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MEMORIAL HOSPITAL OF SOUTH BEND: Form 990, tax year 2010

View the entire original 990 at ProPublica ↗

Organization
MEMORIAL HOSPITAL OF SOUTH BEND (EIN 35-0868132)
Tax period
2010-01-01 to 2010-12-31
Filed
2011-11-15
IRS object ID
201133199349306113
Schema version
2010v3.4
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2011-11-15T13:18:01-05:00Timestamp
Tax Period End Date2010-12-31TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1ERNST & YOUNG US LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1111 MONUMENT CIRCLEAddressLine1
CityINDIANAPOLISCity
StateINState
ZIP Code46204ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2010-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN350868132EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1MEMORIAL HOSPITAL OF SOUTH BEND INCBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlMEMONameControl
Phone5746473549Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1615 N MICHIGAN STREETAddressLine1
CitySOUTH BENDCity
StateINState
ZIP Code46601ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameJEFFREY COSTELLOName
TitleV.P./CFOTitle
Date Signed2011-11-15DateSigned

Preparer Preparer

FieldValueIRS element (for citing)
Phone3176817000Phone
FieldValueIRS element (for citing)
Tax Year2010TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonPHILIP NEWBOLDNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1615 N MICHIGAN STREETAddressLine1
CitySOUTH BENDCity
StateINState
ZIP Code46601ZIPCode
FieldValueIRS element (for citing)
Gross Receipts419825198GrossReceipts
Group Return For AffiliatesfalseGroupReturnForAffiliates
Organization501c3XOrganization501c3
Web Sitewww.qualityoflife.orgWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1923YearFormation
State Legal DomicileINStateLegalDomicile
Activity Or Mission DescriptionMEMORIAL IS COMMITTED TO IMPROVING THE QUALITY OF LIFE OF THE PEOPLE IN OUR COMMUNITY.ActivityOrMissionDescription
Nbr Voting Members Governing Body21NbrVotingMembersGoverningBody
Nbr Independent Voting Members14NbrIndependentVotingMembers
Total Nbr Employees3036TotalNbrEmployees
Total Nbr Volunteers547TotalNbrVolunteers
Total Gross UBI38888TotalGrossUBI
Net Unrelated Business Txbl Income13534NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year3220079ContributionsGrantsPriorYear
Contributions Grants Current Year5006001ContributionsGrantsCurrentYear
Program Service Revenue Prior Year394957158ProgramServiceRevenuePriorYear
Program Service Revenue CY372173020ProgramServiceRevenueCY
Investment Income Prior Year-777596InvestmentIncomePriorYear
Investment Income Current Year4909387InvestmentIncomeCurrentYear
Other Revenue Prior Year21237837OtherRevenuePriorYear
Other Revenue Current Year12921446OtherRevenueCurrentYear
Total Revenue Prior Year418637478TotalRevenuePriorYear
Total Revenue Current Year395009854TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY1222556GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year147694088SalariesEtcPriorYear
Salaries Etc Current Year148393083SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year203891263OtherExpensePriorYear
Other Expenses Current Year210491302OtherExpensesCurrentYear
Total Expenses Prior Year351585351TotalExpensesPriorYear
Total Expenses Current Year360106941TotalExpensesCurrentYear
Revenues Less Expenses Prior Year67052127RevenuesLessExpensesPriorYear
Revenues Less Expenses CY34902913RevenuesLessExpensesCY
Total Assets BOY622488889TotalAssetsBOY
Total Assets EOY638068406TotalAssetsEOY
Total Liabilities BOY201354161TotalLiabilitiesBOY
Total Liabilities EOY219938003TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY421134728NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY418130403NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionMEMORIAL IS COMMITTED TO IMPROVING THE QUALITY OF LIFE OF THE PEOPLE IN OUR COMMUNITY.MissionDescription
Significant New Program ServicesfalseSignificantNewProgramServices
Significant ChangefalseSignificantChange
Expense65561780Expense
Revenue157865066Revenue
DescriptionAncillary Services offers the following services for patients and facilities: - Imaging Services - Outpatient Physical, Occupational and Speech Therapy - Infusion Treatments - Radiation Oncology Therapy - Cancer Research - Cardiac Cath Lab - Sleep Lab - Interventional Radiology - Environmental Services - Nutritional Services - Pharmacy Services - Laboratory 2010 Statistics for this service unit include: - 453,328 Inpatient procedures - 292,525 Outpatient procedures - 1,359 Inpatient Caths - 1,519 Outpatient Caths - 295,014 Outpatient visits - 655,868 MealsDescription

Activity2 Activity2

FieldValueIRS element (for citing)
Expense56838457Expense
Revenue91592813Revenue
DescriptionPatient Care Unit Services provides a wide variety of hospital services including: - Inpatient rehabilitation CARF accredited - Medical - Post surgical - Orthopedic - Oncology - Intensive and intermediate - Heart and Vascular - Mother and Child - Special Care Obstetrics - Neonatal Intensive Care Level III - Emergency - Trauma Level II - Pediatrics - Pediatric Intensive Care - Pediatric Hematology Oncology - Medical Flight program - Pediatric Intensive Care Transports 2010 Statistics for this service unit include: - 84,088 Patient Days - 16,911 Inpatient ER visits - 96,481 Outpatient ER visits - 2,837 Births - 6,586 Observation stays - 235 Medical flights - 840 Full time equivalent employeesDescription

Activity3 Activity3

FieldValueIRS element (for citing)
Expense45258500Expense
Revenue99397638Revenue
DescriptionSurgical Services provides the following services: - General Surgery - Vascular Surgery - Cardiac Surgery - Orthopedic Surgery - Gynecological Surgery - Trauma Surgery - GI Labs - Pulmonary Services - Pain Center - DaVinci Robotic Surgery 2010 Statistics for this service unit include: - 8,085 Inpatient procedures - 366 Open Heart procedures - 18,363 Outpatient proceduresDescription
FieldValueIRS element (for citing)
Total Of Other Program Service Exp110300483TotalOfOtherProgramServiceExp
Total Of Other Program Service Grnt1222556TotalOfOtherProgramServiceGrnt
Total Of Other Program Service Rev27714847TotalOfOtherProgramServiceRev
Total Program Service Expense277959220TotalProgramServiceExpense
Described In501 C3trueDescribedIn501C3
Schedule B RequiredtrueScheduleBRequired
Political ActivitiesfalsePoliticalActivities
Lobbying ActivitiestrueLobbyingActivities
Donor Advised FundsfalseDonorAdvisedFunds
Conservation EasementsfalseConservationEasements
Collections Of ArtfalseCollectionsOfArt
Credit CounselingfalseCreditCounseling
Term Or Permanent EndowmentsfalseTermOrPermanentEndowments
Report Land Bldg EquiptrueReportLandBldgEquip
Report Invest Oth SecuritiestrueReportInvestOthSecurities
Report Prog Rel InvestfalseReportProgRelInvest
Report Other AssetsfalseReportOtherAssets
Report Other LiabilitiestrueReportOtherLiabilities
Report Fin48 FootnotefalseReportFin48Footnote
Independent Audit Financial StmttrueIndependentAuditFinancialStmt
Consolidated Audit Financial StmttrueConsolidatedAuditFinancialStmt
SchoolfalseSchool
Foreign OfficefalseForeignOffice
Foreign ActivitiestrueForeignActivities
More Than5000 K To OrganizationsfalseMoreThan5000KToOrganizations
More Than5000 K To IndividualsfalseMoreThan5000KToIndividuals
Professional FundraisingfalseProfessionalFundraising
Fundraising ActivitiesfalseFundraisingActivities
GamingfalseGaming
HospitaltrueHospital
Financial Stmt AttachedfalseFinancialStmtAttached
Grants To OrganizationstrueGrantsToOrganizations
Grants To IndividualsfalseGrantsToIndividuals
Schedule J RequiredtrueScheduleJRequired
Tax Exempt BondstrueTaxExemptBonds
Invest Tax Exempt BondstrueInvestTaxExemptBonds
Escrow AccountfalseEscrowAccount
On Behalf Of IssuerfalseOnBehalfOfIssuer
Excess Benefit TransactionfalseExcessBenefitTransaction
Prior Excess Benefit TransactionfalsePriorExcessBenefitTransaction
Loan To Officer Or DQPfalseLoanToOfficerOrDQP
Grant To Related PersonfalseGrantToRelatedPerson
Bsnss Rltnshp With OrganizationtrueBsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family MembertrueBsnssRltnshpThruFamilyMember
Officer Entity With Bsnss RltnshptrueOfficerEntityWithBsnssRltnshp
Deductible Non Cash ContributionsfalseDeductibleNonCashContributions
Deductible Contributions Of ArtfalseDeductibleContributionsOfArt
TerminatedfalseTerminated
Partial LiquidationfalsePartialLiquidation
Disregarded EntityfalseDisregardedEntity
Related EntitytrueRelatedEntity
Related Org Controlled EntitytrueRelatedOrgControlledEntity
Transaction Related EntitytrueTransactionRelatedEntity
Transfers To Exempt Non Chrtbl OrgfalseTransfersToExemptNonChrtblOrg
Activities Conducted PartnershipfalseActivitiesConductedPartnership
Schedule O RequiredtrueScheduleORequired
Number Forms Transmitted With1096382NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup WitholdingtrueComplianceWithBackupWitholding
Number Of Employees3036NumberOfEmployees
Employment Tax Returns FiledtrueEmploymentTaxReturnsFiled
Unrelated Business IncometrueUnrelatedBusinessIncome
Form990-T FiledtrueForm990-TFiled
Foreign Financial AccountfalseForeignFinancialAccount
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTrans
Taxable Party NotificationfalseTaxablePartyNotification
Non Deductible ContributionsfalseNonDeductibleContributions
Quid Pro Quo ContributionsfalseQuidProQuoContributions
Form8282 Property Disposed OffalseForm8282PropertyDisposedOf
Funds To Pay PremiumsfalseFundsToPayPremiums
Premiums PaidfalsePremiumsPaid
Indoor Tanning ServicesfalseIndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members21NbrVotingGoverningBodyMembers
Number Independent Voting Members14NumberIndependentVotingMembers
Family Or Business RelationshipfalseFamilyOrBusinessRelationship
Delegation Of Management DutiesfalseDelegationOfManagementDuties
Changes To Organizing DocsfalseChangesToOrganizingDocs
Material Diversion Or MisusefalseMaterialDiversionOrMisuse
Members Or StockholderstrueMembersOrStockholders
Election Of Board MemberstrueElectionOfBoardMembers
Decisions Subject To ApprovaltrueDecisionsSubjectToApproval
Minutes Of Governing BodytrueMinutesOfGoverningBody
Minutes Of CommitteestrueMinutesOfCommittees
Officer Mailing AddressfalseOfficerMailingAddress
Local ChaptersfalseLocalChapters
Form990 Provided To Governing BodytrueForm990ProvidedToGoverningBody
Conflict Of Interest PolicyfalseConflictOfInterestPolicy
Whistleblower PolicyfalseWhistleblowerPolicy
Document Retention PolicyfalseDocumentRetentionPolicy
Compensation Process CEOtrueCompensationProcessCEO
Compensation Process OthertrueCompensationProcessOther
Investment In Joint VenturetrueInvestmentInJointVenture
Written Policy Or ProceduretrueWrittenPolicyOrProcedure
States Where Copy Of Return Is FiledINStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonJEFFREY COSTELLONamePerson
Telephone Number5746473549TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1615 N MICHIGAN STREETAddressLine1
CitySOUTH BENDCity
StateINState
ZIP Code46601ZIPCode
FieldValueIRS element (for citing)
Info In Schedule O Part VIIXInfoInScheduleOPartVII

Form990 Part VII Section A Form990PartVIISectionA (34 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationKey EmployeeKeyEmployeeHighest Compensated EmployeeHighestCompensatedEmployee
Wellington Jones Jr
Chair through Mar 102.0XX431800
Charles Miller
Secretary2.0XX207300
Etta Nevel MD
Trustee2.0X105300
Robert Yount MD
Trustee; Employed Physician2.0X0250000
Keith Sherry MD
Trustee and medical director20.0X176435018498
Sandra Brown MD
Trustee thru Mar 102.0X301100
Faye Magneson MD
Trustee thru August 20102.0X409100
James Schwartz Sr
Trustee2.0X000
Gerard Duprat MD
Trustee Apr thru Dec 102.0X399000
Thomas Cassady Jr
V.C. thru Mar; Chair thru Dec2.0XX446000
Jesse Hseih MD
Trustee2.0X000
Maurice Hurwich MD
Trustee and medical director4.0X3267100
M Rose Meissner
Treas thru 3-10; VC thru 12-102.0XX000
Margaret King
Trustee2.0X000
Thomas Burish PhD
Trustee2.0X000
Thomas Hauch MD
Trustee2.0X000
Maria Slager
Trustee2.0X000
Perry Watson III
Treasurer2.0XX000
Gayle Rosencrantz
Trustee thru Mar 102.0X000
Steven Cramer PhD
Trustee2.0X305100
Melvin Hall
Trustee2.0X000
Delores Wilmoski
Trustee; Apr thru Dec 102.0X000
Peter Baranay
Trustee; Apr thru Dec 102.0X000
Carlton Lyons MD
Trustee; Apr thru Dec 102.0X279700
Philip Newbold
CEO/President2.0X01001875229464
George Soper
Asst. Secretary/VP2.0X024465199920
Jeffrey Costello
Asst. Treasurer/CFO2.0X046934899022
Kreg Gruber
COO40.0X436921098455
Connie M McCahill
Chief Nurse Officer / VP40.0222879044036X
Cheryl Wibbens - Lesh MD
Vice President Medical Staff40.0368127038149X
Robert Riley MD
Physician40.0286762039014X
Scott Thomas MD
Medical Director23.033530609968X
Thomas Sutula MD
Physician40.0220359037550X
Mark Lavallee
Physician40.0222761037417X
FieldValueIRS element (for citing)
Total Reportable Comp From Org2331065TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs1740874TotalReportableCompFrmRltdOrgs
Total Other Compensation751493TotalOtherCompensation
Number Individuals GT100 K99NumberIndividualsGT100K
Formers ListedfalseFormersListed
Total Comp GT150 KtrueTotalCompGT150K
Compensation From Other SourcesfalseCompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
SOUTH BEND EMERGENCY PHYSICIANS
615 N MichiganSOUTH BENDIN46601Physician services6320660
SOUTH BEND MEDICAL FOUNDATION
530 N Lafayette BlvdSOUTH BENDIN46601Lab services6172764
CERNER CORPORATION
2800 ROCKCREEK PARKWAYKANSAS CITYMO64117IS SFTWR MAINTENANCE3177987
INDIANA BLOOD CENTER
3450 N Meridian StreetINDIANAPOLISIN46208Blood Processing Svc3086064
WOODCOX BLDG CONTRACTORS
51175 PRESCOTT AVESOUTH BENDIN46637CONSTRUCTION MANAGER2005882
FieldValueIRS element (for citing)
Number Of Contractors GT100 K83NumberOfContractorsGT100K
Related Organizations3450860RelatedOrganizations
Government Grants1555141GovernmentGrants
Total Contributions5006001TotalContributions

Program Service Revenue ProgramServiceRevenue (5 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
NET PATIENT REVENUE621110370805467370805467
RENTAL REVENUE53200011733291173329
MEDICAL EDUCATION6117107746977469
CASH DISCOUNTS5614993427234272
AMBULANCE SUPPLY6219108248382483
FieldValueIRS element (for citing)
Total Program Service Revenue372173020TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column3296799TotalRevenueColumn
Exclusion$3,296,799ExclusionAmount

Income From Invest Bond Proceeds IncomeFromInvestBondProceeds

FieldValueIRS element (for citing)
Total Revenue Column91693TotalRevenueColumn
Exclusion$91,693ExclusionAmount

Royalties Revenue RoyaltiesRevenue

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn
Exclusion$0ExclusionAmount

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real62798Real

Less Rental Expenses LessRentalExpenses

FieldValueIRS element (for citing)
Real15164Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real47634Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column47634TotalRevenueColumn
Exclusion$47,634ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities26316575Securities
Other4500Other

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities24797573Securities
Other2607Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities1519002Securities
Other1893Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column1520895TotalRevenueColumn
Exclusion$1,520,895ExclusionAmount

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income From Gaming NetIncomeFromGaming

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income Or Loss NetIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnExclusionExclusionAmountRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
GAIN ON SWAP TERMINATION5614995270917$5,270,917
ATHLETIC CLUB7139401661156$1,661,156
MRI (JOINT VENTURE) INCOME56149913263111326311

Miscellaneous Revenue MiscellaneousRevenue

FieldValueIRS element (for citing)
Total Revenue Column4615428TotalRevenueColumn
Related Or Exempt Function Income3071033RelatedOrExemptFunctionIncome
Unrelated Business Revenue38888UnrelatedBusinessRevenue
Exclusion$1,505,507ExclusionAmount
FieldValueIRS element (for citing)
Total Other Revenue12873812TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column395009854TotalRevenueColumn
Related Or Exempt Function Income376570364RelatedOrExemptFunctionIncome
Unrelated Business Revenue38888UnrelatedBusinessRevenue
Exclusion$13,394,601ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total1222556Total
Program Services1222556ProgramServices

Grants To Domestic Individuals GrantsToDomesticIndividuals

FieldValueIRS element (for citing)
Total0Total

Foreign Grants ForeignGrants

FieldValueIRS element (for citing)
Total0Total

Benefits To Members BenefitsToMembers

FieldValueIRS element (for citing)
Total0Total

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total1058738Total
Program Services0ProgramServices
Management And General1058738ManagementAndGeneral
Fundraising0Fundraising

Comp Disqual Persons CompDisqualPersons

FieldValueIRS element (for citing)
Total40200Total
Program Services40200ProgramServices
Fundraising0Fundraising

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total114072645Total
Program Services85616439ProgramServices
Management And General28456206ManagementAndGeneral
Fundraising0Fundraising

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total5636316Total
Program Services4230315ProgramServices
Management And General1406001ManagementAndGeneral
Fundraising0Fundraising

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total19356492Total
Program Services14648769ProgramServices
Management And General4707723ManagementAndGeneral
Fundraising0Fundraising

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total8228692Total
Program Services6176013ProgramServices
Management And General2052679ManagementAndGeneral
Fundraising0Fundraising

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total0Total
Fundraising0Fundraising

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total171419Total
Management And General171419ManagementAndGeneral
Fundraising0Fundraising

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total214598Total
Management And General214598ManagementAndGeneral
Fundraising0Fundraising

Fees For Services Lobbying FeesForServicesLobbying

FieldValueIRS element (for citing)
Total14727Total
Program Services11053ProgramServices
Management And General3674ManagementAndGeneral
Fundraising0Fundraising

Fees For Services Prof Fundraising FeesForServicesProfFundraising

FieldValueIRS element (for citing)
Total0Total
Fundraising0Fundraising

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total1337932Total
Management And General1337932ManagementAndGeneral
Fundraising0Fundraising

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total37559161Total
Program Services28189553ProgramServices
Management And General9369608ManagementAndGeneral
Fundraising0Fundraising

Advertising Advertising

FieldValueIRS element (for citing)
Total77348Total
Program Services58053ProgramServices
Management And General19295ManagementAndGeneral
Fundraising0Fundraising

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total71927324Total
Program Services53983016ProgramServices
Management And General17944308ManagementAndGeneral
Fundraising0Fundraising

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total24426Total
Program Services18333ProgramServices
Management And General6093ManagementAndGeneral
Fundraising0Fundraising

Royalties Royalties

FieldValueIRS element (for citing)
Total0Total
Fundraising0Fundraising

Occupancy Occupancy

FieldValueIRS element (for citing)
Total6231210Total
Program Services4676811ProgramServices
Management And General1554399ManagementAndGeneral
Fundraising0Fundraising

Travel Travel

FieldValueIRS element (for citing)
Total783313Total
Program Services587913ProgramServices
Management And General195400ManagementAndGeneral
Fundraising0Fundraising

Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials

FieldValueIRS element (for citing)
Total0Total
Fundraising0Fundraising

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total211634Total
Program Services158841ProgramServices
Management And General52793ManagementAndGeneral
Fundraising0Fundraising

Interest Interest

FieldValueIRS element (for citing)
Total2675987Total
Program Services2008452ProgramServices
Management And General667535ManagementAndGeneral
Fundraising0Fundraising

Payments To Affiliates PaymentsToAffiliates

FieldValueIRS element (for citing)
Total0Total

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total24524075Total
Program Services18406450ProgramServices
Management And General6117625ManagementAndGeneral
Fundraising0Fundraising

Insurance Insurance

FieldValueIRS element (for citing)
Total2328440Total
Program Services1747602ProgramServices
Management And General580838ManagementAndGeneral
Fundraising0Fundraising

Other Expenses OtherExpenses (5 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
CORPORATE FEE21712987162965995416388
UNCOLLECTIBLE ACCOUNTS3743365937433659
DUES & SUBSCRIPTIONS889044666783222261
RECRUITMENT16181312144840365
WEARING APPAREL1260819463031451

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total2086124Total
Program Services1565732ProgramServices
Management And General520392ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total360106941Total
Program Services277959220ProgramServices
Management And General82147721ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY18825BOY
EOY19325EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY74667024BOY
EOY50012044EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
BOY462022BOY
EOY539700EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY70257527BOY
EOY61880211EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

FieldValueIRS element (for citing)
BOY68370BOY
EOY12376EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY11710633BOY
EOY13706162EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY1104326BOY
EOY1083100EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis541206724LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec261294425LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY274080186BOY
EOY279912299EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY103833867BOY
EOY123873292EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY73770696BOY
EOY99517740EOY

Investments Program Related InvestmentsProgramRelated

FieldValueIRS element (for citing)
BOY788973BOY
EOY765284EOY

Intangible Assets IntangibleAssets

FieldValueIRS element (for citing)
BOY0BOY
EOY1171474EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY11726440BOY
EOY5575399EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY622488889BOY
EOY638068406EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY39071682BOY
EOY34064199EOY

Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
BOY153845BOY
EOY14027EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY142195035BOY
EOY138791700EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY0BOY
EOY1780830EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY19933599BOY
EOY45287247EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY201354161BOY
EOY219938003EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY414636025BOY
EOY414391549EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY6498703BOY
EOY3738854EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY421134728BOY
EOY418130403EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY622488889BOY
EOY638068406EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses34902913ReconcilationRevenueExpenses
Reconcilation Other Changes-37907238ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or ReviewfalseAccountantCompileOrReview
FS AuditedtrueFSAudited
Audit CommitteetrueAuditCommittee
Financial Statement BothXFinancialStatementBoth
Federal Grant Audit RequiredtrueFederalGrantAuditRequired
Federal Grant Audit PerformedtrueFederalGrantAuditPerformed

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Total Grassroots LobbyingTotalGrassrootsLobbying
Total Direct LobbyingTotalDirectLobbying
Total Lobbying ExpendituresTotalLobbyingExpenditures
Other Exempt Purpose ExpendituresOtherExemptPurposeExpenditures
Total Exempt Purpose ExpendituresTotalExemptPurposeExpenditures
Lobbying NontaxableLobbyingNontaxableAmount
Grassroots NontaxableGrassrootsNontaxableAmount
Tot Lobbying Grassroot Minus Non TxTotLobbyingGrassrootMinusNonTx
Tot Lobby Expend Mns Lobbying NontxTotLobbyExpendMnsLobbyingNontx
VolunteersfalseVolunteers
Paid Staff Or ManagementfalsePaidStaffOrManagement
Media AdvertisementsfalseMediaAdvertisements
Mailings MembersfalseMailingsMembers
Publications Or BroadcastfalsePublicationsOrBroadcast
Grants Other OrganizationsfalseGrantsOtherOrganizations
Direct Contact LegislatorsfalseDirectContactLegislators
Rallies DemonstrationstrueRalliesDemonstrations
Rallies Demonstrations$14,727RalliesDemonstrationsAmount
Other ActivitiesfalseOtherActivities
Total Lobbying Expenditures IIB14727TotalLobbyingExpendituresIIB
Not Described In501c3falseNotDescribedIn501c3
Form4720 Filed4912 TaxfalseForm4720Filed4912Tax

Form990 Schedule C Part IV Form990ScheduleCPartIV

FieldValueIRS element (for citing)
IdentifierLobbying DetailIdentifier
Return ReferenceSchedule C, Part IVReturnReference
ExplanationMemorial Hospital paid dues to the following organizations for which the percentage listed was attributable to lobbying: AASM (American Academy of Sleep Medicine) - 1% AORN (Association of periOperative Registered Nurses) - flat amount $26.94 AOTA (American Occupational Therapy Association) - 13% ASET, Inc (American Society of Electroneurodiagnostic Technologists) - flat amount $25 Dietary Managers Association, Inc. - 2% Indiana Chamber of Commerce - 18% Indiana Hospital Association - 5.45% ISMA (Indiana State Medical Association) - 26% Society of Nuclear Medicine, Inc - 2% AAFP (American Academy of Family Physicians) - 20% Chamber of Commerce of St. Joseph County - 5%Explanation

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Art Public Exhibition AmtsArtPublicExhibitionAmts
Held Works Of Art AmtsHeldWorksOfArtAmts

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis18964553OtherCostOrOtherBasis
Book Value18964553BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis304348743OtherCostOrOtherBasis
Depreciation97503997Depreciation
Book Value206844746BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis722092OtherCostOrOtherBasis
Depreciation698406Depreciation
Book Value23686BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis202153138OtherCostOrOtherBasis
Depreciation160464371Depreciation
Book Value41688767BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis15018198OtherCostOrOtherBasis
Depreciation2627651Depreciation
Book Value12390547BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings279912299TotalOfBookValueLandBuildings
Financial DerivativesFinancialDerivatives
Closely Held Equity InterestsCloselyHeldEquityInterests

Other Securities OtherSecurities (2 entries)

DescriptionDescriptionBook ValueBookValue
BOND RESERVE FUND53000
ALTERNATIVE INVESTMENTS99464740
FieldValueIRS element (for citing)
Total Of Book Value Securities99517740TotalOfBookValueSecurities
Federal Income Tax Liability0FederalIncomeTaxLiability

Other Liabilities OtherLiabilities (4 entries)

DescriptionDescriptionAmountAmount
ASSET RETIREMENT OBLIGATION$4,137,590
INTEREST RATE SWAP$36,316,078
CAPITAL LEASE PAYABLE$1,707,226
BOND ARBITRAGE REBATE PAYABLE$3,126,353
FieldValueIRS element (for citing)
Total Of Amounts45287247TotalOfAmounts
Total Revenue395009854TotalRevenue
Total Expenses360106941TotalExpenses
Excess Or Deficit For Year34902913ExcessOrDeficitForYear
Other-$37,917,238OtherAmount
Total Adjustments-37917238TotalAdjustments
Excess Or Deficit Per FS-3014325ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt378814938TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments13417708NetUnrealizedGainsInvestments
Other Revenues-27657429OtherRevenues
Revenue Not Rptd F990-14239721RevenueNotRptdF990
Revenue Subtotal393054659RevenueSubtotal
Other Revenues Not Included1955195OtherRevenuesNotIncluded
Revenue Not Rptd On Fin Stmt1955195RevenueNotRptdOnFinStmt
Total Revenue Per Form990395009854TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt360111101TotExpensesEtcAuditedFinclStmt
Other Expenses Included4160OtherExpensesIncluded
Expenses Not Rptd F9904160ExpensesNotRptdF990
Expenses Subtotal360106941ExpensesSubtotal
Total Expenses Per Form990360106941TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (3 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
Change in Net AssetsPart XI Reconciliaton of Change in Net Assets from 990 to Audited Fin StmtUnrealized Loss on Swap Transactions (27,671,589) Transfers to Affiliates (21,016,908) Change in Interest in Recipient Org (2,759,849) Unrealized Gain on Investments 13,417,708 Capital Contributions 113,400 Total (37,917,238)
Reconciliation of RevenuePart XII Reconciliation of Revenue per Audited Fin Stmt w Revenue per 990Line 2d Other South Bend Chocolate Cafe Expense 15,164 Unrealized Loss on Swap Transaction (27,671,589) Expense Posted to Revenue (1,004) TOTAL (27,657,429) Line 4b Other Net Assets Released 1,955,195
Reconciliation of ExpensesPart XIII Reconciliation of Expenses per Audited Fin Stmt w Exp per 990Line 2d South Bend Chocolate Cafe 15,164 Ambulance donation (10,000) Expense classified as revenue 1,004) TOTAL 4,160

Schedule F IRS990ScheduleF

Accts Actvs Out US Table AcctsActvsOutUSTable

FieldValueIRS element (for citing)
RegionCentral America and the CaribbeanRegion
Type Of Activities ConductedInvestmentsTypeOfActivitiesConducted
Total Expenditures81581380TotalExpenditures
FieldValueIRS element (for citing)
Subtotal Amount Spent81581380SubtotalAmountSpent
Total Amount Spent81581380TotalAmountSpent
Transfer To Foreign CorptrueTransferToForeignCorp
Interest In Foreign TrustfalseInterestInForeignTrust
Own Foreign CorptrueOwnForeignCorp
Passive Foreign Invest CofalsePassiveForeignInvestCo
Foreign PartnershiptrueForeignPartnership
Boycott CountriesfalseBoycottCountries

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care PolicytrueCharityCarePolicy
Written PolicytrueWrittenPolicy
FPG Reference Free CaretrueFPGReferenceFreeCare
Pcent200XPcent200
FPG Reference Discounted CaretrueFPGReferenceDiscountedCare
Pcent350XPcent350
Free Disc Care Medically IndigenttrueFreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity CaretrueAmountsBudgetedForCharityCare
Expenses Exceeded BudgettrueExpensesExceededBudget
Unable To Provide CarefalseUnableToProvideCare
Annual Community Benefit ReporttrueAnnualCommunityBenefitReport
Report Publically AvailabletrueReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Total Community Benefit Expense6812762TotalCommunityBenefitExpense
Net Community Benefit Expense6812762NetCommunityBenefitExpense
Percent Of Total Expense0.02110PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Total Community Benefit Expense50709192TotalCommunityBenefitExpense
Direct Offsetting Revenue19718568DirectOffsettingRevenue
Net Community Benefit Expense30990624NetCommunityBenefitExpense
Percent Of Total Expense0.09600PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Total Community Benefit Expense57521954TotalCommunityBenefitExpense
Direct Offsetting Revenue19718568DirectOffsettingRevenue
Net Community Benefit Expense37803386NetCommunityBenefitExpense
Percent Of Total Expense0.11710PercentOfTotalExpense

Community Health Services CommunityHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense3998651TotalCommunityBenefitExpense
Direct Offsetting Revenue712373DirectOffsettingRevenue
Net Community Benefit Expense3286278NetCommunityBenefitExpense
Percent Of Total Expense0.01020PercentOfTotalExpense

Health Professions Education HealthProfessionsEducation

FieldValueIRS element (for citing)
Total Community Benefit Expense6051113TotalCommunityBenefitExpense
Direct Offsetting Revenue2405868DirectOffsettingRevenue
Net Community Benefit Expense3645245NetCommunityBenefitExpense
Percent Of Total Expense0.01130PercentOfTotalExpense

Research Research

FieldValueIRS element (for citing)
Total Community Benefit Expense820036TotalCommunityBenefitExpense
Direct Offsetting Revenue697447DirectOffsettingRevenue
Net Community Benefit Expense122589NetCommunityBenefitExpense
Percent Of Total Expense0.00040PercentOfTotalExpense

Cash And In Kind Contributions CashAndInKindContributions

FieldValueIRS element (for citing)
Total Community Benefit Expense1098235TotalCommunityBenefitExpense
Direct Offsetting Revenue225085DirectOffsettingRevenue
Net Community Benefit Expense873150NetCommunityBenefitExpense
Percent Of Total Expense0.00270PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense11968035TotalCommunityBenefitExpense
Direct Offsetting Revenue4040773DirectOffsettingRevenue
Net Community Benefit Expense7927262NetCommunityBenefitExpense
Percent Of Total Expense0.02460PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense69489989TotalCommunityBenefitExpense
Direct Offsetting Revenue23759341DirectOffsettingRevenue
Net Community Benefit Expense45730648NetCommunityBenefitExpense
Percent Of Total Expense0.14170PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense ReportedfalseBadDebtExpenseReported
Bad Debt Expense$14,791,196BadDebtExpenseAmount
Amount Attributable To7395598AmountAttributableTo
Amount Reimbursed By Medicare74496965AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare90796161CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall-16299196MedicareSurplusOrShortfall
Costing Methodology UsedCostingMethodologyUsed
Written Debt Collection PolicytrueWrittenDebtCollectionPolicy
Provision For Charity CaretrueProvisionForCharityCare
Number Of Hospital Facilities1NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA

FieldValueIRS element (for citing)
Facility Number1FacilityNumber

Name Name

FieldValueIRS element (for citing)
Business Name Line1Memorial Hospital of South BendBusinessNameLine1

Address Address

FieldValueIRS element (for citing)
Address Line1615 N Michigan StreetAddressLine1
CitySouth BendCity
StateINState
ZIP Code46601ZIPCode
FieldValueIRS element (for citing)
Licensed HospitalXLicensedHospital
General Medical And SurgicalXGeneralMedicalAndSurgical
Childrens HospitalXChildrensHospital
Teaching HospitalXTeachingHospital
Research FacilityXResearchFacility
Er24 HoursXEr24Hours

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1Memorial Hospital of South BendBusinessNameLine1
FieldValueIRS element (for citing)
Hospital Facility Number1HospitalFacilityNumber

Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC

FieldValueIRS element (for citing)
Number Of Other Facilities6NumberOfOtherFacilities

Other Facilities OtherFacilities (6 entries)

Address Line1Address/AddressLine1CityAddress/CityStateAddress/StateZIP CodeAddress/ZIPCodeFacility TypeFacilityType
MEMORIAL SLEEP DISORDER CENTER
53990 CARMICHAEL DRIVESOUTH BENDIN46601OUTPATIENT CLINIC PROVIDING SLEEP RELATED DIAGNOSIS AND TREATMENT
MEMORIAL HEALTH PLEX
111 W JEFFERSON STSOUTH BENDIN46601OUTPATIENT REHABILITATION FACILITY AND FITNESS FACILITY
MEMORIAL BREAST CARE CENTER
100 NAVARRE PLACESOUTH BENDIN46601OUTPATIENT DIAGNOSIS AND TREATMENT
MEMORIAL CHILDREN'S THERAPY CENTER
100 NAVARRE PLACESOUTH BENDIN46601OUTPATIENT DIAGNOSIS AND TREATMENT
MEMORIAL RADIOLOGY
100 NAVARRE PLACESOUTH BENDIN46601OUTPATIENT DIAGNOSIS AND TREATMENT
MEMORIAL LIGHTHOUSE PHYSICAL THERAPY
6913 N MAIN STREETGRANGERIN46530OUTPATIENT DIAGNOSIS AND TREATMENT

Form990 Schedule H Part VI Form990ScheduleHPartVI (17 entries)

IdentifierIdentifierExplanationExplanationReturn ReferenceReturnReference
Part I, Line 3cNot applicable
Part I, Line 6aThe Community Benefit Fund is the System's mechanism for re-investing funds to improve the health status of communities it serves. The System, which includes Memorial Hospital of South Bend Inc., tithes 10% of the previous year's bottom line and transfers it to the Community Benefit Fund for investment in the community. This investment is in addition to the Hospital's charity care and prevention, and education activities supported through its operating budget. The Community Health Enhancement Committee of the Board began the fund in 1993 and makes ongoing policy and oversees the administration of the fund and determines specific investment allocations. Volunteers and staff are committed to prudently investing these resources in an accountable manner. As a community not-for-profit organization, we take seriously our responsibility to invest our resources and energies into understanding and meeting the divergent health care needs of all, and ensure that everyone, regardless of their ability to pay, receives the care they need. Memorial has long been recognized for the collaboration efforts which engage individuals and organizations with diverse socio-economic religious, ethnic, race, age, and gender identity characteristics. Our team of passionate and dedicated health care professionals, along with many partners throughout the Northern Indiana and Southern Michigan (Michiana) region, helped us contribute significantly to the health and well-being of our community. In 2010, we provided charity care to 7,139 individuals. Further, Memorial plays a key role in serving the community as a whole. However, the above is only part of Memorial's community service and investment of the benefit's story. This report paints a picture, of how we touch and improve the health and the quality of lives throughout Michiana. It is a testimony to the commitment and leadership of our medical staff, volunteer board of trustees, employees, auxiliary volunteers, and community partners, whose dedication to serve, touch many lives and make our community a better place to live, work, and play.
Part I, Line 7, Column FBad Debt Expense removed from Total Expenses $37,433,659
Part I, Line 7gNot applicable
Costing MethodologyDonations - the actual cost of the donation or departmental net contribution, whichever is appropriate, from General Ledger records and reports are included In-Kind/Volunteer Services - When a specific person is listed as the event volunteer, the YTD hourly wage is pulled from the labor distribution report for 12/31, multiplied by the number of hours at the event or events. When a specific job class is listed (i.e. "peds rehab"), the average hourly wage is computed for all employees in that job class and department and used in the same manner. Benefits are added to each at a ratio of benefit dollars to total salaries, multiplied by total salaries calculated for the event.Part I, Line 7
Part III, Line 4The Corporation evaluates the collectability of its accounts receivable based on the length of time the receivable is outstanding, payor class, and the anticipated future uncollectible amounts based on historical experience. Accounts receivable are charged to the allowance for doubtful accounts when they are deemed uncollectible. Costing methodology is the same as tax form 990, schedule H, worksheet 2 methodology. Patient care cost adjusted by non-patient activity, expenses, and patient care charges.
Rationale for inclusion of the Medicare shortfall as a Community BenefitParticipation in the governmental Medicare program does not provide the opportunity for a hospital to negotiate a reimbursement rate or structure that would allow the hospital to cover the cost of the medical service rendered to the program participant, as would be the case in contractual negotiations with commercial insurance companies. Nor is the hospital allowed to provide only the services for which reimbursement covers the direct cost of care. This produces the same shortfall outcome as does the participation in the Medicaid program. The Medicaid program is recognized as a community benefit on Schedule H and on community benefit reports for most states. The quality and cost of the patient care is the same regardless of payor source. Hence the acceptance of Medicare reimbursement represents a reduction or relief of the government burden to pay the full cost of care provided.Part III, Line 8
Financial Assistance PolicyThe collection policy and procedures are as follows related to patients who are known to qualify for charity care or financial assistance: To ensure the Hospital fulfills its mission and commitment to the poor, the Hospital shall annually plan for and provide free health care and health-related services to the poor and qualified uninsured/underinsured. A patient is considered for Financial Assistance if all other State and Federal assistance opportunities have been exhausted. The Federal Income and Poverty Guidelines will serve as a guide in determining those patients that may qualify for Financial Assistance. All patients shall be treated consistently in the approval process including Medicare and non Medicare patients. PURPOSE: To provide financial assistance to those patients who cannot afford to pay and to provide discounted care to uninsured patients receiving healthcare services from Memorial Hospital of South Bend. PROCEDURE: 1.Memorial Hospital will assist patients in making a determination regarding whether or not the patient may be able to qualify for some form of entitlement through a Federal or State Government program and complete the appropriate applications for assistance. It is required that the patient will assist in the determination and application process. If the patient does not qualify for any Federal or State Assistance, we will start the Financial Assistance Approval process. 2.Identify patients potentially eligible for Financial Assistance through the pre-registration, admission, eligibility process, or through self pay account review and collection activities. 3.Provide to the patient a Financial Evaluation form. 4.Obtain or receive a signed, completed Financial Evaluation Form from the patient. 5.Determine eligibility by obtaining the following information from the patient: a)Gross income and most recent W-2 b)Prior years tax return (including all schedules) c)Last 3 pay stubs (if unemployed, Work One statement of earnings) d)Employment status and future earnings capacity e)Family size f)Medical expenses including drugs and medical supplies g)Last three bank statements If the patient does not have a prior year tax return, we will make our determination based on current income. A credit report may be run to substantiate documentation. There may be circumstances where a patient may not be able to provide all the above documentation needed to approve financial assistance. It will be up to the discretion of the Department Director and/or the CFO to grant approval in this circumstance. 6.Determine the amount of Financial Assistance by utilizing the Federal Poverty guidelines as a basis for qualification levels. Gross Annual income plus cash assets are used as the basis for income calculations. Financial Assistance will be granted for those patients who are homeless. If a patient is deceased and has no estate, we will grant charity on any outstanding self pay account balances. Documentation that an estate has not been filed will be attached to the Financial Assistance approval form. Note: Approval may be made based on Medical indigence. ie: Patients who have excessive pharmacy, oxygen, or ongoing medical expense. This amount would be deducted from their gross income. Financial Assistance will not be granted for non-medically necessary services. 7.Complete the Financial Assistance Approval form and forward to the Collection Coordinator. 8.The Collection Coordinator will review the Financial Assistance application to ensure that it is complete. The Coordinator will approve or deny the application before sending it to the Patient Account Manager for approval. Depending on the dollar amount of the financial assistance write off, approval signatures are required. The approval guidelines are as follows: $1.00 to $2,500.00 Collection Coordinator $2,501.00 to $10,000.00 Patient Account Service Manager $10,001.00 to $25,000.00 Director, Patient Account Services $25,001.00 and above Vice President, CFO 9. After all the appropriate signatures have been obtained, the Financial Assistance write off along with the corresponding documentation will be forwarded to Cash Application for write off. 10.Send determination letter to notify patient of the approval for Financial Assistance. 11.Financial Assistance approvals will apply retroactively to all open accounts with existing balances (including accounts in collections) and will be active for 6 months following the date of approval. 12.The document will be placed in the Financial Assistance file drawer under the date the write off was posted. UNINSURED SELF PAY DISCOUNTS For those patients who have no insurance and do not meet the above financial assistance guidelines, Memorial Hospital will provide an uninsured discount based on the following tiered structure: 30% discount if account is paid within 30 days from date of service 20% discount if account is paid within 90 days from date of service 10% discount if patient chooses to participate in the CarePayment financing Any exceptions must be approved by the Department Manager or Director.Part III, Line 9b
Needs AssessmentAt Memorial Hospital and Health System, our goal is to strengthen the health and well-being of our individual patients and neighbors, as well as the broader community. Grant dollars totaling $2,174,024 were obtained and blended with Memorial tithing dollars to deliver services and programs that impacted the physical health, mental health and quality of life of tens of thousands of individuals and families. Memorial invested $2,737,938 of tithing funds in community benefit, which in a time of economic upheaval is more important to building the vitality of our community than ever before. The services we provide are essential to not only the community's overall health, but also to the quality of life of every resident. This belief is supported in our culture; our volunteer board of trustees, physicians, nurses, patient care and support staff, and auxiliary volunteers take pride in the community outreach we do in the neighborhoods. It takes a whole system working together and committed to serving the inhabitants of our community. Our community is becoming increasingly diverse. The health risks associated with chronic diseases like diabetes, hypertension, and obesity, are particularly high among our growing, and often medically underserved, Hispanic and African-American populations. We reach out to these groups through churches, local community organizations, and grassroots efforts. Our goal is to help all residents access the care they need; to help them learn to manage their conditions and live healthier lives. In the past year, we collaborated with a number of organizations to gather information about the needs and strengths of our community residents. This information helps us to collaboratively determine our short- and long-term priorities as well as strategies for improving the overall community. Community Plunges provide opportunities for community and hospital leadership to spend time in the neighborhoods meeting with grassroots leaders and neighbors. Getting acquainted with the reality that many of us never see, and do not understand. Community Plunges have become a mainstay of Memorial's research into health and social ills as well as assets and strengths that influence and shape our community. (Plunges are offered annually, beginning in 1988 through 2010.) A committee of the Board of Trustees provides input and oversight into the decision-making of partnership opportunities, addressing the needs, building on the strengths of the community, and setting priorities for resource allocation. The Board Committee is composed of community members who serve on the four System-wide Boards of Directors. In addition, the division of Community Health Enhancement staff and employees of the Hospital and System are seated on most of the social service and health agencies boards and task forces in the community. This involvement provides a vehicle for ongoing communication, which flows continuously between the hospital and the community. The St. Joseph County Health Department Board is chaired by Memorial's Chief Nursing Officer. The CNO also has taken the lead in emergency preparation for the entire county. The greatest health and quality of life needs identified by the community include: - Access to primary and specialty care for the uninsured - Minorities disparities and access to prevention and disease management - Teen pregnancy and minority infant mortality In the coming year, the Hospital will be participating with the Health Department to develop the St. Joseph County Local Public Health System Performance Assessment as part of the State Department of Health's Indiana Public Health System Quality Improvement Program. Once this infrastructure is built through the identification and partnership of key stakeholders, the next activity will be the design and execution of the Community Health Needs Assessment. The projected timeline continues into the spring of 2012 through the strategic identification and planning stage to the implementation of activities to support the objectives based upon the priorities evidenced by the data.Part VI, Line 2
Patient Education and Eligibility for assistanceWhen uninsured patients present to our hospital, they are offered the opportunity to meet with our eligibility specialists. Our eligibility specialists discuss the potential eligibility of the patient for multiple assistance programs, including our own internal financial assistance program. Our statements also include a notice that financial assistance is available to patients, and they can contact our customer service group for guidelines.Part VI, Line 3
Community InformationHoosier Healthwise (HHW), Children of Special Health Care Services, and Healthy Indiana Plan (HIP), are programs provided through the State of Indiana, to provide health care for children, and adults ages ranging from birth to 64 years of age, as well as children with special health care needs and developmental delays. The Community Health Enhancement team provides education, resources and assistance for community-based enrollment for individuals and families in our community for these programs. Spanish-speaking team members assist with enrollment at all community sites. In 2010, the Community Health Enhancement team facilitated needed coverage being obtained for over 700 individuals in our community. Community Information (geography and demographics) Established in 1830, St. Joseph County, Indiana has become the fourth largest county in the state of Indiana. The county spans 467 square miles, which includes a comfortable mix of rural cultural heritage and urban amenities. St. Joseph County is also the regional center for higher education. The County is home to more than eight colleges and universities including but not limited to Notre Dame University, Indiana University, Purdue Ext., Bethel University and St. Mary's College. The heart of the Health System is located within a mile of the University of Notre Dame, 10 miles south of the Michigan state line, and 40 miles east of Lake Michigan. Through the years, the environment of South Bend, the largest city in St. Joseph County, has changed from a focus on manufacturing (Studebaker and Uniroyal) to one of service industry. In fact, among the ten largest employers in the county, just two represent manufacturing. The University of Notre Dame is the largest employer, followed by Memorial Health System, the South Bend Community School Corporation, AM General, and St. Joseph Regional Medical Center. St. Joseph County, the five contiguous counties comprising its secondary service area and 12 counties in its tertiary service area are characterized by a mix of small to mid-size metropolitan areas and rural communities. Population mix is diverse and includes large numbers of first-generation European immigrants, African Americans, Asians, Hispanics, and Amish. The population for St. Joseph County in 2010 was 268,299 individuals. The race in the County is 80% Caucasians, 11.8% African America, and Hispanics represent 6.6, with 1.6 listed as Other. As expected, with an area saturated with post-secondary education, the county has higher than would be projected educational level. Thirty-three percent of the population is high school graduates, 19.4% have some college, 23.3% have graduated from college, and 10.3% have completed post graduate classes. The average household income was $61,271. Of the primary and secondary Memorial service area, St. Joseph County is the largest, with a population just over 274,372 followed by Elkhart County with just over 197,098. Elkhart County continues to have an industrial focus as a major center of the automotive, recreational vehicle, manufactured housing and musical instrument industries. Additional secondary service area counties and their populations include Berrien (MI) 174,642, LaPorte (IN) 109,124; Cass (MI) 43,701 and Marshall (IN) 50,099. Our service area includes patients from St. Joseph and surrounding counties in Indiana and Michigan; a pediatric emergency transport program serving 18 counties; and our MedFlight helicopter that covers communities within a 150-mile radius. We have the region's only Level 3 Newborn Intensive Care Unit, the only Pediatric Intensive Care Unit and the only Pediatric Hematology/Oncology program in the area. Memorial is also the only hospital in the region with Pediatric Hospitalist and Child Life programs. Memorial is not only recognized nationally as a leader in providing high quality care, but also as a leader in innovation, offering new approaches to patient satisfaction and customer service that set us apart from other health care providers. As the region's only designated children's hospital, Memorial Children's Hospital welcomes and treats children with a wide variety of medical and surgical diagnoses from more than 20 referral hospitals throughout Southwestern Michigan and Northern Indiana. Our world-class team includes pediatric hospitalists and intensivists, registered nurses, child life specialists, pediatric diabetic educators, pediatric dietitians, social workers, neonatologists, pediatric oncologists, respiratory therapists, clinical nurse specialists, pastoral care, and pediatric specialists in physical therapy, pulmonary medicine and infectious disease. Memorial Hospital and Health System also serves the community with Memorial Neighborhood Health Center - Southeast Clinic, and the Central Neighborhood Clinic at the Center for the Homeless. These two clinics offer primary health care services including all basic services as well as family planning and reproductive health, low-risk obstetrics, and colonoscopy services. Services are available to anyone, and our fees are within the customary range for your community. We accept Medicaid, Medicare and private insurance, and offer a sliding fee scale based on income guidelines for uninsured. We also participate in Hoosier Healthwise, the CHIP program that provides healthcare for Indiana children, pregnant women and low-income families. Other hospitals in our region include: St. Joseph Regional Medical Center, Elkhart General Hospital, Goshen Hospital and Lakeland Health Care. Education and Research for a Healthy Future We consider education and research to be part of our mission. Each is vital to preparing the next generation of health care professionals to meet future health care demands. As our country ages, we will need more caregivers than ever before; at the same time, there is a shortage of new graduates in key clinical and technical positions. To ensure that we have the quality workforce we need to care for our patients in the future, we are committed to the education of current and future caregivers, and have partnered with local high schools, colleges, universities and Indiana University Medical School at Notre Dame. Preparing for tomorrow's health care needs also requires a commitment to researching new and innovative treatments that battle tomorrow's health care challenges. Clinical research is a part of programming across the Health System. Memorial Medical Group participates in a significant number of pharmaceutical trials annually; physicians in the Hospital participate in various research projects that are national in scope and are evaluated by FDA guidelines by Memorial's Institutional Review Board. Memorial is also a member of an Oncology Consortium which does cancer-related research with grants funding in excess of $853,600. Our medical staff is working to find tomorrow's treatments and cures today. Research also evolves from the nursing, pre-medical and social service disciplines at the local post-secondary education institutions. The University of Notre Dame is a close partner in community-based research, which includes evaluating education curricula, intervention modalities, and quantitative analysis as well as qualitative research methods. Together, we offer a comprehensive learning experience for medical students, enabling interns, residents, and fellows to utilize our state-of-the-art training facilities and integrate advanced technology learned in the classroom directly with patient care. Together, we further the evidence of community-based research in addition to clinical research, particularly in the intersection of neuroscience and medical interventions, such as the impact of chemotherapy on the memory and cognitive functioning of breast cancer victims.Part VI, Line 4
Community Building ActivitiesAll information included in Part I, see 'Other Information Required'.Part VI, Line 5
Part VI, Line 6Community plunges were developed at Memorial 23 years ago. The first was the Aging Plunge, which looked at the plight of an aging society, living independently as long as possible, often isolated, suffering from depression, had little opportunities for socialization, and was mismanaging their health with polypharmacy resulting in counter indications, and dangerous interactions, from seeing different physicians to treat many different diseases and ailments. Board members, staff, and community leaders spend a few hours together delving into the problems confronting our society; personally interacting with an Alzheimer's victim, a gang member, a cocaine addict, a child in the midst of family and neighborhood, a mother whose two-year-old had suffered a Sickle Cell stroke, homeless children with developmental delays, bright children of immigrants without citizenship and in dead-in jobs, rural communities without sufficient access to medical care, pregnant teens, and high school drop-outs. In 2010, Memorial invested $26,087 in acquainting Community Leaders with the needs in the community through their participation in plunges. Over the past two decades, these forays into the community have educated us about the reality of poverty, of being uninsured, pregnant with the tenth child, with only two living babies, both with severe disabilities. The stories often move us to tears, which makes the learning even more poignant and the reality more urgent. Two plunges that have influenced outreach programming have been (a) "Enough is Enough: Violence as a Public Health Mandate," and (b) "High School Drop Out" which incorporated a number of opportunities for youth who had dropped out to tell their stories about the bearing it has had on their life and economic health. Included in the plunge was "The Pact" - shared by three doctors who grew up in public housing in Newark; had brushes with the law, and succeeded in their middle-school pact to become doctors. The teens from Washington High School, who spent time with The Three Doctors, developed an anti-violence mime which was produced along with a discussion guide by the group. The students then formed and named their team 212-degrees. This skit and the 212-degree teens were instrumental in participating in the Civic League's competition which resulted in South Bend being named one of the top ten cities in the nation. Quality of Life Programs Memorial's Community Health Enhancement team innovatively served Michiana with a wide range of effective, evidence-based and fiscally-responsible programs and initiatives in 2010. Community Health Enhancement's programs reached across the life span, ensuring healthy pregnancies, productive senior years, and proactive disease management now and wise investment in our community's future. Pre-Natal Programs Community Health Enhancement's team provided a variety of programs for expectant mothers with two common goals - helping the women stay healthy, and helping their babies be born healthy - and one common denominator: caring staff skillful at building trusting relationships. Specific 2010 highlights include: Keeping pregnant women alcohol free throughout pregnancy through Foundations for Alcohol Cessation, Education, and Support. Educators teach expectant women about alcohol's harmful effects on fetal brain development and screen for alcohol use during pregnancy. 22% of women screened in 2010 received an intervention, and 98% who were followed remained alcohol-free throughout their pregnancy. Numbers Served: 3,271 The establishment of Black American Mothers Breastfeeding Awareness Initiative, a local initiative to increase awareness of the benefits of breastfeeding throughout the African American Community. This group is also studying reasons African American women are less inclined to breastfeed than their white and Latina peers. Bedtime Basics for Baby: This First Candle program educates families about safe infant sleep practices and provides free pack and play cribs. Numbers Served: 180 Pre-natal Care Coordination educators work with clients to reduce barriers to receiving prenatal care and connect them with resources such as breastfeeding classes, medical and mental health care providers and insurance programs, programs teaching parenting and childcare skills, immunization resources, and the BABE store. 275 Pregnant women were served, Almost daily science and medicine are making groundbreaking discoveries that will forever change how we: -focus on building a strong brain foundation during the critical early childhood development years, -help teens navigate new brain impulses toward risky behaviors on their way to learning reasoning and judgment, -understand and use our own brain to find efficiency, focus, and calm in this overwhelming world of many distractions and obligations, -best assure a vibrant mind and working memory able to be resilient against Alzheimer's and dementia. In 2010, BrainWorks continued innovating at the intersection of lifestyle, science and medicine offering actionable step to bring the insights of neuroscience into daily life to a total of over 4600 attendees. Feedback from programs confirmed the relevance of this information with 88% of individuals stating that some or all the information they learned was new to them, and that they intended to make changes in their life because of it. BrainWorks chartered new territory in an early childhood development plunge by bringing together the views from academic research, pediatrics and NICU care, school psychology, and parenting for an art based learning journey about best practices in early childhood brain health and development. In follow-up to this, BrainWorks awarded mini-grants of up to $5,000 to each of five local non-profits so they could add brain-based childhood development programming to their services to children between the ages of 0 - 4, or to create additional capacity in well orchestrated existing programs that support healthy brain development. This nicely supplemented the success BrainWorks achieved in influencing mother/child play practices through the redesign of play spaces, the most recent of which was implemented at the YWCA in conjunction with and with support from the Junior League of South Bend's Done in a Day projects. In the business community, BrainWorks provided 65 brain health based programs to 1775 individuals ranging from a full-day conference to the Mendoza School of Business team to break out sessions for the St. Joseph County Public Libraries professional development day to being part of courses offered at IUSB, Holy Cross College, and the University of Notre Dame. BrainWorks continue to partner with others for the purpose of contributing to research that results in useable information to our community. In conjunction with Indiana University South Bend and Memorial Sleep Lab, BrainWorks kicked off a research project exploring the impact of sleep variability on cognitive processes in two differently aged populations. Running concurrently with this, and staged to begin in spring of 2011, a second research project assessing a non-medical protocol to improve the side effects of Community Health Enhancement commonly called chemobrain will begin. And lastly, BrainWorks was proud to be able to continue the over a decade long tradition of bringing national experts in to speak to the community. Dr. Bruce Perry, national expert in brain-based remediation for children of trauma presented to service providers, physicians, and the general public. And through the generous support of the Butler-Oare Foundation, Dr. James Rippe, national lifestyle medicine expert provided an educational program for the physicians of our community and a complementary evening program to the public on improving mind and body health through lifestyle changes. Health Education and Outreach for At-Risk, Underserved Populations The Health System's innovative community outreach has received national recognition for models of involvement as well as state and federal grants to assist in the support of some of these programs. African American Women in Touch, provides breast care information, education, and screenings. Forty women were referred to the free community-based gestational diabetes program (Bebes Dulces sin Azucar: Sweet Babies without Sugar); there were no babies born over ten pounds, overall birth outcomes were positive, and mothers returned to normal glucose readings six-weeks post-partum. Memorial was in collaboration with the Health Department to address the potential influenza pandemic; as well as preparing the community for a national and/or regional disaster. Additional Spanish-speaking education and screens for cancer included breast screens for Latino women, and Latino men were screened for prostate cancer. A program for African American men had been introduced at a local barbershop, to increase awareness and encourage men to make behavioral changes to monitor their blood pressur
Affiliated Health Care System RolesSee 'Other Information Required'.
Financial AssistancePatients are notified on their statements that financial assistance is available.
Charges for Medical CareUninsured patient accounts do not have discounts posted automatically.
STATE FILING OF COMMUNITY BENEFIT REPORTIN,990 SCHEDULE H, PART VI

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records MaintainedtrueRecordsMaintained

Recipient Table RecipientTable (26 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEIN Of RecipientEINOfRecipientIRC SectionIRCSectionAmount Of Cash GrantAmountOfCashGrantPurpose Of GrantPurposeOfGrantAddress Line2AddressUS/AddressLine2Amount Of Non Cash AssistanceAmountOfNonCashAssistance
BIKE MICHIANA COALITION INC
66841 WALNUT RDWALKERTONIN46574263357356501(c)(3)7100DONATION
NORTHERN INDIANA HISTORICAL SOCIETY INC
808 W WASHINGTONSOUTH BENDIN46601351124156501(C)(3)10600GOLD SPONSORSHIP
COMMUNITY COORDINATED CHILD CARE OF ST JOSEPH CNTY
401 E COLFAX AVESOUTH BENDIN46617351389028501(C)(3)76721SPONSORSHIPSUITE 210
COMMUNITY FOUNDATION OF ST JOSEPH COUNTY
PO BOX 837SOUTH BENDIN46624237365930501(C)(3)10000SPONSORSHIP AFRICAN AMERICAN COMM
EL CAMPITO INC
1024 THOMAS STSOUTH BENDIN46601351438892501(C)(3)8160CHE MINI GRANT
FAMILY & CHILDREN'S CENTER CDS
1411 LINCOLNWAY WESTMISHAWAKAIN46544351404782501(C)(3)57000CHAG 2010
GRACE COMMUNITY CENTER INC
PO BOX 1671SOUTH BENDIN46634351900380501(C)(3)25000VOYAGES 2010
HABITAT FOR HUMANITY INTERNATIONAL INC
402 E SOUTH STSOUTH BENDIN46601311196894501(C)(3)10000WOMEN BUILD 2010
HISPANIC LEADERSHIP COALITION INC
PO BOX 3744SOUTH BENDIN46619352151895501(c)(3)5250SPONSORSHIP
RESCUE INC
PO BOX 4488SOUTH BENDIN46634351038532501(C)(3)750002010 HOPE FOR KIDS
INNOVATION PART AT NOTRE DAME INC
1400 E ANGELA BLVDSOUTH BENDIN46634943445005501(C)(3)10000CONTRIBUTION
MEDICAL EDUCATION FOUNDATION INC
PO BOX 1132SOUTH BENDIN46634351291588501(C)(3)15000MED BALL BENEFACTOR
NEAR NORTHWEST NEIGHBORHOOD
PO BOX 1132SOUTH BENDIN46624237414729501(C)(3)35000CONTRIBUTION
NORTHEAST NEIGHBORHOOD REVITALIZATION ORGANIZATION
803 LINCOLNWAY WESTSOUTH BENDIN46616352118149501(C)(3)50000CONTRIBUTION
O'HANA HERITAGE FOUNDATION INC
PO BOX 186SOUTH BENDIN46624371523448501(C)(3)80000CONTRIBUTION
PENN-HARRIS-MADISON EDUC FOUNDATION INC
55900 BITTERSWEET RDMISHAWAKAIN46545351996785501(C)(3)7000RUNNING FOR EDUCATION
PROJECT FUTURE CHARITABLE FUND
401 E COLFAXSOUTH BENDIN46617311033632501(C)(3)120000CONTRIBUTION
SALVATION ARMY
540 S CARROLL STSOUTH BENDIN46601362167910501(c)(3)50000CONTRIBUTION
SJC BRIDGES OUT OF POVERTY INC
117 N LAFAYETTE BLVDSOUTH BENDIN46601263195466501(C)(3)73160CONTRIBUTION
SOUTH BEND HERITAGE FOUNDATION INC
803 LINCOLNWAY WESTSOUTH BENDIN46601237394320501(C)(3)72500CONTRIBUTION
SOUTH BEND SYMPHONY
127 N MICHIGAN STSOUTH BENDIN46601356042189501(C)(3)10000STRYCKER MUSIC
THE NATIONAL FOOTBALL FOUNDATION & COLLEGE HALL OF
1105 CLERMONTH DRSOUTH BENDIN46617351436531501(C)(3)52502010 ENSHRINEMENT
UNIVERSITY OF NOTRE DAME DU LAC
731 GRACE HALLNOTRE DAMEIN46556350868188501(C)(3)115545CONTRIBUTION
MICHIANA PUBLIC BROADCASTING CORPORATION
300 W JEFFERSONSOUTH BENDIN46601351155594501(C)(3)105430SPONSORSHIP
STUDEBAKER NATIONAL MUSEUM INC
201 S CHAPIN STREETSOUTH BENDIN46601351555535501(C)(3)20000CONTRIBUTION
SAINT JOSEPH COUNTY POLICE DEPARTMENT
401 SOUTH SAMPLE STREETSOUTH BENDIN46601356000194AMBULANCE10000
FieldValueIRS element (for citing)
Total Nbr Of501 C3 And Govt Grants29TotalNbrOf501C3AndGovtGrants
Total Nbr Of Other Organizations0TotalNbrOfOtherOrganizations

Form990 Schedule I Part IV Form990ScheduleIPartIV

FieldValueIRS element (for citing)
IdentifierGRANT MONITORING PROCEDURESIdentifier
Return ReferenceSCHEDULE I, PART IVReturnReference
ExplanationPart of the Organization's mission is to improve the health of our community. In order to fulfill this goal, our Administrators have the ability to make donations to Organizations that improve the health and well being of our community.Explanation

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
First Class Or Charter TravelXFirstClassOrCharterTravel
Travel For CompanionsXTravelForCompanions
Idemnification Gross Up PaymentsXIdemnificationGrossUpPayments
Club Dues Or FeesXClubDuesOrFees
Written Policy Re T And E ExpensestrueWrittenPolicyReTAndEExpenses
Substantiation RequiredtrueSubstantiationRequired
Compensation CommitteeXCompensationCommittee
Independent ConsultantXIndependentConsultant
Written Employment ContractXWrittenEmploymentContract
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance PaymentfalseSeverancePayment
Supplemental Nonqual Retire PlantrueSupplementalNonqualRetirePlan
Equity Based Comp ArrangementfalseEquityBasedCompArrangement
Comp Based On Revenue Of Filing OrgfalseCompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related OrgsfalseCompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing OrgtrueCompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate OrgstrueCompBasedNetEarningsRelateOrgs
Any Non Fixed PaymentsfalseAnyNonFixedPayments
Initial Contract ExceptionfalseInitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (11 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
Philip Newbold
0556903030435501406170210175019289012313390140555
George Soper
0178933044616021102078746021174034457100
Jeffrey Costello
02731860106000090162084363014659056837000
Keith Sherry MD
1764350000062810122170194933000
Kreg Gruber
29822401194800192170722500262050535376000
Cheryl Wibbens - Lesh MD
296356070042017290196710184780406276000
Connie M McCahill
1690430420730117630298140142220266915000
Robert Riley MD
28203300047290275870114270325776000
Scott Thomas MD
33501400029209968000345274000
Thomas Sutula MD
21487800054810202470173030257909000
Mark Lavallee
197208020892046610187090187080260178000

Form990 Schedule J Part III Form990ScheduleJPartIII (3 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
Health Club and Spousal TravelSchedule J, Part I, Line 1AMemorial Hospital reimburses trustees for the tax effect of the 1099 reportable benefits for health club membership with Memorial's Health and Lifestyle Center and spousal travel. This reporting impacts 11 current Board Members. Memorial Hospital also reimburses for direct expenses related to any travel on Memorial's behalf. Social club membership included in taxable compensation - 2 employees (Jeff Costello and Kreg Gruber) Spousal travel included in taxable compensation - 1 employee (Philip Newbold) CHARTER TRAVEL FOR INVESTMENT COMMITTEE MEMBERS TO TRAVEL TO INVESTMENT ADVISOR, LOCATED IN MINNEAPOLIS. CHARTER TRAVEL ALLOWED THE ORGINIZATION TO REDUCE THE OVERALL COST OF TRAVEL, BY ELIMINATING THE NEED FOR OVER NIGHT ACCOMIDATIONS. THE CHARTER TRAVEL ALSO REDUCED THE TIME UNPAID BOARD MEMBERS HAD TO COMMIT. (1 INDIVIDUAL LISTED ON PART VII, SECTION LINE 1A - JEFFREY COSTELLO)
Supplemental Non-Qualified Retirement PlanSchedule J, Part I, Line 4BRelated Organization (Memorial Health System, Inc.) 2010 Earned Vested 457(f) Phillip Newbold $108,930 Jeffrey Costello $ 66,001 Memorial Health System provides a non-qualified Supplemental Executive Retirement Program (SERP) to certain executives. The plan provides for an added retirement benefit over the qualified retirement program. Qualified individuals are eligible to receive a benefit, in the form of an after tax lump sum which is the actuarial equivalent of an annuity equal to 65% of the average of their last five years of preretirement earnings, or 70% with more than 25 years of service, with offsets for the value of social security and qualified retirement plan benefits. Participants vest into the SERP after five years of service. The increase in value of the benefit each year is included in the taxable compensation of vested SERP participants. Such amounts are included in Part II Column (b) (iii). The annual value of the benefit is converted to a lump sum and paid to the participant after fulfilling the terms of their non-compete agreement.
Compensation Contingent on Net EarningsSchedule J, Part I, Line 6A & 6BThe related organization has 2 incentive plans (employee and management) which have a net operating income to budget measurement for the payout threshold. The employee plan shares the excess over budgeted net operating income with the non-management employees for Memorial Health System, Inc and the affiliated entities which includes Memorial Hospital of South Bend, Inc. The employee incentive pool has a maximum cap of $2,500,000. The management incentive plan pays a sliding percentage of base compensation if the net operating income is equal to or greater than 80% of the budgeted net operating income. The sliding scale caps when operating income reaches 120% of the budgeted operating income.

Schedule K IRS990ScheduleK

Form990 Schedule K Part I Form990ScheduleKPartI (4 entries)

Issuer EINIssuerEINCUSIP NumberCUSIPNumberDate IssuedDateIssuedIssue PriceIssuePriceDescription Of PurposeDescriptionOfPurposeDefeasedDefeasedOn Behalf Of IssuerOnBehalfOfIssuerPool FinancingPoolFinancing
HOSPITAL AUTHORITY OF ST JOSEPH COUNTY
35631191479061BCQ62007-05-0180000000SEE SCHEDULE O FOR DESCRIPTIONfalsefalsefalse
HOSPITAL AUTHORITY OF ST JOSEPH COUNTY
35631191479061BCW32006-03-1638580000SEE SCHEDULE O FOR DESCRIPTIONfalsefalsefalse
HOSPITAL AUTHORITY OF ST JOSEPH COUNTY
35631191479061BCX12008-08-2839915000SEE SCHEDULE O FOR DESCRIPTIONfalsefalsefalse
HOSPITAL AUTHORITY OF ST JOSEPH COUNTY
3563119140000000002008-07-012147750SEE SCHEDULE O FOR DESCRIPTIONfalsefalsefalse

Form990 Schedule K Part II Form990ScheduleKPartII (4 entries)

Total ProceedsTotalProceedsIssuance Costs From ProceedsIssuanceCostsFromProceedsCapital ExpendituresCapitalExpendituresOther Spent ProceedsOtherSpentProceedsYear Of Subst CompletionYearOfSubstCompletionCurrent RefundingCurrentRefundingAdvance RefundingAdvanceRefundingFinal Allocation MadeFinalAllocationMadeAdequate Books And Recds MaintaindAdequateBooksAndRecdsMaintaindRefunding EscrowRefundingEscrow
848147837623127920160048508712009falsefalsetruetrue
3858000012437642000truefalsetruetrue38580000
399150005772042003truefalsetruetrue39337496
214775021477502008falsefalsetruetrue

Form990 Schedule K Part III Form990ScheduleKPartIII (3 entries)

Owning Bond Financed PropertyOwningBondFinancedPropertyAny Lease ArrangementsAnyLeaseArrangementsMngment Cntrct Bond Financd PrprtyMngmentCntrctBondFinancdPrprtyAny Research AgreementsAnyResearchAgreementsBond Counsel Routinely EngagedBondCounselRoutinelyEngagedPrcntge Prvt Business Use By OthersPrcntgePrvtBusinessUseByOthersPercentage Of Prvt Business Re UBIPercentageOfPrvtBusinessReUBITotal Private Business UseTotalPrivateBusinessUsePost Issuance Compliance ProcdrsPostIssuanceComplianceProcdrs
falsefalsetruefalsetrue0.000000.000000.00000true
falsefalsetruefalsetrue0.000000.000000.00000true
falsefalsetruefalsetrue0.000000.000000.00000true

Form990 Schedule K Part IV Form990ScheduleKPartIV (4 entries)

Form8038 T FiledForm8038TFiledVariable Rate IssueVariableRateIssueHedge Identified In Books And RecdsHedgeIdentifiedInBooksAndRecdsGross Proceeds Invested In GICGrossProceedsInvestedInGICTerm Of GICTermOfGICRegulatory Safe Harbor SatisfiedRegulatorySafeHarborSatisfiedGross Proceeds InvestedGrossProceedsInvestedException To RebateExceptionToRebateSuperintegrated HedgeSuperintegratedHedgeHedge TerminatedHedgeTerminated
HYPO PUBLIC FINANCE
falsetruefalsetrue3.91falsefalsefalse
CITIGROUP FINANCIAL
falsetruetruefalsefalsetruefalsefalse
CITIGROUP FINANCIAL
truefalsefalsetruefalsefalse
(no name)
falsefalsefalsefalsefalsefalsefalsefalse

Schedule L IRS990ScheduleL

Form990 Schedule L Part IV Form990ScheduleLPartIV (7 entries)

RelationshipRelationshipAmount Of TransactionAmountOfTransactionDescription Of TransactionDescriptionOfTransactionSharing Of RevenuesSharingOfRevenues
Geralrd Duprat MD
Trustee2151838Purchase of JV ownershipfalse
Sandra Brown MD
Trustee349517Bldg rental, Proctor Servicesfalse
Carlton Lyons MD
Trustee349517Bldg rental, Proctor Servicesfalse
Candace Hurwich
See Part V40200See Part Vfalse
Robert Yount MD
Trustee604688Trauma Call Servicesfalse
Jesse Hseih MD
Trustee258920Trauma Call Servicesfalse
Keith Sherry MD
Trustee6320660Professional ER Phys. Servicesfalse

Form990 Schedule L Part V Form990ScheduleLPartV

FieldValueIRS element (for citing)
IdentifierBusiness Transactions Involving Interested PersonsIdentifier
Return ReferenceSchedule L, Part IVReturnReference
ExplanationCandace Hurwich, wife of Maurice Hurwich, MD (Trustee and Medical Director) was compensated for services as a Staff RN on the Emergency Response Team.Explanation

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (18 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
VOLUNTEERSForm 990, Part I, Line 6Memorial Hospital of South Bend has a department called Ambassador and Customer Services. It is the responsibilty of this department to recruit, orient, process and place new ambassadors in approximately 30 service areas of the hospital. It is also the responsibility of the department to follow up, schedule and recognize ambassadors. Some of the areas of service include Major Surgery Waiting Room, Escort Service, Flower Delivery, Mail Delivery, Living History Program, Emergency Department Volunteers and Cookie Bakers. In 2010, Memorial had 547 volunteers in this program who served 38,567.5 hours.
Other Program ServicesForm 990, Part III, Line 4dMemorial Health System, Inc. (the "Corporation") was established as the parent corporation of Memorial Hospital of South Bend, Inc. (the "Hospital") in 1981 to develop a full spectrum of health-related services for North Central Indiana and Southwestern Michigan. The Corporation is community-owned and not-for-profit. Along with its subsidiaries, the Corporation serves the greater community throughout the continuum of care from health promotion and sickness prevention to diagnosis, inpatient, outpatient and home health services. It controls the Hospital, Memorial Health Foundation, the Hospital's philanthropic arm, and Memorial Home Care, Inc., collectively referred to as the "System". The Hospital with 526 licensed adult beds and 80 bassinets, a staff of approx. 2,693, a medical staff of more than 605, and a volunteer Auxiliary of 594, is the largest hospital in the primary and secondary service areas. The Corporation owns and operates the acute care Hospital facility and Family Practice Residency Program. The Hospital's purpose is to provide hospital care and enhance wellness for the community. The Hospital has its own Board of Trustees (the "Hospital Board") elected by the persons serving on the Board of Directors of the Corporation. The Hospital Board has responsibility for the operation of the Hospital as defined in its bylaws. Memorial Hospital of South Bend is the largest and most comprehensive tertiary care medical center in Northern Indiana. Services are delivered through service divisions and professional ancillary services: Adult Patient Services, Cardiovascular & Critical Care Services, Women's and Children's Services, Surgical Services, Oncology Services and Professional Services. Key utilization Statistics for the Hospital for 2010 include: Admissions 18,824 Total Patient Days 77,727 Births 2,614 Inpatient Surgical Procedures 4,357 Outpatient Surgical Procedures 7,825 Emergency Department visits 52,349 Creating community health is at the core of Memorial Hospital of South Bend, Inc's mission. Promotion of community health is the right thing to do and a key to long term cost effectiveness. In addition, improving the health status of a community is as much a social, economic and environmental issue, as it is a medical one. Consequently, the System takes a broad approach to creating community health. This approach has included ongoing education of board members, staff and local leaders through community plunges (experiential activities to involve the community residents with a neighborhood-based agency), Community Foundation support, ongoing allocation of tithing resources, a clear statement of vision and goals, a commitment to continuous quality improvement and promotion of volunteer involvement and community partnerships. In the early 1990s, the System made a dramatic shift from a disease-focused medical model to a prevention-focused model. Its vision is to continue the journey to be among the nation's healthiest communities. Memorial's health enhancement plan focuses on five priorities: schools, neighborhoods, congregations, seniors and mother/child concerns. Its methods include building partnerships, investing dollars, listening and communicating, nurturing leadership, and continuous evaluation backed by sound outcome and impact measurement. The Community Benefit Fund is the System's mechanism for re-investing funds to improve the health status of communities it serves. The System, which includes Memorial Hospital of South Bend Inc, tithes 10% of the previous year's excess operating revenue and transfers it to the Community Benefit Fund. This investment is in addition to the Hospital's charity care and prevention and education activities supported through its operating budget. The Community Health Enhancement Committee of the Board began the fund in 1993 and makes ongoing policy and oversees the administration of the fund and determines specific investment allocations. Volunteers and staff are committed to prudently investing these resources in an accountable manner. BrainWorks at Memorial Hospital is housed within the Leighton Center, located on the Hospital campus. The programs sponsored at the Leighton Center promote a holistic understanding and approach to brain health across the lifespan, emphasizing the importance of a healthy brain to enhance the quality of life at every age. Education and physical movement are important aspects of aging well for all of us. Programming at the Leighton Center supports a platform to expand the knowledge of brain health. While the focus continues to be on holistic health, brain health as a key component to well-being which can contribute to the prevention of neurodegenerative disorders, improve rehabilitation and recovery from trauma, and enhance productivity and capabilities to be realized in the later years. As a part of senior programming, Memorial's Sage-ing Center contributes to spiritually Eldering and socially responsible aging. The System's innovative community outreach has received national recognition for models of involvement as well as state and federal grants to assist in the support of some of these programs. Programs include: African American Women in Touch - breast care education and screening programs, the PEDS developmental delay screening program for infants 0 to 3 years of age which is offered at the St. Joseph County WIC clinics, the YWCA, and the Center for the Homeless, and health education and outreach into the Latino community, including an innovative diabetes education and case management program that has had significant results. More than 220 Type II diabetics have participated in the program with no hospitalizations in 2010. The program expanded to include African Americans and Caucasians as well. The newest addition has two Zumba exercise classes, which have approximately 50 individuals of all ages participating in each session. Nearly 40 women were referred to the gestational diabetes program; of the deliveries, there were a few minor complications, however the overall birth outcomes were positive, and mothers returned to normal glucose readings six-weeks post-partum. Two programs which received federal grants to be initiated in St. Joseph County were the Fetal Alcohol screening and education program for pregnant women, and the HUD affiliated program working with Healthy Homes. Other noteworthy programs include the free Children's Health Clinic providing school physicals and early detection of health problems at Memorial's Southeast Neighborhood Clinic's event for approximately 150 children. 6,207 South Bend youths, in school year 2010-2011, participated in the evidenced-based program, "Draw the Line, Respect the Line" targeting middle school aged students on making and practicing good choices. The "Healthy Babies Program" focused on proper prenatal care and reducing infant mortality. A program for African American men was held at three local barbershops during one weekend, to increase awareness and encourage men to make behavioral changes to monitor their blood pressure and take steps to control high blood pressure received additional support. In 2010, 98 men participated in the program. The Sickle Cell Initiative serves Northwest Indiana with screening, education, and counseling. In 2010, new initiatives included high school athlete screening, regular educational newsletters, and public service announcements. The total number served in 2010 was 5,233 individuals. The "Domestic Violence Ends ("DOVE") project, and the Health Professionals, a free service for residents needing physician referral or health information have proven their value to the community, while the partnership with South Bend Community School's magnet schools finds Memorial's evolving role in building a high school program intended to prepare students for future careers in health care and scientific research. Summer programs were offered to Latino students at La Casa de Amistad, Martin Luther King Center, and with the South Bend Community School Corporation's Bilingual Education department. As a supporter of the St. Joseph County Volunteer Provider Network providing care for the uninsured adults in our community, with over 363 physicians, diagnostic service providers, and two hospitals, VPN contributed over 7 million dollars worth of care in 2010. A demonstration project in partnership with South Bend Heritage Foundation provides health and social service case management to 60 low-income elderly living independently in the converted Robertson's Department Store. The results of the intervention have shown a decrease in depression and increases in 8 indices of health in those elderly participating in the program. This project received funding from a local foundation to expand to seniors living in public housing.
Members of the OrganizationForm 990, Part VI, Section A, Line 6Membership in Memorial Hospital of South Bend shall be divided into two classes: Corporate and Personal. The Corporate Member shall be Memorial Health System, Inc. The Personal Members shall be the directors of Memorial Hospital of South Bend.
Election of Board MembersForm 990, Part VI, Section A Line 7AThe Corporate Member shall appoint the Board of Directors of Memorial Hospital of South Bend and shall have such powers of advance approval regarding corporate actions as are delineated in the By-Laws of Memorial Hospital of South Bend.
Decisions of The Board of DirectorsForm 990, Part VI, Section A, Line 7BDecisions of the Board of Directors must be approved by the Corporate Member.
FORM 990, PART VI, SECTION BTHE ORGINIZATION HAS WRITTEN POLICIES AND PROCEDURES THAT COVER NUMEROUS TOPICS. THESE POLICIES AND PROCEDURES WERE NOT APPROVED BY THE GOVERNING BOARD IN THE CURRENT TAX YEAR, BUT WILL BE REVIEWED AND APPROVED BY THE GOVERNING BOARD IN FUTURE YEARS. A FEW OF THE TOPICS COVERED BY THE CURRENT POLICIES AND PROCEDURES OF THE ORGINIZATION ARE: - LOCAL CHAPTERS, BRANCHES AND AFFILIATES - CONFLICT OF INTEREST - WHISTLEBLOWER - DOCUMENT RETENTION AND DESTRUCTION - JOINT VENTURES
Review ProcessForm 990, Part VI, Section B, Line 11BThe organization incorporates numerous parties in the production and review of the Form 990 and associated schedules. Senior accounting staff and management complete the Form 990 and schedules. The forms and schedules are reviewed by the Accounting Manager, Controller and CFO. Subsequent to those steps, the organization engaged Ernst & Young to review the completed Form 990 and appropriate schedules. Prior to filing the return, the compensation committee of the organization and the CEO conduct a general overview of the form 990, including applicable compensation schedules. In addition, the Board of Directors and the Audit Committee will receive a copy of the 990 prior to filing.
Conflict of Interest PolicyForm 990, Part VI, Section B, Line 12There are three separate forms that are sent out through the Internal Audit Department to Key Employees or Board Members regarding Conflict of Interest. They are as follows 1. The first is a Conflict of Interest Statement that is sent to Senior level Administration, Management, and select staff such as Purchasing Department employees. The purpose of the Statement is to require these Employees to disclose any potential conflict of interests they may have. The Statements are sent in January of each year and we pursue the replies to get a 100% response rate. In the current year we sent out over 250 Statements and did achieve a 100% response rate. Each response is reviewed by the Director of Internal Audit and the results are reported to the CEO of Memorial as well as the Audit Committee of the Board of Directors. 2. The second Statement is the Board Duality of Interest Statement that is sent to current Board Members, former Board Members from the last five years, the five highest compensated employees from the previous year, employees that are on the Grant and Scholarship Committees, and Other key Employees. The Duality of Interest Statements was sent out in May, 2010. The replies are reviewed by the Director of Internal Audit who summarizes the results which are reviewed by an independent party. The results are reported to the CEO of Memorial and the Audit Committee of the Board of Directors. 3. The third Statement is entitled "Code of Ethics for Senior Financial Officers". The Statement requires an acknowledgment form to be signed by Memorial's Key Financial Employees that Memorial's financial information is to the best of their knowledge true and accurate. This Statement was sent out in early January, 2010 and the signed acknowledgements are kept by the Director of Internal Audit. In 2010, fourteen designated employees were requested to sign the form and we had a 100% compliance rate. Any potential Conflicts of Interest are reviewed by independent parties both internal and external to the organization, and if necessary, corrective action would be taken to resolve a true Conflict. The individual with the potential conflict of interest is excluded from all review proceedings.
Process For Determining CompensationForm 990, Part VI, Section B, Line 15An extensive examination is conducted using comparable market data and it is then reviewed by an independent consultant hired by, and reporting to, the Board of Directors. Recommendations are presented to the Compensation Committee of the Memorial Health System Inc Board for deliberation and final decision. Deliberation and final decision are performed by the independent members of the Board.
Public Availability for DocumentsForm 990, Part VI, Section C, Line 19The governing documents and conflict of interest policy are not made available to the public. The financial statements are distributed quarterly to the Electronic Municipal Market Access (EMMA) website as part of the continuing disclosures for the Memorial Health System, Inc. bonds.
Other Changes in Net Assets of Fund BalancesPart XI, Line 5Unrealized Loss on Swap Transactions (27,671,589) Transfers to Affiliates (21,016,908) Change in Interest in Recipient Org (2,759,849) Unrealized Gain on Investments 13,417,708 Capital Contributions 113,400 Ambulance donation 10,000 Total (37,907,238)
Bond Purpoase Descr for Schedule KSchedule K, Part I, Column FLine A(f) - The Hospital Authority of St. Joseph County Health System Revenue Bonds, Series 2007 (Memorial Health System) were issued for the purpose, together with other available funds, of financing the costs of health care capital improvements. Line B(f) - The Hospital Authority of St. Joseph County Health System Revenue Bonds, Series 2006 (Memorial Health Care Network), were issued for the purpose, together with other available funds, of refunding all or a portion of the Organization's Series 2000 Bonds which were originally issued on 12/01/2000. The Series 2006 Bonds were exchanged for the Hospital Authority of St. Joseph County Health System Revenue Bonds, Series 2008A (Memorial Health System) on August 28, 2008. Based on the advice of bond counsel, the Organization is treating the Series 2008A Bonds as the same issue as the Series 2006 Bonds for federal income tax purposes. Further information regarding the Series 2008A Bonds is set forth in the table below. Line C(f) - The Hospital Authority of St. Joseph County Health System Revenue Refunding Bonds, Series 2008B Memorial Health System) were issued for the purpose, together with other available funds, of refunding the then-outstanding Hospital Authority of St. Joseph County Health System Revenue Bonds, Series 2003 (Memorial Health System), on a current basis. Line D(f) - The Lease Obligations under a Lease Purchase Agreement dated July 1, 2008 were issued for the purpose of financing certain equipment used for health care purposes.
Private Business Use for Schedule KSchedule K, Part III, Line 5In August 2008, the Hospital Authority of St. Joseph County, on behalf of the Corporation, issued revenue refunding bonds in the principal amount of $39,915,000 to refund Series 2003 Bonds. The Series 2003 Bonds were used to finance various capital projects including the Heart and Vascular Center. As part of the planning for the Series 2003 Bonds, the Memorial Hospital management team planned for private use of the first floor of the Heart and Vascular Center. After planning for the private use of the first floor the Memorial management team consulted bond counsel at that time. Bond counsel advised that the first floor should be funded through equity. Memorial Hospital followed bond counsels recommendations and the Heart and Vascular Center first floor was entirely funded by equity. Memorial Hospital had used approximately $22,100,000 in equity in relation to the projects funded with Series 2003 bond draws.
Arbitrage for Schedule KSchedule K, Part IVPart IV is not completed for the Series 2008A Bonds because such bonds indirectly refunded new money bonds issued in 2000.
HOURS DEVOTED FOR RELATED ORGANIZATIONFORM 990 PART VIINAME:Robert Yount MD TITLE:Trustee; Employed Physician HOURS:40
HOURS DEVOTED FOR RELATED ORGANIZATIONFORM 990 PART VIINAME:Philip Newbold TITLE:CEO/President HOURS:40
HOURS DEVOTED FOR RELATED ORGANIZATIONFORM 990 PART VIINAME:George Soper TITLE:Asst. Secretary/VP HOURS:40
HOURS DEVOTED FOR RELATED ORGANIZATIONFORM 990 PART VIINAME:Jeffrey Costello TITLE:Asst. Treasurer/CFO HOURS:40

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (2 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusBusiness Name Line1DirectControllingEntityName/BusinessNameLine1
Memorial Health System Inc
615 N Michigan StreetSouth BendIN46601351536132Corp Svc/ClinIN501c(3)9NA
Memorial Health Foundation Inc
615 N Michigan StreetSouth BendIN46601351536129Financial SupIN501c(3)9MHS

Form990 Schedule R Part IV Form990ScheduleRPartIV

Name Of Related Org NameOfRelatedOrg

FieldValueIRS element (for citing)
Business Name Line1Memorial Home Care IncBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1615 N Michigan StreetAddressLine1
CitySouth BendCity
StateINState
ZIP Code46601ZIPCode
FieldValueIRS element (for citing)
EIN351901068EIN
Primary ActivityHome MedicalPrimaryActivity
Legal Domicile StateINLegalDomicileState

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1NABusinessNameLine1
FieldValueIRS element (for citing)
Type Of EntityCTypeOfEntity
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents RoyaltiesfalseReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other OrgtrueGiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other OrgtrueGiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other OrgfalseLoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other OrgfalseLoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other OrgfalseSaleOfAssetsToOtherOrg
Purchase Of Assets From Other OrgfalsePurchaseOfAssetsFromOtherOrg
Exchange Of AssetstrueExchangeOfAssets
Rental Of Facilities To Other OrgsfalseRentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other OrgsfalseRentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other OrgstruePerformOfServicesForOtherOrgs
Perform Of Services By Other OrgstruePerformOfServicesByOtherOrgs
Sharing Of FacilitiestrueSharingOfFacilities
Sharing Of Paid EmployeestrueSharingOfPaidEmployees
Reimbursement Paid To Other OrgtrueReimbursementPaidToOtherOrg
Reimbursement Paid By Other OrgtrueReimbursementPaidByOtherOrg
Other Transfer To Other OrgtrueOtherTransferToOtherOrg
Other Transfer From Other OrgtrueOtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (7 entries)

Transaction TypeTransactionTypeAmount InvolvedAmountInvolved
Memorial Health Foundation Inc
C175884
Memorial Health Foundation Inc
H163004
Memorial Health Foundation Inc
L3450860
Memorial Health Foundation Inc
O77061
Memorial Health Foundation Inc
Q82427
Memorial Home Care Inc
L717407
Memorial Home Care Inc
R642419