2011-09-26T10:11:49-04:00 2010-12-31 ERNST & YOUNG US LLP 111 MONUMENT CIRCLE SUITE 2600 INDIANAPOLIS IN 46204 990 2010-01-01 237042323 BEDFORD REGIONAL MEDICAL CENTER INC BEDF 8122751200 2900 WEST 16TH STREET BEDFORD IN 47421 CHARLES SHETLER 2011-09-26 3176817000 2010 2016-03-07 17:11:31Z Bradford Dykes 2900 West 16th Street Bedford IN 47421 50895790 false X IUHEALTHBEDFORD.ORG X 1970 IN Improving Lives with High Quality Compassionate Care. 12 8 550 34 0 0 171874 141727 52337589 50520096 52948 55284 236382 175355 52798793 50892462 3550 1380 0 0 30004362 30610747 0 0 0 20729608 16940894 50737520 47553021 2061273 3339441 29650265 33577272 13745034 14332762 15905231 19244510 Improving Lives with High Quality Compassionate Care. false false 8141977 1380 6754571 Physician Group The Bedford Regional Medical Center (Physician Group) consists of approximately 16 Physicians and 6 Nurse Practitioners. It is designed to have a service area that covers Lawrence, Monroe, Martin, Greene, Jackson, Washington and Orange Counties. The Physicians and Nurse Practitioners had 60,047 Office Visits in 2010. 7153856 0 11064767 Inpatient Care We had 1,398 Inpatient Admissions resulting in 5,354 Inpatient Days. We also had 519 Swing Bed Days. 21142471 0 32700758 Outpatient Care BRMC had 86,468 Outpatient Registrations resulting in 259 Observation Stays, 841 Outpatient Surgeries, 170,747 Outpatient Lab Tests, 21,688 Outpatient Radiology Tests, 4,904 Cat Scans, 14,055 ER visits, 19,632 Physical Therapy Procedures, 3,714 Cardio Pulmonary Procedures and 2,156 Ambulance runs. 36438304 true true false false false false false false true true false false false true false false true false false false false false false false false true false false false true false false false false false false false false false false false false false true true false false false true 100 0 true 550 true false false false false false false false false false false X 12 8 false false false false true true true true true false false false true true true true true true true false IN X ANITA HAMILTON 8122785281 2900 West 16th Street Bedford IN 47421 Harley Brown 3.0 X X 7200 0 0 Mary Lu Hanson 3.0 X 3840 0 0 Randy Hawkins 3.0 X X 4320 0 0 Helen Nash 3.0 X 4410 0 0 James T Oswalt 3.0 X 4860 0 0 Jack Kenworthy 3.0 X 4860 0 0 J T Bellush 3.0 X 3960 0 0 Gene Robbins 3.0 X 0 0 0 Dan Dusleag MD 40.0 X 130171 0 33016 Hojjat Shamloo MD 40.0 X 349375 0 39196 Bradford W Dykes 40.0 X X 0 314102 7453 Neil Pickett 3.0 X 0 252094 13240 Charles Shetler 40.0 X 145967 0 28184 Brenda Davis 40.0 X 119132 0 9859 Cindy Smale 40.0 X 100385 0 21857 Rafi Siddiqi MD 40.0 X 371776 0 37352 Randall Martin MD 40.0 X 335417 0 39816 Eung Jun Cha MD 40.0 X 318829 0 33535 Stephen Schultz MD 40.0 X 276422 0 31774 Alan Smith MD 40.0 X 262656 0 32982 2443580 566196 328264 24 false true false ALLIANCE HEALTHCARE SERVICES PO Box 96485 Chicago IL 60693 MRI Testing 667353 HMS MONITOR 2739 Momentium Place Chicago IL 60689 Computer System 452983 UNITY PHYSICIAN GROUP 1155 West Third St Bloomington IN 47404 Physicians 412937 MAYO MEDICAL LABS 2001 1st Street Rochester MN 55905 Lab Testing 307021 SIMPLEXGRINNELL Dept CH 10320 Palatine IL 60055 Contractor 273322 11 20806 120921 10348 141727 Net Patient Revenue 622110 50236112 50236112 Counseling Contract Revenue 900099 231746 231746 Physician Medicare Incentive 900099 29438 29438 Dewitte Disability Exams 900099 9900 9900 All other program service revenue 900099 12900 12900 50520096 45784 45784 0 0 80473 3328 77145 77145 77145 9500 0 9500 9500 9500 0 0 0 Cafeteria Sales 722320 82420 82420 Purch Discount Late Fees 900099 9940 9940 All other revenue 900099 5850 5850 98210 50892462 50520096 0 230639 1380 1380 0 0 0 1010592 1010592 0 23593116 18162971 5430145 1261612 971441 290171 3125775 2284075 841700 1619652 1247132 372520 3354616 2758877 595739 47589 47589 49871 49871 0 0 0 839928 839928 276556 276556 7564605 7098349 466256 861557 594474 267083 0 1222639 843621 379018 19996 19996 0 211429 122710 88719 649061 447852 201209 0 2147262 1481611 665651 428565 240010 188555 Bad Debt Expense -1426392 -1426392 Repairs 501862 412205 89657 MISCELLANEOUS EXPENSES 191750 61508 130242 47553021 36438304 11114717 0 3111837 6452369 6014509 6059324 5047364 5682302 9752 0 348058 32683 799251 805233 534314 465416 39373552 25293607 13785180 14079945 29650265 33577272 2804990 3753506 10940044 10579256 13745034 14332762 X 15824399 19164807 80832 79703 15905231 19244510 29650265 33577272 X 3339441 -162 X false true true X true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 80832 1129 79703 76206 4626 80832 78190 1984 76206 1.00000 false false 912711 912711 15672893 6839973 8832920 21724517 17865692 3858825 1063431 587942 475489 14079945 0 Due to Medicare/Medicaid 2045574 Professional Liability/Tail Coverage 75971 INDIANA UNIVERSITY HEALTH 8457711 10579256 Restricted Funds Schedule D, Part V Hospice Donations are used for the needs of our cancer patients. Money is donated by the Medical Group to pay for Patient's prescriptions who cannot afford them. These are donations on the Hospital's books that are earmarked for the Foundation. Radiology incentive is money donated for seminars etc for Radiology employees. Restricted donations are monies that are donated to the Hospital for specific use only. FIN 48 Footnote from Financial Statements Schedule D, Part X Bedford Regional Medical Center Inc. is a subsidiary in the consolidated financial statement of Indiana University Health (formerly known as Clarian Health Partners, Inc.). Indiana University Health adopted FIN 48 in 2007. No disclosures were required under GAAP as Indiana University Health does not have any material tax contingencies that required disclosures in the footnotes. true true X true X true X true true false true true 1840 3333454 0 3333454 0.06810 2949 5440815 635176 4805639 0.09810 4789 8774269 635176 8139093 0.16620 9 1072 469369 1780 467589 0.00950 2 45 9557 0 9557 0.00020 2 0 500292 0 500292 0.00640 1 0 1380 0 1380 0.00000 14 1117 980598 1780 978818 0.01610 14 5906 9754867 636956 9117911 0.18230 1 0 1163 0 1163 0.00000 1 0 366 0 366 0.00000 1 22 293 0 293 0.00000 3 22 1822 0 1822 0.00000 false 0 0 16015256 14934390 1080866 X true true 1 1 BEDFORD REGIONAL MEDICAL CENTER

2900 WEST 16TH STREET BEDFORD IN 47421

X X BEDFORD REGIONAL MEDICAL CENTER 1 Part I, Line 6a The community benefit is included in Indiana University Health's community benefit report. Part I, Line 7, Column (f) Bad Debt expense of $(1,426,392) was excluded from total expenses in the calculation of the percent of total expense. Part I, Line 7 We used the Cost to Charge Ratio as our costing methodology. Part II - Community Building Activites We support Community Building Activities by involvement in the Economic Development Committee, the local Chamber of Commerce, and the Indiana State Department of Health Licensure Council. We also offer career education and job shadowing for local students. Part III, Line 4 Bad Debt Expense We did not show any Bad Debt in our 2010 Community Benefits. Bad debt expense is actually a credit balance this year. Bad debts were over accrued because a majority was determined to be charity care. Part III, Line 8 Medicare Shortfalls and Surplus We did not have a Medicare shortfall in 2010. We have worked hard to manage our patients' length of stay and the use of Observation Beds. Many of the Medicare beneficiaries are poor and would have qualified for the Hospital's Charity Care Program or Medicaid in addition to Medicare. If these patients had been treated as Charity Care, the entire cost of medical care would have been considered Community Benefit. We used our Medicare Cost Report to come up with the Medicare shortfall or surplus. Part III, Line 9b Bad Debt Policy The first statement lists detail by revenue code, the total balance due and the discounted amount due if paid within 30 days of statement date. The first Statement for uninsured patients will also reflect the uninsured discount, according to policy. Statements will be aged by the last payment date on the account. Patients with Medicare will receive 3 statements after the initial detail statement. Non-Medicare patients will receive 2 additional statements after the initial detail statement. Accounts not paid in full that receive the 4th statement for Medicare patients, 3rd statement for Non-Medicare, will be referred to a collection agency. When a patient establishes a payment plan, the statement process is changed to a monthly reminder of payment amount now due. A 10 day extension from the due date will be granted to allow for mailing and processing time, before a payment is considered delinquent. Multiple missed payments will result in the account being referred to a collection agency. Part VI, Line 2 - Needs Assessment In 2008 a Community Health Needs Assessment of Lawrence County was conducted by Professional Research Consultants (PRC). Part VI, Line 3 - Patient Education of Eligibility for Assistance Any patient that we contact or contacts us, in person or over the phone, about their bill is walked through the following process: We ask if they can pay their bill in full with a prompt pay discount. We discuss payment arrangements: If the patient indicated that they can't afford this bill we explain the HIP Program and our Financial Assistance Program to them. We offer to assist with the HIP application process. We give them an information packet and application for Financial Assistance. We also conduct monthly HIP education outreach programs. Part VI, Line 4 - Community Information BRMC serves Lawrence, Orange, Martin, Greene and Jackson Counties. All counties represent more than 97% Caucasian individuals. The average median household income of the 5 counties is $43,062. Part VI, Line 5 - Promotion of Community Health Bedford Regional Medical Center operates as a Critical Access Hospital with Inpatient, Outpatient and Ambulatory Care Services and 24-Hour Emergency Room and EMS Services. BRMC is a modern, JCAHO approved Rural Health Care facility which offers up-to-date technology and medical practices. It also employs a Physician Group Practice, Bedford Medical Group, which is a multi-specialty Physicians' group practice providing medical services in Internal Medicine, Family Practice, General Surgery, Orthopedics, Obstetrics and Gynecology, and Pediatrics. Nurse Practitioners in Adult and Pediatric Primary Care have been added to expand Medical Care. BRMC will provide assurance to our Patients and Community that their needs are met within our organization's resources, and will be their Provider of Choice, or serve as navigator to access the Broader Resources of the Indiana University Health Regional and Statewide Network. Part VI, Line 6 - Affiliated Health Care System Roles Bedford Regional Medical Center is an affiliate of Indiana University Health, which includes Methodist Hospital, Indiana University Hospital and Riley Hospital for Children. Other Indiana University Health affiliates include: La Porte Regional Health System Starke Memorial Hospital Clarian Arnett Health Rehabilitation Hospital of Indiana Clarian West Medical Center Goshen Health System, Blackford Community Hospital Tipton Hospital Ball Memorial Hospital Clarian North Medical Center Clarian Health: Methodist, IU, Riley Bloomington Hospital Midwest Proton Radiotherapy Institute Bloomington Hospital of Orange County The immediate advantages of being an affiliate of Indiana University Health include centralized services which results in a reduction of duplicated services and lowers health care costs for our patients. STATE FILING OF COMMUNITY BENEFIT REPORT 990 SCHEDULE H, PART VI IN, X false false false false false false false true false Dan Dusleag MD 129955 0 0 0 216 0 9625 0 23391 0 163187 0 0 0 Hojjat Shamloo MD 348925 0 0 0 450 0 18027 0 21169 0 388571 0 0 0 Bradford W Dykes 0 223936 0 89200 0 966 0 0 0 7453 0 321555 0 0 Neil Pickett 0 240497 0 11459 0 138 0 0 0 13240 0 265334 0 0 Charles Shetler 130013 0 13903 0 2051 0 9445 0 18739 0 174151 0 13903 0 Rafi Siddiqi MD 371146 0 0 0 630 0 18027 0 19325 0 409128 0 0 0 Randall Martin MD 335417 0 0 0 0 0 18027 0 21789 0 375233 0 0 0 Eung Jun Cha MD 316057 0 0 0 2772 0 18027 0 15508 0 352364 0 0 0 Stephen Schultz MD 274578 0 0 0 1844 0 18027 0 13747 0 308196 0 0 0 Alan Smith MD 257322 0 0 0 5334 0 18027 0 14955 0 295638 0 0 0 SCHEDULE J, PART I, LINE 7 Criteria for Executive Incentive Pay Effective Date: 6/07 Incentive goals will be developed and reviewed annually for Bedford Regional Medical Center Executives. The percentage of pay-out will be approved by the Executive Committee of the Hospital Board of Directors. The pay-out is based on a set of goals to be accomplished during a budget year. The goals will be established by the Executive and his or her direct supervisor. The goals will be identified in written format. Predetermined financial criteria (operating margin and days of cash on hand) will be met before any percent of the incentive compensation will be paid out. Pay-out will be distributed after the final audit of the financial statements and the financial criteria has been met. Pay-out will be in compliance with any legal or regulatory guidelines. Description of Classes of Members or Stockholders Form 990, Part VI, Line 6 Bedford Regional Medical Center has one member which is Indiana University Health. Description of Classes of Persons and the Nature of Their Rights Form 990, Part VI, Line 7a The Directors serving on the Board of Directors have the right to nominate prospective Directors for six positions. The Physicians constituting the corporation's Clinic Physician Group have the right to nominate the two Director positions. The Member shall nominate the three remaining prospective Directors of the Board. After viewing the nominations of prospective Directors as set forth above, the Member shall elect the Board of Directors. The President and CEO is also appointed by the Member. Descr Classes of Persons, Decisions Requiring Appr & Type of Voting Rights Form 990, Part VI, Line 7b A) Adoption and amendment of the Articles and Bylaws of the Corporation; B) Adoption, Interpretation and change of any statement of the Mission or Purposes of the Corporation; C) Adoption of any material changes in the services provided by the Corporation; D) The appointment or removal of the Chief Executive Officer of the Corporation; E) Adoption, Interpretation or change of the Strategic Plan of the Corporation; F) Incurrence of debt or execution of any debt instrument that is not approved in the annual or operating budgets; G) Adoption and Change of the annual operating and capital budgets; H) Acquisition, sale, lease, transfer or alienation of any corporation assets other than in the usual and regular course of the Corporation's business when such acquisition, sale, lease, transfer or alienation is outside the terms of the annual operating or capital budget previously approved by the Member; (I) Participation of the Corporation in Healthcare Networks, Alliances or other Healthcare Delivery Systems; and (J) Adoption and change of any Managed Care or Third Party Payor contracts, whether new or renewal. Describe the Process used by Management &/or Governing Body to Review 990 Form 990, Part VI, Line 11 Management will provide a copy of the return to the members of the Finance Committee of the Board and review the return with the Committee before the 990 is filed with the IRS. Description of Process to Monitor Transactions for Conflicts of Interest Form 990, Part VI, Line 12c The Bedford Regional Medical Center Bylaws require each Director and Officer of the Corporation to refrain from participation in any discussion, evaluation, or approval of a transaction involving the corporation in which the Director, or Officer (or immediate family member) has a financial interest or Professional Interest which impairs the good faith discharge of his or her duty of loyalty. Annually each Director and Officer is required to execute a Standard of Conduct and Conflict of interest statement and certify to the Corporation that no conflict of interest exists which would substantially impair that Person's overall ability to fulfill his or her duty of loyalty to the Corporation. In addition to the annual Conflict of Interest Statement, each Director and Officer has a duty to disclose any potential conflict of interests arising from a transaction or arrangement to be considered by the Board of Directors at any meeting where the transaction is discussed or voted upon. Disclosure of the material facts underlying the potential conflict of interest shall be submitted in writing to the Chairman and included in the minutes of the meeting. The Director or Officer submitting such a disclosure is required to leave the meeting while his or her disclosure is discussed. The remaining Directors must make a determination by a majority vote as to whether the material facts constitute a conflict of interest. Any Director or Officer who is determined to have a conflict of interest with regard to any transaction or arrangement shall not be entitled to attend any portion of a meeting in which the matter is discussed or voted upon. The Board may take all appropriate disciplinary action with regard to a violation of the conflict of interest policy, including the removal of the Director or Officer. Senior Management and Department Directors are also required to sign an annual conflict of interest statement, disclosing any potential conflicts of interest Process for Determining Compensation for CEO Form 990, Part VI, Line 15a Our CEO is an Employee of Indiana University Health. We are billed monthly for his services. Process for Determining Compensation for Other Officers or Key Employees Form 990, Part VI, Line 15b The evaluation of salaries for Executives and key employees occurs annually. Data is submitted to the Indiana Hospital Association Salary Survey in April and a comparison survey of other Indiana Hospitals is returned. CEO approves the salary amount. Information on compensation for the CEO is provided to the Board Executive Committee. Avail of Gov Docs, Conflict of Interest Policy, & Fin Stmts to Gen Public Form 990, Part VI, Line 19 The organizing documents, financial statements and Conflict of Interest Policy are made available to the Public upon written request or by a request in person. Hours devoted to related organizations Form 990, Part VII, Section A, Line 1a, column (B) Neil Pickett devotes 45 hours per week to a related organization, Indiana University Health. 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