2025-11-14T14:15:22-06:00 2024-12-31 420714325 RSM US LLP 30 South Wacker Dr Suite 3300 Chicago IL 606063392 990 2024-01-01 350877574 Elkhart General Hospital Inc ELKH 5745233208 600 East Blvd Elkhart IN 46514 Jeffrey Costello CFO 5745233208 2025-11-07 1 1 Rebekuh Eley P01247672 3126343400 2025-11-07 2024 2025-03-06 01:10:19Z Carl Risk 600 East Blvd Elkhart IN 46514 395644688 0 X www.beaconhealthsystem.org X 1909 IN We deliver outstanding care, inspire health, and connect with heart. 10 9 1934 82 373841 0 318234 10877713 362276419 381003182 276807 334744 2764538 2976030 365635998 395191669 431718 619064 0 0 125698773 122175340 0 0 0 194689436 225107189 320819927 347901593 44816071 47290076 274314068 269148571 79266586 76290195 195047482 192858376 X We deliver outstanding care, inspire health, and connect with heart. 0 0 288293432 619064 381811988 Elkhart General Hospital, Inc. has been providing comprehensive, advanced medical care primarily to Elkhart County and other contiguous counties in North Central Indiana and South Central Michigan for over 100 years. Elkhart General Hospital, Inc. consists of a 365-bed licensed hospital that provides services without regard to patient race, religion, national origin, economic status, or ability to pay. During 2024, the Hospital admitted 11,807 patients for a total of 46,366 inpatient days.Inpatient units consisted of medical, post-surgical, oncology, pediatric, critical care, cardiac care, behavioral health, rehabilitation, obstetric, and nursery intensive care. The Hospital also provided 3,913 outpatient surgeries, 46,223 emergency room visits, and 68,732 ancillary services.Elkhart General Hospital also provided $47,626,199 in unreimbursed care to the elderly covered by Medicare, and $5,353,774 in financial assistance. Part of the mission of Elkhart General Hospital is to provide for a healthier community through medication assistance programs and community health education. Due to the non-revenue generating or community investment nature of many of the programs, they operate at a loss. See schedule H for the details on the community outreach represented in other program services. 288293432 1 1 0 1 0 0 0 0 0 1 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 121 0 1 1934 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 10 9 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 IN X Jeffrey Costello 5746473549 615 N Michigan Street South Bend IN 46601 Tim Morgan MD Director, Chair through 3/31/24 2.00 40.00 X X 0 75027 12554 Matt Zimmerman Chair 2.00 0.00 X X 1220 0 0 Sam Borrelli MD Vice Chair 2.00 0.00 X X 200 0 0 Chris Annis MD Secretary 2.00 0.00 X X 920 0 0 John Deputy Director 2.00 0.00 X 1220 0 0 Dawn Fisher Director 2.00 0.00 X 1220 0 0 Esleen Fultz Director 2.00 0.00 X 200 0 0 Tonja Lucchese Director 2.00 0.00 X 1220 0 0 Shelley Moore Director 2.00 0.00 X 200 0 0 Bruce Newswanger DO Director 2.00 0.00 X 200 0 0 Kreg R Gruber CEO 2.00 50.00 X 0 1848714 287708 Jeffrey P Costello CFO 2.00 50.00 X 0 1077612 188598 Carl W Risk II President 40.00 0.00 X 0 674217 158223 Michelle R Bache VP Medical Affairs 40.00 0.00 X 516412 0 27372 James E Cantrell Lead Perfusionist 40.00 0.00 X 328145 0 63514 John P Scheu Perfusionist 40.00 0.00 X 299543 0 62073 Kaleena M Freeman Perfusionist 40.00 0.00 X 282335 0 28799 Candace J Andresen VP Nursing & Patient Care Srvcs 40.00 0.00 X 250990 0 36963 1684025 3675570 865804 243 0 1 0 Apogee Physicians 2525 E Camelback Rd Phoenix AZ 85016 Physician Services 4343402 Dynamic Mechanical 1606 Chestnut St Mishawaka IN 46545 Mechanical Services 2160997 South Bend Medical Foundation 3355 Douglas Rd South Bend IN 46635 Lab Services 2074690 LabCorp Indiana PO Box 8014 Burlington NC 27216 Lab Services 1889821 Aya Healthcare PO Box 123519 Dallas TX 75312 Temporary Labor 1889363 43 470690 10407023 10877713 Net Patient Revenue 622110 372952723 372952723 Outpatient Pharmacy 446110 6852823 327980 6524843 Rent from Related Part 622110 1197636 1197636 381003182 312219 312219 919666 421227 498439 498439 498439 54317 31792 22525 22525 22525 CAFETERIA 722514 1288304 1288304 QUALITY INCENTIVE 622110 742052 742052 PRIMLEY DISTRIBUTION 523000 334620 334620 112615 66754 45861 2477591 395191669 374959165 373841 8980950 298326 298326 320738 320738 839041 839041 96652412 82853153 13799259 3029742 2597180 432562 14728200 12625425 2102775 6925945 5937114 988831 4940908 4235485 705423 16810 16810 89352 89352 1813 1813 260211 260211 29081459 24929411 4152048 867 867 3633023 3114329 518694 14691 12594 2097 3321122 2846959 474163 97734 83780 13954 40345 34585 5760 1876395 1608498 267897 14989669 12849564 2140105 1360940 1166636 194304 PATIENT SUPPLIES, DRUGS 71523291 71523291 CORPORATE ALLOCATION FE 46524780 39882344 6642436 HOSPITAL ASSESSMENT FEE 24817600 21274341 3543259 BAD DEBT EXPENSE 22399898 22399898 116281 99679 16602 347901593 288293432 59608161 0 7810 7810 14485661 8718891 66587288 58217290 328003 368093 11539619 12608516 522020 841689 440851425 275435108 168648694 165416317 8420513 8899279 2536226 2536226 1238234 11534460 274314068 269148571 24912022 26120462 52721476 48550540 1633088 1619193 79266586 76290195 X 186626969 183959097 8420513 8899279 195047482 192858376 274314068 269148571 X 47290076 478766 -49957948 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 1813 1813 0 Part II-B, Line 1: Academy, CDR - 11.3% ACEP - 25.1% ACHE (American College of Healthcare Executives) - 0.7% AMA (American Medical Assoc.) - 17.4% American Academy of SL - 3% American College of CL - 5% American Hospital Assoc. - 13% ASHP (American Society of Health-System Pharmacists) - 3.7% Indiana Psychological Assoc. - 2.1% Oncology Nursing Society - 0.1% APA (American Psychiatric Assoc.)- 3.3% Trauma Center Assoc. - 15.4% 50876447 9625097 3135087 4428203 334621 58873807 46573387 2440358 3598804 1424963 311139 50876447 51847680 3689060 -5391156 3270255 301942 46573387 45447655 3126708 5095842 1536648 285877 51847680 42268939 1692784 3115564 1353300 276332 45447655 0.57025 0.00679 0.42295 0 1 1 4973897 4973897 282933586 155352675 127580911 147084620 120082433 27002187 5859322 5859322 165416317 MED MAL IBNR 1619193 1619193 X Part V, Line 4: Net assets with donor restrictions consist of assets whose use is limited by donor imposed, time and/or purpose restrictions. Some net assets have been restricted by donors to be maintained by the corporation in perpetuity. In accordance with the restriction, a majority of the investment income and investment gains or losses from these net assets are restricted by the donor for a specific purpose. A specified portion of income earned by the net assets is released from restriction and used for operations each year and, therefore, is included in the consolidated statements of operations and changes in net assets as other revenue. The hospital has one endowment fund established for patient care purposes with a value of $8,899,279. The hospital has established investment and spending policies related to the appreciation of this endowment. Should the underlying assets fall below this targeted amount the hospital pursues action consistent with established policies to return the endowment to the targeted amount. Based on these policies, endowment amounts are temporarily restricted until board authorized release of funds for patient care purposes are approved. As a member organization of Beacon Health System, the hospital also can benefit from endowment funds held by related entities, the value of which was $49,974,526 at 12/31/2024. In 2024, the hospital received $470,690 from the related party endowment funds. Part X, Line 2: ASC 740, Income Taxes, requires that realization of an uncertain income tax position be more likely than not (i.e., greater than 50% likelihood of receiving a benefit) before it is recognized in the consolidated financial statements as the amount most likely to be realized assuming a review by tax authorities having all relevant information and applying current conventions. This interpretation also clarifies the financial statement classification of tax-related penalties and interest and sets forth new disclosures regarding unrecognized tax benefits. No amount was recorded for the years ended December 31, 2024 or 2023. 1 1 X 1 X 1 X 1 1 0 1 1 1153158 0 1153158 0.00350 64010596 52295790 11714806 0.03600 65163754 52295790 12867964 0.03950 1450171 96591 1353580 0.00420 1468172 0 1468172 0.00450 283050 0 283050 0.00090 3201393 96591 3104802 0.00960 68365147 52392381 15972766 0.04910 1 4824749 2412374 50447812 68117722 -17669910 X 1 1 1 1 Elkhart General Hospital Inc 600 East Blvd Elkhart IN 46514 www.beaconhealthsystem.org 23-005017-1 X X X Elkhart General Hospital Inc 1 0 0 1 X X X X X X X X X 24 1 1 0 1 X https://impact.beaconhealthsystem.org/chna X X 1 22 1 https://impact.beaconhealthsystem.org/chna 0 1 X 200.000000000000 350.000000000000 X X X 1 1 X X X 1 X www.beaconhealthsystem.org/patients-and-visitors X www.beaconhealthsystem.org/patients-and-visitors X www.beaconhealthsystem.org/patients-and-visitors X X X X X X 1 X 0 X X X X 1 X 0 0 Elkhart General Hospital, Inc. Part V, Section B, Line 5: Beacon Health System's 2024 Community Health Needs Assessment (CHNA) represents more than just a regulatory requirement for non-profit hospitals. The organization views it as a valuable opportunity to engage with communities across their four-county service area (St. Joseph County IN, Elkhart County, Marshall County, and St. Joseph County MI) to understand health and social needs of community members.The assessment follows the MAPP 2.0 framework (Mobilizing for Action through Planning and Partnerships) developed by the National Association of County & City Health Officials. This community-driven assessment and planning process is designed to support health equity while focusing on strategic, prioritized needs. The framework helps recognize and align resources across integrated sectors by emphasizing diverse and inclusive assessment activities.The CHNA is structured around three primary assessment components:Community Status Assessment (CSA) - Provides a foundation of secondary research data about demographics, health status, health inequities, and social drivers of health. This helps identify communities at greater risk of poor health outcomes and understand which groups may need more services.Community Partner Assessment (CPA) - Reviews existing resources, systems, processes, and capacities, both individually and collectively as a network of community partners. This component recognizes that community partnerships form the required network of support for public health improvement, as rarely can a single agency address all interrelated needs.Community Context Assessment (CCA) - Collects and analyzes qualitative data through community engagement. This component captures the lived experiences of community members, providing insights about helpful resources, organizational strengths, cultural nuances, and priorities.The assessment methodology employed a mixed methods approach between January and September 2024, including secondary research, community surveying, resource guide reviews, access audits, qualitative interviews, focus groups, and a needs prioritization process. Throughout the process, Beacon utilized:A Multi-Sector Health Advisory Council with a total of 23 representatives from across the four-county service area who received MAPP 2.0 training and met monthly throughout the project. Eight Equity Champions representing diverse communities helped ensure the needs of underrepresented or historically marginalized communities were understood. Beacon Health System is dedicated to understanding health equity and disparities within the communities it serves. Equity Champions participated in a stakeholder interview, participated in a focus group or helped host and recruit community members for a focus group, and participated in the prioritization process. The Equity Champions met regularly throughout the CHNA process.The research engaged many participants throughout the four-county region. 150 participants were for the focus groups and stakeholder interviews. We had 1,513 individuals complete our community survey. 49 partners completed the partner survey. We completed an access audit/mystery shopper with 25 facilities across the region. Community members participated in focus groups that explored local health needs and how these intersect with individual health experiences. Meanwhile, professionals and community leaders contributed their expertise through both focus groups and stakeholder interviews to provide insights into the broader health landscape. The participants represented diverse sectors that influence community health, including healthcare professionals, government representatives, faith-based organizations, community-based organizations, educational institutions, and social service providers. This multi-sector approach ensured a well-rounded understanding of health needs from various perspectives, combining both personal experiences and professional knowledge.Collectively with the health advisory council, health equity champions, the community survey, key informant interviews, and focus groups who took into account input received from persons who represent the broad interests of the community served. Secondary data provides an essential framework from which to better understand the fabric of the community. This analysis highlights sociodemographic factors, social drivers of health (SDOH), behavioral health risk factors, and other key indicators to further guide the development of effective strategies to meet evolving needs. In addition to collecting key demographic secondary data, research also focused on the SDOH. The SDOH includes a wide range of factors, including, but not limited to, income, education, job security, food security, housing, basic amenities, the environment, social inclusion and non-discrimination, and access to quality affordable health care.The top priority was identified through the modified delphi technique with our advisory council and internal leaders. The assessment identified 49 community needs, with "Access to Providers" emerging as the top priority area. This includes several subcategories:- Shortages of various provider types (primary care, specialists like endocrinology, OBGYN, pediatrics, rheumatology, neurology, podiatry)- Need for community health workers and peer support specialists- Improving cultural competency of providers- Addressing community mistrust of providersThe report defines "providers" broadly to include anyone within the health system who interacts with patients or community members (nurses, front desk staff, cafeteria workers, environmental services). Elkhart General Hospital, Inc. Part V, Section B, Line 6a: Elkhart General Hospital (EGH) developed the 2024 St. Joseph County CHNA in partnership with Community Hospital of Bremen, Memorial Hospital South Bend, and Three Rives Health, Beacon Health System (BHS) care partners. Elkhart General Hospital, Inc. Part V, Section B, Line 7d: The Community Health Needs Assessment (CHNA) was made widely available to the community through posting on the Beacon Health System website at https://impact.beaconhealthsystem.org/chna and through email transmission upon request. Hospital staff were also available to discuss the results of the CHNA and implementation strategies in requested community forums. Elkhart General Hospital, Inc. Part V, Section B, Line 11: Beacon Health System completed a Community Health Needs Assessment (CHNA) in 2021 to better understand and prioritize the health needs of the communities we serve in Indiana (Elkhart, LaPorte, Marshall, and St. Joseph counties). The CHNA process included secondary data collection, a key informant survey and focus groups throughout Beacon's core service area in Indiana. Executive leaders approved mental health and healthcare access as the top priorities after analysis of the data collected. Three Rivers Health, which serves St. Joseph County in Michigan, joined the Beacon family after the completion of the 2021 CHNA. They participated in their local health department's CHNA, which found mental health and resource accessibility to be among the top three health needs, which aligns with our priority areas and implementation strategy. Beacon's implementation strategy (2022 -2024) aligns with our mission and values by enhancing the skills of patients, practitioners and the community. Over the past three years, Beacon prioritized expanding mental health services and improving healthcare access to better serve our communities. Beacon worked with community partners and internal programs to improve access to health and wellness services by improving and strengthening local social and healthcare systems. Mental illness, especially depression, increases the risk for many types of adverse physical health outcomes, particularly long-lasting conditions like type 2 diabetes and heart disease. Similarly, the presence of chronic conditions can increase the risk for mental illness. Robert Wood Johnson's County Health Rankings model examines quality of life and tells us a lot about how people perceive their health whether they feel healthy and satisfied. When communities have higher rates of those who do not feel healthy, it can influence other factors of health, including mortality rates, unemployment and poverty. Increasing healthcare access, quality and equity addresses all major social, economic, environmental and behavioral factors that enable individuals and communities to make healthy choices and enjoy a long, healthy life. Additionally, our 2021 CHNA research indicated that individuals with low health literacy were significantly more likely to delay or forgo needed care or to report difficulty finding a provider, compared with individuals who have adequate health literacy.Mental Health Metrics % of the population with frequent mental health distress % of the population with two or more trusted support people Healthcare Access Metrics % of the population with health insurance (adults < 65 and children) % of adults who reported their healthcare providers always involved them in decisions about their care, as much as they wanted. Beacon Community Impact provided community resources to 59,738 individuals across our service area Elkhart, Marshall, and St. Joseph, IN Counties and St Jospeh County, Michigan in 2024. Within Beacon Health System, the Beacon Community Impact Department leads efforts impact our priority areas of mental health and healthcare access using a combination of internal programs and collaborative partnerships. Our implementation strategy incorporates a three-pronged approach:We provide direct services to clients through Beacon's Early Childhood Services and Community Health Services teams. Early Childhood Services include the St. Joseph County (Ind.) WIC program, two sickle cell programs and our Family & Infants Support Program. These programs focus on the health status of women, infants and young families, particularly the most vulnerable in Beacon's service area. Our Community Health Services team focuses on prevention through community health educators with school curricula delivered throughout middle and high schools in the three Indiana counties we serve. Summer programming shifts to health-related day camps and participation at community health fairs. Though it may not be their primary focus, these community health teams screen for and provide referrals for clients experiencing mental health challenges. Likewise, they emphasize the importance of trusted adults as protective factors for youth.We fund local community organizations with expertise in their service areas. These organizations are community nonprofits with boots-on-the-ground services in the most vulnerable neighborhoods and more diverse populations. Each of the funded partners addresses the top two health priorities and reports on the number of participants and on an outcome metric for either mental health or healthcare access. In addition, Beacon partnered with the local health department in Three Rivers, Michigan, to support building out their Community Health Worker Program to increase services addressing healthcare access and mental health. Participating organizations Community partners- Center for Healing and Hope - diabetes support program- Child and Parent Services, Inc. (CAPS) - maternal and infant health support- Healthy Beginnings (Elkhart County Health Department) - maternal and infant health support- Mental Health Awareness of Michiana (MHAM) - behavioral and mental health- United Health Services - healthcare navigation- La Casa de Amistad - social service support- Maple City Health Care - maternal infant health support- Transformation Ministries - youth advocacy and support- Gentleman and Scholars, Inc. - youth advocacy and support- Imani Unidad - health literacy and case management- Horizon Education Alliance - health literacy and case management- Branch-Hillsdale-St. Joseph Community Health Agency, Health Department Beacon Community Impact Programs- Beacon Health Navigator- Family and Infant Support Program (FISP)- Health and Wellness Programs- Sickle Cell Infant Screening- Sickle Cell Broadscope- Women, Infants and Children (WIC) Clinic Elkhart General Hospital, Inc. Part V, Section B, Line 13h: The policy allows for patients to qualify for assistance by two means: financial or catastrophic. The financial assistance program also allows for partial assistance or full assistance based on eligibility criteria in this policy.Financial assistance1. A patient qualifying for financial assistance is a person who is uninsured or underinsured, receives care and is unable to pay their bill.2. To be eligible for assistance under the financial assistance guidelines, a person's income shall be at or below a percentage of the federal poverty level (FPL) as determined by federal poverty guidelines. Household size and income determines the % of FPL. Elkhart General Hospital or its designee may consider other financial assets and liabilities of the person when determining eligibility.3. Elkhart General Hospital will use the most current poverty income guidelines issued by the U.S. Department of Health and Human Services to determine an individual's eligibility for financial assistance. The poverty income guidelines are published annually in the federal register and for the purposes of this policy will become effective the first day of the month following the month of publication.4. To qualify under the financial assistance portion of this policy, a completed, signed financial assistance application must be submitted and proof of income, proof of no income, proof of lack of financial assets and other required documents must accompany the application. Catastrophic assistance criteria1. A patient qualifying for catastrophic assistance is a person whose hospital bills exceed a specified percentage of the person's annual gross income as set forth in the policy and who is unable to pay the remaining bill.2. To be eligible for catastrophic assistance, the amount owed by the patient must exceed one hundred fifty (150) percent of the patient's annual gross income and the patient must be unable to pay the remaining bill. Elkhart General Hospital may consider other financial assets and liabilities of the person when determining ability to pay.3. If a determination is made that a patient has the ability to pay the remainder of the bill, such a determination does not prevent a reassessment of the patient's ability to pay at a later date should their financial circumstances change.4. After eligibility is determined under this provision, assistance will be provided to discount the bill by 75% of the current balance.5. If a patient has cash assets, those assets will be added to their income when determining eligibility for assistance. Part I, Line 3c: Household size and incomeThe following factors may be considered in determining the eligibility of the patient for assistance and must be provided by all income earning residents in the countable household unit unless they are not dependents based on IRS guidelines for determining whether a household member can be considered a dependent.1. Indiana workforce wage report for last 2 quarters (unemployment income).2. Last 3 pay stubs or a letter or printout from employer(s) providing verification of gross income if currently employed. This documentation should not be more than 30 days old from date of issue and include year-to-date information.3. Last 3 bank statements (including explanations of regular deposits not explained by pay stubs).4. Social security award or entitlement letter or other proof of gross monthly award.5. Retirement income.6. Investment income.7. Statement from person(s) that are providing direct support.8. Number of dependents.9. Most recent tax return (including W2 and all supporting schedules).10. Other financial obligations.11. The amount and frequency of hospital/medical bills.12. Other financial resources that produce income.13. If self-employed, gross income less cost of goods sold and employee salaries.Financial capacity1. Individuals with the financial capacity to purchase health insurance coverage through the health insurance marketplace may be required to purchase and will be provided access to meet with an Indiana certified navigator as a means of assuring access to healthcare services, for their overall personal health, and for the protection of their individual assets.2. Individuals found to be ineligible for Medicaid or other affordable health care coverage must provide proof of denial.3. Food stamps or supplemental nutrition assistance program (SNAP) will not be counted as income.4. Cosmetic services are not eligible for any type of assistance and cannot be included in the amount of hospital/medical bills owed. Part I, Line 6a: Beacon Health System prepared the annual community benefit report for Elkhart General Hospital. Part I, Line 7: The costing method used to calculate financial assistance reported on lines 7 a through d was the cost-to-charge ratio as derived on tax form 990, Schedule H, worksheet 2. All other community benefits were calculated using direct costs. Part I, Line 7, Column (f): The Bad Debt expense included on Form 990, Part IX, Line 25, Column (A), but subtracted for purposes of calculating the percentage in this column is $ 22,399,898. Part II, Community Building Activities: Elkhart County's early childhood initiative, Building Strong Brains, represents an unprecedented coordinated, system approach to kindergarten readiness. Five local organizations agree to collectively lead a coalition of stakeholders across education, health, business, nonprofit, and philanthropic sectors, with the goal of increasing kindergarten readiness for the children in Elkhart County. The comprehensive approach includes maternal & child health, community supports for children and families, and quality childcare and early learning environments. The coalition has been divided into three action teams that each have a specialty of focus to map the current system of services and supports and identify opportunities and gaps and identifies potential strategies to address need. Beacon Community Impact gladly supports this coalition, we have had an associate serving as an Action Team Chair since the inception in 2022.The Greater Elkhart Chamber of Commerce has many councils, the purpose of the Education/Career Development Council is to support, promote and align with our education system, worker training and instruction programs to help our citizens in Elkhart County meet the demands of the future. Beacon Community Impact supports this effort, we have an associate serving as a Co-Chair to share information from our health system and bridge the needs of the community with educators and local businesses in the greater Elkhart area. By meeting with local school administrators we are able to share updates from our CHNA strategies, provide resources and connect partners more efficiently. Beacon Health System is also able to support the goal of the council in which to increase the level of career and college readiness in Elkhart County by welcoming internships from our local Elkhart County high schools at Elkhart General Hospital and offices. In addition, BCI is active with the Greater Elkhart Chamber of Commerce Leadership Academy Advisory Council, this work promotes servant leadership through an awareness program combining key community issues and enhanced leadership skill development to advance community stewardship.Together We Rock Program, which serves and brings together infant and early childhood providers in Elkhart County for learning circles, training and collaboration. This work parallels the Partnership for Children (PFC) program in many ways, just with an early childhood focus. Beacon Community Impact has a representative on this coalition. Part III, Line 2: 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 receivable are charged to the allowance for doubtful accounts when they are deemed uncollectible. Costing methodology is the same as tax form 990, Schedule H, worksheet 2 methodology. Patient care is cost adjusted by non-patient activity, expenses, and patient care charges. The amount of bad debt reported on Part III, Line 2 is calculated by applying the cost-to-charge ratio, as determined by worksheet 2, to total bad debt expense per the audited financial statements. Bad debt expense which is attributable to eligible patients is considered part of Elkhart General Hospital's community benefit because of our mission to create a healthier community while continuing our charitable role in the community. Part III, Line 3: Bad debt attributable to the FAP is estimated based on the historical trend of the sources of the bad debt. The majority of bad debt is attributable to uninsured patients which represent the majority of the population that would fall under the FAP. We have applied the historical estimate (50%) to the total bad debt expense to determine the amount attributable to the FAP. Part III, Line 4: The provision for bad debts is based upon management's assessment of historical and expected net collections, taking into consideration the trends in health care coverage, historical economic trends, and other collection indicators. Management assesses the adequacy of the allowances periodically throughout the year based upon historical write-off experience by major payor category. The results of the review are then utilized to make modifications, as necessary, to the provision for bad debts to provide for an appropriate allowance for uncollectible accounts. A significant portion of the corporation's uninsured patients will be unable or unwilling to pay for the services provided. Thus, the corporation records a significant provision for bad debts related to uninsured patients in the period the services are provided. Part III, Line 8: Rationale for inclusion of the Medicare shortfall as a community benefit. Participation in the governmental Medicare program does not provide the opportunity for a hospital to negotiate a reimbursement rate or structure that would allow the hospital to cover the cost of the medical service rendered to the program participant, as would be the case in contractual negotiations with commercial insurance companies. Nor is the hospital allowed to provide only the services for which reimbursement covers the direct cost of care. This produces the same shortfall outcome as does the participation in the Medicaid program. The Medicaid program is recognized as a community benefit on Schedule H and on community benefit reports for most states. The quality and cost of the patient care is the same regardless of payor source. Hence the acceptance of Medicare reimbursement represents a reduction or relief of the government burden to pay the full cost of care provided. The source used for the costing methodology for the amount reported on line 6 was the 2023 Medicare cost report. Part III, Line 9b: Collection practicesPatients known to qualify for financial assistance follow the same collection policy as all individuals with balances remaining after application of financial assistance. Credit and collections policy: Elkhart General Hospital relies on timely payment of patient accounts receivable to allow the hospital to continue to provide high-quality medical care and to secure the latest in health care technology for its patients. Elkhart General Hospital, recognizing the burden that unexpected health care expenses can place on patients and their families, will assist patients to resolve open accounts for hospital services by working with third party payers to adjudicate patient's insurance claims and by providing alternative payment plans for patients. The hospital also provides subsidized care for those patients who qualify. However, with the exception of some government and contracted care plans, ultimate responsibility for resolution or payment of accounts rests with the patient. Patients are expected to work with hospital personnel to resolve accounts with their insurance companies and/or employers as appropriate. Where there is an estimated self-pay balance due, Elkhart General Hospital will ask non-emergency patients to pay that balance prior to or at the time of admission/registration.1. If a patient does not qualify for financial assistance and does not pay their account according to the options provided, then the patient's account will be processed according to the bad debt write off policy.2. If a patient has begun making payments but then is later determined to qualify under the FAP, Elkhart General Hospital would issue a refund to the patient for any amount that has been determined to exceed their newly determined financial responsibility.3. Elkhart General Hospital may request and collect a deposit, based on the patient's total estimated portion of a bill, from appropriate non-emergency inpatient admissions, same day surgery patients, and patients scheduled for high-dollar outpatient procedures prior to or at the time of admission or registration. In the event that a request for payment is not made prior to or at the time of the patient's arrival, a financial counselor may calculate the estimated deposit amount and confer with the patient/guarantor for payment following the admission or registration process via a financial interview. (in some instances, this could occur while the patient is in his/her assigned room.) At the time of discharge, emergency patients may be requested to pay any co-pay or deductible.4. Where appropriate, Elkhart General Hospital will identify, and request payment of, aged patient balances as part of the request for deposit. Payment for open prior balances will not delay care for emergency or medically necessary care. Aged open prior balances will be considered by the collection staff in patient account services whenever payment arrangements or an alternative payment program is developed for a patient.5. Uninsured patients are given a 35% discount from gross charges.6. Elkhart General Hospital will conduct financial interviews with patients and/or guarantors when necessary. All financial interviews will be conducted in an environment that is both private and professional.7. In addition to cash, check, and credit cards, the approved payment arrangement methods might include:A. Hospital payment plan - A payment plan with the hospital is not to exceed three months. Exceptions must be approved by the manager of patient account services or revenue cycle director. Patients may be required to sign a promissory note based on the agreed upon payment arrangement.B. Carepayment - An extended payment plan which allows the patient an extended period not to exceed 36 months at 0% interest to pay their balance between $100 and $15,000. Patients may be automatically enrolled in the carepayment plan if their account has not been paid in full 2 months after their first statement. All patients are eligible provided that they provide a valid social security number, are over 18 and have not previously defaulted on their carepayment account.C. Medicaid/HIP - Patients who do not have coverage when they present to the hospital for treatment will be screened for other coverage through state assistance programs. An eligibility specialist will assist the patient/guarantor to complete and submit all necessary forms required by the Indiana Department of Public Aid for these types of programs.D. Hospital financial assistance (uncompensated care) - Reasonable efforts will be made to determine if patients are eligible for financial assistance through the hospital financial assistance program. All financial assistance must be approved according to the FAP for the hospital. (Refer to the hospital's financial assistance policy) 8. Extraordinary collection actions will not be taken until after Elkhart General Hospital has made reasonable efforts to determine if a patient will qualify for financial assistance. Extraordinary collection actions include suit, wage garnishment, lien or adverse credit bureau reporting. Part VI, Line 2: Beacon Community Impact formed the first Community Health Advisory Council in 2016. Still operating on an as needed basis today the Council consists of representation from Community Hospital of Bremen, Elkhart General Hospital, Memorial Hospital of South Bend, and Three Rivers Health. The council is made up of individuals from Beacon Health System and Community stakeholders (i.e. Council at Large, Public School Systems, other Health Care entities, Indiana University South Bend, University of Notre Dame, Ivy Tech Community College, community organizations, local churches, community persons, etc.). The Advisory Council met monthly in 2024 following the MAPP 2.0 training during the Community Health Needs Assessment (CHNA) procedures and will meet 2-4 times per year to learn about community health, the CHNA process, and to review local hospital and community data collected regarding health in our community; there are periodic email communications as well. The Advisory Council provides input on the health priority areas, offers best practices, identifies areas of opportunities, and monitors progress on addressing health needs. Part VI, Line 3: When uninsured patients present to our hospital, they are offered the opportunity to meet with our eligibility specialists. Our eligibility specialists discuss the potential eligibility of the patient for multiple assistance programs, including our own internal financial assistance program. Our statements also include a notice that financial assistance is available to patients, and they can contact our customer service group for guidelines. Patients are also made aware of our financial assistance program via telephone conversation with our patient accounts staff. Staff is particularly sensitive to address this program with anyone who indicates there might be a financial need. Part VI, Line 4: Elkhart County, Indiana, was established in 1830, with the original county seat in Dunlap and was later moved to Goshen. Today Elkhart County has three growing cities, four towns, and 16 townships with a population of 206,409 individuals according to the U.S. Census Bureau (year 2023). Elkhart County is located in northern Indiana and borders the state of Michigan. The County is approximately 463.16 square miles in size. Elkhart County lies halfway between Chicago and Cleveland and is located near Interstate 80/90 and the Indiana Toll Road. Elkhart County's service providers have a history of actively forming partnerships in an effort to meet the health needs of its residents. Elkhart County takes pride in offering its residents a great place to live and continually strives to establish new businesses and provide an entrepreneurial atmosphere.Elkhart, Marshall and St. Joseph Counties are all located in Northern Indiana. They have a total of 6 cities and 16 towns with a combined population of 525,609. St. Joseph is the largest and Marshall the smallest, which is classified as rural. St. Joseph County, Michigan borders Elkhart County, Indiana and is similar in rural classification as Marshall County. Although each varies in population density, they are closer in geographic size (SJC, IN-457 square miles, Elkhart-463, Marshall-443, SJC, MI-521). The median household income (2018-2022) is comparable across Beacon's service area counties, with Marshall County leading at $66,016, followed by Elkhart County at $63,978, St. Joseph County, MI at $62,281, and St. Joseph County, IN at $61,877 - all below the U.S. median of $75,149. Poverty rates vary, with St. Joseph County, IN experiencing the highest rate at 14.4%, followed by St. Joseph County, MI at 12.9%, Elkhart County at 12.0%, and Marshall County with the lowest at 10.8%. Elkhart County remains the "RV Capital of the World," with the industry generating over $32.4 billion in annual economic impact nationwide and supporting over 18,000 local jobs. Marshall County continues as one of Indiana's agricultural leaders, with over 219,000 acres of farmland generating $171 million in agricultural products. St. Joseph County, IN serves as the regional center for higher education, home to institutions like Notre Dame, Indiana University South Bend, and Saint Mary's College, which have helped transform the local economy from manufacturing to health, education, and service sectors. St. Joseph County, MI maintains its natural beauty with numerous lakes and woodlands, including over 42 lakes and Sturgeon Lake, which spans 220 acres. Part VI, Line 5: In partnership with Beacon Health System (BHS), the mission of Elkhart General Hospital (EGH) is to deliver outstanding care, inspire health and connect with heart. BHS is committed to clinical excellence, compassionate care, and the ongoing improvement of quality of life. Our commitment will lead BHS to be the community's provider of outstanding quality, superior value and comprehensive health care services. Both BHS and EGH consistently invest funds to improve the quality of life for our communities.BHS values reflect an unwavering commitment to the communities we serve. EGH has as its values:- Patients are at the center - Patient needs, care and safety are our top priority. - Trust - Our actions will firmly demonstrate our integrity, abilities and our character.- Respect - We will treat our patients, community members, and each other with the highest level of regard, demonstrating an understanding of different perspectives, cultures, interests and needs of others. - Integrity - We will continually do the right thing for patients, associates, and communities we serve. - Compassion - We will appropriately demonstrate empathy and sympathy, and express the desire to help.Elkhart General Hospital seeks to promote the health and wellbeing of Elkhart County residents, with specific focus on the most vulnerable populations, by providing education to aid in early detection and prevention of disease and to improve the health status of the community as a whole. A key mechanism by which this goal is carried out is Elkhart General Hospital's serious, consistent, deliberate search for and partnership with like-minded organizations. Elkhart General Hospital continues to seek out partnerships with multiple community entities to address the needs of the medically underserved and to improve the health status of our community. These collaborative alliances included local public health, schools, churches, social service agencies, minority advocacy groups, victim assistance, and community health providers.Elkhart General Hospital's governing body is comprised of persons who reside in Elkhart County. Board of Directors, who serve without pay, guides the system in its mission to provide high quality, affordable health care to the communities it serves. The Board's roles include guaranteeing fair and equal access, approving new medical staff members and approving long-term strategies for the continued success of the hospital. Additionally, Elkhart General Hospital extends medical staff privileges to all qualified physicians in our community.Beacon Health System welcomed Three Rivers Health in Three Rivers, Michigan, to the Beacon family in September 2021. In 2023, Community Impact established a working relationship with the local health department, Branch-Hillsdale-St. Joseph Community Health Agency, to address the top needs in the community. Beacon Health System employs a comprehensive approach to health promotion across its four-county service area, focusing on two priority areas: healthcare access and mental health. This integrated strategy works through community partnerships and internal programs to address social determinants of health and build healthier communities.Beacon's healthcare access work aims to decrease the number of uninsured individuals and increase patients' confidence in communicating with healthcare providers. Key programs include:- The Beacon Health Navigator program, which helps connect people to appropriate health resources and insurance options, preventing situations like fraudulent insurance schemes- Cultural and language-appropriate services for diverse populations- Targeted support for uninsured individuals through community partnerships- Specialized outreach to underserved communities through partners like La Casa de AmistadBeacon's mental health initiatives focus on reducing mentally unhealthy days and increasing social support systems for both youth and adults. Activities include:- Suicide prevention training (safeTALK) that provides education and emotional healing- Culturally-responsive mental health support for diverse populations- Programming that connects isolated individuals with supportive communities- Trauma-informed approaches to mental health careRecognizing maternal and infant health as a critical indicator of community wellbeing, Beacon has implemented:- A comprehensive maternal health strategy with care coordination between clinical providers and community programs- Dedicated care teams including doulas, community health workers, nurses, and social workers- The Family Journey initiative, funded by a $5.4 million federal grant, to improve birth outcomes and eliminate health disparities- Remote patient monitoring for pregnant patients with hypertension- Sickle cell screening and education for newborns and parents- B.A.B.E. stores providing essential supplies to new parents who earn "coupons" through healthy behaviors- WIC nutritional support programs with successful breastfeeding promotion initiativesBeacon extends its health promotion work through:- Street Medicine South Bend to improve care for those experiencing homelessness- Food pantry services at the Family Medicine Residency Clinic- The Beacon School of Nursing partnership with Ivy Tech to address nursing shortages- Associate volunteer programs encouraging community service- Annual Sunburst races promoting physical activity while supporting Beacon Children's Hospital- Continuing education for healthcare providers on community health issuesThis multi-faceted approach demonstrates Beacon's commitment to improving health outcomes by addressing both clinical care and underlying social determinants of health throughout their service area. Part VI, Line 6: In 2011, Elkhart General Hospital affiliated with Memorial Hospital South Bend, Indiana, under the name of Beacon Health System. In 2018, Beacon Health System affiliated with Community Hospital of Bremen. In October 2021, Beacon Health System affiliated with Three Rivers Health System. All organizations continue as full-care providers for their respective Counties, and they are committed to promoting the health of the communities they serve. The Elkhart General Hospital board of directors consists of 10 voting board members. The Beacon Health System Board of Directors consists of 14 voting board members. Part VI, Line 7, Reports Filed With States IN 1 Boys and Girls Club of Greater Goshen Inc PO Box 614 Goshen IN 46527 351033735 501(c)(3) 10000 0 Sponsor Programs Center of Healing Hope PO Box 195 Goshen IN 46514 020560511 501(c)(3) 15700 0 Medical/Advocacy Svcs Child & Parent Services 100 W Hively Ave Elkhart IN 46517 350888765 501(c)(3) 25000 0 Healthy Families Crossroads United Way Inc 6312 Seven Corners Center 361 Falls Church VA 22044 350953433 501(c)(3) 20000 0 Sponsor Programs Economic Development Corp of Elkhart 300 Bibco Parkway Elkhart IN 46516 351973845 501(c)(3) 10000 0 Financial Investment Elkhart County Health Department 117 N Second Street Goshen IN 46526 356000142 501(c)(3) 30000 0 Prenatal Care Horizon Education Alliance Inc 124 E Washington St Goshen IN 46528 460803293 501(c)(3) 30000 0 Parenting Program Indiana University Foundation IUSM-SB 1633 North Capitol Avenue Ste 1200 Indianapolis IN 46202 356043086 501(c)(3) 7500 0 Sponsor Programs Indiana Youth Services Association 303 N Alabama St Ste 210 Indianapolis IN 46204 351481092 501(c)(3) 20000 0 Sponsor Programs Maple City Health Care Center Inc 213 Middlebury St Goshen IN 46528 351749398 501(c)(3) 25000 0 Sponsor Programs Mental Health Awareness of Michiana 3220 E Jefferson Blvd 46615 South Bend IN 46615 824359500 501(c)(3) 20000 0 Sponsor Programs Ribbon of Hope 600 East Boulevard Elkhart IN 46514 352118856 501(c)(3) 25000 0 Cancer Support 12 0 Transporation Services 330 246616 Tuition Reimbursement 11 74122 Part I, Line 2: Part of Elkhart General Hospital's mission is to improve the health of its community. In order to fulfill this goal, our administrators have the ability to make donations to organizations that improve the health and well being of our community. Since the majority of grants to organizations are made to 501(c)(3) entities, there are no procedures for monitoring the use of the funds. Elkhart General Hospital also pays for the transportation of specific individuals from the hospital facility to nearby nursing homes and other assisted living facilities. These payments are made directly to the third party transportation service provider at cost. Part III: Number of recipients for the transportation services is estimated based on the number of invoices from outside organizations for other assistance made for the benefit of individual recipients. X 1 1 0 1 0 0 0 0 0 1 0 Kreg R Gruber CEO 0 1081233 0 557131 0 210350 0 259693 0 28015 0 2136422 0 64523 Jeffrey P Costello CFO 0 626239 0 261724 0 189649 0 166583 0 22015 0 1266210 0 61622 Carl W Risk II President 0 414730 0 176363 0 83124 0 123638 0 34585 0 832440 0 50653 Michelle R Bache VP Medical Affairs 405261 0 107539 0 3612 0 26080 0 1292 0 543784 0 0 0 James E Cantrell Lead Perfusionist 227179 0 100000 0 966 0 30423 0 33091 0 391659 0 0 0 John P Scheu Perfusionist 199096 0 100000 0 447 0 27999 0 34074 0 361616 0 0 0 Kaleena M Freeman Perfusionist 182185 0 100000 0 150 0 0 0 28799 0 311134 0 0 0 Candace J Andresen VP Nursing & Patient Care Srvcs 200337 0 49717 0 936 0 10180 0 26783 0 287953 0 0 0 Part I, Line 1a Elkhart General Hospital, Inc. offers complimentary health club membership to Beacon Health System's Health And Lifestyle Center, a related party. Health or social club dues for the following individuals was included in taxable compensation: Chris Annis, John Deputy, Dawn Fisher, Tim Morgan, Matt Zimmerman, and Tonja Lucchese. Part I, Line 3 Elkhart General Hospital,Inc. uses a related organization's (Beacon Health System, Inc.) compensation review process. This review process includes an extensive examination using comparable market data that is then reviewed by an independent consultant hired by, and reported to, the board of directors. Recommendations are presented to the board for deliberation and final decision. Part I, Line 4b Beacon Health System implemented an executive retention plan to attract and retain key employees by providing additional deferred compensation. The Chief Executive Officer will participate in the plan and will select other participants pursuant to the guidelines set by the employer's board of directors. The employer may make contributions under the plan and has sole discretion over whether to make a contribution. Vesting occurs on January 1 of the fifth year for which such contributions are made for participants who have been continuously employed. The plan also allows vesting to occur if the participant attains the age of 62. The following individuals received vested payments in 2024, reflected in column (b)(iii): Kreg Gruber, $198,816 Jeffrey Costello, $130,545 Carl Risk, $73,692 The following individuals received deferred payments in 2024 that will vest in future years, which are reflected in column c: Kreg Gruber, $215,393 Jeffrey Costello, $122,283 Carl Risk, $79,338 Part I, Line 7 The Organization has three incentive plans (employee, management, and executive) 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 nonmanagement employees for Beacon Health System, Inc. and the affiliated entities. The employee incentive has a maximum cap of $4,500,000. The payout and amount of the payout for the employee incentive plan is made at the discretion of the board. The management incentive plan is funded when operating income is equal to or greater than 50% of the budgeted net operating income. Reward amounts are based on a balanced score card methodology utilizing Beacon's strategic imperatives and measured using selected metrics set on a sliding scale defined as threshold 50%, target 100%, and maximum 150%. The strategic imperatives are clinical excellence, great workplace, customer-driven culture, smart growth, and financial sustainability. Each imperative carries a default weight of 20%. The payout of the management incentive is made at the discretion of the board. Executives are covered under the Beacon Health System executive short-term incentive plan (ESTIP). The ESTIP is funded when operating income is equal to or greater than 50% of the budgeted net operating income. Reward amounts are based on a balanced score card methodology utilizing Beacon's strategic imperatives and measured using selected metrics set on a sliding scale defined as threshold 50%, target 100%, and maximum 150%. The strategic imperatives are clinical excellence, great workplace, customer-driven culture, smart growth, and financial sustainability. Each imperative carries a default weight of 20%. The payout of the ESTIP is made at the discretion of the board. A Indiana Finance Authority 351602316 2017-09-08 40210000 Refund Bonds Issued 12/09/2008 0 0 0 B Indiana Finance Authority 351602316 2023-06-16 20026050 Refund Taxable Bonds on 9/21/2021 0 0 0 A 8435000 40210000 40210000 2017 1 0 1 1 B 3023825 20026050 46832 19979218 2013 0 1 1 1 A 0 1 1 1 0 0.01900 0.00000 0.01900 0 0 1 B 0 0 1 1 0 0.00000 0.00000 0.00000 0 0 1 A 0 0 1 1 1 0 0 0 1 B 0 1 0 0 0 0 0 0 1 A 1 B 1 Part IV, Line 2c - Part IV, Column A The date the rebate computation was performed on Indiana Finance Authority was 9/8/22. Form 990, Part VI, Section A, line 6 Beacon Health System, Inc. is the sole corporate member of Elkhart General Hospital, Inc. Form 990, Part VI, Section A, line 7a The Corporate Member shall appoint the board of directors of Elkhart General Hospital, Inc. And shall have such powers of advance approval regarding corporate actions as are delineated in the bylaws of Elkhart General Hospital, Inc. In the absence of such selection by the Corporate Member, or until the Corporate Member determines otherwise, directors shall be selected as follows: eight (8) directors shall be determined by the Member or by the board with the approval of the Member. The President of the medical staff of the corporation shall not be a director but shall be entitled to participate ex officio with the board of directors, with the ability to participate in deliberations but without the right to vote, so long as such individual holds the position of President of the medical staff. Form 990, Part VI, Section A, line 7b Decisions of the board of directors must be approved by the Corporate Member. Beacon Health System, the sole member of Elkhart General Hospital, has control over Elkhart General Hospital's operations. The following matters require the approval of Beacon Health System's board: 1. Selection and retention of auditors. 2. Approval of all contracts, policies, or programs of insurance establishing the types of insurance coverage required as well as the coverage levels. 3. The nomination, election and removal of members of the board of the Corporation. 4. Other matters determined from time to time by the Member, or as provided in the bylaws or other governing documents. In addition, the Member may elect in its discretion to take action directly with respect to any matter including matters within the scope of the board of directors of the Corporation, and such actions will supersede any inconsistent actions of the board of directors of the Corporation. 1. The Member shall take action annually for the purpose of electing directors and conducting such other business as shall properly come before such meeting. This meeting shall be held at such date, time and place as the member shall determine, but if no determination is made, shall be held on the same date as the annual meeting of the Member, at the principal office of the Member. 2. Any action required or permitted to be taken by the member may be taken by the Member by written consent to such action and delivery of the writing or writings to the corporation for inclusion in the minutes of the members for filing with the corporation's records. Action taken pursuant to this section is effective on the date the Member signs the consent unless the consent contains an earlier or later effective date. 3. The Corporation may rely on a certificate signed by the secretary or other officer of the Member that an action has been taken by the Member. 4. Membership in the Corporation may be transferred, for or without consideration, by the Member. The Corporation shall not admit additional members without the prior consent of the Member. 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 related schedules. Some forms and schedules are reviewed by the controller. Subsequent to those steps, the Organization engaged RSM to prepare form 990 and appropriate schedules. Prior to filing the return, the CFO, the audit committee of the Organization, and the CEO conduct a general overview of the form 990, including applicable compensation schedules. In addition, each board member receives notification of the IRS form 990 placement on the Organization's board portals which allows for board member review prior to filing the return. 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 these employees to disclose any potential conflict of interests they may have. The statements are sent in January of each year for the previous year activities. We pursue the replies to get a 100% response rate. In the current year, we sent out 372 statements and are working to achieve a 100% response rate. Each response is reviewed by the director of internal audit and the results are reported to the CEO of Beacon Health System, the audit committee chairman, 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, and other key employees. The duality of interest statement is sent using a web-based survey tool provided by RSM. The replies are reviewed by the director of internal audit. The results of the surveys are summarized using the web-based tool and are reviewed by RSM in completing the 990. The results are reported to the CEO of Beacon Health System, the audit committee chairman, 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 acknowledgement form to be signed by Beacon Health System's key financial employees that Beacon's financial information is to the best of their knowledge true and accurate. This statement was sent out on March 4, 2025 and the signed acknowledgements are kept by the director of internal audit. In 2024, 31 designated employees were requested to sign the form and we had a 100% compliance rate. 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 would be excluded from all review proceedings. Form 990, Part VI, Section B, line 15 Elkhart General Hospital, Inc.'s parent, Beacon Health System, Inc. has a comprehensive process in place for reviewing and approving compensation of the executive leadership team. This review compares the total compensation provided to each executive to that provided to functionally similar positions in similarly situated organizations. This review is conducted regularly by the board compensation committee in consultation with an independent compensation advisor who is hired by and reports to the board compensation committee. Based on the advice of the compensation advisor and comparable and appropriate market data reported in third-party compensation surveys, and applying the organization's executive compensation philosophy, the board compensation committee makes compensation recommendations regarding the CEO's compensation to the board of directors for approval and the CEO makes compensation recommendation regarding all other members of the executive leadership team to the board compensation committee for approval. Deliberations and final decisions are contemporaneously documented. The annual compensation review was completed by the board compensation committee in March 2025 and the independent compensation advisor provided a statement of reasonableness of the compensation provided to the CEO and executive leadership team members. 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 Beacon Health System, Inc. bonds. Form 990, Part XI, line 9: Write Off Intercompany Balances -49,957,948. Beacon Medical Group Inc 615 N Michigan St South Bend IN 46601 351536132 Physician Practices IN 501(c)(3) Line 10 Beacon Health System Inc 1 Beacon Health Foundation Inc 615 N Michigan St South Bend IN 46601 351536129 Financial Support IN 501(c)(3) Line 7 Beacon Health System Inc 1 Beacon Health System Inc 615 N Michigan St South Bend IN 46601 453864076 Parent Organization IN 501(c)(3) Line 12c, III-FI N/A 0 Memorial Hospital of South Bend Inc 615 N Michigan St South Bend IN 46601 350868132 Hospital IN 501(c)(3) Line 3 Beacon Health System Inc 1 Elkhart General Hospital Auxiliary 600 East Blvd Elkhart IN 46514 350938148 Vol Support IN 501(c)(3) Line 12c, III-FI N/A 0 Community Hospital of Bremen Inc 1020 High Road Bremen IN 46506 350835006 Hospital IN 501(c)(3) Line 3 Beacon Health System Inc 1 Three Rivers Health System 701 S Health Parkway Three Rivers MI 49093 451257972 Hospital MI 501(c)(3) Line 3 Beacon Health System Inc 1 South Bend Specialty Surgery Center LLC 335 Florence Ave 1B Granger IN 46530 460571418 Ambulatory Surgery Center IN N/A 0 0 Beacon Health Ventures Inc 615 N Michigan St South Bend IN 46601 351901068 Home Medical IN Beacon Health System Inc C 0 Beacon Health Ventures Michigan Inc 615 N Michigan St South Bend IN 46601 208259773 Home Medical MI Beacon Health System Inc C 0 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 1 1 1 1 Beacon Health Foundation Inc C 470690 Actual Charges Beacon Medical Group Inc J 1114140 Actual Charges Beacon Medical Group Inc P 17131051 Actual Charges Memorial Hospital of South Bend Inc P 1836293 Actual Charges Community Hospital of Bremen Inc P 84551 Actual Charges Beacon Medical Group Inc Q 1452689 Actual Charges Memorial Hospital of South Bend Inc Q 1188283 Actual Charges Beacon Medical Group Inc R 8499988 Cash Memorial Hospital of South Bend Inc R 276323 Cash Beacon Medical Group Inc S 6064234 Cash Memorial Hospital of South Bend Inc S 371686 Cash Community Hospital of Bremen Inc S 56555 Cash