BEACON MEDICAL GROUP INC: Form 990, tax year 2010
View the entire original 990 at ProPublica ↗
- Organization
- BEACON MEDICAL GROUP INC (EIN 35-1536132)
- Tax period
- 2010-01-01 to 2010-12-31
- Filed
- 2011-11-15
- IRS object ID
- 201143199349305934
- 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
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule H
- Schedule I
- Schedule J
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2011-11-15T13:17:59-05:00 | Timestamp |
| Tax Period End Date | 2010-12-31 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ERNST & YOUNG LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 111 MONUMENT CIRCLE STE 2600 | AddressLine1 |
| City | INDIANAPOLIS | City |
| State | IN | State |
| ZIP Code | 46204 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2010-01-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 351536132 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MEMORIAL HEALTH SYSTEM INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | MEMO | NameControl |
| Phone | 5746473549 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 615 N MICHIGAN STREET | AddressLine1 |
| City | SOUTH BEND | City |
| State | IN | State |
| ZIP Code | 46601 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | JEFFREY COSTELLO | Name |
| Title | V.P./CFO | Title |
| Date Signed | 2011-11-15 | DateSigned |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 3176817000 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2010 | TaxYear |
| Build TS | 2016-03-07 17:11:31Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | PHILIP NEWBOLD | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 615 N MICHIGAN STREET | AddressLine1 |
| City | SOUTH BEND | City |
| State | IN | State |
| ZIP Code | 46601 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 78719025 | GrossReceipts |
| Group Return For Affiliates | false | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | QUALITYOFLIFE.ORG | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1981 | YearFormation |
| State Legal Domicile | IN | StateLegalDomicile |
| Activity Or Mission Description | MEMORIAL HEALTH SYSTEM, INC. IS COMMITTED TO IMPROVING THE QUALITY OF LIFE OF THE PEOPLE IN OUR COMMUNITY. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 13 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 10 | NbrIndependentVotingMembers |
| Total Nbr Employees | 876 | TotalNbrEmployees |
| Total Nbr Volunteers | 0 | TotalNbrVolunteers |
| Total Gross UBI | 2311155 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 1791723 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 1966424 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 66403457 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 67793807 | ProgramServiceRevenueCY |
| Investment Income Prior Year | -409523 | InvestmentIncomePriorYear |
| Investment Income Current Year | 604115 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 2613431 | OtherRevenuePriorYear |
| Other Revenue Current Year | 2403293 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 70399088 | TotalRevenuePriorYear |
| Total Revenue Current Year | 72767639 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 0 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 329745 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 59284259 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 60258564 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 29361381 | OtherExpensePriorYear |
| Other Expenses Current Year | 31507624 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 88645640 | TotalExpensesPriorYear |
| Total Expenses Current Year | 92095933 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | -18246552 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | -19328294 | RevenuesLessExpensesCY |
| Total Assets BOY | 100079170 | TotalAssetsBOY |
| Total Assets EOY | 99994316 | TotalAssetsEOY |
| Total Liabilities BOY | 49049473 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 46648276 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 51029697 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 53346040 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | MEMORIAL HEALTH SYSTEM, INC. IS COMMITTED TO IMPROVING THE QUALITY OF LIFE OF THE PEOPLE IN OUR COMMUNITY. | MissionDescription |
| Significant New Program Services | false | SignificantNewProgramServices |
| Significant Change | false | SignificantChange |
| Expense | 54557387 | Expense |
| Revenue | 44126035 | Revenue |
| Description | MEMORIAL HEALTH SYSTEM, INC. (THE "CORPORATION") OPERATES MEMORIAL MEDICAL GROUP. MEMORIAL MEDICAL GROUP IS A PRIMARY CARE NETWORK OF PHYSICIANS AND ALSO INCLUDES THE MED-POINT IMMEDIATE CARE CENTERS AND CENTER FOR OCCUPATIONAL HEALTH. MEMORIAL MEDICAL GROUP (MMG) IS THE OWNED MULTI-SPECIALTY INTERGRATED PHYSICIAN NETWORK OF MEMORIAL HEALTH SYSTEM. IN ADDITION TO THE PHYSICIAN PRACTICES, MMG OPERATES A HIGH COMPLEXITY CORE LABORATORY FOR THE SUPPORT OF ITS EMPLOYED PHYSICIANS. THE CENTER FOR OCCUPATIONAL HEALTH (COH) AND WORKER'S COMPENSATION SERVICES FOR 1500 CLIENT COMPANIES IN ST. JOSEPH AND LAPORTE COUNTIES. MMG ALSO OPERATES MED-POINT URGENT CARE CENTERS TO SUPPLEMENT THE SERVICES OF THE MEDICAL GROUP AND COH. MMG OPERATES MED-POINT EXPRESS, A RETAIL BASED WALK-IN CLINIC AT VARIOUS RETAIL SUPERCENTERS OR GROCERY STORES. IN ADDITION TO THE CORPORATION'S PRIMARY CARE NETWORK, MEMORIAL MEDICAL GROUP MANAGES THE OPERATION OF SEVERAL HOSPITAL BASED PRACTICES FOR THE HOSPITALISTS, TRAUMA ORTHOPEDIC SURGEON, AND PEDIATRIC INTENSIVISTS. | Description |
Activity2 Activity2
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 16263312 | Expense |
| Grants | 329745 | Grants |
| Revenue | 23394492 | Revenue |
| Description | MEMORIAL 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 CONTINUM OF CARE FROM HEALTH PROMOTION AND SICKNESS PREVENTION TO DIAGNOSIS, INPATIENT, OUTPATIENT AND HOME CARE 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 CORPORATION PROVIDES CORPORATE SERVICES TO THE ABOVE MENTIONED AFFILIATED ORGANIZATIONS. ALONG WITH ITS OWN AFFILIATED ORGANIZATIONS, MEMORIAL HEALTH SYSTEM, INC. HAS FORMED SEVERAL JOINT VENTURES WHICH FURTHERS ITS WORK IN THE CONTINUUM OF CARE. | Description |
Activity3 Activity3
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 325899 | Expense |
| Revenue | 278051 | Revenue |
| Description | MEMORIAL HEALTH SYSTEM, INC. (THE "CORPORATION") OPERATES MEMORIAL MEDICAL GROUP (MMG). ALONG WITH THE PRIMARY CARE NETWORK, MMG ALSO OPERATES THE MEMORIAL MEDICAL GROUP CLINICAL RESEARCH INSTITUTE (CLINICAL RESEARCH). CLINICAL RESEARCH IS CURRENTLY FOCUSED ON PHARMACOLOGY STUDIES. CLINICAL RESEARCH HAS BROUGHT THE FOLLOWING POSITIVE BENEFITS TO MMG: IMPROVED PATIENT CARE - BRINGS MMG PHYSICIANS AND NURSES CLOSER TO LEADING-EDGE MEDICINE. CORPORATE POSITIONING - CLINICAL RESEARCH CAN ENHANCE MMG'S IDENTITY AND BRAND, IT CAN PROVIDE A MEANS TO MEET PHYSICIANS' ACADEMIC NEEDS AND ENHANCE PHYSICIAN RECRUITMENT. | Description |
Activity Other ActivityOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 655622 | Expense |
| Revenue | 11562 | Revenue |
| Description | MANAGED CARE SERVICES | Description |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Other Program Service Exp | 655622 | TotalOfOtherProgramServiceExp |
| Total Of Other Program Service Rev | 11562 | TotalOfOtherProgramServiceRev |
| Total Program Service Expense | 71802220 | TotalProgramServiceExpense |
| Described In501 C3 | true | DescribedIn501C3 |
| Schedule B Required | true | ScheduleBRequired |
| Political Activities | false | PoliticalActivities |
| Lobbying Activities | true | LobbyingActivities |
| Donor Advised Funds | false | DonorAdvisedFunds |
| Conservation Easements | false | ConservationEasements |
| Collections Of Art | false | CollectionsOfArt |
| Credit Counseling | false | CreditCounseling |
| Term Or Permanent Endowments | false | TermOrPermanentEndowments |
| Report Land Bldg Equip | true | ReportLandBldgEquip |
| Report Invest Oth Securities | false | ReportInvestOthSecurities |
| Report Prog Rel Invest | true | ReportProgRelInvest |
| Report Other Assets | false | ReportOtherAssets |
| Report Other Liabilities | true | ReportOtherLiabilities |
| Report Fin48 Footnote | false | ReportFin48Footnote |
| Independent Audit Financial Stmt | false | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | true | ConsolidatedAuditFinancialStmt |
| School | false | School |
| Foreign Office | false | ForeignOffice |
| Foreign Activities | false | ForeignActivities |
| More Than5000 K To Organizations | false | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividuals |
| Professional Fundraising | false | ProfessionalFundraising |
| Fundraising Activities | false | FundraisingActivities |
| Gaming | false | Gaming |
| Hospital | true | Hospital |
| Financial Stmt Attached | false | FinancialStmtAttached |
| Grants To Organizations | true | GrantsToOrganizations |
| Grants To Individuals | true | GrantsToIndividuals |
| Schedule J Required | true | ScheduleJRequired |
| Tax Exempt Bonds | false | TaxExemptBonds |
| Excess Benefit Transaction | false | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | false | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | false | LoanToOfficerOrDQP |
| Grant To Related Person | false | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | false | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | false | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | true | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | false | DeductibleNonCashContributions |
| Deductible Contributions Of Art | false | DeductibleContributionsOfArt |
| Terminated | false | Terminated |
| Partial Liquidation | false | PartialLiquidation |
| Disregarded Entity | false | DisregardedEntity |
| Related Entity | true | RelatedEntity |
| Related Org Controlled Entity | true | RelatedOrgControlledEntity |
| Transaction Related Entity | true | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | false | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | false | ActivitiesConductedPartnership |
| Schedule O Required | true | ScheduleORequired |
| Number Forms Transmitted With1096 | 224 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | true | ComplianceWithBackupWitholding |
| Number Of Employees | 876 | NumberOfEmployees |
| Employment Tax Returns Filed | true | EmploymentTaxReturnsFiled |
| Unrelated Business Income | true | UnrelatedBusinessIncome |
| Form990-T Filed | true | Form990-TFiled |
| Foreign Financial Account | false | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTrans |
| Taxable Party Notification | false | TaxablePartyNotification |
| Non Deductible Contributions | false | NonDeductibleContributions |
| Quid Pro Quo Contributions | false | QuidProQuoContributions |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | false | FundsToPayPremiums |
| Premiums Paid | false | PremiumsPaid |
| Indoor Tanning Services | false | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 13 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 10 | NumberIndependentVotingMembers |
| Family Or Business Relationship | true | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | false | DelegationOfManagementDuties |
| Changes To Organizing Docs | false | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuse |
| Members Or Stockholders | false | MembersOrStockholders |
| Election Of Board Members | false | ElectionOfBoardMembers |
| Decisions Subject To Approval | false | DecisionsSubjectToApproval |
| Minutes Of Governing Body | true | MinutesOfGoverningBody |
| Minutes Of Committees | true | MinutesOfCommittees |
| Officer Mailing Address | false | OfficerMailingAddress |
| Local Chapters | true | LocalChapters |
| Policies Reference Chapters | false | PoliciesReferenceChapters |
| Form990 Provided To Governing Body | true | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | false | ConflictOfInterestPolicy |
| Whistleblower Policy | false | WhistleblowerPolicy |
| Document Retention Policy | false | DocumentRetentionPolicy |
| Compensation Process CEO | true | CompensationProcessCEO |
| Compensation Process Other | true | CompensationProcessOther |
| Investment In Joint Venture | true | InvestmentInJointVenture |
| Written Policy Or Procedure | false | WrittenPolicyOrProcedure |
| States Where Copy Of Return Is Filed | IN | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | JEFFREY COSTELLO | NamePerson |
| Telephone Number | 5746473549 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 615 N MICHIGAN STREET | AddressLine1 |
| City | SOUTH BEND | City |
| State | IN | State |
| ZIP Code | 46601 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | X | InfoInScheduleOPartVII |
Form990 Part VII Section A Form990PartVIISectionA (23 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Key EmployeeKeyEmployee | Highest Compensated EmployeeHighestCompensatedEmployee | FormerFormer |
|---|---|---|---|---|---|---|---|---|---|
| JOHN HILER | |||||||||
| DIRECTOR - VICE CHAIR | 2.0 | X | X | 3482 | 0 | 0 | |||
| RICHARD WARNER CSC | |||||||||
| DIRECTOR - CHAIR | 2.0 | X | X | 400 | 0 | 0 | |||
| VIVIAN SALLIE | |||||||||
| DIRECTOR - SECRETARY | 2.0 | X | X | 2562 | 0 | 0 | |||
| RAFAT ANSARI MD | |||||||||
| DIRECTOR - MED DIRECTOR | 4.0 | X | 0 | 460 | 0 | ||||
| LARRY HARDING | |||||||||
| DIRECTOR - TREASURER | 2.0 | X | X | 2562 | 0 | 0 | |||
| VINCENT HENDERSON MD | |||||||||
| DIRECTOR / EMPLOYED PHYSICIAN | 40.0 | X | 394421 | 0 | 40651 | ||||
| TODD SCHURZ | |||||||||
| DIRECTOR | 2.0 | X | 3501 | 0 | 0 | ||||
| PHILIP NEWBOLD | |||||||||
| PRESIDENT & CEO | 40.0 | X | X | 1001875 | 0 | 229464 | |||
| BIPIN DOSHI | |||||||||
| DIRECTOR | 2.0 | X | 0 | 0 | 0 | ||||
| JAMES KEENAN | |||||||||
| DIRECTOR | 2.0 | X | 0 | 2073 | 0 | ||||
| WES WILLIAMS | |||||||||
| DIRECTOR | 2.0 | X | 3051 | 0 | 0 | ||||
| RICHARD RICE | |||||||||
| DIRECTOR | 2.0 | X | 3051 | 0 | 0 | ||||
| TRACY D GRAHAM | |||||||||
| DIRECTOR | 2.0 | X | 0 | 0 | 0 | ||||
| JEFFREY COSTELLO | |||||||||
| ASSISTANT TREASURER & CFO | 40.0 | X | 469348 | 0 | 99022 | ||||
| MICHAEL O'NEIL | |||||||||
| COO | 40.0 | X | 347315 | 0 | 34407 | ||||
| GREG CONRAD | |||||||||
| ASST SECRETARY | 8.0 | X | 39145 | 156581 | 25999 | ||||
| MICHAEL GORDON | |||||||||
| EXECUTIVE DIRECTOR | 40.0 | 254903 | 0 | 38808 | X | ||||
| BRYAN BOYER MD | |||||||||
| PHYSICIAN | 40.0 | 597326 | 0 | 35207 | X | ||||
| OMAR A ALI | |||||||||
| PHYSICIAN | 40.0 | 503386 | 0 | 0 | X | ||||
| RAMANAK MITRA MD | |||||||||
| PHYSICIAN | 40.0 | 898591 | 0 | 23797 | X | ||||
| DAVID HORNBACK MD | |||||||||
| PHYSICIAN | 40.0 | 953709 | 0 | 35235 | X | ||||
| DANIEL MENG MD | |||||||||
| PHYSICIAN | 40.0 | 507095 | 0 | 26780 | X | ||||
| THEODORE FOTI | |||||||||
| ASSISTANT SECRETARY & VP | 18.0 | 119914 | 0 | 16094 | X | ||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 6105637 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 159114 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 605464 | TotalOtherCompensation |
| Number Individuals GT100 K | 109 | NumberIndividualsGT100K |
| Formers Listed | true | FormersListed |
| Total Comp GT150 K | true | TotalCompGT150K |
| Compensation From Other Sources | false | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| CERNER CORPORATION | |||||
| 2800 ROCKCREEK PKWY | KANSAS CITY | MO | 46117 | IS SFTWR MAINTENANCE | 1601286 |
| WOODCOX BLDG CONTRACTORS | |||||
| 51175 PRESCOTT AVE | SOUTH BEND | IN | 46637 | CONSTRUCTION MANAGER | 1509014 |
| MCKESSON INFORMATION SOLUTIONS LLC | |||||
| PO BOX 98347 | CHICAGO | IL | 60693 | IS SFTWR MAINTENANCE | 1444864 |
| BVK | |||||
| 250 W COVENTRY COURT | MILWAUKEE | WI | 53217 | ADVERTISING | 949258 |
| SOFTWARE INFORMATION SYSTEMS LLC | |||||
| 455 PARK PLACE SUITE 301 | LEXINGTON | KY | 40511 | IS SFTWR MAINTENANCE | 939357 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 34 | NumberOfContractorsGT100K |
| Related Organizations | 629455 | RelatedOrganizations |
| Government Grants | 1336969 | GovernmentGrants |
| Total Contributions | 1966424 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (5 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome | Unrelated Business RevenueUnrelatedBusinessRevenue | ExclusionExclusionAmount |
|---|---|---|---|---|---|
| NET PATIENT REV | 621110 | 44126035 | 44043591 | 82444 | |
| CLINICAL TRIAL REV | 621500 | 278051 | 278051 | ||
| MGT ADMIN SVCS | 561499 | 22399661 | 20211851 | 2187810 | |
| JOINT VENTURES | 621110 | 250905 | 219737 | 31168 | |
| AFFILIATE RENT | 531120 | 739155 | $739,155 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 67793807 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 168507 | TotalRevenueColumn |
| Exclusion | $168,507 | ExclusionAmount |
Income From Invest Bond Proceeds IncomeFromInvestBondProceeds
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Royalties Revenue RoyaltiesRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 273 | TotalRevenueColumn |
| Exclusion | $273 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 4060167 | Real |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 2182416 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 1877751 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 1877751 | TotalRevenueColumn |
| Unrelated Business Revenue | 4770 | UnrelatedBusinessRevenue |
| Exclusion | $1,872,981 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 2997766 | Securities |
| Other | 1206812 | Other |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 2946381 | Securities |
| Other | 822589 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 51385 | Securities |
| Other | 384223 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 435608 | TotalRevenueColumn |
| Exclusion | $435,608 | ExclusionAmount |
Net Income From Fundraising Events NetIncomeFromFundraisingEvents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Net Income From Gaming NetIncomeFromGaming
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Net Income Or Loss NetIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Other Revenue Misc OtherRevenueMisc (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | ExclusionExclusionAmount |
|---|---|---|---|
| PROFESSIONAL CALL VOLUME - ASK A NURSE HOTLINE | 621300 | 130570 | $130,570 |
| MEDICAL DIRECTORSHIP | 561499 | 166166 | $166,166 |
| REAL PROPERTY TAX REFUND FROM ST JOSEPH COUNTY | 531120 | 183478 | $183,478 |
Miscellaneous Revenue MiscellaneousRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 45055 | TotalRevenueColumn |
| Related Or Exempt Function Income | 11562 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 4963 | UnrelatedBusinessRevenue |
| Exclusion | $28,530 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 525269 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 72767639 | TotalRevenueColumn |
| Related Or Exempt Function Income | 64764792 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 2311155 | UnrelatedBusinessRevenue |
| Exclusion | $3,725,268 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 86482 | Total |
| Program Services | 86482 | ProgramServices |
Grants To Domestic Individuals GrantsToDomesticIndividuals
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 243263 | Total |
| Program Services | 243263 | ProgramServices |
Foreign Grants ForeignGrants
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Benefits To Members BenefitsToMembers
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2972768 | Total |
| Program Services | 646562 | ProgramServices |
| Management And General | 2326206 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Comp Disqual Persons CompDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 46154601 | Total |
| Program Services | 40239063 | ProgramServices |
| Management And General | 5915538 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2369636 | Total |
| Program Services | 1053906 | ProgramServices |
| Management And General | 1315730 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5907557 | Total |
| Program Services | 5692069 | ProgramServices |
| Management And General | 215488 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2854002 | Total |
| Program Services | 2206556 | ProgramServices |
| Management And General | 647446 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
| Program Services | 0 | ProgramServices |
| Management And General | 0 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 102163 | Total |
| Program Services | 2561 | ProgramServices |
| Management And General | 99602 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 150013 | Total |
| Program Services | 14308 | ProgramServices |
| Management And General | 135705 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Fees For Services Lobbying FeesForServicesLobbying
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 7072 | Total |
| Program Services | 3145 | ProgramServices |
| Management And General | 3927 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
| Fundraising | 0 | Fundraising |
Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
| Program Services | 0 | ProgramServices |
| Management And General | 0 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4002691 | Total |
| Program Services | 2802439 | ProgramServices |
| Management And General | 1200252 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1978829 | Total |
| Program Services | 891301 | ProgramServices |
| Management And General | 1087528 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 11733145 | Total |
| Program Services | 8331732 | ProgramServices |
| Management And General | 3401413 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 22663 | Total |
| Program Services | 12777 | ProgramServices |
| Management And General | 9886 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Royalties Royalties
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
| Program Services | 0 | ProgramServices |
| Management And General | 0 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2630549 | Total |
| Program Services | 1984500 | ProgramServices |
| Management And General | 646049 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 277253 | Total |
| Program Services | 148240 | ProgramServices |
| Management And General | 129013 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
| Program Services | 0 | ProgramServices |
| Management And General | 0 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 252564 | Total |
| Program Services | 209829 | ProgramServices |
| Management And General | 42735 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
| Program Services | 0 | ProgramServices |
| Management And General | 0 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Payments To Affiliates PaymentsToAffiliates
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
| Program Services | 0 | ProgramServices |
| Management And General | 0 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5472711 | Total |
| Program Services | 3229068 | ProgramServices |
| Management And General | 2243643 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1001406 | Total |
| Program Services | 873634 | ProgramServices |
| Management And General | 127772 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral | FundraisingFundraising |
|---|---|---|---|---|
| BAD DEBT EXPENSE | 1896288 | 1896288 | 0 | 0 |
| LICENSES & TAXES | 771515 | 505467 | 266048 | 0 |
| GENERAL DUES & SUBSCRIPTIONS | 317903 | 200973 | 116930 | 0 |
| OTHER EXPENSE | 890859 | 528057 | 362802 | 0 |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 92095933 | Total |
| Program Services | 71802220 | ProgramServices |
| Management And General | 20293713 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5631 | BOY |
| EOY | 5781 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3603302 | BOY |
| EOY | 2879783 | EOY |
Pledges And Grants Receivable PledgesAndGrantsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 387424 | BOY |
| EOY | 304670 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5304563 | BOY |
| EOY | 5963233 | EOY |
Other Notes Loans Receivable Net OtherNotesLoansReceivableNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 197 | BOY |
| EOY | 106522 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5583920 | BOY |
| EOY | 5304783 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 108924189 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 46975598 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 62915962 | BOY |
| EOY | 61948591 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3521702 | BOY |
| EOY | 3850908 | EOY |
Investments Program Related InvestmentsProgramRelated
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 15263365 | BOY |
| EOY | 15623397 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3493104 | BOY |
| EOY | 4006648 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 100079170 | BOY |
| EOY | 99994316 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 14583684 | BOY |
| EOY | 11775949 | EOY |
Deferred Revenue DeferredRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 26743 | BOY |
| EOY | 26636 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 34439046 | BOY |
| EOY | 34845691 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 49049473 | BOY |
| EOY | 46648276 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 51029697 | BOY |
| EOY | 53346040 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 51029697 | BOY |
| EOY | 53346040 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 100079170 | BOY |
| EOY | 99994316 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | -19328294 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | 21644637 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | false | AccountantCompileOrReview |
| FS Audited | true | FSAudited |
| Audit Committee | true | AuditCommittee |
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Federal Grant Audit Required | true | FederalGrantAuditRequired |
| Federal Grant Audit Performed | true | FederalGrantAuditPerformed |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Publicly Supported Org509a2 | X | PubliclySupportedOrg509a2 |
Gifts Grants Contrib Received509 GiftsGrantsContribReceived509
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 1287379 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 831024 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 1265409 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 1791723 | CurrentTaxYearMinus1Year |
| Current Tax Year | 1966424 | CurrentTaxYear |
| Total | 7141959 | Total |
Gross Receipts From Admissions GrossReceiptsFromAdmissions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 60054785 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 63654671 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 62463577 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 66413343 | CurrentTaxYearMinus1Year |
| Current Tax Year | 67810140 | CurrentTaxYear |
| Total | 320396516 | Total |
Total509 Total509
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 61342164 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 64485695 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 63728986 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 68205066 | CurrentTaxYearMinus1Year |
| Current Tax Year | 69776564 | CurrentTaxYear |
| Total | 327538475 | Total |
Amts Recd From Disqual Persons AmtsRecdFromDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 0 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 0 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 0 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 0 | CurrentTaxYearMinus1Year |
| Total | 0 | Total |
Amts From Subst Contributors AmtsFromSubstContributors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 27869255 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 29878877 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 22391069 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 20657376 | CurrentTaxYearMinus1Year |
| Current Tax Year | 19468541 | CurrentTaxYear |
| Total | 120265118 | Total |
Support From DQ Ps Etc SupportFromDQPsEtc
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 27869255 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 29878877 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 22391069 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 20657376 | CurrentTaxYearMinus1Year |
| Current Tax Year | 19468541 | CurrentTaxYear |
| Total | 120265118 | Total |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total509 | 207273357 | PublicSupportTotal509 |
Gross Investment Income509 GrossInvestmentIncome509
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 2536939 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 2904040 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 3258293 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 2405482 | CurrentTaxYearMinus1Year |
| Current Tax Year | 4224177 | CurrentTaxYear |
| Total | 15328931 | Total |
Post1975 UBTI Post1975UBTI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 4206 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 4830 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 4867 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 4893 | CurrentTaxYearMinus1Year |
| Current Tax Year | 4963 | CurrentTaxYear |
| Total | 23759 | Total |
Investment Income And UBTI InvestmentIncomeAndUBTI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 2541145 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 2908870 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 3263160 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 2410375 | CurrentTaxYearMinus1Year |
| Current Tax Year | 4229140 | CurrentTaxYear |
| Total | 15352690 | Total |
Other Income509 OtherIncome509
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 316246 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 583054 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 388924 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 395391 | CurrentTaxYearMinus1Year |
| Current Tax Year | 325266 | CurrentTaxYear |
| Total | 2008881 | Total |
Total Support Total TotalSupportTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 64199555 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 67977619 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 67381070 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 71010832 | CurrentTaxYearMinus1Year |
| Current Tax Year | 74330970 | CurrentTaxYear |
| Total | 344900046 | Total |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Percentage509 | 0.60097 | PublicSupportPercentage509 |
| Prior Year Support Percentage | 0.57336 | PriorYearSupportPercentage |
| Investment Income Percentage | 0.04451 | InvestmentIncomePercentage |
| Prior Yr Invest Income Percentage | 0.04279 | PriorYrInvestIncomePercentage |
| Thirty Three Percnt Tests CY509 | X | ThirtyThreePercntTestsCY509 |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Grassroots Lobbying | TotalGrassrootsLobbying | |
| Total Direct Lobbying | TotalDirectLobbying | |
| Total Lobbying Expenditures | TotalLobbyingExpenditures | |
| Other Exempt Purpose Expenditures | OtherExemptPurposeExpenditures | |
| Total Exempt Purpose Expenditures | TotalExemptPurposeExpenditures | |
| Lobbying Nontaxable | LobbyingNontaxableAmount | |
| Grassroots Nontaxable | GrassrootsNontaxableAmount | |
| Tot Lobbying Grassroot Minus Non Tx | TotLobbyingGrassrootMinusNonTx | |
| Tot Lobby Expend Mns Lobbying Nontx | TotLobbyExpendMnsLobbyingNontx | |
| Volunteers | false | Volunteers |
| Paid Staff Or Management | false | PaidStaffOrManagement |
| Media Advertisements | false | MediaAdvertisements |
| Mailings Members | false | MailingsMembers |
| Publications Or Broadcast | false | PublicationsOrBroadcast |
| Grants Other Organizations | false | GrantsOtherOrganizations |
| Direct Contact Legislators | false | DirectContactLegislators |
| Rallies Demonstrations | false | RalliesDemonstrations |
| Other Activities | true | OtherActivities |
| Other Activities | $7,071 | OtherActivitiesAmount |
| Total Lobbying Expenditures IIB | 7071 | TotalLobbyingExpendituresIIB |
| Not Described In501c3 | false | NotDescribedIn501c3 |
Form990 Schedule C Part IV Form990ScheduleCPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | OTHER ACTIVITIES | Identifier |
| Return Reference | PART II-B | ReturnReference |
| Explanation | MEMORIAL HEALTH SYSTEM, INC PAYS FOR THE MEMBERSHIP FEES TO SEVERAL NATIONAL ORGANIZATIONS FOR ITS EMPLOYEES. THESE NATIONAL ORGANIZATIONS INDICATE A PORTION OF THE MEMBERSHIP FEES ARE USED FOR LOBBYING PURPOSES. THE MEMBERSHIP FEES PAID WERE FOR THE FOLLOWING ORGANIZATIONS: -AMERICAN INSTITUTE OF CERTIFIED PUBLIC ACCOUNTANTS -AMERICA COLLEGE OF HEALTH CARE EXECUTIVES -AMERICAN DIETETIC ASSOCIATION -FINANCIAL EXECUTIVE INSTITUTE -MEDICAL GROUP MANAGEMENT ASSOCIATION -AMERICAN ACADEMY OF FAMILY PHYSICIANS -AMERICAN COLLEGE OF PHYSICIANS -AMERICAN COLLEGE OF CARDIOLOGY | Explanation |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Art Public Exhibition Amts | ArtPublicExhibitionAmts | |
| Held Works Of Art Amts | HeldWorksOfArtAmts |
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 16819050 | OtherCostOrOtherBasis |
| Book Value | 16819050 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 49446631 | OtherCostOrOtherBasis |
| Depreciation | 15114614 | Depreciation |
| Book Value | 34332017 | BookValue |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 1950533 | OtherCostOrOtherBasis |
| Depreciation | 1386839 | Depreciation |
| Book Value | 563694 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 40707975 | OtherCostOrOtherBasis |
| Depreciation | 30474145 | Depreciation |
| Book Value | 10233830 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Land Buildings | OtherLandBuildings | |
| Total Of Book Value Land Buildings | 61948591 | TotalOfBookValueLandBuildings |
| Total Of Book Value Program Related | 0 | TotalOfBookValueProgramRelated |
| Federal Income Tax Liability | 0 | FederalIncomeTaxLiability |
Other Liabilities OtherLiabilities (4 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| ACCRUED SUPPLEMENTAL BENEFITS | $4,577,180 |
| ACCRUED PENSION | $29,809,442 |
| CEO DEFERRED INCENTIVE | $447,831 |
| NOTE PAYABLE - MADISON CENTER | $11,238 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 34845691 | TotalOfAmounts |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | true | CharityCarePolicy |
| Written Policy | true | WrittenPolicy |
| FPG Reference Free Care | true | FPGReferenceFreeCare |
| Pcent100 | X | Pcent100 |
| FPG Reference Discounted Care | true | FPGReferenceDiscountedCare |
| Pcent400 | X | Pcent400 |
| Free Disc Care Medically Indigent | true | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | false | AmountsBudgetedForCharityCare |
| Annual Community Benefit Report | false | AnnualCommunityBenefitReport |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 518730 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 518730 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00770 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 8481419 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 8723816 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.12630 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 9000149 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 9242546 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.13400 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 86482 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 86482 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00130 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 86482 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 86482 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00130 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 9086631 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 9329028 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.13530 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | false | BadDebtExpenseReported |
| Bad Debt Expense | $1,723,395 | BadDebtExpenseAmount |
| Amount Attributable To | 172340 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 15904181 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 22438915 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | -6534734 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | X | CostToChargeRatio |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | true | WrittenDebtCollectionPolicy |
| Provision For Charity Care | true | ProvisionForCharityCare |
Form990 Schedule H Part IV Form990ScheduleHPartIV (3 entries)
| Description Ent Primary ActivityDescriptionEntPrimaryActivity | Organization Profit Or OwnershipOrganizationProfitOrOwnership | Officers Etc Profit Or OwnershipOfficersEtcProfitOrOwnership | Physicans Profit Or OwnershipPhysicansProfitOrOwnership |
|---|---|---|---|
| MEMORIAL SPINE & NEU | |||
| SPINAL INJECTIONS & OTHER MIN | 0.50000 | 0.50000 | |
| LAPORTE MEDICAL GROU | |||
| OUTPATIENT SURGERY CENTER | 0.46670 | 0.20000 | |
| PHYSICIAN'S HOSPITAL | |||
| LONGTERM ACUTE CARE FACILITY | 0.33981 | 0.25243 | 0.04369 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Hospital Facilities | 1 | NumberOfHospitalFacilities |
Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Number | 1 | FacilityNumber |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RIVERCREST SPECIALTY HOSPITAL | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1625 EAST JEFFERSON BLVD | AddressLine1 |
| City | MISHAWAKA | City |
| State | IN | State |
| ZIP Code | 46545 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| Other | LONG TERM ACUTE CARE | Other |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RIVERCREST SPECIALTY HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Other Facilities | 31 | NumberOfOtherFacilities |
Other Facilities OtherFacilities (31 entries)
| Address Line1Address/AddressLine1 | CityAddress/City | StateAddress/State | ZIP CodeAddress/ZIPCode | Facility TypeFacilityType |
|---|---|---|---|---|
| MEMORIAL ADVANCED CARDIOVASCULAR INSTITU | ||||
| 610 N MICHIGAN SUITE 400 | SOUTH BEND | IN | 46601 | PHYSICIAN PRACTICE OUTPATIENT SERVICES |
| LAPORTE MEDICAL GROUP | ||||
| 900 I STREET | LAPORTE | IN | 46350 | PHYSICIAN PRACTICE OUTPATIENT SERVICES |
| MAIN STREET MEDICAL GROUP | ||||
| 6913 N MAIN STREET SUITE 300 | GRANGER | IN | 46530 | PHYSICIAN PRACTICE OUTPATIENT SERVICES |
| LAPORTE LAB | ||||
| 900 I STREET | LAPORTE | IN | 46350 | LAB SERVICES |
| IRELAND ROAD MEDICAL GROUP | ||||
| 1815 E IRELAND RD | SOUTH BEND | IN | 46614 | PHYSICIAN PRACTICE OUTPATIENT SERVICES |
| LAPORTE SURGERY CENTER | ||||
| 900 I STREET | LAPORTE | IN | 46350 | OUTPATIENT SURGERY |
| MICHIANA ARTHRITIS AND OSTEOARTHRITIS CE | ||||
| 707 N MICHIGAN SUITE 102 | SOUTH BEND | IN | 46601 | PHYSICIAN PRACTICE OUTPATIENT SERVICES |
| FAMILY PRACTICE CENTER | ||||
| 714 SOUTH MICHIGAN STREET | SOUTH BEND | IN | 46601 | PHYSICIAN PRACTICE OUTPATIENT SERVICES |
| NAVARRE PEDIATRIC SATELLITE | ||||
| 6913 N MAIN STREET SUITE 200 | GRANGER | IN | 46530 | PHYSICIAN PRACTICE OUTEPATIENT SERVICES |
| RADIATION ONCOLOGY | ||||
| 615 N MICHIGAN STREET | SOUTH BEND | IN | 46601 | PHYSICIAN PRACTICE OUTPATIENT SERVICES |
| MEMORIAL SPINE & NEUROSCIENCE CENTER | ||||
| 100 NAVARRE SUITE 4405 | SOUTH BEND | IN | 46601 | SPINE & OUTPATIENT SURGERY PROCEDURES |
| WOMEN'S REPRODUCTIVE MEDICINE | ||||
| 100 NAVARRE SUITE 4470 | SOUTH BEND | IN | 46601 | PHYSICIAN PRACTICE OUTPATIENT SERVICES |
| MEMORIAL HOSPITALISTS | ||||
| 100 NAVARRE SUITE 5500 | SOUTH BEND | IN | 46601 | PHYSICIAN PRACTICE OUTPATIENT SERVICES |
| NAVARRE PEDIATRIC GROUP | ||||
| 100 NAVARRE SUITE 4400 | SOUTH BEND | IN | 46601 | PHYSICIAN PRACTICE OUTPATIENT SERVICES |
| SCHWARTZ-WEIKAMP MEDICAL GROUP | ||||
| 4630 VISTULA ROAD | MISHAWAKA | IN | 46544 | PHYSICIAN PRACTICE OUTPATIENT SERVICES |
| PORTAGE MEDICAL GROUP | ||||
| 3575 PORTAGE ROAD | SOUTH BEND | IN | 46628 | PHYSICIAN PRACTICE OUTPATIENT SERVICES |
| DR BRYAN BOYER | ||||
| 100 NAVARRE SUITE 5500 | SOUTH BEND | IN | 46601 | PHYSICIAN PRACTICE OUTPATIENT SERVICES |
| MATERNALFETAL MEDICINE | ||||
| 100 NAVARRE SUITE 4400 | SOUTH BEND | IN | 46601 | PHYSICIAN PRACTICE OUTPATIENT SERVICES |
| SOUTHEAST CLINIC | ||||
| 1708 S HIGH STREET | SOUTH BEND | IN | 46613 | PHYSICIAN PRACTICE OUTPATIENT SERVICES |
| MEMORIAL CRITICAL KIDS | ||||
| 615 N MICHIGAN | SOUTH BEND | IN | 46601 | PHYSICIAN PRACTICE OUTPATIENT SERVICES |
| CENTRAL CLINIC | ||||
| 813 S MICHIGAN STREET | SOUTH BEND | IN | 46601 | PHYSICIAN PRACTICE OUTPATIENT SERVICES |
| CENTER FOR OCCUPATIONAL HEALTH | ||||
| 2301 N BENDIX DRIVE | SOUTH BEND | IN | 46628 | PHYSICIAN PRACTIVE OUTPATIENT SERVICES |
| SPORTS MEDICINE INSTITUTE | ||||
| 111 W JEFFERSON BLVD SUITE 100 | SOUTH BEND | IN | 46601 | PHYSICIAN PRACTICE OUTPATIENT SERVICES |
| PEDIATRIC HEMATOLOGY AND ONCOLOGY | ||||
| 615 N MICHIGAN | SOUTH BEND | IN | 46601 | PHYSICIAN PRACTICE OUTPATIENT SERVICES |
| MEDPOINT EXPRESS - VALPARAISO | ||||
| 2400 NORTHLAND DRIVE | VALPARAISO | IN | 46383 | PHYSICIAN PRACTICE OUTPATIENT SERVICES |
| DEVELOPMENTAL PEDIATRICS | ||||
| 615 N MICHIGAN | SOUTH BEND | IN | 46601 | PHYSICIAN PRACTICE OUTPATIENT SERVICES |
| MEDPOINT EXPRESS - ERSKINE | ||||
| 926 ERSKINE PLAZA | SOUTH BEND | IN | 46614 | PHYSICIAN PRACTICE OUTPATIENT SERVICES |
| MEDPOINT EXPRESS - ELKHART | ||||
| 3900 E BRISTOL STREET | ELKHART | IN | 46514 | PHYSICIAN PRACTICE OUTPATIENT SERVICES |
| PEDIATRIC SURGERY | ||||
| 615 N MICHIGAN | SOUTH BEND | IN | 46601 | PHYSICIAN PRACTICE OUTPATIENT SERVICES |
| LAKEVILLE FAMILY PRACTICE | ||||
| 601 N MICHIGAN | LAKEVILLE | IN | 46536 | PHYSICIAN PRACTICE OUTPATIENT SERVICES |
| BARIATRIC SERVICES | ||||
| 6913 N MAIN STREET | GRANGER | IN | 46530 | PHYSICIAN PRACTICE OUTPATIENT SERVICES |
Form990 Schedule H Part VI Form990ScheduleHPartVI (11 entries)
| IdentifierIdentifier | ExplanationExplanation |
|---|---|
| SCHEDULE H, PART I, LINE 3c | NOT APPLICABLE |
| SCHEDULE H, PART I, LINE 6a | MEMORIAL HEALTH SYSTEM, INC. IS A 33.98% OWNER IN PHYSICIAN'S HOSPITAL, LLC, WHICH IS A TAXABLE ENTITY AND DOES NOT FILE A COMMUNITY BENEFIT REPORT. MEMORIAL HEALTH SYSTEM, INC., OPERATES SEVERAL PHYSICIAN CLINICS THAT PROVIDE SERVICES TO INDIVIDUALS, REGARDLESS OF THEIR ABILITY TO PAY. MEMORIAL'S CENTRAL CLINIC IS LOCATED AT THE SOUTH BEND HOMELESS SHELTER, WHILE THE SOUTHEAST CLINIC IS LOCATED IN A NEIGHBORHOOD WITH HISTORLICLY LOW INCOME LEVELS. |
| SCHEDULE H, PART I, LINE 7, COLUMN F | BAD DEBT EXPENSE REMOVED FROM TOTAL EXPENSES OF $1,928,598 |
| SCHEDULE H, PART I, LINE 7 | DONATIONS - THE ACTUAL COST OF THE DONATION OR DEPARTMENTAL NET CONTRIBUTION, WHICHEVER IS APPROPRIATE, FROM THE GENERAL LEDGER RECORDS AND REPORTS ARE INCLUDED. |
| SCHEDULE H, PART III, LINE 4 | THE 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 RECEIVABLES 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. |
| SCHEDULE H, PART III, LINE 8 | PARTICIPATION IN THE GOVERNMENTAL MEDICARE PROGRAM DOES NOT PROVIDE THE OPPORTUNITY FOR A HEALTH PROVIDER TO NEGOTIATE A REIMBURSMENT RATE OR STRUCTURE THAT WOULD ALLOW THE PROVIDER TO COVER THE COST OF THE MEDICAL SERVICE RENDERED TO THE PROGRAM PARTICIPTANT, AS WOULD BE THE CASE IN CONTRACTUAL NEGOTIATIONS WITH COMMERCIAL INSURANCE COMPANIES. NOR IS THE PROVIDER ALLOWED TO PROVIDE ONLY THE SERVICES FOR WHICH REIMBURSMENT 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 REIMBURSMENT REPRESENTS A REDUCTION OR RELIEF OF THE GOVERNMENT BURDEN TO PAY THE FULL COST OF CARE PROVIDED. |
| SCHEDULE H, PART III, LINE 9b | The collection policy and procedures are as follows related to patients who are known to qualify for charity care or financial assistance: To ensure that Memorial fulfills its mission and commitment to the poor, Memorial 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 Health System. PROCEDURE: 1.Memorial Health System 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 Health System 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. |
| SCHEDULE H, PART VI, LINE 3 | PHYSICIAN'S HOSPITAL, LLC IS DEDICATED TO SERVICING THE HEALTH CARE NEEDS OF ITS PATIENTS NEEDING FINANCIAL ASSISTANCE. PATIENTS NEED ONLY REQUEST FINANCIAL ASSISTANCE, AND COMPLETE AND SIGN A FINANCIAL ASSISTANCE APPLICATION TO BE CONSIDERED. |
| SCHDULE H, PART VI, LINE 4 | ESTABLISHED IN 1830, ST JOSEPH COUNTY INDIANA HAS BECOME THE FOURTH LARGEST COUNTY IN INDIANA. THE COUNTY SPANS 467 SQUARE MILES, WHICH INCLUDES A COMFORTABLE MIX OF RUAL CULTRUAL HERITAGE AND URBAN AMENITIES. THE POPULATION FOR ST. JOSEPH COUNTY IN 2010 WAS 268,299 INDIVIDUALS. THE RACE IN THE COUNTY IS 80% CAUCASIANS, 11.8% AFRICAN AMERICAN, AND HISPANICS REPRESENT 6.6%, WITH 1.6% LISTED AS OTHER. OUR SERVICE AREA INCLUDES PATIENTS FROM ST. JOSEPH COUNTY AND SURROUNDING COUNTIES IN INDIANA AND MICHIGAN. |
| SCHEDULE H, PART VI, LINE 6 | MEMORIAL HEALTH SYSTEM, INC. IS A 33.98% OWNER IN PHYSICIAN'S HOSPITAL, LLC. PHYSICIAN'S HOSPITAL, LLC, DOING BUISNESS AS RIVERCREST SPECIALTY HOSPITAL (THE "HOSPITAL") PROVIDES INPATIENT LONG-TERM ACUTE CARE SERVICES. THE HOSPITAL OPERATES A 30 BED, FREESTANDING SPECIALTY ACUTE CARE HOSPITAL LOCATED IN MISHAWAKA, INDIANA. THE HOSPITAL PROVIDES SHORT-TERM, COMPREHENSIVE REHABILITATION SERVICES TO PATIENTS, AND ITS PROGRAMS ARE DESIGNED TO RESTORE PHYSICAL FUNCTIONS FOLLOWING AN ACUTE ILLNESS OR TRAUMA. INPATIENT THERAPY AND SUPPORT SERVICES PROVIDED BY THE HOSPITAL INCLUDE PHYSICAL, OCCUPATIONAL, SPEECH AND RECREATION THERAPY, RADIOLOGY, VENTILATORS, LABORATORY AND DIETARY SERVICES. |
| SCHEDULE H, PART VI, LINE 7 | MEMORIAL HEALTH SYSTEM, INC. IS A 33.98% OWNER IN PHYSICIAN'S HOSPITAL, LLC. PHYSICIAN'S HOSPITAL LLC, DOES NOT CURRENTLY FILE A COMMUNITY BENEFIT REPORT. |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Records Maintained | true | RecordsMaintained |
Recipient Table RecipientTable (2 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EIN Of RecipientEINOfRecipient | IRC SectionIRCSection | Amount Of Cash GrantAmountOfCashGrant | Purpose Of GrantPurposeOfGrant |
|---|---|---|---|---|---|---|---|
| ALS THERAPY DEVELOPMENT FOUNDATION | |||||||
| 215 FIRST STREET | CAMBRIDGE | MA | 02142 | 043462719 | 501(c)(3) | 5144 | SPONSORSHIP:FRIENDS FOR FAY EVENT |
| DOWNTOWN SOUTH BEND INC | |||||||
| 217 S MICHIGAN ST | SOUTH BEND | IN | 46601 | 351546291 | 501(c)(6) | 50000 | 2010 PLEDGE |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Nbr Of501 C3 And Govt Grants | 1 | TotalNbrOf501C3AndGovtGrants |
| Total Nbr Of Other Organizations | 1 | TotalNbrOfOtherOrganizations |
Form990 Schedule I Part III Form990ScheduleIPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Type Of Grant | SCHOLARSHIPS/TUITION REIMBURSMENT | TypeOfGrant |
| Number Of Recipients | 136 | NumberOfRecipients |
| Amount Of Cash Grant | 329745 | AmountOfCashGrant |
Form990 Schedule I Part IV Form990ScheduleIPartIV (2 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| SCHEDULE I, PART II | CHARITABLE DONNATIONS | PART OF THE ORGANIZATION'S MISSION IS TO IMPROVE THE HEALTH OF OUR COMMUNITY. IN ORDER TO FULFUILL THIS GOAL, OUR ADMINISTRATORS HAVE THE ABILITY TO MAKE DONATIONS TO ORGANIZATIONS THAT IMPROVE THE HEALTH AND WELL BEING OF OUR COMMUNITY. |
| SCHEDULE I, PART III | SCHOLARSHIPS / TUITION REIMBURSMENT | FOR SCHOLARSHIPS THE INDIVIDUAL MUST MEET SEVERAL REQUIREMENTS TO QUALIFY. IN ORDER TO QUALIFY FOR A SCHOLARSHIP THE INDIVIDUAL MUST (1) APPLY ON-LINE (INTRANET) AND WITHIN THE ACCEPTABLE TIME PARAMETERS FOR THE SEMESTER OF FUNDS BEING REQUESTED, (2) MAINTAIN A GRADE OF C OR BETTER, (3) PAY FOR TUITION/BOOKS AND SUBMIT CORRESPONDING ORIGINAL RECEIPTS FOR REIMBURSEMENT. REIMBURSED UP TO THE AMOUNT AWARDED BY THE SCHOLARSHIP COMMITTEE. (4) MEET ANY ADDITIONAL REQUIREMENTS OF THE SPECIFIC SCHOLARSHIP FUND, AND (5) MEET ELIGIBILITY REQUIREMENTS WHICH INCLUDE: (A) EMPLOYED BY MEMORIAL HEALTH SYSTEM, INC. (B) ENROLLED IN A QUALIFIED PROGRAM; (C) SUBMITTED A POSITIVE RECOMMENDATION EACH SEMESTER FROM THE IMMEDIATE SUPERVISOR; AND (D) SUBMITTED A POSITIVE RECOMMENDATION EACH SEMESTER FROM THE SCHOOL. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| First Class Or Charter Travel | X | FirstClassOrCharterTravel |
| Travel For Companions | X | TravelForCompanions |
| Idemnification Gross Up Payments | X | IdemnificationGrossUpPayments |
| Club Dues Or Fees | X | ClubDuesOrFees |
| Written Policy Re T And E Expenses | true | WrittenPolicyReTAndEExpenses |
| Substantiation Required | true | SubstantiationRequired |
| Compensation Committee | X | CompensationCommittee |
| Independent Consultant | X | IndependentConsultant |
| Written Employment Contract | X | WrittenEmploymentContract |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | false | SeverancePayment |
| Supplemental Nonqual Retire Plan | true | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | false | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | false | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | false | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | true | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | true | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | true | AnyNonFixedPayments |
| Initial Contract Exception | false | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (12 entries)
| Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| VINCENT HENDERSON MD | |||||||||||||
| 359086 | 0 | 30625 | 0 | 4710 | 0 | 27431 | 0 | 13220 | 0 | 435072 | 0 | 0 | 0 |
| THEODORE FOTI | |||||||||||||
| 115754 | 0 | 0 | 0 | 4160 | 0 | 0 | 0 | 16094 | 0 | 136008 | 0 | 0 | 0 |
| JEFFREY COSTELLO | |||||||||||||
| 273186 | 0 | 106000 | 0 | 90162 | 0 | 84363 | 0 | 14659 | 0 | 568370 | 0 | 0 | 0 |
| MICHAEL O'NEIL | |||||||||||||
| 213113 | 0 | 80860 | 0 | 53342 | 0 | 24147 | 0 | 10260 | 0 | 381722 | 0 | 0 | 0 |
| PHILIP NEWBOLD | |||||||||||||
| 556903 | 0 | 304355 | 0 | 140617 | 0 | 210175 | 0 | 19289 | 0 | 1231339 | 0 | 140555 | 0 |
| MICHAEL GORDON | |||||||||||||
| 208224 | 0 | 41547 | 0 | 5132 | 0 | 20270 | 0 | 18538 | 0 | 293711 | 0 | 0 | 0 |
| BRYAN BOYER MD | |||||||||||||
| 596352 | 0 | 0 | 0 | 974 | 0 | 13402 | 0 | 21805 | 0 | 632533 | 0 | 0 | 0 |
| OMAR A ALI | |||||||||||||
| 499990 | 0 | 2916 | 0 | 480 | 0 | 0 | 0 | 0 | 0 | 503386 | 0 | 0 | 0 |
| RAMANAK MITRA MD | |||||||||||||
| 871816 | 0 | 25725 | 0 | 1050 | 0 | 12250 | 0 | 11547 | 0 | 922388 | 0 | 0 | 0 |
| GREG CONRAD | |||||||||||||
| 31687 | 126748 | 6514 | 26057 | 944 | 3776 | 3155 | 12620 | 2045 | 8179 | 44345 | 177380 | 0 | 0 |
| DAVID HORNBACK MD | |||||||||||||
| 596051 | 0 | 356278 | 0 | 1380 | 0 | 12250 | 0 | 22985 | 0 | 988944 | 0 | 0 | 0 |
| DANIEL MENG MD | |||||||||||||
| 499378 | 0 | 4657 | 0 | 3060 | 0 | 7502 | 0 | 19278 | 0 | 533875 | 0 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII (4 entries)
| IdentifierIdentifier | ExplanationExplanation | Return ReferenceReturnReference |
|---|---|---|
| PART I, LINE 1A | MEMORIAL HEALTH SYSTEM, INC. REIMBURSES DIRECTORS FOR THE TAX EFFECT OF THE 1099 REPORTABLE BENEFITS FOR HEALTH CLUB MEMBERSHIP, WITH MEMORIAL HEALTH SYSTEM'S HEALTH AND LIFESTYLE CENTER AND SPOUSAL TRAVEL. THIS REPORTING IMPACTS 7 CURRENT BOARD MEMBERS. MEMORIAL HEALTH SYSTEM ALSO REIMBURSES FOR DIRECT EXPENSES RELATED TO ANY TRAVEL ON MEMORIAL HEALTH SYSTEM'S BEHALF. SOCIAL CLUB MEMBERSHIPS INCLUDED IN TAXABLE COMPENSATION - 2 EMPLOYEES (JEFFERY COSTELLO, AND MICHAEL O'NEIL) 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 ORGANIZATION TO REDUCE THE OVERALL COST OF TRAVEL, BY ELIMINATING THE NEED FOR OVER NIGHT ACCOMMODATIONS. THE CHARTER TRAVEL ALSO REDUCED THE TIME UNPAID BOARD MEMBERS HAD TO COMMIT. (2 INDIVIDUALS LISTED ON PART VII, SECTION LINE 1A - JEFFREY COSTELLO, AND JAMES KEENAN) | |
| PART I, LINE 4B | EMPLOYEE 2010 EARNED 457(f) PHILIP NEWBOLD $108,930 MICHAEL O'NEIL $32,493 JEFFERY 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. | SUPPLEMENTAL EXECUTIVE RETIREMENT PROGRAM (457(F)) |
| PART I, LINE 6A & 6B | THE ORGANIZATION HAS TWO 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 BUDGET NET OPERATING INCOME WITH THE NON-MANAGMENT EMPLOYEES FOR MEMORIAL HEALTH SYSTEM, INC AND THE AFFILIATED ENTITIES, WHICH INCLUDES MEMORIAL HOSPITAL OF SOUTH BEND, INC. THE EMPLOYEE INCENTIVE HAS A MAXIMUM CAP OF $2,500,00. 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. | |
| PART I, LINE 7 | BRYAN BOYER, MD IS ELIGIBLE FOR AN INCENTIVE BASED UPON EXCEEDING GROSS PROFESSIONAL BILLINGS. THE INCENTIVE IS A COMPONENT OF THE EMPLOYMENT CONTRACT WITH DR. BOYER. DR. BOYER DID NOT QUALIFY FOR AN INCENTIVE PAYMENT IN 2010. DAVID HORNBACK, MD RECEIVED AN INCENTIVE BASED UPON NET PREOFESSIONAL BILLINGS. THE INCENTIVE IS A COMPONENT OF THE EMPLOYMENT CONTRACT. FACULTY INCENTIVE FOR FAMILY PRACTICE RESIDENCY CLINICS PROVIDES FOR AN INCENTIVE PAYMENT WHEN COLLECTIONS FOR PERSONALLY RENDERED SERVICES EXCEED A THRESHOLD. THESE INCENTIVE ARE CAPPED. PHYSICIAN RELATIONS INCENTIVE PLAN PROVIDES FOR AN INCENTIVE PAYMENT TO EMPLOYEES IN A PHYSICIANS RELATIONS POSITION BASED UPON ATTAINMENT OF SATISFACTION SCORES. PAID AS A PERCENTAGE OF BASE PAY UP TO 5%. |
Schedule L IRS990ScheduleL
Form990 Schedule L Part IV Form990ScheduleLPartIV
Name Of Interested Person NameOfInterestedPerson
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | RAFAT ANSARI MD | NamePerson |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship | DIRECTOR | Relationship |
| Amount Of Transaction | 525037 | AmountOfTransaction |
| Description Of Transaction | LEASES OFFICE SPACE | DescriptionOfTransaction |
| Sharing Of Revenues | false | SharingOfRevenues |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (9 entries)
| IdentifierIdentifier | ExplanationExplanation | Return ReferenceReturnReference |
|---|---|---|
| FORM 990, PART VI, SECTION A, LINE 2 | BUSINESS RELATIONSHIPS - TERRY GERBER & JOHN HILER BUSINESS RELATIONSHIPS - VINCENT HENDERSON & RICK RICE | |
| FORM 990, PART VI, SECTION B | THE ORGANIZATION 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 ORGANIZATION ARE: - LOCAL CHAPTERS, BRANCHES AND AFFILIATES - CONFLICT OF INTEREST - WHISTLEBLOWER - DOCUMENT RETENTION AND DESTRUCTION - JOINT VENTURES | |
| FORM 990, PART VI, SECTION B, LINE 11b | THE 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 US, LLP TO REVIEW THE COMPLETED FORM 990 AND APPROPRIATE SCHEDULES. PRIOR TO FILING THE RETURN, THE COMPENSATION COMMITTEE OF THE ORGANIZATION AND 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. | |
| FORM 990, PART VI, SECTION B, LINE 12c | THERE 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 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 ACHIEVED A 100% RESPONSE RATE. EACH RESPONSE IS REVIEWED BY THE DIRECTOR OF INTERNAL AUDIT AND THE RESULTS ARE REPORTED TO THE CEO OF MEMORIAL HEALTH SYSTEM, INC 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 WERE 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 HEALTH SYSTEM, INC 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 HEALTH SYSTEM, INC'S KEY FINANCIAL EMPLOYEES THAT MEMORIAL HEALTH SYSTEMS, INC'S FINANCIAL INFORMATION IS TO THE BEST OF THEIR KNOWLEDGE TRUE AND ACCURATE. THIS STATEMENT WAS SENT OUT IN JANUARY, 2010. SIGNED ACKNOWLEDGEMENTS ARE KEPT BY THE DIRECTOR OF INTERNAL AUDIT. IN 2010, FOURTEEN DESIGNATED EMPLOYEES WERE REQUESTED TO SIGN THE FORM AND 100% COMPLIED WITH THIS REQUEST. ANY POTENTIAL CONFLICTS OF INTERESTS 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 | |
| FORM 990, PART VI, SECTION B, LINE 15a & 15b | AN 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. | |
| FORM 990, PART VI, SECTION C, LINE 19 | THE 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. | |
| FORM 990, PART XI, LINE 5 | CASH TRANSFERS FROM MEMORIAL HOSPITAL OF SOUTH BEND: $18,686,057 WRITE OFF INTER COMPANY MEMORIAL HOSPITAL OF SOUTH BEND $ 2,506,736 WRITE OFF INTER COMPANY MEMORIAL HEALTH FOUNDATION $-1,367,336 CHANGE IN PENSION LIABILITY $ 1,498,690 UNREALIZED GAINS/LOSS ON DEFERRED COMPENSATION PLAN $ 137,556 CHANGE IN MARKET VALUE ON LIFE INSURANCE PLANS $ 182,933 TOTAL $21,644,636 | |
| HOURS DEVOTED FOR RELATED ORGANIZATION | NAME:RAFAT ANSARI, MD TITLE:DIRECTOR - MED DIRECTOR HOURS:40 | FORM 990 PART VII |
| HOURS DEVOTED FOR RELATED ORGANIZATION | NAME:GREG CONRAD TITLE:ASST SECRETARY HOURS:32 | FORM 990 PART VII |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (2 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Business Name Line1DirectControllingEntityName/BusinessNameLine1 |
|---|---|---|---|---|---|---|---|---|---|
| MEMORIAL HOSPITAL OF SOUTH BEND INC | |||||||||
| 615 N MICHIGAN ST | SOUTH BEND | IN | 46601 | 350868132 | HOSPITAL | IN | 501(c)(3) | 3 | MHS |
| MEMORIAL HEALTH FOUNDATION INC | |||||||||
| 615 N MICHIGAN ST | SOUTH BEND | IN | 46601 | 351536129 | FINANCIAL SUP | IN | 501(c)(3) | 9 | MHS |
Form990 Schedule R Part IV Form990ScheduleRPartIV
Name Of Related Org NameOfRelatedOrg
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MEMORIAL HOME CARE INC | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 615 N MICHIGAN ST | AddressLine1 |
| City | SOUTH BEND | City |
| State | IN | State |
| ZIP Code | 46601 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 351901068 | EIN |
| Primary Activity | HOME MEDICAL | PrimaryActivity |
| Legal Domicile State | IN | LegalDomicileState |
| Type Of Entity | C | TypeOfEntity |
| Share Of Total Income | 21646538 | ShareOfTotalIncome |
| Share Of EOY Assets | 13609358 | ShareOfEOYAssets |
| Percentage Ownership | 1.00000 | PercentageOwnership |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | true | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | true | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | true | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | false | LoansOrGuaranteesFromOtherOrg |
| Sale Of Assets To Other Org | false | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | true | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | true | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | true | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | true | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | true | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | true | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | true | SharingOfFacilities |
| Sharing Of Paid Employees | true | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | true | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | true | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | true | OtherTransferToOtherOrg |
| Other Transfer From Other Org | true | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable (22 entries)
| Transaction TypeTransactionType | Amount InvolvedAmountInvolved |
|---|---|
| MEMORIAL HOME CARE INC | |
| a iv | 77017 |
| MEMORIAL HOSPITAL OF SOUTH BEND INC | |
| a iv | 743834 |
| MEMORIAL HOME CARE INC | |
| j | 75254 |
| MEMORIAL HOSPITAL OF SOUTH BEND INC | |
| j | 204612 |
| MEMORIAL HEALTH FOUNDATION INC | |
| b | 1367336 |
| MEMORIAL HOSPITAL OF SOUTH BEND INC | |
| c | 21192793 |
| MEMORIAL HEALTH FOUNDATION INC | |
| c | 629455 |
| MEMORIAL HOME CARE INC | |
| k | 4538767 |
| MEMORIAL HOSPITAL OF SOUTH BEND INC | |
| k | 180192059 |
| MEMORIAL HOSPITAL OF SOUTH BEND INC | |
| l | 19804289 |
| MEMORIAL HOME CARE INC | |
| l | 1382156 |
| MEMORIAL HEALTH FOUNDATION INC | |
| l | 407562 |
| MEMORIAL HEALTH FOUNDATION INC | |
| n | 583396 |
| MEMORIAL HOME CARE INC | |
| p | 3760484 |
| MEMORIAL HOSPITAL OF SOUTH BEND INC | |
| p | 27186057 |
| MEMORIAL HEALTH FOUNDATION INC | |
| p | 155000 |
| MEMORIAL HEALTH FOUNDATION INC | |
| q | 678451 |
| MEMORIAL HOME CARE INC | |
| q | 4740168 |
| MEMORIAL HOSPITAL OF SOUTH BEND INC | |
| q | 32412014 |
| MEMORIAL HEALTH FOUNDATION INC | |
| r | 711906 |
| MEMORIAL HOME CARE INC | |
| r | 4302378 |
| MEMORIAL HOSPITAL OF SOUTH BEND INC | |
| r | 34918749 |