COMMUNITY HEALTH AND WELL-BEING PROGRAMS FOCUSING ON: CHRONIC DISEASE, NUTRITION, EXERCISE, SMOKING CESSATION, HEALTH FAIRS, SENIORS, PRE-NATAL SERVICES, AND COLLABORATES WITH OTHER AREA HEALTH CARE PROVIDERS TO ASSIST AND CARE FOR THE UNDERSERVED POPULATION.SJRMC-SOUTH BEND PROVIDED IN-KIND DONATIONS TO MANY AGENCIES, INCLUDING MEDICAL SUPPLIES AND DRUGS TO MISSION TRIPS, LUNCHES TO HOPE MINISTRIES, AND PRINTING SERVICES FOR LOCAL NON-PROFIT AGENCIES.SJRMC-SOUTH BEND MADE SIGNIFICANT CONTRIBUTIONS TO THE DIOCESE OF FORT WAYNE/SOUTH BEND, CENTER FOR THE HOMELESS, UNITED WAY, AMERICAN HEART ASSOCIATION, UNIVERSITY OF NOTRE DAME HARPER CANCER RESEARCH, LOGAN INC. (CENTER FOR PEOPLE WITH DISABILITIES), WOMEN'S CARE CENTER, MARCH OF DIMES, RIVERBEND CANCER SERVICES, HANNAH'S HOUSE (HOME FOR PREGNANT WOMEN), AND THE IU SCHOOL OF MEDICINE. PART VI, LINE 6: SJRMC-SOUTH BEND IS A MEMBER OF TRINITY HEALTH, ONE OF THE LARGEST CATHOLIC HEALTH CARE DELIVERY SYSTEMS IN THE COUNTRY. TRINITY HEALTH ANNUALLY REQUIRES THAT ALL MEMBER ORGANIZATIONS DEFINE - AND ACHIEVE - SPECIFIC COMMUNITY HEALTH AND WELL-BEING GOALS. IN FISCAL YEAR 2017, GOALS INCLUDED 1) PARTICIPATING IN LOCAL COALITION AND ADVOCACY EFFORTS AIMED AT CURBING TOBACCO USE AND PREVENTING OBESITY, 2) ASSESSING CAPACITY TO IDENTIFY AND SUPPORT INDIVIDUALS THAT ARE HOUSING INSECURE AND ACKNOWLEDGING OTHER BARRIERS INDIVIDUALS HAVE ACCESSING HEALTH CARE AND 3) EXPANDING ACCESS AND DELIVERY OF DIABETES PREVENTION PROGRAMS. TRINITY HEALTH ACKNOWLEDGES THE IMPACT SOCIAL DETERMINANTS SUCH AS ADEQUATE HOUSING, SAFETY, ACCESS TO FOOD, EDUCATION, INCOME, AND HEALTH COVERAGE HAVE ON THE HEALTH OF THE COMMUNITY. IN FISCAL YEAR 2016, TRINITY HEALTH LAUNCHED THE TRANSFORMING COMMUNITIES INITIATIVE (TCI), AWARDING EIGHT COMMUNITIES FUNDING TO IMPROVE THE HEALTH AND WELL-BEING OF THEIR COMMUNITIES IN PARTNERSHIP WITH THE LOCAL TRINITY HEALTH MEMBER HOSPITAL. THE AWARDED COMMUNITIES FOCUS ON POLICY, SYSTEM, AND ENVIRONMENTAL CHANGES THAT SPECIFICALLY IMPACT COMMUNITY IDENTIFIED NEEDS AND THAT WILL REDUCE CHILDHOOD OBESITY AND YOUTH TOBACCO USE. IN FISCAL YEAR 2017, TRINITY HEALTH INVESTED $2.7 MILLION IN TCI.AS A NOT-FOR-PROFIT HEALTH SYSTEM, TRINITY HEALTH REINVESTS ITS PROFITS BACK INTO OUR COMMUNITIES THROUGH PROGRAMS SERVING THOSE WHO ARE POOR AND VULNERABLE, HELPING MANAGE CHRONIC CONDITIONS LIKE DIABETES, PROVIDING HEALTH EDUCATION, PROMOTING WELLNESS AND DEVELOPING PROGRAMS AND POLICIES TO SPECIFICALLY SUPPORT VULNERABLE POPULATIONS. ANNUALLY, THE ORGANIZATION INVESTS OVER $1.1 BILLION IN SUCH COMMUNITY BENEFITS AND WORKS TO ENSURE THAT ITS MEMBER HOSPITALS AND OTHER ENTITIES/AFFILIATES ENHANCE THE OVERALL HEALTH OF THE COMMUNITIES THEY SERVE BY ADDRESSING THE SPECIFIC NEEDS OF EACH COMMUNITY.FOR MORE INFORMATION ABOUT TRINITY HEALTH, VISIT WWW.TRINITY-HEALTH.ORG. PART VI, LINE 7, REPORTS FILED WITH STATES IN 1 AMERICAN ACADEMY OF FERTILITY CARE 13885 WAGON PASS RD PLATTE CITY MO 64079 431276731 501(C)(3) 7450 COMMUNITY BENEFIT AMERICAN HEART ASSOCIATION 7272 GREENVILLE AVE DALLAS TX 75231 135613797 501(C)(3) 19800 COMMUNITY BENEFIT BETHEL COLLEGE INDIANA 1001 BETHEL CIRCLE MISHAWAKA IN 46545 350935587 501(C)(3) 30000 NURSING LAB FUND/RENOVATION CENTER FOR THE HOMELESS INC 813 S MAIN STREET SOUTH BEND IN 466013102 351768544 501(C)(3) 14400 SUPPORT OPERATIONS COMMUNITY FOUNDATION OF SAINT JOSEPH COUNTY PO BOX 837 SOUTH BEND IN 46624 237365930 501(C)(3) 10000 COMMUNITY BENEFIT DIOCESE OF FORT WAYNESOUTH BEND 915 S CLINTON ST FORT WAYNE IN 46801 350876373 501(C)(3) 130000 ANNUAL PLEDGE HANNAHS HOUSE INC 518 W 4TH ST MISHAWAKA IN 46544 351871289 501(C)(3) 13260 UNDERSERVED HEALTH AND HOSPITAL CORPORATION OF MARION COUNTY 3838 N RURAL ST INDIANAPOLIS IN 46205 356005697 501(C)(3) 15000 COMMUNITY BENEFIT HOLY CROSS COLLEGE 54515 STATE ROAD 933 NORTH NOTRE DAME IN 46556 351148835 501(C)(3) 119000 COMMUNITY BENEFIT HOPE MINISTRIES PO BOX 4488 SOUTH BEND IN 46634 351038532 501(C)(3) 0 5100 FMV MEALS COMMUNITY BENEFIT HOSPICE FOUNDATION 111 SUNNYBROOK CT SOUTH BEND IN 46637 300433147 501(C)(3) 37434 BUILDING CAMPAIGN & PROGRAM SPONSORSHIP INDIANA UNIVERSITY OF SOUTH BEND POBOX 500 BLOOMINGTON IN 47402 356018940 501(C)(3) 10000 COMMUNITY BENEFIT INDIANA UNIVERSITY SCHOOL OF MEDICINE 1234 NOTRE DAME AVE SOUTH BEND IN 46617 366001673 501(C)(3) 9500 1857 COMMUNITY BENEFIT KELLY CARES FOUNDATION PO BOX 853 NOTRE DAME IN 46556 263591070 501(C)(3) 10000 COMMUNITY BENEFIT LA CASA DE AMISTAD 746 S MEADE ST SOUTH BEND IN 46619 351350013 501(C)(3) 64500 2325 FMV PRINTED MATERIALS COMMUNITY BENEFIT LOGAN COMMUNITY RESOURCES INC 2205 EAST JEFFRERSON BLVD SOUTH BEND IN 46624 350965639 501(C)(3) 29000 SUPPORT AUTISM CHILDREN OF ABRAHAM 6635 HOHMAN AVENUE HAMMOND IN 46635 010821110 501(C)(3) 134074 COST MEDICAL SUPPLIES COMMUNITY BENEFIT NORTHERN IN HISTORICAL SOCIETY 808 WEST WASHINGTON STREET SOUTH BEND IN 46601 351124156 501(C)(3) 9561 SUPPORT MUSEUM PROGRAMS NORTHEAST NEIGHBORHOOD REVIT 803 LINCOLN WAY WEST SOUTH BEND IN 46616 352118149 501(C)(3) 50000 COMMUNITY BENEFIT PHM EDUCATIONAL FOUNDATION 55900 BITTERSWEET ROAD MISHAWAKA IN 46545 351996785 501(C)(3) 5000 COMMUNITY BENEFIT REAL SERVICES INC 1151 S MICHIGAN SOUTH BEND IN 46634 351157606 501(C)(3) 12000 COMMUNITY BENEFIT RIVERBEND CANCER SERVICES 3516 E JEFFERSON BLVD SOUTH BEND IN 46615 350872359 501(C)(3) 10000 COMMUNITY BENEFIT SAINT MARY'S COLLEGE PO BOX 180 NOTRE DAME IN 46556 350868158 501(C)(3) 50000 COMMUNITY BENEFIT SAINT PIUS X CATHOLIC CHURCH 52553 FIR ROAD GRANGER IN 46530 350940397 501(C)(3) 50000 CAPITAL CAMPAIGN SOUTH BEND SYMPHONY ASSOCIATION INC 127 N MICHIGAN ST SOUTH BEND IN 466011603 356042189 501(C)(3) 5500 COMMUNITY BENEFIT ST JOSEPH HIGH SCHOOL 453 NORTH NOTRE DAME AV SOUTH BEND IN 46617 350924794 501(C)(3) 15000 OPERATIONS ST JOSEPH HIGH SCHOOL 453 NORTH NOTRE DAME AV SOUTH BEND IN 46617 350924794 501(C)(3) 25000 CHAPEL BUILDING UNIVERSITY OF NOTRE DAME 100 GRACE HALL NOTRE DAME IN 46556 350868188 501(C)(3) 125000 MEDICAL RESEARCH UNIVERSITY OF NOTRE DAME 100 GRACE HALL NOTRE DAME IN 46556 350868188 501(C)(3) 40000 CENTER FOR ARTS & CULTURE BLDG PLEDGE 27 0 PART I, LINE 2: DONATIONS MADE BY SJRMC-SOUTH BEND TO CHARITABLE ORGANIZATIONS ARE MADE IN FURTHERANCE OF THE RECIPIENT ORGANIZATION'S EXEMPT PURPOSE. DONATIONS ARE INCLUDED IN COMMUNITY BENEFITS IN SCHEDULE H IF THE CONTRIBUTION HAS BEEN FORMALLY RESTRICTED TO A COMMUNITY BENEFIT ACTIVITY THAT MEETS THE CRITERIA TO BE REPORTED ON SCHEDULE H. 1 1 0 0 0 0 0 0 0 ALBERT GUTIERREZ DIR; PRES & CEO SJHS THR 9/16 0 484220 0 146232 0 226254 0 11925 0 36208 0 904839 0 78685 CHRISTOPHER KARAM PRES SJRMC-SB;PRES SJRMC-PLY AT 3/17 0 272581 0 31572 0 638 0 16544 0 23911 0 345246 0 0 MICHAEL FINEGAN DIRECTOR; TH SVP OPERATIONAL PERF. 0 326458 0 84366 0 95357 0 11925 0 26245 0 544351 0 0 JASON SCHULTZ SECRETARY; SJRMC GEN COUNSEL 0 179856 0 12467 0 127 0 9015 0 8134 0 209599 0 0 JANICE DUNN CFO SJHS THROUGH 1/17 0 304005 0 52382 0 1344 0 11925 0 19253 0 388909 0 0 ROBERT SINK INTERIM CFO SJHS 1/17-4/17; VP FIN 0 162548 0 18074 0 325 0 12342 0 13706 0 206995 0 0 STEPHEN ANDERSON MD CMO SJHS 0 310122 0 53258 0 6560 0 11925 0 20527 0 402392 0 0 JULIE WEST MD PHYSICIAN 284833 0 30000 0 40263 0 7950 0 19705 0 382751 0 0 0 MARTIN WIESCHHAUS MD PHYSICIAN 288907 0 39097 0 1270 0 19875 0 23639 0 372788 0 0 0 STEPHEN SIMONS MD PHYSICIAN 259738 0 25030 0 1710 0 19875 0 18128 0 324481 0 0 0 THEODORE NEUMANN MD PHYSICIAN 249853 0 0 0 1596 0 19153 0 17025 0 287627 0 0 0 KEVIN ERICSON MD PHYSICIAN 237310 0 0 0 952 0 14290 0 2810 0 255362 0 0 0 KURT MEYER FORMER KEY EMPLOYEE; CHRO SJRMC 0 231169 0 39710 0 955 0 12045 0 16457 0 300336 0 0 KENNETH HALL FORMER KEY EMPLOYEE; CNO THR 10/16 0 159855 0 33560 0 33282 0 17129 0 24482 0 268308 0 0 RICHARD O'CONNELL FORMER KE; TRINITY EVP THR 10/16 0 878773 0 258051 0 408585 0 11925 0 35437 0 1592771 0 112018 PART I, LINE 3 SJRMC-SOUTH BEND IS A SUBSIDIARY IN THE TRINITY HEALTH SYSTEM. SJRMC-SOUTH BEND'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-SOUTH BEND'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, LINES 4A-B THE FOLLOWING INDIVIDUAL RECEIVED SEVERANCE PAYMENTS IN CALENDAR 2016. THIS AMOUNT IS INCLUDED IN COLUMN B(III) OF SCHEDULE J, PART II: KENNETH HALL - $31,018 IN ADDITION, COLUMN C OF SCHEDULE J, PART II INCLUDES $7,754 OF SEVERANCE FOR KENNETH HALL WHICH WAS UNPAID AS OF 12/31/16. THE $7,754 WAS PAID AND INCLUDED IN KENNETH HALL'S TAXABLE INCOME IN 2017. THE FOLLOWING ARE PARTICIPANTS IN A TRINITY HEALTH SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP) IN 2016. 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 2016, AND BENEFITS FOR PARTICIPANTS NOT YET VESTED IN A PLAN WERE ACCRUED IN 2016. THE FOLLOWING PAYOUTS FOR 2016 FOR THE PLAN ARE INCLUDED IN COLUMN B(III) OF SCHEDULE J, PART II: MICHAEL FINEGAN - $79,910 ALBERT GUTIERREZ - $113,367 RICHARD O'CONNELL - $221,949 THE FOLLOWING ACCRUAL FOR 2016 IS INCLUDED IN COLUMN F OF FORM 990, PART VII: CHAD TOWNER - $18,375 THE FOLLOWING ARE PARTICIPANTS IN A TRINITY HEALTH RESTORATION OR RETENTION PLAN. THE RESTORATION PLAN PROVIDES RETIREMENT BENEFITS FOR CERTAIN TRINITY HEALTH SYSTEM OFFICE EXECUTIVES WITH EARNINGS ABOVE THE IRS PAY CAP FOR QUALIFIED PLANS ($265,000 FOR 2016). THE FOLLOWING PAYOUT FOR 2016 FOR THIS PLAN IS INCLUDED IN COLUMN B(III) OF SCHEDULE J, PART II: ALBERT GUTIERREZ - $80,681 RICHARD O'CONNELL - $121,018 COLUMN (F) OF SCHEDULE J, PART II INCLUDES THE PORTION OF THIS AMOUNT THAT WAS REPORTED AS DEFERRED COMPENSATION IN PRIOR YEARS. ELLEN BRUNEEL FAMILY MEMBER OF JOHN ROSENTHAL, OFFICER AND DIRECTOR 22411 EMPLOYMENT ARRANGEMENT 0 JEAN LOUISE HALL FAMILY MEMBER OF KENNETH HALL, FORMER KEY EMPLOYEE 29309 EMPLOYMENT ARRANGEMENT 0 FORM 990, PART VI, SECTION A, LINE 2 SJRMC-SOUTH BEND BOARD MEMBERS ABRAHAM MARCUS AND JOHN ROSENTHAL HAVE A BUSINESS RELATIONSHIP. ABRAHAM MARCUS AND JANICE DUNN, OFFICER, HAVE A BUSINESS RELATIONSHIP. FORM 990, PART VI, SECTION A, LINE 6 THE SOLE MEMBER OF SAINT JOSEPH REGIONAL MEDICAL CENTER - SOUTH BEND (SJRMC-SOUTH BEND) IS SAINT JOSEPH REGIONAL MEDICAL CENTER. SEE LINE 7 FOR ADDITIONAL INFORMATION. FORM 990, PART VI, SECTION A, LINE 7A SAINT JOSEPH REGIONAL MEDICAL CENTER IS THE SOLE MEMBER OF SJRMC-SOUTH BEND. SAINT JOSEPH REGIONAL MEDICAL CENTER HAS THE RIGHT TO APPOINT ALL PERSONS TO THE BOARD OF DIRECTORS OF SJRMC-SOUTH BEND FORM 990, PART VI, SECTION A, LINE 7B AS SOLE MEMBER, SAINT JOSEPH REGIONAL MEDICAL CENTER MUST APPROVE CERTAIN DECISIONS OF THE GOVERNING BODY, INCLUDING THE STRATEGIC PLAN, ANNUAL CAPITAL PLAN, AND ANNUAL OPERATING BUDGET. SAINT JOSEPH REGIONAL MEDICAL CENTER 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-SOUTH BEND IS REVIEWED BY SENIOR MANAGEMENT. IN ADDITION, CERTAIN KEY SECTIONS OF THE FORM ARE REVIEWED BY THE BOARD OF DIRECTORS. EACH MEMBER OF 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-SOUTH BEND 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-SOUTH BEND, 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-SOUTH BEND 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 INTERNAL LEGAL COUNSEL AND THE INTEGRITY AND COMPLIANCE OFFICER, 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-SOUTH BEND (OR A DELEGATED COMMITTEE OF THE BOARD) ON A YEARLY BASIS. INTERESTED PERSONS ARE REQUIRED TO MAKE FULL DISCLOSURE TO SJRMC-SOUTH BEND 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-SOUTH BEND (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-SOUTH BEND. 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-SOUTH BEND 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-SOUTH BEND 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. FORM 990, PART VI, SECTION C, LINE 19 SJRMC-SOUTH BEND 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. IN ADDITION, SJRMC-SOUTH BEND INCLUDES A COPY OF ITS MOST RECENTLY FILED SCHEDULE H ON TRINITY HEALTH'S WEBSITE. SJRMC-SOUTH BEND'S GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE AVAILABLE UPON REQUEST. FORM 990, PART XI, LINE 9: EQUITY TRANSFERS TO AFFILIATES -27,796,001. FORM 990, PART I, DOING BUSINESS AS: SAINT JOSEPH REGIONAL MEDICAL CENTER REHABILITATION INSTITUTE SAINT JOSEPH REHABILITATION INSTITUTE SAINT JOSEPH PODIATRIC RESIDENCY CLINIC FAMILY MEDICINE CENTER OF SJRMC SAINT JOSEPH REGIONAL MEDICAL CENTER SPORTS MEDICINE INSTITUTE SR. MAURA BRANNICK DENTAL CENTER FAMILY MEDICINE FACULTY PHYSICIANS OUR LADY OF THE ROSARY HEALTH CENTER PEDIATRIC SPECIALTY CLINIC SPORTS MEDICINE INSTITUTE ELM ROAD SLEEP DISORDER CENTER ELM ROAD OCCUPATIONAL HEALTH ELM ROAD OUTPATIENT THERAPY/INDUSTRIAL REHABILITATION HEALTHY FAMILY CENTER MIDWIFERY OF MICHIANA MOBILE MEDICAL UNIT OCCUPATIONAL HEALTH SR. MAURA BRANNICK HEALTH CENTER SAINT JOSEPH REGIONAL MEDICAL CENTER SJRMC REHABILITATION INSTITUTE SAINT JOSEPH HEALTH SYSTEM SLEEP DISORDER CENTER - MISHAWAKA SJHS IMAGING CENTER AT MIDWWEST CARDIOLOGY 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 1221 MAIN STREET SUITE 213 HOLYOKE MA 01040 042182395 HEALTH CARE SERVICES MA 501(C)(3) LINE 10 THE MERCY HOSPITAL INC 1 CAPITAL REGION GERIATRIC CENTER INC 421 WEST COLUMBIA ST COHOES NY 12047 141701597 LONG TERM CARE NY 501(C)(3) LINE 10 LTC (EDDY) INC 1 CARING PARTNERS HOME HEALTH INC 1200 EARHART RD ANN ARBOR MI 48105 201681131 HOME HEALTH SERVICES MI 501(C)(3) LINE 10 GLACIER HILLS INC 1 CATHERINE MCAULEY HEALTH SERVICES CORP PO BOX 995 ANN ARBOR MI 48106 382507173 HEALTH CARE SERVICES MI 501(C)(3) LINE 3 TRINITY HEALTH-MICHIGAN 1 CATHOLIC HEALTH MINISTRIES 20555 VICTOR PARKWAY LIVONIA MI 48152 GOVERNANCE AND MANAGEMENT OF TRINITY HEALTH SYSTEM VT 501(C)(3) LINE 1 N/A 0 COLUMBUS ACQUISITION CORP 111 CENTRAL AVENUE NEWARK NJ 07102 262616342 INACTIVE ENTITY NJ 501(C)(3) LINE 10 SAINT MICHAEL'S MEDICAL CENTER 1 CRANBROOK HOSPICE CARE 1111 W LONG LAKE RD STE 102 TROY MI 48098 383320699 HOSPICE SERVICES MI 501(C)(3) LINE 10 TRINITY HOME HEALTH SERVICES 1 DILEY RIDGE MEDICAL CENTER 6150 EAST BROAD STREET COLUMBUS OH 43213 342032340 HEALTH CARE AND HOSPITAL SERVICES OH 501(C)(3) LINE 3 MOUNT CARMEL HEALTH SYSTEM 1 DUBUQUE MERCY HEALTH FOUNDATION 250 MERCY DRIVE DUBUQUE IA 52001 262227941 FOUNDATION IA 501(C)(3) LINE 12A, I MERCY HEALTH SERVICES-IOWA CORP 1 DYERSVILLE HEALTH FOUNDATION INC 1111 3RD STREET SW DYERSVILLE IA 52040 205383271 FOUNDATION IA 501(C)(3) LINE 12A, I MERCY HEALTH SERVICES-IOWA CORP 1 EAST NORRITON PHYSICIANS SERVICES INC ONE WEST ELM STREET SUITE 100 CONSHOHOCKEN PA 19428 232515999 HEALTH CARE SERVICES PA 501(C)(3) LINE 3 MERCY PHYSICIAN NETWORK 1 EDDY LICENSED HOME CARE AGENCY 433 RIVER ST SUITE 3000 TROY NY 12180 141818568 HOME HEALTH SERVICES NY 501(C)(3) LINE 3 LTC (EDDY) INC 1 EMBRACING AGE INC 333 BUTTERNUT DRIVE SUITE 100 DEWITT NY 13214 461051881 PACE PROGRAM NY 501(C)(3) LINE 10 ST JOSEPH'S HEALTH INC 1 EMPIRE HOME INFUSION SERVICE INC 10 BLACKSMITH DRIVE MALTA NY 12020 141795732 HOME HEALTH SERVICES NY 501(C)(3) LINE 10 LTC (EDDY) INC 1 FARREN CARE CENTER INC 1221 MAIN STREET SUITE 213 HOLYOKE MA 01040 042501711 LONG TERM CARE MA 501(C)(3) LINE 3 THE MERCY HOSPITAL INC 1 FRANCISCAN ELDERCARE CORPORATION PO BOX 2500 WILMINGTON DE 19805 223008680 LONG TERM CARE (INACTIVE) DE 501(C)(3) LINE 10 ST FRANCIS HOSPITAL 1 GLACIER HILLS FOUNDATION 1200 EARHART RD ANN ARBOR MI 48105 208072723 FOUNDATION MI 501(C)(3) LINE 12A, I GLACIER HILLS INC 1 GLACIER HILLS INC 1200 EARHART RD ANN ARBOR MI 48105 381891500 SENIOR LIVING COMMUNITY MI 501(C)(3) LINE 10 TRINITY CONTINUING CARE SERVICES 1 GLEN EDDY INC 1 GLEN EDDY DRIVE NISKAYUNA NY 12309 141794150 SENIOR LIVING COMMUNITY NY 501(C)(3) LINE 10 LTC (EDDY) INC 1 GLOBAL HEALTH MINISTRY 20555 VICTOR PARKWAY LIVONIA MI 48152 421253527 HEALTH CARE SERVICES MI 501(C)(3) LINE 12A, I TRINITY HEALTH CORPORATION 1 GOOD SAMARITAN HOSPITAL INC 5401 LAKE OCONEE PARKWAY GREENSBORO GA 30642 261720984 HEALTH CARE AND HOSPITAL SERVICES GA 501(C)(3) LINE 3 ST MARY'S HEALTH CARE SYSTEM INC 1 GOTTLIEB COMMUNITY HEALTH SERVICES CORPORATION 701 W NORTH AVE MELROSE PARK IL 60160 363332852 COMMUNITY OUTREACH IL 501(C)(3) LINE 10 GOTTLIEB MEMORIAL HOSPITAL 1 GOTTLIEB MEMORIAL FOUNDATION 701 W NORTH AVE MELROSE PARK IL 60160 743260011 FOUNDATION IL 501(C)(3) LINE 12C, III-FI N/A 0 GOTTLIEB MEMORIAL HOSPITAL 701 W NORTH AVE MELROSE PARK IL 60160 362379649 HEALTH CARE AND HOSPITAL SERVICES IL 501(C)(3) LINE 3 LOYOLA UNIVERSITY HEALTH SYSTEM 1 GRAND RAPIDS MEDICAL EDUCATION PARTNERS INC 945 OTTAWA AVE NW GRAND RAPIDS MI 49503 237270669 MEDICAL EDUCATION TRAINING PROGRAMS MI 501(C)(3) LINE 12A, I TRINITY HEALTH-MICHIGAN 1 HACKLEY LIFE COUNSELING 125 E SOUTHERN AVENUE MUSKEGON MI 49442 381386362 HEALTH CARE SERVICES MI 501(C)(3) LINE 10 MERCY HEALTH PARTNERS 1 HAWTHORNE RIDGE INC 30 COMMUNITY WAY EAST GREENBUSH NY 12061 800102840 SENIOR LIVING COMMUNITY NY 501(C)(3) LINE 10 LTC (EDDY) INC 1 HEART CENTER OF GREATER WATERBURY INC PO BOX 2153 WATERBURY CT 06722 830416893 MANAGEMENT CT 501(C)(3) LINE 12A, I N/A 0 HERITAGE HOUSE NURSING CENTER INC 2920 TIBBITS AVE TROY NY 12180 141725101 LONG TERM CARE NY 501(C)(3) LINE 10 LTC (EDDY) INC 1 HOLY CROSS CARENET INC PO BOX 9184 FARMINGTON HILLS MI 48152 521945054 LONG TERM CARE MD 501(C)(3) LINE 10 TRINITY CONTINUING CARE SERVICES 1 HOLY CROSS HEALTH FOUNDATION INC 1500 FOREST GLEN RD SILVER SPRING MD 20910 208428450 FOUNDATION MD 501(C)(3) LINE 7 HOLY CROSS HEALTH INC 1 HOLY CROSS HEALTH INC 1500 FOREST GLEN RD SILVER SPRING MD 20910 520738041 HEALTH CARE AND HOSPITAL SERVICES MD 501(C)(3) LINE 3 TRINITY HEALTH CORPORATION 1 HOLY CROSS HOSPITAL INC 4725 NORTH FEDERAL HIGHWAY FT LAUDERDALE FL 33308 590791028 HEALTH CARE AND HOSPITAL SERVICES FL 501(C)(3) LINE 3 TRINITY HEALTH CORPORATION 1 HOLY CROSS MEDICAL PROPERTIES INC 4725 NORTH FEDERAL HIGHWAY FT LAUDERDALE FL 33308 650666283 BUILDING MANAGEMENT SERVICES FL 501(C)(2) N/A HOLY CROSS HOSPITAL INC 1 HOLY CROSS OUTPATIENT SERVICES INC 4725 NORTH FEDERAL HIGHWAY FT LAUDERDALE FL 33308 465421068 HEALTH CARE SERVICES FL 501(C)(3) LINE 10 HOLY CROSS HOSPITAL INC 1 HOLY CROSS PRIMARY CARE INC 4725 NORTH FEDERAL HIGHWAY FT LAUDERDALE FL 33308 812531495 HEALTH CARE SERVICES FL 501(C)(3) LINE 10 HOLY CROSS HOSPITAL INC 1 HOME & COMMUNITY HEALTH SERVICES INC 114 WOODLAND STREET HARTFORD CT 06105 810723591 HOME HEALTH SERVICES CT 501(C)(3) LINE 10 TRINITY HEALTH OF NEW ENGLAND CORP INC 1 HOME AIDE SERVICE OF EASTERN NEW YORK INC 433 RIVER ST SUITE 3000 TROY NY 12180 141514867 HOME HEALTH SERVICES NY 501(C)(3) LINE 10 LTC (EDDY) INC 1 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