2025-11-14T14:15:15-06:00 2024-12-31 420714325 RSM US LLP 30 South Wacker Dr Suite 3300 Chicago IL 606063392 990 2024-01-01 350835006 Community Hospital of Bremen Inc COMM 5745462211 1020 High Road Bremen IN 46506 Jeffrey Costello CFO 5745462211 2025-11-07 1 1 Rebekuh Eley P01247672 3126343400 2025-11-07 2024 2025-03-06 01:10:19Z David Bailey 1020 High Road Bremen IN 46506 31813684 0 X www.beaconhealthsystem.org X 1948 IN We deliver outstanding care, inspire health and connect with heart. 8 7 0 26 0 0 50000 2026 27716662 31547349 58262 93873 171303 163385 27996227 31806633 0 0 0 0 13010576 13670806 0 0 0 15024377 16197775 28034953 29868581 -38726 1938052 20753967 19445142 10590227 9483977 10163740 9961165 X We deliver outstanding care, inspire health and connect with heart. 0 0 27397174 0 31558744 Founded in 1948, Community Hospital Of Bremen, Inc. (CHB) is a not-for-profit, 24-bed critical access hospital serving the healthcare needs of Bremen and the surrounding communities. With the primary physician medical staff base, CHB embraces a holistic approach to patient care. Inpatient services include medical/surgical, obstetrics, physical and occupational therapy, and swing bed/skilled nursing. Outpatient services include medical/surgical and physical and occupation therapy. Services in the emergency department are available 24 hours per day. A full service CAP accredited laboratory and comprehensive radiology department meets the diagnostic testing needs of inpatients and outpatients. The physicians also provide primary care and specialty care services such as cardiology, orthopedics, urology, gynecology, podiatry, and more through hospital-based outpatient clinics. In additional, the Hospital provides the following programs: - free care and/or subsidized care - care provided to persons covered by governmental programs at/or below cost - other health activities and programs to support the community such as wellness programs, community education programs, special programs for the elderly, handicapped, medically underserved, and a variety of broad community support activities. 27397174 1 0 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 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 X 38 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 X 8 7 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 Kreg R Gruber CEO 2.00 50.00 X 0 1848714 287708 Jeffrey P Costello CFO 2.00 50.00 X 0 1077612 188598 David H Bailey President 40.00 0.00 X 0 400833 75923 Jason Marker MD Vice Chair, Chief Med Officer 2.00 40.00 X X 0 316255 61809 Bill Davis Chair 2.00 0.00 X X 200 0 0 Greg Miller Secretary 2.00 0.00 X X 200 0 0 Carol Hochstetler Director 2.00 0.00 X 200 0 0 Dennis Hochstetler Director 2.00 0.00 X 200 0 0 Anthony Wagner Director 2.00 0.00 X 200 0 0 Trend Weldy Director 2.00 0.00 X 200 0 0 Linda Yoder Director 2.00 0.00 X 200 0 0 Jeffrey Brinkman Secretary/Treasurer thru 3/31/24 2.00 0.00 X X 0 0 0 Alfred Alvarado Director thru 3/31/24 2.00 0.00 X 0 0 0 1400 3643414 614038 0 0 1 0 South Bend Emergency Physicians 615 North Michigan South Bend IN 46601 Physician services 1713750 Midwest Hospitalists LLC 50593 Aborwood Court Granger IN 46530 Physician services 866500 Jebs Anesthesia Consultants LLC PO Box 591 Granger IN 46530 Anesthesia services 502406 Labcorp Indiana Inc PO Box 8014 Burlington NC 27216 Contract services 137099 UHS Hammond LLC PO Box 632007 Cincinnati OH 45263 Contract services 110793 5 2026 2026 Radiology Net Patient Revenue 622110 7013314 7013314 Other Net Patient Revenue 622110 6386668 6386668 Emergency Services 622110 6382213 6382213 Surgery Net Patient Revenue 622110 6358452 6358452 Lab Net Patient Revenue 622110 5263509 5263509 143193 143193 31547349 93873 93873 30192 7051 23141 23141 23141 CAFE SALES 722514 128849 128849 MEALS ON WHEELS 624200 10116 10116 MEDICAL RECORDS 621500 75 75 1204 1204 140244 31806633 31558744 0 245863 X 1400 1400 10908764 9352498 1556266 1984365 1701053 283312 776277 665446 110831 27760 23797 3963 5544 5544 2726 2337 389 29675 29675 4314369 4196575 117794 194 166 28 652553 559387 93166 480943 412278 68665 9427 8081 1346 1111 952 159 121464 104122 17342 1018564 873142 145422 96936 83096 13840 Corporate Allocation Fe 3856509 3856509 Patient Supplies, Drugs 3413688 3413688 Hospital Assessment Fee 1071056 1071056 Bad Debt Expense 939307 939307 155949 133684 22265 29868581 27397174 2471407 0 1250 1250 2765793 -134635 4407970 6805150 260691 287996 336708 403473 50726 35547 16426942 6491299 10326817 9935643 1759124 1759124 844888 351594 20753967 19445142 1381290 1234018 8901857 7809005 307080 440954 10590227 9483977 X 10163740 9961165 10163740 9961165 20753967 19445142 X 1938052 -2140627 X 0 1 X 1 0 X 0 0 0 0 0 0 0 0 1 2726 2726 0 Part II-B, Line 1: Community Hospital Of Bremen paid dues to the following organizations for which the amount or percentage listed was attributed to lobbying: ACHE (American College of Healthcare Executives) - 1% AORN (Association of Perioperative Registered Nurses) - 25.46% ASHP (American Society of Health-System Pharmacists) - 19% CAP (College of American Pathologists) - 35% 42456771 9625097 2320861 4428203 49974526 38758960 2440358 2682416 1424963 42456771 42986124 3689060 -4645969 3270255 38758960 37554313 3126708 3841751 1536648 42986124 34924914 1692784 2289915 1353300 37554313 0.67190 0.00000 0.32810 0 1 1 779000 779000 10103397 2709909 7393488 5393762 3781390 1612372 150783 150783 9935643 Financing Lease Liability 181533 Due to Third Party Payors 259421 440954 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. 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 board has discretion to utilize each year the incomes, revenues and profits arising and accruing from the endowments in defraying costs associated with the trust and the remainder for support, betterment, improvement, upkeep, expansion and replacement of Beacon Health System, Inc. and its corporate affiliates. Part X, Line 2: ASC 740, income taxes, requires that realization of an uncertain income tax position is 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 42637 0 42637 0.00150 4266495 1815126 2451369 0.08470 4309132 1815126 2494006 0.08620 23260 1465 21795 0.00080 2525432 520831 2004601 0.06930 2548692 522296 2026396 0.07010 6857824 2337422 4520402 0.15630 1 348137 0 4436779 6300119 -1863340 X 1 1 1 1 Community Hospital of Bremen Inc 1020 High Road Bremen IN 46506 www.beaconhealthsystem.org 23-005097-01 X X X Community Hospital of Bremen 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 Community Hospital of Bremen, 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). Community Hospital of Bremen, Inc. Part V, Section B, Line 6a: Community Hospital of Bremen (CHB) developed the 2024 Marshall County CHNA in Partnership with Memorial Hospital of South Bend, Elkhart General Hospital, and Three Rivers Health, Beacon Health System (BHS) care partners. Community Hospital of Bremen, 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. Community Hospital of Bremen, 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 Community Hospital of Bremen, 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 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. Community Hospital of Bremen, or its designee, may consider other financial assets and liabilities of the person when determining eligibility.3. Community Hospital of Bremen 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 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. Community Hospital of Bremen 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 (EIN: 45-3864076) prepared the annual community benefit report. 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 7g: Community Hospital Of Bremen changed the way we calculated the community benefit related to subsidized health services in 2019. In prior years, the cost-to-charge ratio was used from the cost report, but for a more accurate representation of CHB's emergency room, we used an allocation of specific expenses, as well as the expenses allocated directly to the ER. No physician clinic costs were included in the subsidized health services. 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 $ 939,307. Part II, Community Building Activities: Marshall County Hope is a peer-led consortium comprising over 20 community partners dedicated to providing treatment, education, and recovery support for individuals and their families navigating substance use disorder. MC Hope embraces all pathways to recovery, aiming to meet individuals where they are in their journey, helping them overcome barriers, build recovery capital, and take the next steps in their personal recovery journey.Beacon Community Impact plays an instrumental role in the MC Hope consortium, creating pathways for the success of our safe and supported program in Marshall County. Through building relationships and working collaboratively with the consortium, we have expanded the supported and safe program into the Marshall County Jail. This expansion allows us to provide program services to those currently incarcerated and bridge the gap between receiving services while incarcerated and upon their release. 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. The costing methodology is the same as the tax form 990, Schedule H, worksheet 2 methodology. Patient care cost is 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. Part III, Line 3: CHB does not attribute any bad debt expense to patients eligible under the organization's financial assistance policy. Therefore, no portion of bad debt is considered a community benefit. 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. Part III, Line 9b: Collections 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: Community Hospital of Bremen 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. Community Hospital of Bremen, 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, Community Hospital of Bremen 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, Community Hospital of Bremen would issue a refund to the patient for any amount that has been determined to exceed their newly determined financial responsibility.3. Community Hospital of Bremen 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, Community Hospital of Bremen 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. Community Hospital of Bremen 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 Community Hospital of Bremen 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 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: Established in 1836, Marshall County, Indiana is the 24th largest county in the state of Indiana (Census Bureau, 2022). The county spans 443.62 Square Miles, which includes a comfortable mix of rural, cultural, heritage, and urban amenities. Marshall County has a population of 46,352 according to the U.S. Census Bureau (year 2023). Located south of St. Joseph County, Indiana and at the junction of US 30 and US 31, Marshall County is home to many small towns and Indiana's second largest natural lake, Lake Maxinkuckee. Due to low tax rates in the county, nearly a hundred manufacturers are present, six of whom are international companies and nine corporate headquarters, according to Marshall County Economic Development Center. Marshall County boasts low crime rates and safe, high performing schools, including the world premier college preparatory school, Culver Academies, with students from around the world.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 Community Hospital of Bremen (CHB) 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 CHB consistently invest funds to improve the quality of life for our communities.BHS values reflect an unwavering commitment to the communities we serve. CHB 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.CHB seeks to promote the health and well-being of St. Joseph County (SJC) 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 CHB's serious, consistent, and deliberate search for and partnership with like-minded organizations. CHB 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 include local public health, schools, churches, social service agencies, minority advocacy groups, victim assistance, and community health providers.Community Hospital of Bremen's governing body is comprised of persons who reside in Marshall 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, Community Hospital of Bremen 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 2018, Community Hospital of Bremen affiliated with Memorial Hospital of South Bend and Elkhart General Hospital, under the name Beacon Health System. 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 Community Hospital of Bremen board of directors consists of 8 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 0 1 0 0 0 0 0 0 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 David H Bailey President 0 251789 0 105335 0 43709 0 73071 0 2852 0 476756 0 33166 Jason Marker MD Vice Chair, Chief Med Officer 0 280939 0 34426 0 890 0 28412 0 33397 0 378064 0 0 Part I, Line 3 Community Hospital of Bremen, 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 reporting 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 David Bailey, $32,166 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 David Bailey, $47,692 Form 990, Part V, Line 2a Employees are paid by Memorial Hospital of South Bend (EIN 35-0868132) and expenses to Community Hospital of Bremen, Inc. through contract labor. Form 990, Part VI, Section A, line 6 Beacon Health System, Inc. is the sole corporate member of Community Hospital Of Bremen, Inc. Form 990, Part VI, Section A, line 7a The Corporate Member shall appoint the board of directors of Community Hospital of Bremen and shall have such powers of advance approval regarding corporate actions as are delineated in the bylaws of Community Hospital of Bremen. Form 990, Part VI, Section A, line 7b Decisions of the board of directors must be approved by the Corporate Member. Beacon Health System, Inc., the sole member of Community Hospital Of Bremen, has the sole power with respect to the following matters: 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. The appointment and evaluation of the President of the Corporation. 5. Compensation of executive management of the Corporation. 6. Other matters determined from time to time by the Member, or as provided in the bylaws or other governing documents. 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 information for 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 Community Hospital of Bremen, 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 IX, line 11g Lab Fees: Program service expenses 150,218. Management and general expenses 0. Fundraising expenses 0. Total expenses 150,218. Other PS: Program service expenses 333,573. Management and general expenses 55,557. Fundraising expenses 0. Total expenses 389,130. P/S Medical: Program service expenses 679,742. Management and general expenses 0. Fundraising expenses 0. Total expenses 679,742. Radiology Fees: Program service expenses 9,091. Management and general expenses 0. Fundraising expenses 0. Total expenses 9,091. Repair & Maint: Program service expenses 85,991. Management and general expenses 14,321. Fundraising expenses 0. Total expenses 100,312. Service Contracts: Program service expenses 219,167. Management and general expenses 36,502. Fundraising expenses 0. Total expenses 255,669. Consulting: Program service expenses 32,913. Management and general expenses 5,482. Fundraising expenses 0. Total expenses 38,395. Fees - Phys: Program service expenses 2,595,874. Management and general expenses 0. Fundraising expenses 0. Total expenses 2,595,874. Rep Parts/Mat: Program service expenses 1,968. Management and general expenses 327. Fundraising expenses 0. Total expenses 2,295. Blood Supply: Program service expenses 54,381. Management and general expenses 0. Fundraising expenses 0. Total expenses 54,381. Contract Labor: Program service expenses 22,813. Management and general expenses 3,799. Fundraising expenses 0. Total expenses 26,612. Trash Removal: Program service expenses 10,844. Management and general expenses 1,806. Fundraising expenses 0. Total expenses 12,650. Form 990, Part XI, line 9: Write Off Intercompany -2,140,627. 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 Elkhart General Hospital Inc 600 East Boulevard Elkhart IN 46514 350877574 Hospital IN 501(c)(3) Line 3 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 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 N/A C 0 Beacon Health Ventures Michigan Inc 615 N Michigan St South Bend IN 46601 208259773 Home Medical MI N/A C 0 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 1 1 1 1 Beacon Medical Group Inc J 111788 Actual Charges Memorial Hospital of South Bend Inc P 13077669 Actual Charges Memorial Hospital of South Bend Inc Q 1034640 Actual Charges Elkhart General Hospital Inc Q 84551 Actual Charges Memorial Hospital of South Bend Inc R 2025954 Cash Beacon Medical Group Inc R 93202 Cash Elkhart General Hospital Inc R 56555 Cash Memorial Hospital of South Bend Inc S 10017075 Cash