2014-05-09T11:50:27-05:00 2013-06-30 990 2012-07-01 351142669 SAINT JOSEPH REGIONAL MEDICAL CENTER - PLYMOUTH CAMPUS INC SAIN 5749363181 PO BOX 670 PLYMOUTH IN 465639366 JANICE DUNN 5749363181 2014-05-08 2012 2015-11-30 17:44:51Z SAINT JOSEPH HEALTH CENTER LORETTA SCHMIDT PO BOX 670 PLYMOUTH IN 465639366 54214530 0 0928 X WWW.SJMED.COM X 1983 IN HEALTHCARE SERVICES 14 10 389 88 0 0 260947 255958 50277629 50142728 986461 2047789 2022972 1768055 53548009 54214530 1100 45535 0 0 17068831 18236771 0 0 0 26428710 25702226 43498641 43984532 10049368 10229998 63049113 65436219 11735556 10164454 51313557 55271765 HEALTHCARE SERVICES - SEE SCHEDULE H FOR MORE INFORMATION 0 0 33794503 45535 51385929 SAINT JOSEPH REGIONAL MEDICAL CENTER-PLYMOUTH CAMPUS, INC. (THE HOSPITAL), A NOT-FOR-PROFIT CORPORATION, OWNS AND OPERATES A 45-BED ACUTE CARE HOSPITAL IN PLYMOUTH, INDIANA. THE HOSPITAL PROVIDES SERVICES TO RESIDENTS OF THE LOCAL GEOGRAPHIC REGION. THE HOSPITAL IS A MEMBER OF TRINITY HEALTH, AN INDIANA NOT-FOR-PROFIT CORPORATION SPONSORED BY CATHOLIC HEALTH MINISTRIES, A PUBLIC JURIDIC PERSON OF THE HOLY ROMAN CATHOLIC CHURCH. FOR MORE INFORMATION ON SPECIFIC SERVICES PROVIDED, PLEASE SEE THE HOSPITAL'S WEBSITE AT WWW.SJMED.COM. MISSION:THE MISSION STATEMENT FOR THE HOSPITAL IS AS FOLLOWS:WE, CHE TRINITY HEALTH, SERVE TOGETHER IN THE SPIRIT OF THE GOSPEL AS A COMPASSIONATE AND TRANSFORMING HEALING PRESENCE WITHIN OUR COMMUNITIES. 33794503 1 1 0 1 0 0 0 0 0 0 1 1 0 0 1 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 96 0 1 389 1 0 0 0 0 0 0 0 0 0 0 X 14 10 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 IN X WAYNE NOETHE 5744726083 837 EAST CEDAR ST STE 350 SOUTH BEND IN 466172069 JOHN ZEGLIS 2.00 X X 0 0 0 JOHN J OLIVER SR 2.00 X X 0 0 0 FRANCIS K ELLERT 2.00 X X 0 0 0 TED CHITTUM 2.00 X 0 0 0 RANDY DANIELSON 2.00 X 0 0 0 MICHAEL A EIFRID MD 2.00 48.00 X 0 261807 50229 THOMAS FLYNN 2.00 X 0 0 0 SR JOAN E JOHNSON CSC 2.00 X 0 0 0 KATHY LINTNER 2.00 X 0 0 0 SR JOY O'GRADY CSC 2.00 X 0 0 0 LORI PRICE 20.00 30.00 X X 276673 0 53524 JOSEPHINE RANDAZZO DO 2.00 48.00 X 0 535485 39260 TOD A STILLSON MD 2.00 48.00 X 0 314956 38768 ALBERT GUTIERREZ 10.00 40.00 X 0 663705 79538 LORETTA SCHMIDT 50.00 X X 140574 0 29029 SR MARY ALICE BOWLER CSC 2.00 X 0 0 0 DEAN COLVIN 2.00 X 0 0 0 LOUISE MASON 2.00 X 0 0 0 DAN TYREE 2.00 X 0 0 0 JASON SCHULTZ 10.00 40.00 X 0 144481 13998 JANICE DUNN 10.00 40.00 X 0 369419 37148 JOSEPH SWEDISH 2.00 53.00 X 0 3233500 601476 KEDRICK ADKINS 2.00 53.00 X 0 1821619 126167 J RICHARD O'CONNELL 2.00 53.00 X 0 1036410 130423 KURT MEYER 10.00 40.00 X 0 262457 32717 KENNETH HALL 10.00 40.00 X 0 210311 35666 SUZANNE RISNER 50.00 X 111972 0 10891 JULIE HANUS 50.00 X 110295 0 10422 BARBARA COX 50.00 X 101208 0 30734 JOHN MICHAEL REICHERT 50.00 X 100856 0 9213 MICHAEL MURPHY 0.00 X 0 180882 16630 AARON AUSTIN 0.00 X 0 248006 24501 841578 9283038 1370334 6 1 1 0 SOUTH BEND MEDICAL FOUNDATION 530 N LAFAYETTE BLVD SOUTH BEND IN 46601 LABORATORY SERVICES 893856 GREAT LAKES ANESTHESIA PC 500 N NAPPANEE ST STE 11-B ELKHART IN 46514 PROFESSIONAL MEDICAL SERVICES 881194 NATIONAL WOUND CARE & HYPERBARIC 5220 BELFORT RD STE 200 JACKSONVILLE FL 32256 HEALTH CARE SERVICES 408060 AMERICAN HEALTHCARE STAFFING ASSOC 10126 E CHERRY RD STE 101 TRAVERSE CITY MI 49684 STAFFING SERVICES 232011 ZIOLKOWSKI CONSTRUCTION INC 4050 RALPH JONES DR SOUTH BEND IN 46628 CONSTRUCTION SERVICES 230949 12 255958 255958 NET PATIENT SVC REV 900099 50142728 50142728 50142728 1236307 1236307 366174 0 366174 366174 366174 811482 0 811482 811482 811482 MEDICARE/MEDICAID HIT 900099 1010037 1010037 OTHER REVENUE 900099 233164 233164 CAFETERIA REVENUE 900099 158680 158680 1401881 54214530 51385929 0 2572643 45535 45535 483964 483964 13893527 13456279 437248 993195 976616 16579 1846330 1774029 72301 1019755 971732 48023 167396 167396 3243044 3154754 88290 2467 61 2406 552186 391331 160855 37678 12338 25340 953650 934799 18851 39062 27672 11390 41806 31579 10227 250578 250578 2490302 1642258 848044 426063 426063 INTERCO. PURCHASED SVCS 7481033 240819 7240214 MEDICAL SUPPLIES 4678185 4678185 BAD DEBT 2301745 2301745 HOSPITAL PROVIDER TAX 2077400 2077400 959631 909975 49656 43984532 33794503 10190029 0 1050 810802 9488483 8583257 1042687 1077086 267239 261191 56047740 39793524 16768971 16254216 13478244 19274990 21544900 18340332 457539 834345 63049113 65436219 3303291 3228028 22680 8409585 6936426 11735556 10164454 X 51217393 55271765 96164 0 51313557 55271765 63049113 65436219 X 10229998 824375 -7096165 X X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 1295 0 0 0 1295 0 EXPLANATION OF LOBBYING ACTIVITIES: PART II-B, LINE 1: SAINT JOSEPH REGIONAL MEDICAL CENTER-PLYMOUTH CAMPUS, INC. (THE HOSPITAL) 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 THE HOSPITAL WITH AN ESTIMATED PERCENTAGE OF DUES PAYMENTS WHICH ARE USED FOR LOBBYING ACTIVITIES. SAINT JOSEPH REGIONAL MEDICAL CENTER-PLYMOUTH CAMPUS, INC. MADE NO CONTRIBUTIONS TO ANY LEGISLATORS OR CANDIDATES. 477930 477930 33182460 23101580 10080880 21802088 16691944 5110144 585262 585262 16254216 COMMINGLED FUNDS DIRECTLY HOLDING SECURITIES 5614387 F EQUITY METHOD INVESTMENTS 6737265 C HEDGE FUNDS 5988680 F 18340332 DEFERRED COMPENSATION LIABILITY 186074 INTERCOMPANY NOTES PAYABLE 6505269 INTERCOMPANY ACCOUNTS PAYABLE 172922 OTHER LONG-TERM LIABILITIES 72161 6936426 1 1 X 1 X 1 X 1 1 1 0 1 1 1 3875 1661710 1661710 0.03990 50 11858 6524632 4822459 1702173 0.04080 51 15733 8186342 4822459 3363883 0.08070 5 945 98987 98987 0.00240 2 11563 594789 115579 479210 0.01150 3 41156 350 40806 0.00100 10 12508 734932 115929 619003 0.01490 61 28241 8921274 4938388 3982886 0.09560 1 5000 5000 0.00010 1 5000 5000 0.00010 0 662671 236574 10781684 10793744 -12060 X 1 1 1 1 SAINT JOSEPH REG MED CENTER- PLYMOUTH

1915 LAKE AVENUE PLYMOUTH IN 46563

WWW.SJMED.COM/PLYMOUTH-CAMPUS X X X SAINT JOSEPH REG MED CENTER- PLYMOUTH 1 1 X X X X X X X X X 11 1 1 1 X X X X X X X X X 0 0 1 1 150.000000000000 1 400.000000000000 1 X X X X X X 1 1 X X 1 0 X X X X 1 X 0 0 2 WASHINGTON STREET CLINIC

112 116 E WASHINGTON STREET PLYMOUTH IN 46563

FAMILY HEALTH CENTER MEDICAL OFFICE BUILDING

2349 LAKE AVENUE PLYMOUTH IN 46563

VARIOUS MEDICAL OFFICES 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: SAINT JOSEPH REGIONAL MEDICAL CENTER - PLYMOUTH CAMPUS PREPARES AN ANNUAL COMMUNITY BENEFIT REPORT, WHICH IT SUBMITS TO THE STATE OF INDIANA. IN ADDITION, SAINT JOSEPH REGIONAL MEDICAL CENTER - PLYMOUTH CAMPUS REPORTS ITS COMMUNITY BENEFIT INFORMATION AS PART OF THE CONSOLIDATED COMMUNITY BENEFIT INFORMATION REPORTED BY TRINITY HEALTH IN ITS ANNUAL REPORT, AVAILABLE AT WWW.TRINITY-HEALTH.ORG.IN ADDITION, SAINT JOSEPH REGIONAL MEDICAL CENTER - PLYMOUTH CAMPUS 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, L7 COL(F): THE FOLLOWING NUMBER, $2,301,745, 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 - SAINT JOSEPH REGIONAL MEDICAL CENTER - PLYMOUTH STRIVES TO LIVE ITS MISSION OF SERVING THE POOR AND UNDERSERVED BY ASSISTING LOCAL ORGANIZATIONS IN CREATING PROGRAMS AIMED AT HELPING THE CITIZENS OF OUR COMMUNITY BECOME MORE PRODUCTIVE, HEALTHY MEMBERS OF SOCIETY AND IMPROVING THE OVERALL HEALTH STATUS OF THE COMMUNITY. THROUGH OUR COMMUNITY HEALTH NEEDS ASSESSMENT, IT BECAME EVIDENT THAT AGENCIES THAT WOULD BEST MEET THE IDENTIFIED NEEDS AND, THEREFORE, BE OUR BEST PARTNERS ARE AGENCIES THAT: 1) PROVIDE MEDICAL CARE FOR THE MEDICALLY UNDER-SERVED AND/OR HOMELESS, 2) PROMOTE DIVERSITY,3) SERVE WOMEN AND CHILDREN AND KEEP THEM SAFE, CLOTHED, FED AND EDUCATED, AND 4) WORK WITH OTHER HEALTH AND HUMAN SERVICES AGENCIES IN THE COMMUNITY TO FIND COMMON WAYS OF MEETING SOCIAL NEEDS.MOST OF THE COMMUNITY BUILDING PROGRAMS AND ORGANIZATIONS THAT SJRMC/PLYMOUTH SUPPORTS IN MARSHALL COUNTY SERVE THE BROADER COMMUNITY OR OFFER EDUCATION TO MEMBERS OF THE COMMUNITY WHO HELP THOSE POPULATIONS. AMONG THE MANY PROGRAMS SJRMC/PLYMOUTH SUPPORTS ARE: MARSHALL COUNTY NEIGHBORHOOD ASSOCIATION FOR DEVELOPMENT OF HEALTHY CHOICES FOOD PANTRY, CULVER TRI KAPPA TOUR DE MAX BICYCLE RACE, MOON TREE STUDIOS FOR SUPPORT OF VETERAN ART ACTIVITIES, ST. MICHAEL'S SCHOOL FOR SCHOLARSHIPS AND PLYMOUTH HIGH SCHOOL EXTRA-CURRICULAR PROGRAMS. PART III, LINE 4: SAINT JOSEPH REGIONAL MEDICAL CENTER - PLYMOUTH CAMPUS IS INCLUDED IN THE CONSOLIDATED FINANCIAL STATEMENTS OF TRINITY HEALTH. THE FOLLOWING IS THE TEXT OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS FOOTNOTE FROM PAGE 17 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 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 MINISTRY ORGANIZATION 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 2:METHODOLOGY USED FOR LINE 2: BAD DEBT EXPENSE REPORTED ON LINE 2 IS SHOWN AT COST AND WAS CALCULATED USING A COST TO CHARGE RATIO METHODOLOGY.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 - SAINT JOSEPH REGIONAL MEDICAL CENTER - PLYMOUTH CAMPUS USES A PREDICTIVE MODEL THAT INCORPORATES THREE DISTINCT VARIABLES IN COMBINATION TO PREDICT WHETHER A PATIENT QUALIFIES FOR CHARITY: (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. FY13 WAS THE FIRST YEAR SAINT JOSEPH REGIONAL MEDICAL CENTER - PLYMOUTH CAMPUS UTILIZED THE PREDICTIVE MODEL WITH RESULTS USED FOR ANALYSIS ONLY. STARTING IN FY14, SAINT JOSEPH REGIONAL MEDICAL CENTER - PLYMOUTH CAMPUS IS RECORDING AMOUNTS AS CHARITY CARE (INSTEAD OF BAD DEBT EXPENSE) BASED ON THE RESULTS OF THE PREDICTIVE MODEL. PART III, LINE 8: SAINT JOSEPH REGIONAL MEDICAL CENTER - PLYMOUTH CAMPUS, INC. 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 HEALTHCARE 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. SAINT JOSEPH REG. MED. CENTER- PLYMOUTH PART V, SECTION B, LINE 3: PRIOR ANALYSIS BY THE COMMUNITY BENEFIT COUNCIL IDENTIFIED THREE IMPORTANT COMMUNITY-RELATED ISSUES: DIABETES, SENIOR SERVICES AND PRENATAL CARE. THE METHODOLOGY FOR CONDUCTING THE CHNA INVOLVED DEPLOYMENT OF A COMMUNITY SURVEY, BOTH ON PAPER AND ONLINE, DURING THE MONTHS OF AUGUST THROUGH OCTOBER 2011. THE SURVEY TAKERS WERE ASKED WHAT THREE AREAS SHOULD SAINT JOSEPH REGIONAL MEDICAL CENTER (SJRMC) MOST IMPROVE. THEY WERE GIVEN A LIST OF OPTIONS FROM WHICH TO SELECT MULTIPLE ANSWERS. THE IMPORTANT ISSUES IDENTIFIED BY THE SURVEY TAKERS WERE: AWARENESS, EDUCATION AND ACCESSIBILITY.THE COUNCIL THEN BROUGHT TOGETHER DIFFERENT GROUPS INCLUDING: LEADERSHIP ALUMNI, YOUNG PROFESSIONALS, SENIORS, CLINICS, BUSINESS LEADERS IN PLYMOUTH, EXPECTANT & NEW MOTHERS, AND LATINO COMMUNITY LEADERS. THE FOCUS GROUPS WERE ASKED TO DISCUSS ISSUES THAT HAD BEEN IDENTIFIED AS IMPORTANT BY SJRMC AND BY THE SURVEY RESULTS.COMMUNITY BENEFIT COUNCIL SUBCOMMITTEES OF SENIOR SERVICES, DIABETES AND PRE-NATAL CARE WERE FORMED AND MET TO DISCUSS TO IMPROVE THE AREAS THEY WERE ASSIGNED. AFTER DISCUSSION, ACTION PLANS WERE DEVELOPED AND APPROVED AND BUDGETED. SAINT JOSEPH REG. MED. CENTER- PLYMOUTH PART V, SECTION B, LINE 4: SAINT JOSEPH REGIONAL MEDICAL CENTER - SOUTH BEND CAMPUS SAINT JOSEPH REG. MED. CENTER- PLYMOUTH PART V, SECTION B, LINE 5C: LINE 5A:HTTP://WWW.SJMED.COM/DOCUMENTS/14337-SJRMC-PLY-ORS%20CHNA(EMAIL).PDFLINE 5C: ALL FOCUS GROUPS MEMBERS AND COMMUNITY BENEFIT COUNCIL MEMBERS RECEIVED A PRINTED OR E-MAILED COPY OF THE COMPLETE CHNA. SAINT JOSEPH REG. MED. CENTER- PLYMOUTH PART V, SECTION B, LINE 7: SJRMC PLYMOUTH DID NOT IMPLEMENT STRATEGIES THAT ADDRESS EACH INDIVIDUAL BARRIER AND COMPLICATION WITHIN THE SENIOR SERVICES NEED BECAUSE OF OTHER COMMUNITY RESOURCES, SUCH AS THE MARSHALL COUNTY COUNCIL ON AGING. MARSHALL COUNTY COUNCIL ON AGING PARTNERS WITH LIFEPLEX FITNESS CENTER TO PROVIDE OPPORTUNITIES FOR SENIORS TO EXERCISE AT A LOW COST. SJRMC MISHAWAKA, A RELATED ORGANIZATION, HAS A SENIOR SERVICES NAVIGATOR WHO WORKS WITH OUR PLYMOUTH CAMPUS TO PROMOTE PROGRAMS AND HEALTH FAIRS TO THE SENIOR POPULATION ALONG WITH SUPPORT FROM THE COUNCIL ON AGING. SJRMC MISHAWAKA ALSO ADDRESSES SENIOR SERVICES WITHIN THEIR ROBUST IMPLEMENTATION STRATEGY. SAINT JOSEPH REG. MED. CENTER- PLYMOUTH PART V, SECTION B, LINE 12H: 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 HEALTHCARE 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. SAINT JOSEPH REG. MED. CENTER- PLYMOUTH PART V, SECTION B, LINE 14G: BASIC INFORMATION ABOUT THE FINANCIAL ASSISTANCE POLICY WAS POSTED IN ENGLISH AND SPANISH IN THE EMERGENCY AND OTHER WAITING ROOMS, PATIENT REGISTRATION BOOTHS AND PHYSICIAN OFFICES. DURING FISCAL YEAR 2013, IF AN INDIVIDUAL WANTED A SUMMARY OF THE FINANCIAL ASSISTANCE POLICY, HE/SHE COULD GET A BROCHURE OF THIS INFORMATION AT ALL POINTS OF SERVICES MENTIONED IN THE LATTER SENTENCE. BROCHURES ARE ALSO AVAILABLE FROM THE CASHIERS, FINANCIAL COUNSELORS AND ELIGIBILITY SPECIALISTS. PATIENTS WERE PROVIDED INFORMATION ABOUT OBTAINING A COPY OF THE FINANCIAL ASSISTANCE POLICY (FAP) WITH BILLING INVOICES. THE FAP SUMMARY AND APPLICATION WERE NOT ON THE SAINT JOSEPH REGIONAL MEDCIAL CENTER WEBSITE DURING FISCAL YEAR 2013. SAINT JOSEPH REG. MED. CENTER- PLYMOUTH PART V, SECTION B, LINE 20D: PATIENTS WITH INCOME AT OR BELOW 150% OF THE FEDERAL POVERTY GUIDELINES (FPG) ARE ELIGIBLE FOR 100% CHARITY CARE WRITE OFF OF THE CHARGES FOR MEDICALLY NECESSARY SERVICES. PATIENTS WITH INCOME BETWEEN 151% AND 400% OF THE FPG RECEIVE A PERCENTAGE DISCOUNT OFF OF HOSPITAL CHARGES FOR MEDICALLY NECESSARY SERVICES, BASED UPON A SLIDING SCALE. PART VI, LINE 2: SAINT JOSEPH REGIONAL MEDICAL CENTER - PLYMOUTH ASSESSES THE HEALTH STATUS OF ITS COMMUNITY IN THE NORMAL COURSE OF OPERATIONS AND IN THE CONTINUOUS EFFORTS TO IMPROVE PATIENT CARE AND THE HEALTH OF THE OVERALL 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, IN THE ASSESSMENT OF THE COMMUNITY. ADDITIONALLY, SOME EMPLOYEES OF SJRMC PLYMOUTH ARE MEMBERS OF COMMUNITY AGENCIES, SUCH AS BREAD OF LIFE AND UNITED WAY. COMMUNITY INFORMATION IS SHARED WITH THE COMMUNITY BENEFIT LEADERS THAT ASSESS AND ADDRESS MARSHALL COUNTY HEALTH NEEDS. PART VI, LINE 3: PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE - SJRMC-PLYMOUTH IS COMMITTED TO:- PROVIDING ACCESS TO QUALITY HEALTHCARE 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 COMMUNITY.IN ACCORDANCE WITH AMERICAN HOSPITAL ASSOCIATION RECOMMENDATIONS, SJRMC-PLYMOUTH 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-PLYMOUTH PROVIDES EFFECTIVE COMMUNICATIONS 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. SJRMC-PLYMOUTH RECOGNIZES THE MANY CHALLENGES THAT FACE ITS UNINSURED AND UNDERINSURED PATIENTS WHEN APPLYING FOR STATE AND FEDERAL PROGRAMS TO HELP WITH HEALTHCARE EXPENSES. THEREFORE, SJRMC-PLYMOUTH ESTABLISHED THE ELIGIBILITY ASSISTANCE DEPARTMENT THAT UTILIZES A SOCIAL SERVICE APPROACH WITH A COMMITMENT TO PATIENT DIGNITY, COMPASSION, INTEGRITY AND PATIENT CENTERED CARE. HIGHLY TRAINED SPECIALISTS WHO KNOW AND UNDERSTAND THE DIFFERENT REQUIREMENTS FOR MANY LOCAL, STATE AND FEDERAL PROGRAMS STAFF THE ELIGIBILITY ASSISTANCE DEPARTMENT. ONCE IT IS DETERMINED THAT A PATIENT QUALIFIES FOR A PROGRAM, AN ELIGIBILITY SPECIALIST IS ASSIGNED TO THE PATIENT'S CASE. THE ELIGIBILITY SPECIALIST WORKS WITH THE PATIENT'S PROVIDERS, DEPARTMENT OF CARE MANAGEMENT, AND ALL APPROPRIATE STATE AND FEDERAL AGENCIES WHILE NAVIGATING THE PATIENT THROUGH PROCESSES. FINANCIAL COUNSELORS, IN CONJUNCTION WITH THE ELIGIBILITY ASSISTANCE DEPARTMENT, 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 HEALTHCARE SERVICES. EVERY EFFORT IS MADE TO DETERMINE A PATIENT'S ELIGIBILITY PRIOR TO OR AT THE TIME OF ADMISSION OR SERVICE. HOWEVER, DETERMINATION FOR FINANCIAL SUPPORT CAN BE MADE DURING ANY STAGE OF THE PATIENT'S STAY AFTER STABILIZATION OR COLLECTION CYCLE.SJRMC-PLYMOUTH OFFERS FINANCIAL SUPPORT TO PATIENTS WITH LIMITED MEANS. THIS SUPPORT IS AVAILABLE TO UNINSURED AND UNDERINSURED INDIVIDUALS WHO DO NOT QUALIFY FOR PUBLIC PROGRAMS OR OTHER ASSISTANCE. NOTIFICATION ABOUT FINANCIAL ASSISTANCE, INCLUDING CONTACT INFORMATION, IS AVAILABLE THROUGH VARIOUS MEANS, WHICH INCLUDE, BUT ARE NOT LIMITED TO, PATIENT BROCHURES, MESSAGES INCLUDED ON PATIENT BILLS, NOTICES IN PUBLIC REGISTRATION AREAS INCLUDING EMERGENCY ROOMS, URGENT CARE CENTERS, ADMITTING AND REGISTRATION DEPARTMENTS, HOSPITAL PATIENT ACCOUNTING DEPARTMENTS, AND OTHER PATIENT FINANCIAL SERVICES OFFICES THAT ARE LOCATED ON FACILITY CAMPUSES. SUMMARIES OF HOSPITAL PROGRAMS ARE MADE AVAILABLE TO THE INDIANA DIVISION OF FAMILY RESOURCES, UNITED WAY, THE LOCAL CHAPTER OF THE AMERICAN RED CROSS, THE AREA COUNCIL ON AGING, LOCAL PRIVATE AND PUBLIC SCHOOLS AND OTHER COMMUNITY HEALTH AND HUMAN SERVICES AGENCIES THAT ASSIST PEOPLE IN NEED. INFORMATION REGARDING FINANCIAL ASSISTANCE PROGRAMS IS ALSO AVAILABLE ON THE HOSPITAL WEBSITE AND IN THE DEPARTMENT ADMISSION PACKAGES. IN ADDITION TO ENGLISH, THIS INFORMATION IS ALSO AVAILABLE IN SPANISH, REFLECTING THE OTHER PRIMARY LANGUAGE SPOKEN BY THE POPULATION SERVICED BY THE HOSPITAL. SJRMC-PLYMOUTH HAS ESTABLISHED A WRITTEN POLICY FOR THE BILLING, COLLECTION AND SUPPORT FOR PATIENTS WITH PAYMENT OBLIGATIONS. SJRMC-PLYMOUTH 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. SJRMC-PLYMOUTH EDUCATES STAFF MEMBERS WHO WORK CLOSELY WITH PATIENTS (INCLUDING THOSE WORKING IN PATIENT REGISTRATION AND ADMITTING, FINANCIAL ASSISTANCE, CUSTOMER SERVICE, BILLING AND COLLECTIONS) ABOUT THESE POLICIES WITH AN EMPHASIS ON TREATING ALL PATIENTS WITH DIGNITY AND RESPECT REGARDLESS OF THEIR INSURANCE STATUS OR THEIR ABILITY TO PAY FOR SERVICES. ALL OF THE AFOREMENTIONED STAFF RECEIVE TRAINING ON TRINITY HEALTH'S MISSION, VISION AND CORE VALUES. THIS ALLOWS THE ASSOCIATES TO OFFER FINANCIAL ASSISTANCE TO PATIENTS WITH COMPASSION AND INTEGRITY, WHILE MAINTAINING THE PATIENT'S DIGNITY. PART VI, LINE 4: COMMUNITY INFORMATION - SJRMC-PLYMOUTH SERVES THE 103,559 RESIDENTS OF INDIANA'S SOUTHERN TIER, WHICH INCLUDES MARSHALL, FULTON, STARKE AND PULASKI COUNTIES. THESE COUNTIES ARE RELATIVELY RURAL IN NATURE WITH LIGHT INDUSTRY CENTERED IN THE TOWNS OF PLYMOUTH AND BREMEN. NEARBY CULVER IS THE HOME OF CULVER ACADEMIES, WHICH ATTRACTS STUDENTS TO INDIANA FROM ALL OVER THE WORLD. TOTAL POPULATION FOR THE SOUTHERN TIER SERVICE AREA IS EXPECTED TO GROW ONLY 1.5% FROM 2010 THROUGH 2015. COMPARED TO THE STATE OF INDIANA, THE SOUTHERN TIER HAS A LOWER PROJECTED POPULATION GROWTH AND A HIGHER MEDIAN AGE. INDIVIDUALS AGE 65 AND OLDER REPRESENT 15.2% OF THE TOTAL POPULATION, A PERCENTAGE THAT IS EXPECTED TO INCREASE 7.8% OVER THE NEXT FIVE YEARS.MEDIAN HOUSEHOLD INCOME IS BELOW THAT FOR THE STATES OF INDIANA, MICHIGAN AND OHIO, THOUGH IT REMAINS STABLE ACROSS THE REGION, WITH AREAS OF MARGINALLY HIGHER AFFLUENCE IN MARSHALL AND FULTON COUNTIES. AS IN MOST RURAL MID-WESTERN COMMUNITIES, THE POPULATION IS ALMOST EXCLUSIVELY MADE UP OF WHITE NON-HISPANIC INDIVIDUALS OF NORTHERN EUROPEAN DESCENT, THOUGH THERE HAS BEEN AN INCREASE IN THE HISPANIC POPULATION OVER THE PAST TEN YEARS.IN 2008, 9.6% OF INDIVIDUALS IN MARSHALL COUNTY LIVED IN POVERTY, WITH 12.2% OF FULTON COUNTY RESIDENTS, 15.4% OF STARKE COUNTY RESIDENTS AND 12.9% OF THOSE IN PULASKI COUNTY. IN INDIANA OVERALL, IN 2008 10.1% OF FAMILIES LIVED IN POVERTY. PART VI, LINE 5: OTHER INFORMATION - SJRMC-PLYMOUTH EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS. BY DOING SO, IT IS ABLE TO ENSURE THE COMMUNITY THAT HIGH QUALITY AND EASILY ACCESSIBLE CARE IS AVAILABLE IN A VARIETY OF PRIMARY AND SOME SPECIALTY CARE AREAS. REFERRALS FOR NEEDED SERVICES NOT AVAILABLE IN PLYMOUTH ARE EASILY MADE WITH SJRMC-MISHAWAKA OR OTHER LOCAL HOSPITALS.SJRMC-PLYMOUTH PRIDES ITSELF ON ITS RELATIONSHIP WITH SJRMC-MISHAWAKA, 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. INTERACTION OF THE MEDICAL STAFFS, ASSOCIATES, AND ANCILLARY SERVICES ALLOWS SJRMC-PLYMOUTH TO PROVIDE ITS PATIENTS WITH THE SAME LEVEL OF CARE OFFERED THE RESIDENTS OF THE CITIES OF SOUTH BEND AND MISHAWAKA.SJRMC-PLYMOUTH HAS 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 OF THIS PRIMARILY RURAL AREA TREATS PATIENTS WITH A RANGE OF MEDICAL NEEDS AND CAN TRANSPORT THEM TO OTHER HOSPITALS WHEN NECESSARY.SJRMC-PLYMOUTH PARTICIPATES IN MEDICARE, MEDICAID, TRICARE AND OTHER GOVERNMENT-SPONSORED HEALTH CARE PROGRAMS. THE HOSPITAL ALSO OFFERS CHARITY CARE AND CARE ON A SLIDING FEE SCALE. IN KEEPING WITH ITS MISSION STATEMENT AND VALUES, SJRMC-PLYMOUTH ASSURES UNINSURED PATIENTS THAT THEY RECEIVE THE SAME HIGH QUALITY MEDICAL CARE AS THOSE WHO ARE ABLE 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-PLYMOUTH SPONSORS A HEALTH CENTER THAT PROVIDES CARE SPECIFICALLY FOR THE UNINSURED. STAFFED PRIMARILY BY A MID-LEVEL PRACTITIONER IN A COLLABORATIVE AGREEMENT WITH LOCAL DOCTORS, THIS HEALTH CENTER SEES A HIGHLY DIVERSE POPULATION AND OFFERS SPECIALIZED CLINICS IN CHRONIC DISEASE MANAGEMENT, COUMADIN CARE, SMOKING CESSATION, HIV/AIDS, AND SUBSTANCE ABUSE. ADVOCACY FOR VARIOUS HEALTH-RELATED ISSUES IS AT THE FOREFRONT AT SJRMC-PLYMOUTH, INCLUDING EFFORTS RELATED TO OBTAINING HEALTH CARE FOR ALL, ELIMINATING THE HEALTH CARE DISPARITIES AMONG DIVERSE POPULATIONS AND OBTAINING AFFORDABLE PHARMACEUTICALS. SJRMC-PLYMOUTH CONTINUES TO BE THE LEADER IN FOUNDING AND FUNDING PROGRAMS THAT IMPACT THE HEALTH OF ITS COMMUNITIES, PROVIDING LOCAL SCHOOLS WITH ATHLETIC TRAINERS AND ESTABLISHING AN URGENT CARE CENTER.VOLUNTEERS WITHIN THE SJRMC-PLYMOUTH 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-PLYMOUTH 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 A REFLECTION/PRAYER ROOM, AND FULL-TIME CHAPLAINS AFFORD EVERYONE THE CERTITUDE THAT THE WHOLE PERSON AND HIS/HER CARE ARE ADDRESSED.SJRMC-PLYMOUTH 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-PLYMOUTH PARTICIPATES IN MANY OUTREACH COMMUNITY PROGRAMS AND SERVICES. SJRMC-PLYMOUTH WORKS WITH AND PROVIDES ASSISTANCE TO UNITED WAY OF MARSHALL COUNTY, THE AMERICAN CANCER SOCIETY, OUNCE OF PREVENTION, PLYMOUTH FIRE AND EMS, SCHOOL ATHLETIC TRAINING PROGRAMS AT ANCILLA COLLEGE, WINAMAC COMMUNITY, PLYMOUTH, CULVER, JOHN GLENN AND TRITON HIGH SCHOOLS, AND THE BOYS AND GIRLS CLUB. PART VI, LINE 6: SAINT JOSEPH REGIONAL MEDICAL CENTER - PLYMOUTH IS A MEMBER OF CHE TRINITY HEALTH, THE SECOND-LARGEST CATHOLIC HEALTH CARE SYSTEM IN THE COUNTRY. CHE TRINITY HEALTH ANNUALLY REQUIRES THAT ALL MEMBER ORGANIZATIONS DEFINE - AND ACHIEVE - COMMUNITY BENEFIT GOALS THAT INCLUDE IMPLEMENTING NEEDED SERVICES OR EXPANDING ACCESS TO SERVICES FOR LOW-INCOME INDIVIDUALS. AS A NOT-FOR-PROFIT HEALTH SYSTEM, CHE TRINITY HEALTH REINVESTS ITS PROFITS BACK INTO THE COMMUNITY THROUGH PROGRAMS SERVING THOSE WHO ARE POOR AND UNINSURED, HELPING MANAGE CHRONIC CONDITIONS LIKE DIABETES, PROVIDING HEALTH EDUCATION, PROMOTING WELLNESS AND REACHING OUT TO UNDERSERVED POPULATIONS. OVERALL, THE ORGANIZATION INVESTS MORE THAN $800 MILLION 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 EACH COMMUNITY'S SPECIFIC NEEDS. FOR MORE INFORMATION ABOUT CHE TRINITY HEALTH, VISIT WWW.NEWHEALTHMINISTRY.ORG. REPORTS FILED WITH STATES PART VI, LINE 7 IN 1 1 0 0 0 0 0 0 0 MICHAEL A EIFRID MD 0 260310 0 426 0 1071 0 30896 0 19333 0 312036 0 0 LORI PRICE 247226 0 29094 0 353 0 34259 0 19265 0 330197 0 0 0 JOSEPHINE RANDAZZO DO 0 534270 0 0 0 1215 0 19850 0 19410 0 574745 0 0 TOD A STILLSON MD 0 314014 0 0 0 942 0 19590 0 19178 0 353724 0 0 ALBERT GUTIERREZ 0 434245 0 167275 0 62185 0 59770 0 19768 0 743243 0 0 LORETTA SCHMIDT 124683 0 14398 0 1493 0 10029 0 19000 0 169603 0 0 0 JASON SCHULTZ 0 144267 0 0 0 214 0 7464 0 6534 0 158479 0 0 JANICE DUNN 0 280828 0 63623 0 24968 0 21050 0 16098 0 406567 0 0 JOSEPH SWEDISH 0 1402192 0 786411 0 1044897 0 572762 0 28714 0 3834976 0 520902 KEDRICK ADKINS 0 784856 0 366716 0 670047 0 112792 0 13375 0 1947786 0 265335 J RICHARD O'CONNELL 0 607209 0 284428 0 144773 0 97104 0 33319 0 1166833 0 0 KURT MEYER 0 209297 0 52111 0 1049 0 15400 0 17317 0 295174 0 0 KENNETH HALL 0 162705 0 45309 0 2297 0 14430 0 21236 0 245977 0 0 MICHAEL MURPHY 0 139488 0 0 0 41394 0 4650 0 11980 0 197512 0 0 AARON AUSTIN 0 45182 0 0 0 202824 0 7237 0 17264 0 272507 0 0 PART I, LINE 3 SAINT JOSEPH REGIONAL MEDICAL CENTER } PLYMOUTH CAMPUS IS A SUBSIDIARY IN THE TRINITY HEALTH SYSTEM. SAINT JOSEPH REGIONAL MEDICAL CENTER } PLYMOUTH CAMPUS' 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 SAINT JOSEPH REGIONAL MEDICAL CENTER } PLYMOUTH CAMPUS' 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 A SEVERANCE PAYMENT IN CALENDAR 2012. THIS AMOUNT IS INCLUDED IN COLUMN B(III): AARON AUSTIN - $179,577 PART I LINE 4B: THE FOLLOWING ARE PARTICIPANTS IN THE TRINITY HEALTH CASH BALANCE RESTORATION AND RETENTION PLAN, A NONQUALIFIED PLAN, WHICH PROVIDES RETENTION BENEFITS PLUS RETIREMENT BENEFITS FOR CERTAIN ASSOCIATES WITH EARNINGS ABOVE THE IRS PAY CAP FOR QUALIFIED PLANS ($250,000 FOR 2012). THE FOLLOWING ACCRUALS FOR 2012 FOR THIS PLAN ARE INCLUDED IN COLUMN C OF SCHEDULE J, PART II: KEDRICK ADKINS - $100,292 ALBERT GUTIERREZ - $47,270 RICHARD O'CONNELL - $77,104 JOSEPH SWEDISH - $543,977 PART II: THE FOLLOWING INDIVIDUALS ARE VESTED IN A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP). THE FOLLOWING VESTED SERP AMOUNTS ARE INCLUDED IN COLUMN B(III) OF SCHEDULE J, PART II: KEDRICK ADKINS - $185,540 JOSEPH SWEDISH - $530,000 COLUMN F OF SCHEDULE J INCLUDES THE PORTION OF THESE AMOUNTS THAT WERE REPORTED AS DEFERRED COMPENSATION IN PRIOR YEARS. FORM 990, PART VI, SECTION A, LINE 6 THE SOLE MEMBER OF SAINT JOSEPH REGIONAL MEDICAL CENTER - PLYMOUTH CAMPUS, INC. IS SAINT JOSEPH REGIONAL MEDICAL CENTER, INC. SEE LINE 7 FOR ADDITIONAL INFORMATION. FORM 990, PART VI, SECTION A, LINE 7A SAINT JOSEPH REGIONAL MEDICAL CENTER, INC. IS THE SOLE MEMBER OF SAINT JOSEPH REGIONAL MEDICAL CENTER - PLYMOUTH CAMPUS, INC. SAINT JOSEPH REGIONAL MEDICAL CENTER, INC. HAS THE RIGHT TO APPOINT ALL PERSONS TO THE BOARD OF DIRECTORS OF SAINT JOSEPH REGIONAL MEDICAL CENTER - PLYMOUTH CAMPUS, INC. FORM 990, PART VI, SECTION A, LINE 7B AS SOLE MEMBER, SAINT JOSEPH REGIONAL MEDICAL CENTER, INC. MUST APPROVE CERTAIN DECISIONS OF THE GOVERNING BODY, INCLUDING THE STRATEGIC PLAN, ANNUAL CAPITAL PLAN, AND ANNUAL OPERATING BUDGET. SAINT JOSEPH REGIONAL MEDICAL CENTER, INC. MUST ALSO APPROVE SIGNIFICANT CHANGES SUCH AS A MERGER, DISSOLUTION, SALE OF ASSETS IN EXCESS OF CERTAIN LIMITS, A MATERIAL CHANGE IN MISSION, AND MODIFICATIONS TO GOVERNING DOCUMENTS. FORM 990, PART VI, SECTION B, LINE 11 PRIOR TO FILING, THE FORM 990 FOR SAINT JOSEPH REGIONAL MEDICAL CENTER - PLYMOUTH CAMPUS, INC. 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 SAINT JOSEPH REGIONAL MEDICAL CENTER - PLYMOUTH CAMPUS, INC. HAS ADOPTED A CONFLICT OF INTEREST POLICY WHICH CONTAINS THE ELEMENTS IN THE MODEL CONFLICT OF INTEREST POLICY ISSUED BY THE IRS. IT APPLIES TO ALL "INTERESTED PERSONS" OF SAINT JOSEPH REGIONAL MEDICAL CENTER - PLYMOUTH CAMPUS, INC., WHICH INCLUDES DIRECTORS, PRINCIPAL OFFICERS AND EXECUTIVES, AND MEMBERS OF COMMITTEES WITH BOARD DESIGNATED POWERS. INTERESTED PERSONS ARE REQUIRED TO ACT AT ALL TIMES IN A MANNER CONSISTENT WITH SAINT JOSEPH REGIONAL MEDICAL CENTER - PLYMOUTH CAMPUS, INC.'S CHARITABLE PURPOSE AND SERVICE TO THE COMMUNITY AND TO AVOID CONFLICTS OF INTEREST. INTERESTED PERSONS ARE REQUIRED TO MAKE FULL DISCLOSURE TO SAINT JOSEPH REGIONAL MEDICAL CENTER - PLYMOUTH CAMPUS, INC. OF ANY FINANCIAL OR BUSINESS INTERESTS THAT MIGHT RESULT IN OR HAVE THE APPEARANCE OF A CONFLICT OF INTEREST. INTERESTED PERSONS ARE REQUIRED TO RECUSE THEMSELVES FROM DISCUSSION AND VOTING ON MATTERS INVOLVING A CONFLICT OF INTEREST. THE BOARD OF DIRECTORS OF SAINT JOSEPH REGIONAL MEDICAL CENTER - PLYMOUTH CAMPUS, INC. IS RESPONSIBLE FOR THE REVIEW AND APPROVAL OF TRANSACTIONS WITH INTERESTED PERSONS, INCLUDING DETERMINING THAT SUCH TRANSACTIONS ARE FAIR AND REASONABLE TO SAINT JOSEPH REGIONAL MEDICAL CENTER - PLYMOUTH CAMPUS, INC. 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 REVIEWED WITH THE BOARD OF DIRECTORS OF SAINT JOSEPH REGIONAL MEDICAL CENTER - PLYMOUTH CAMPUS, INC. ON AN ANNUAL BASIS. FORM 990, PART VI, SECTION B, LINE 15 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 CERTAIN OFFICERS AND KEY MANAGEMENT OFFICIALS OF SAINT JOSEPH REGIONAL MEDICAL CENTER- PLYMOUTH CAMPUS, INC. 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 HEALTHCARE 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 SAINT JOSEPH REGIONAL MEDICAL CENTER - PLYMOUTH CAMPUS, INC. 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 ANNUAL REPORT (WHICH INCLUDES COMMUNITY BENEFIT MINISTRY INFORMATION) AND CONSOLIDATED AUDITED FINANCIAL STATEMENTS ARE PUBLICLY AVAILABLE. IN ADDITION, SAINT JOSEPH REGIONAL MEDICAL CENTER - PLYMOUTH CAMPUS, INC. INCLUDES A COPY OF ITS MOST RECENTLY FILED SCHEDULE H ON TRINITY HEALTH'S WEBSITE AS WELL AS SAINT JOSEPH REGIONAL MEDICAL CENTER'S WEBSITE (WWW.SJMED.COM). CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 9: EQUITY TRANSFERS TO AFFILIATES: -7,096,165. FORM 990, PART XII, LINE 2: SAINT JOSEPH REGIONAL MEDICAL CENTER - PLYMOUTH CAMPUS, INC.'S FINANCIAL STATEMENTS WERE INCLUDED IN THE FY13 CONSOLIDATED FINANCIAL STATEMENTS OF TRINITY HEALTH, WHICH WERE AUDITED BY AN INDEPENDENT PUBLIC ACCOUNTING FIRM. ADVANTAGE HEALTHSAINT MARY'S MEDICAL GROUP 245 STATE ST SE GRAND RAPIDS MI 49503 272491974 HEALTHCARE SERVICES MI 501(C)(3) LINE 9 TRINITY HEALTH-MICHIGAN 0 AMICARE HOSPICE SERVICES INC 20555 VICTOR PARKWAY LIVONIA MI 48152 382949053 PROVIDE HOSPICE SERVICES MI 501(C)(3) LINE 9 TRINITY HOME HEALTH SERVICES INC 0 AUXILIARY OF HOLY ROSARY HOSPITAL 351 SW 9TH STREET ONTARIO OR 97914 943059469 SUPPORTS SERVICES OF RELATED HOSPITAL OR 501(C)(3) LINE 9 SAINT ALPHONSUS MEDICAL CENTER-ONTARIO 0 BAUM HARMON MERCY HOSPITAL 255 NORTH WELCH AVENUE PRIMGHAR IA 51245 421500277 ACUTE/AMBULATORY HEALTHCARE SERVICES IA 501(C)(3) LINE 3 MERCY HEALTH SERVICES-IOWA CORP 0 BAUM HARMON MERCY HOSPITAL & CLINICS FOUNDATION 255 NORTH WELCH AVENUE PRIMGHAR IA 51245 262973307 SUPPORT THE SERVICES OF RELATED HOSPITAL IA 501(C)(3) LINE 11A, I BAUM HARMON MERCY HOSPITAL 0 CATHERINE MCAULEY HEALTH SERVICES CORP PO BOX 995 ANN ARBOR MI 48106 382507173 FURTHER TRINITY HEALTH ACTIVITIES, ORGANIZE AND DEVELOP MEDICAL SERVICES MI 501(C)(3) LINE 11B, II TRINITY HEALTH-MICHIGAN 0 CHE TRINITY INC 20555 VICTOR PARKWAY LIVONIA MI 48152 900931907 HEALTHCARE SYSTEM MANAGEMENT AND SUPPORT IN 501(C)(3) LINE 11B, II N/A 0 COMMUNITY HEALTH PARTNERS OF SOUTH BEND PO BOX 3998 SOUTH BEND IN 46619 263051440 HEALTHCARE SERVICES IN 501(C)(3) LINE 3 SAINT JOSEPH REGIONAL MEDICAL CENTER INC 0 CRANBROOK HOSPICE CARE 1111 W LONG LAKE RD STE 102 TROY MI 48098 383320699 PROVIDE HOSPICE HEALTH SERVICES MI 501(C)(3) LINE 11A, I TRINITY HOME HEALTH SERVICES INC 0 DILEY RIDGE MEDICAL CENTER 6150 EAST BROAD STREET COLUMBUS OH 43213 342032340 HOSPITAL CAMPUS IN FAIRFIELD COUNTY OHIO OH 501(C)(3) LINE 3 MOUNT CARMEL HEALTH SYSTEM 0 DUBUQUE MERCY HEALTH FOUNDATION INC 250 MERCY DRIVE DUBUQUE IA 52001 262227941 SUPPORT THE SERVICES OF RELATED HOSPITAL IA 501(C)(3) LINE 11A, I MERCY HEALTH SERVICES-IOWA CORP 0 DYERSVILLE HEALTH FOUNDATION INC 1111 3RD STREET SW DYERSVILLE IA 52040 205383271 SUPPORT THE SERVICES OF RELATED HOSPITAL IA 501(C)(3) LINE 11A, I MERCY HEALTH SERVICES-IOWA CORP 0 GOTTLIEB COMMUNITY HEALTH SERVICES CORPORATION 701 W NORTH AVE MELROSE PARK IL 60160 363332852 SUPPORT THE SERVICES OF RELATED HOSPITAL IL 501(C)(3) LINE 9 GOTTLIEB MEMORIAL HOSPITAL 0 GOTTLIEB MEMORIAL FOUNDATION 701 W NORTH AVE MELROSE PARK IL 60160 743260011 SUPPORT THE SERVICES OF RELATED HOSPITAL IL 501(C)(3) LINE 11C, III-FI N/A 0 GOTTLIEB MEMORIAL HOSPITAL 701 W NORTH AVE MELROSE PARK IL 60160 362379649 HEALTHCARE SERVICES IL 501(C)(3) LINE 3 LOYOLA UNIVERSITY HEALTH SYSTEM 0 HACKLEY HOSPITAL 1700 CLINTON ST PO BOX 3302 MUSKEGON MI 494433302 381358196 HEALTHCARE SERVICES MI 501(C)(3) LINE 3 MERCY HEALTH PARTNERS 0 HACKLEY HOSPITAL SELF INSURANCE PROFESSIONAL LIABILITY TRUST PO BOX 3302 MUSKEGON MI 494433302 382299878 SELF INSURANCE FOR GENERAL AND MALPRACTICE LIABILITY MI 501(C)(3) LINE 11C, III-FI MERCY HEALTH PARTNERS 0 HACKLEY LIFE COUNSELING 1352 TERRACE ST MUSKEGON MI 494423545 381386362 COUNSELING, EDUCATION, AND 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