2021-11-09T11:01:28-06:00 2020-12-31 990 2020-01-01 351720796 Indiana University Health Bloomington Inc INDI 3179634842 950 N MERIDIAN STREET 300 INDIANAPOLIS IN 46204 MICHAEL L CRAIG VP & CFO 2021-11-09 MICHAEL L CRAIG 999009999 2020 2022-09-23 18:48:47Z BRIAN T SHOCKNEY 950 N MERIDIAN STREET 300 INDIANAPOLIS IN 46204 812230916 false X SEE SCHEDULE O X 1988 IN lead the transformation of healthcare through quality, innovation & education, and make Indiana one of the nation's healthiest states. 13 7 4310 108 0 0 4796212 5836676 580265290 659501845 14764804 23937936 3011232 3314567 602837538 692591024 471925 29371 0 216680653 319165782 0 0 270279443 305738768 487432021 624933921 115405517 67657103 802954447 947208663 106365256 182875577 696589191 764333086 X lead the transformation of healthcare through quality, innovation & education, and make Indiana one of the nation's healthiest states. false false 486035708 29371 621200556 INDIANA UNIVERSITY HEALTH BLOOMINGTON, INC. ("IU HEALTH BLOOMINGTON") IS A 278-BED FULL SERVICE HOSPITAL THAT OFFERS A BROAD RANGE OF SERVICES TO CARE FOR ITS PATIENTS WITHOUT REGARD TO THEIR ABILITY TO PAY. BASED UPON THE VALUES OF TRUST, EXCELLENCE, ACCOUNTABILITY, AND MUTUAL RESPECT, IU HEALTH BLOOMINGTON ENHANCES THE HEALTH OF ITS PATIENTS AND COMMUNITY IN SOUTH-CENTRAL INDIANA BY ADVANCING THE ART AND SCIENCE OF MEDICINE THROUGH THE USE OF NEW TECHNOLOGIES, PROCEDURES, AND CARE. 11124834 14740353 IU HEALTH BLOOMINGTON PROVIDES SERVICES TO RELATED TAX-EXEMPT ORGANIZATIONS. 22794495 As of December 31, 2020, Indiana University Health Bloomington had received stimulus funds from the Provider Relief Fund under the provisions of the Coronavirus Aid, Relief, and Economic Security Act (CARES Act) and Paycheck Protection Program and Health Care Enhancement Act. Indiana University Health Bloomington recognized $22,794,495 as other program service revenue. Indiana University Health Bloomington will continue to monitor compliance with the terms and conditions of the Provider Relief Fund. 571827 757668 IU HEALTH BLOOMINGTON RECEIVES REVENUE FROM THE FOLLOWING PASS-THROUGH ENTITIES: BROWN COUNTY MEDICAL COOPERATIVE, LLC, SIRA IMAGING CENTER, LLC, SOUTHERN INDIANA SURGERY CENTER, LLC AND PIMCO BRAVO FUND. 6621 8773 RENTAL INCOME FROM RELATED TAX-EXEMPT ENTITIES 578448 766441 497738990 true true false true false false false false true true false false true true true false true false false false false false false false false true true true false true false false false false false false false false false false false false true true true true false false true 335 0 true 4310 true false false false false false false false false false false false false X 13 7 false false false false true true true true true false false true true true true true true true true true true IN X CRAIG J JONES 3179634842 950 N MERIDIAN ST STE 300 INDIANAPOLIS IN 46204 BRIAN T SHOCKNEY DIRECTOR/REGIONAL PRESIDENT (SCR) 34.0 21.0 X X 0 849268 141492 DANIEL J PETERSON DIRECTOR/CHAIR 2.0 2.0 X X 0 0 0 JACK A KENWORTHY DIRECTOR/VICE CHAIR 2.0 2.0 X X 0 0 0 JOYCE B POLING DIRECTOR/SECRETARY 2.0 2.0 X X 0 0 0 BLAKE A DYE DIRECTOR 2.0 53.0 X 0 781159 136531 DAVID L BEACHY DO DIRECTOR 53.0 2.0 X 234599 0 37064 HOJJAT M SHAMLOO MD DIRECTOR 53.0 2.0 X 639453 0 51385 JAMES J LAUGHLIN MD DIRECTOR 53.0 2.0 X 392882 0 18400 JANET FARLOW PERRY DIRECTOR 2.0 2.0 X 0 0 0 JOHN S STROBEL MD DIRECTOR 53.0 2.0 X 700794 0 45997 JULIE MINTON DIRECTOR 2.0 2.0 X 0 0 0 LYNN H COYNE DIRECTOR 2.0 2.0 X 0 0 0 RICHARD G HENDRICKSON DIRECTOR 2.0 3.0 X 0 3600 0 MICHAEL L CRAIG VP & CFO (SCR) 35.0 25.0 X 0 315709 36561 ALAN W BIGGS COO (SCR) 35.0 20.0 X 333717 0 25662 BRUCE R WADE VP - HUMAN RESOURCES (SCR) 35.0 20.0 X 0 256569 42146 CYNTHIA R HERRINGTON VP & CNO (SCR) 35.0 20.0 X 259290 0 35091 DANIEL A HANDEL MD VP & CMO (SCR) 35.0 20.0 X 467692 0 39986 BRET J SPIER MD PHYSICIAN 50.0 0 X 858455 0 66957 DAVID J LICINI MD PHYSICIAN 50.0 0 X 791296 0 49759 FRED Y WU MD PHYSICIAN 50.0 0 X 873113 0 37687 JASON VOORHIES MD PHYSICIAN 50.0 0 X 1046292 0 63091 TODD EADS MD PHYSICIAN 50.0 0 X 1366507 0 44559 DEREK B FIELDS FORMER KEY EMPLOYEE 55.0 0 X 203370 0 26951 KENNETH E MARSHALL MD FORMER KEY EMPLOYEE 55.0 0.0 X 219557 0 48907 LARRY R BAILEY FORMER KEY EMPLOYEE 0.0 55.0 X 9220 296108 35616 WENDY S HERNANDEZ FORMER KEY EMPLOYEE 0.0 50.0 X 0 266242 38141 8396238 2768656 1021982 111 true true false FA WILHELM CONSTRUCTION CO INC 3914 PROSPECT STREET INDIANAPOLIS IN 46203 CONSTRUCTION 151599050 TRIMEDX LLC 5451 LAKEVIEW PKWY S DR INDIANAPOLIS IN 46268 CLINICAL ENGINEERING 4637268 MEDEFIS 2121 N 117th Ave OMAHA NE 68164 VENDOR MANAGEMENT 3620999 weddle bros building group llc po box 1330 bloomington IN 47402 construction 3590266 CSO ARCHITECTS INC PO BOX 6069 DEPT 94 INDIANAPOLIS IN 462066069 ARCHITECTURAL/DESIGN 1991129 42 559765 4960295 316616 5836676 NET PATIENT SERVICE REVENUE 622110 621200556 621200556 SHARED SERVICES 541900 14740353 14740353 FEDERAL RECOVERY REVENUE 900099 22794495 22794495 INCOME (LOSS) FROM PASS-THROUGH ENTITIES 900099 757668 757668 RENT FROM RELATED 501(C)(3) ORGS. 532000 8773 8773 0 0 0 0 659501845 6491736 6491736 705266 115897 589369 0 589369 589369 136970195 119523995 17446200 0 17446200 17446200 CAFETERIA/FOOD SERVICE 721110 1250091 1250091 VENDING 900099 15903 15903 EDUCATION 900099 50733 50733 1408471 0 0 1408471 2725198 692591024 659501845 0 27252503 X 29371 29371 3185485 2958421 227064 1134111 1053271 80840 260482644 241915220 18567424 8804980 8136456 668524 29645677 27680748 1964929 15912885 14644782 1268103 525 525 170307 170307 8173 8173 11477 11477 260294 260294 119839174 26890113 92949061 0 266831 11917 254914 2158203 1952465 205738 1118046 919572 198474 16196608 15144401 1052207 192404 171624 20780 52680 45147 7533 1793 1793 16405799 13277557 3128242 5421260 567614 4853646 DRUGS AND MEDICAL SUPPLIES 91779724 91779724 BAD DEBT 33531547 33531547 NONCAPITALIZED EQUIPMENT 396640 396640 HOSPITAL ASSESSMENT FEE 11578381 11578381 6348902 5051701 1297201 0 624933921 497738990 127194931 0 4604950 290315 2738169 2450177 1075143 2159069 79089239 73700105 0 0 0 0 3265358 2985168 6564763 12897622 10379084 10761586 693386439 281994209 225301563 411392230 184776412 201853147 0 2345871 2383539 10661813 8423667 272152082 217912038 802954447 947208663 56355772 119420398 16377222 26651599 0 0 0 33632262 36803580 106365256 182875577 X 683254355 754211678 13334836 10121408 696589191 764333086 802954447 947208663 X 67657103 2421627 -2334835 X false true X true true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 11477 11477 false Schedule C, Part II-B, Line 1i OTHER ACTIVITIES IU HEALTH bloomington PAID INSTITUTIONAL MEMBERSHIP DUES TO THE INDIANA HOSPITAL ASSOCIATION ("IHA") AND AMERICAN HOSPITAL ASSOCIATION DURING 2020 IN THE AMOUNT OF $31,492 AND $39,520 RESPECTIVELY. EACH MEMBERSHIP ORGANIZATION NOTIFIED IU HEALTH bloomington THAT A PORTION OF THE DUES IT PAID WERE USED FOR LOBBYING PURPOSES. THE IHA USED 7.18%, OR $2,261 OF THE 2020 MEMBERSHIP DUES PAID BY IU HEALTH bloomington, FOR LOBBYING EXPENDITURES. AMERICAN HOSPITAL ASSOCIATION USED 23.32% OR $9,216 OF 2020 MEMBERSHIP DUES PAID BY IU HEALTH bloomington, FOR LOBBYING EXPENDITURES. 13334836 -2334836 11000000 13334836 13334836 13334836 13334836 4906654 8468719 16073 49762 4513 2335 13334836 4906654 4906654 0.0 0.417 0.583 false false 19741447 19741447 154956494 147281870 7674624 11283226 7819844 3463382 136297608 115604622 20692986 371107664 11287873 359819791 411392230 INT. IN NET ASSETS OF FNDTN. 11000000 INTERCOMPANY RECEIVABLES (NET) 206617181 ALL OTHER ASSETS 194857 SECURITY DEPOSITS 100000 217912038 DUE TO THIRD-PARTY PAYERS 12110273 SELF-INSURANCE LIABILITIES 280891 ENVIRONMENTAL OBLIGATIONS 412602 ALL OTHER LIABILITIES 23999814 36803580 X Schedule D, Part V, Line 4 Intended uses of endowment funds TEMPORARILY AND PERMANENTLY RESTRICTED NET ASSETS ARE GENERALLY RESTRICTED FOR INDIGENT AND OTHER PATIENT CARE SERVICES, MEDICAL EDUCATION AND RESEARCH PROGRAMS, AND MEDICAL SUPPLIES AND EQUIPMENT. Schedule D, Part X, Line 2 FIN 48 (ASC 740) footnote IU HEALTH BLOOMINGTON IS A SUBSIDIARY IN INDIANA UNIVERSITY HEALTH, INC.'S ("IU HEALTH") CONSOLIDATED AUDITED FINANCIAL STATEMENTS. The Internal Revenue Service (IRS) has determined that Indiana University Health and certain of its affiliated entities are tax-exempt organizations as defined in Section 501(c)(3) of the Internal Revenue Code (IRC). Indiana University Health and its tax-exempt affiliates are, however, subject to federal and state income taxes on unrelated business income under the provisions of IRC Section 511. Deferred income taxes that, as of December 31, 2020 and 2019, have no net carrying value reflect the net tax effect of temporary differences between the carrying amounts of assets and liabilities for financial reporting and the amounts used for income tax purposes. As of December 31, 2020 and 2019, the Indiana University Health System had gross deferred tax assets of $135,889,000 and $143,157,000 respectively, primarily relating to net operating loss carryovers. Management determined that a full valuation allowance at December 31, 2020 and 2019, was necessary to reduce the deferred tax assets to the amount that would more likely than not be realized. Based on the weight of the evidence, if it is more likely than not that some portion or all of the deferred tax assets will not be realized, a valuation allowance to reduce the deferred tax assets is recorded. The decrease in the valuation allowance for the current year was $7,264,000. At December 31, 2020, the Indiana University Health System has available net operating loss carryforwards of $546,376,000. Net operating losses generated from 2000 through 2017 will expire between 2021 and 2037. Net operating losses generated after 2017 do not expire. true true X true X 300 false true true true false true true 8083 9057093 9057093 0.0153 23744 111328196 98174492 13153704 0.0222 0 0.0 0 31827 120385289 98174492 22210797 0.0376 13 11047 3683191 578572 3104619 0.0052 4 2401 956851 312216 644635 0.0011 2 15893 28002376 22061059 5941317 0.0100 0 0.0 3 142 1254713 1144107 110606 0.0002 22 29483 33897131 24095954 9801177 0.0166 22 61310 154282420 122270446 32011974 0.0541 0 0.0 0 0.0 1 20339 20339 0.0000 0 0.0 0 0.0 1 494 6469 6469 0.0000 1 8 68 68 0.0000 1 71 8852 8852 0.0000 0 0.0 4 573 35728 0 35728 0.0001 false 9395539 94031780 108810715 -14778935 X true true SIRA IMAGING CENTER LLC DIAG. AND OTHER OUTPATIENT 0.5 0.5 SOUTHERN INDIANA SURGERY CENTER LLC AMBULATORY SURGERY CENTER 0.5 0.5 BROWN COUNTY MEDICAL COOPERATIVE LLC PHYSICIAN OFFICE SPACE 0.5 0.5 1 1 IU HEALTH BLOOMINGTON HOSPITAL 601 WEST SECOND STREET BLOOMINGTON IN 47403 HTTPS://IUHEALTH.ORG/FIND-LOCATIONS/IU-HEALTH-BLOOMINGTON-HOSPITAL 20-005047-1 X X X IU HEALTH BLOOMINGTON HOSPITAL 1 false false true X X X X X X X X X 18 true false false true X HTTPS://IUHEALTH.ORG/IN-THE-COMMUNITY/COMMUNITY-BENEFIT true 19 true HTTPS://IUHEALTH.ORG/IN-THE-COMMUNITY/COMMUNITY-BENEFIT false true X 300.0 0.0 X X X X X X X true true X X X true X HTTPS://IUHEALTH.ORG/PAY-A-BILL/FINANCIAL-ASSISTANCE X HTTPS://IUHEALTH.ORG/PAY-A-BILL/FINANCIAL-ASSISTANCE X HTTPS://IUHEALTH.ORG/PAY-A-BILL/FINANCIAL-ASSISTANCE X X X X X X X true X false X X X X true X false false Schedule H, Part V, Section B, Line 3E IU HEALTH BLOOMINGTON'S 2018 COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) REPORT INCLUDES A PRIORITIZED DESCRIPTION OF SIGNIFICANT HEALTH NEEDS IN THE COMMUNITY. THE CHNA REPORT IDENTIFIED THE FOLLOWING SEVEN NEEDS AS PRIORITIES FOR IU HEALTH BLOOMINGTON: - ACCESS TO HEALTH CARE SERVICES - Chronic Disease and Chronic Disease Management - DRUG AND SUBSTANCE ABUSE (Including Opioids and alcohol) * - Mental Health * - OBesity, diabetes, and physical inactivity - Senior Health - Social Determinants of Health * IU HEALTH USES THE TERM BEHAVIORAL HEALTH TO REFER TO MENTAL HEALTH AND DRUG AND SUBSTANCE ABUSE (INCLUDING OPIOIDS AND ALCOHOL). Schedule H, Part V, Section B, Line 5 Facility , 1 Facility , 1 - IU HEALTH BLOOMINGTON HOSPITAL. IN CONDUCTING ITS MOST RECENT CHNA, IU HEALTH BLOOMINGTON'S APPROACH TO GATHERING QUALITATIVE DATA CONSISTED OF A MULTI-COMPONENT APPROACH TO IDENTIFY AND VERIFY COMMUNITY HEALTH NEEDS FOR THE IU HEALTH BLOOMINGTON SERVICE AREA. THIS INCLUDED THE FOLLOWING COMPONENTS: 1. COMMUNITY MEETINGS 2. KEY STAKEHOLDERS INTERVIEWS 3. COMMUNITY SURVEY COMMUNITY MEETINGS (MONROE & OWEN COUNTIES) TO OBTAIN A MORE COMPLETE PICTURE OF THE FACTORS THAT PLAY INTO THE MONROE AND OWEN COUNTY COMMUNITY HEALTH, INPUT FROM LOCAL LEADERS WITH A STAKE IN THE COMMUNITY'S HEALTH WERE INVITED TO ATTEND A COMMUNITY HEALTH SUB-COMMITTEE MEETING ON MAY 8, 2018 HELD AT IU HEALTH BLOOMINGTON. ORGANIZATIONS WHO PARTICIPATED IN THE FOCUS GROUPS ARE AS FOLLOWS: - BLOOMINGTON ECONOMIC DEVELOPMENT CENTER - BLOOMINGTON HEALTH FOUNDATION - BLOOMINGTON NORTH HIGH SCHOOL - MONROE COUNTY HEALTH DEPARTMENT - LOCAL COUNCIL OF WOMEN - UNITED WAY OF MONROE COUNTY - SLOTEGRAFF AND NIEHOFF THE MEETING BEGAN WITH A PRESENTATION THAT DISCUSSED THE GOALS AND STATUS OF THE CHNA PROCESS AND THE PURPOSE OF THE COMMUNITY MEETING. THEN, SECONDARY DATA WERE PRESENTED, ALONG WITH A SUMMARY OF THE MOST UNFAVORABLE COMMUNITY HEALTH INDICATORS. FOR THE COMMUNITY SERVED BY IU HEALTH BLOOMINGTON HOSPITAL, THOSE INDICATORS WERE (IN ALPHABETICAL ORDER): - CARDIOVASCULAR DISEASES AND RELATED MORTALITY - DRUG AND SUBSTANCE ABUSE - MOTOR VEHICLE ACCIDENTS AND DRUNK DRIVING - PHYSICALLY AND MENTALLY UNHEALTHY DAYS - POVERTY AND UN-EMPLOYMENT - SEVERE HOUSING PROBLEMS - SMOKING, INCLUDING DURING PREGNANCY - SUPPLY OF PRIMARY CARE PHYSICIANS AND MENTAL HEALTH PROVIDERS MEETING PARTICIPANTS THEN WERE ASKED TO DISCUSS WHETHER THE IDENTIFIED, UNFAVORABLE INDICATORS ACCURATELY IDENTIFIED THE MOST SIGNIFICANT COMMUNITY HEALTH ISSUES AND WERE ENCOURAGED TO ADD ISSUES THAT THEY BELIEVED WERE SIGNIFICANT. SEVERAL ISSUES WERE ADDED, SUCH AS: CHILDHOOD POVERTY, TRANSPORTATION NEEDS, INFANT MORTALITY, SEXUALLY TRANSMITTED DISEASES, OBESITY, PATIENT COMPLIANCE, AND CHRONIC DISEASE. IN ADDITION, THE GROUP DECIDED IT WOULD BE BEST TO SPLIT POVERTY AND UN-EMPLOYMENT INTO TWO DISTINCT NEEDS. AFTER DISCUSSING THE NEEDS IDENTIFIED THROUGH SECONDARY DATA AND ADDING OTHERS TO THE LIST, EACH PARTICIPANT WAS ASKED THROUGH A VOTING PROCESS TO IDENTIFY THREE TO FIVE NEEDS THEY CONSIDER TO BE THE MOST SIGNIFICANT. FROM THIS PROCESS, THE GROUP IDENTIFIED THESE FIVE NEEDS AS BEING THE MOST SIGNIFICANT IN THE COMMUNITY SERVED BY IU HEALTH BLOOMINGTON HOSPITAL: - DRUG AND SUBSTANCE ABUSE - CHRONIC DISEASE - SMOKING, INCLUDING DURING PREGNANCY - OBESITY - PHYSICALLY AND MENTALLY UNHEALTHY DAYS IN ADDITION TO THE SUB-COMMITTEE MEETING, TWO OPEN FOCUS GROUPS WERE CONDUCTED AT LOCAL SCHOOLS IN MONROE COUNTY AND A THIRD OPEN FOCUS GROUP WAS CONDUCTED AT THE OWEN COUNTY YMCA. A MEMBER OF THE OWEN COUNTY HEALTH BOARD ATTENDED THE OWEN COUNTY YMCA FOCUS GROUP. IN TOTAL, 18 INDIVIDUALS PARTICIPATED IN THESE FOCUS GROUPS. INDIVIDUAL INTERVIEWS WERE CONDUCTED WITH PEOPLE EXPERIENCING OR RECENTLY EXPERIENCING HOMELESSNESS AND THE BLOOMINGTON COMMISSION ON AGING. THE TOP HEALTH ISSUES IDENTIFIED WERE: - HOMELESSNESS - LACK OF MENTAL HEALTHCARE PROVIDERS - TRANSPORTATION TO HEALTHCARE APPOINTMENTS FOR THOSE WITHOUT VEHICLES - FOOD INSECURITIES - SUBSTANCE ABUSE - CHILDREN AND INFANTS IN NEED - HOUSING - HEALTHCARE DURING THE MEETINGS, A RANGE OF OTHER TOPICS WERE DISCUSSED INCLUDING: - RESOURCE ACCESS - SUBSTANCE USE - FOOD INSECURITY - IMPORTANCE OF SIDE-WALKS FOR COMMUNITY BUILDING, - TRANSPORTATION, AND RECREATION - HEALTHCARE - BASIC NEEDS - HOMELESSNESS - CHILDHOOD CONDITIONS - UNDERSTANDING SELF - SENSE OF BELONGING TO COMMUNITY - TRANSPORTATION - SOCIAL CONNECTIONS - INSURANCE - HIGH COST OF HOUSING - CARE OF OLDER ADULTS IN THE COMMUNITY - MENTAL HEALTH AFTER COMPARING, THE DATA GATHERED FROM THE MEETINGS AND INTERVIEWS, THE FOLLOWING FIVE NEEDS WERE NOTED AS THE MOST SIGNIFICANT FOR THE COMMUNITY SERVED BY IU HEALTH BLOOMINGTON HOSPITAL: - DRUG AND SUBSTANCE ABUSE - CHRONIC DISEASE - SMOKING, INCLUDING DURING PREGNANCY - OBESITY - MENTAL HEALTH COMMUNITY MEETING (LAWRENCE COUNTY) TO OBTAIN A MORE COMPLETE PICTURE OF THE FACTORS THAT PLAY INTO THE LAWRENCE COMMUNITY HEALTH, INPUT FROM LOCAL LEADERS WITH A STAKE IN THE COMMUNITY'S HEALTH WERE INVITED TO ATTEND A COMMUNITY HEALTH SUB-COMMITTEE MEETING ON APRIL 10, 2018 HELD AT IU HEALTH BEDFORD. ORGANIZATIONS WHO PARTICIPATED IN THE FOCUS GROUPS ARE AS FOLLOWS: - BEDFORD PUBLIC LIBRARY - BEDFORD CHAMBER OF COMMERCE - CITY OF BEDFORD - CITY OF BEDFORD PARKS AND RECREATION - PURDUE EXTENSION - STONE CITY PRODUCTS THE MEETING BEGAN WITH A PRESENTATION THAT DISCUSSED THE GOALS AND STATUS OF THE CHNA PROCESS AND THE PURPOSE OF THE COMMUNITY MEETING. THEN, SECONDARY DATA WERE PRESENTED, ALONG WITH A SUMMARY OF THE MOST UNFAVORABLE COMMUNITY HEALTH INDICATORS. FOR THE COMMUNITY SERVED BY IU HEALTH BLOOMINGTON HOSPITAL, THOSE INDICATORS WERE (IN ALPHABETICAL ORDER): - CHRONIC DISEASE MANAGEMENT AND MORTALITY - LOW BIRTHWEIGHT AND TEEN BIRTH RATES - MENTAL ILLNESS AND SUPPLY OF MENTAL HEALTH PROVIDERS - MORTALITY FROM MOTOR VEHICLE ACCIDENTS AND OTHER INJURIES - OBESITY AND PHYSICAL INACTIVITY - SMOKING AND SMOKING DURING PREGNANCY - UNEMPLOYMENT AND ECONOMIC FACTORS MEETING PARTICIPANTS THEN WERE ASKED TO DISCUSS WHETHER THE IDENTIFIED, UNFAVORABLE INDICATORS ACCURATELY IDENTIFIED THE MOST SIGNIFICANT COMMUNITY HEALTH ISSUES AND WERE ENCOURAGED TO ADD ISSUES THAT THEY BELIEVED WERE SIGNIFICANT. SEVERAL ISSUES WERE ADDED, SUCH AS: SUBSTANCE ABUSE AND TREATMENT, ACCESS TO AND PRICING OF HEALTHCARE, COLLABORATION IN THE COMMUNITY ON HEALTH NEEDS, AND HEALTHY FOOD ACCESS AND KNOWLEDGE. DURING THE MEETINGS, A RANGE OF OTHER TOPICS WERE DISCUSSED INCLUDING: - HOSPITAL ADMISSION THAT ARE PREVENTABLE - SKILLS GAP IN LOCAL AREA COMPARED TO JOB OPPORTUNITIES - MENTAL HEALTH STIGMA - SMOKING POLICIES - LIMITED RESOURCES IN THE COMMUNITY - LACK OF AWARENESS OF EXISTING PROGRAMS/RESOURCES - POPULATION PATTERNS IN THE WORLD AND IN RURAL COMMUNITIES AFTER DISCUSSING THE NEEDS IDENTIFIED THROUGH SECONDARY DATA AND ADDING OTHERS TO THE LIST, EACH PARTICIPANT WAS ASKED THROUGH A VOTING PROCESS TO IDENTIFY THREE TO FIVE NEEDS THEY CONSIDER THE MOST SIGNIFICANT. FROM THIS PROCESS, THE GROUP IDENTIFIED FIVE NEEDS AS BEING THE MOST SIGNIFICANT IN THE LAWRENCE COUNTY COMMUNITY: - SUBSTANCE ABUSE AND TREATMENT - OBESITY AND PHYSICAL INACTIVITY - ACCESS TO AND PRICING OF HEALTHCARE - UNEMPLOYMENT AND ECONOMIC FACTORS/WORKFORCE TRAINING AND EDUCATION - MENTAL ILLNESS AND SUPPLY OF MENTAL HEALTH PROVIDERS KEY STAKEHOLDER INTERVIEWS (MONROE AND LAWRENCE COUNTIES) IU HEALTH BLOOMINGTON ALSO CONDUCTED KEY STAKEHOLDER INTERVIEWS WITH REPRESENTATIVES OF THE MONROE AND LAWRENCE COUNTY HEALTH DEPARTMENTS. AN INTERVIEW WAS NOT CONDUCTED WITH THE OWEN COUNTY HEALTH DEPARTMENT; HOWEVER, A MEMBER OF THE OWEN COUNTY HEALTH BOARD ATTENDED THE OWEN COUNTY YMCA FOCUS GROUP. THE INTERVIEWS WERE CONDUCTED TO ASSURE THAT APPROPRIATE AND ADDITIONAL INPUT WAS RECEIVED FROM THE GOVERNMENTAL PUBLIC HEALTH OFFICIALS. ACCORDINGLY, THE RESULTS OF THE COMMUNITY MEETINGS WERE DISCUSSED AND INSIGHTS WERE SOUGHT REGARDING SIGNIFICANT COMMUNITY HEALTH NEEDS, WHY SUCH NEEDS ARE PRESENT, AND HOW THEY CAN BE ADDRESSED. THE INTERVIEWS WERE GUIDED BY A STRUCTURAL PROTOCOL THAT FOCUSED ON OPINIONS REGARDING SIGNIFICANT COMMUNITY HEALTH NEEDS, DESCRIBING WHY SUCH NEEDS ARE PRESENT, AND SEEKING IDEAS FOR HOW TO ADDRESS THEM. MONROE COUNTY DURING THE APRIL 5, 2018 FOCUS GROUP MEETING, THE INTERVIEWEE CONFIRMED THAT THE NEEDS IDENTIFIED THROUGH THE COMMUNITY MEETINGS WERE ALL ISSUES, INCLUDING: - DRUG AND SUBSTANCE ABUSE - CHRONIC DISEASE - SMOKING, INCLUDING PREGNANCY - OBESITY - PHYSICAL INACTIVITY OVERALL, SERVICES FOR MENTAL HEALTH AND SUBSTANCE ABUSE TREATMENT WERE CONSIDERED SOME OF THE MOST SIGNIFICANT NEEDS. SUBSTANCE ABUSE CONTINUES TO BE A MAJOR ISSUE AND SEEMS TO HAVE INCREASED IN RECENT YEARS DESPITE MANY EFFORTS TO CURB THE EPIDEMIC. WHILE OBESITY HAS IMPROVED IN RECENT TIMES IN MONROE COUNTY, IT IS STILL AN ISSUE AND LEADING TO CHRONIC DISEASES SUCH AS HEART DISEASE AND DIABETES. EARLY CHILDHOOD TRAUMA AND EARLY ADULT TRAUMA WERE IDENTIFIED AS CONTRIBUTING FACTORS FOR MANY OF THESE ISSUES AS IT WAS THOUGHT THAT MANY WHO EXPERIENCE TRAUMATIC EVENTS DO NOT LEARN COPING SKILLS TO CARRY ON LATER INTO LIFE. ACCESS TO HEALTH CARE AND HEALTH SERVICES IS A NEED. ALTHOUGH MONROE COUNTY HAS AN ABUNDANCE OF RESOURCES, IT IS OFTEN DIFFICULT TO GET ECONOMICALLY DISADVANTAGED POPULATIONS TO AFFORDABLE PROVIDERS. BASIC NEEDS INSECURITY IS AN ISSUE FOR CERTAIN RESIDENTS, AND AFFECTS MANY ASPECTS OF HEALTH. Schedule H, Part V, Section B, Line 5 Facility , 2 Facility , 2 - IU HEALTH BLOOMINGTON HOSPITAL. ENCOURAGING VACCINATIONS IN THE COMMUNITY IS AN IMPORTANT NEED, AS CONDITIONS LIKE MUMPS, MEASLES AND OTHERS SEEM TO HAVE BEEN REVITALIZED. PUBLIC HEALTH FUNDING IS A MAJOR NEED, AS FUNDING OPPORTUNITIES ARE TYPICALLY FOR NEW PROGRAMS WHILE PREVIOUSLY ESTABLISHED PROGRAMS HAVE DIFFICULTY MAINTAINING THEIR EFFECTIVENESS WITHOUT CONTINUED FUNDING. LAWRENCE COUNTY DURING THE APRIL 10, 2018 MEETING, THE INTERVIEWEE CONFIRMED THAT THE TOP NEEDS IDENTIFIED BY THE COMMUNITY MEETING GROUP WERE SOME OF THE MOST SIGNIFICANT. THESE NEEDS WERE: - SUBSTANCE ABUSE AND TREATMENT - OBESITY AND PHYSICAL INACTIVITY - ACCESS TO AND PRICING OF HEALTHCARE - UNEMPLOYMENT AND ECONOMIC FACTORS/WORKFORCE TRAINING - MENTAL ILLNESS AND SUPPLY OF MENTAL HEALTH PROVIDERS FACTORS THAT INFLUENCE MANY OF THE HEALTH NEEDS INCLUDE FINANCIAL ISSUES, INFORMATION DISSEMINATION AND AVAILABILITY, AND TRANSPORTATION OPTIONS. ACCESS TO AFFORDABLE HEALTH INSURANCE WAS IDENTIFIED AS AN ISSUE, WITH THE CHALLENGES OF NAVIGATING THE BUREAUCRACY OF HEALTH INSURANCE DIFFICULT FOR MANY RESIDENTS. SUBSTANCE ABUSE WAS IDENTIFIED AS A SIGNIFICANT ISSUE WITH MANY CONTRIBUTING FACTORS, INCLUDING THE NEED FOR OTHER ACTIVITIES AND EMPLOYMENT OPPORTUNITIES FOR YOUNG RESIDENTS. THE NEED FOR A HEALTH EDUCATOR WAS IDENTIFIED AS SIGNIFICANT, WITH IMMUNIZATION EDUCATION AND SUBSTANCE ABUSE EDUCATION HIGHLIGHTED AS PARTICULARLY IMPORTANT. AN INCREASE IN COMMUNICABLE DISEASE, PARTICULARLY WITH HEPATITIS, HAS BEEN NOTED IN THE COMMUNITY AND TIED TO THE SUBSTANCE ABUSE PREVALENCE. THERE IS CONCERN AMONG RESIDENTS ABOUT ADEQUATE ACCESS TO HEALTHCARE, AND SOME RESIDENTS FEAR THAT DUE TO CONSOLIDATION IN HEALTHCARE THAT INPATIENT UNITS MAY BE ON THE DECLINE AS PROVIDER OPTIONS IN THE COMMUNITY. COMMUNITY SURVEYS: FOR THE 2018 COMMUNITY HEALTH NEEDS ASSESSMENT, INDIANA UNIVERSITY HEALTH CONDUCTED THE COMMUNITY SURVEY DATA COLLECTION IN COLLABORATION WITH INDIANA UNIVERSITY, UNIVERSITY OF EVANSVILLE AND AN INDIANA HOSPITAL COLLABORATIVE, INCLUDING COMMUNITY HEALTH NETWORK, FRANCISCAN ALLIANCE, ST. VINCENT HEALTH AND OTHER HOSPITAL PARTNERS. THE SURVEY WAS CONDUCTED IN TWO PHASES, WITH PHASE 1 CONDUCTED AS A PAPER SURVEY MAILED TO AN ADDRESS-BASED SAMPLE, AND PHASE 2 ADMINISTERED BY SOME OF THE HOSPITALS TO A CONVENIENCE SAMPLE THEY SELECTED. IU HEALTH PARTICIPATED IN PHASE 1. A QUESTIONNAIRE WAS DEVELOPED, WITH INPUT PROVIDED BY THE INDIANA HOSPITAL SYSTEMS, AND INCLUDED A NUMBER OF QUESTIONS ABOUT GENERAL HEALTH STATUS, ACCESS AND UTILIZATION OF SERVICES, PERSONAL BEHAVIORS, SOCIAL DETERMINANTS OF HEALTH, AND ALSO RESPONDENT DEMOGRAPHIC INFORMATION (E.G., ZIP CODE, INCOME LEVEL, EMPLOYMENT STATUS, RACE AND ETHNICITY, HOUSEHOLD SIZE, GENDER, AND AGE). THE SURVEY WAS MAILED TO APPROXIMATELY 82,000 HOUSEHOLDS, AND THE "FIELD PERIOD" WAS APRIL 2, 2018 THROUGH JUNE 29, 2018. THE PROCESS INCLUDED TWO MAILINGS TO EACH ADDRESS; A POSTCARD MAILING ALSO TOOK PLACE TO ENCOURAGE RESPONSES. OVERALL, 9,161 COMPLETED THE QUESTIONNAIRES WERE RECEIVED BY ALL OF THE PARTICIPATING HOSPITALS, FOR AN OVERALL RESPONSE RATE OF 11.6%, 5,030 QUESTIONNAIRES WERE RECEIVED FROM THE 17 INDIANA COUNTIES SERVED BY ONE OF MORE IU HEALTH HOSPITAL. A DATASET WAS THEN CREATED FROM THE IU HEALTH SURVEY RESPONSES, AND THE RESPONSES WERE ADJUSTED FOR TWO FACTORS; THE NUMBER OF ADULTS IN EACH HOUSEHOLD AND A POST-STRATIFICATION ADJUSTMENT DESIGNED TO MAKE THE RESULTS MORE REPRESENTATIVE OF THE POPULATION IN EACH COMMUNITY. FOR IU HEALTH BLOOMINGTON HOSPITAL, SURVEYS WERE RECEIVED FROM 855 COMMUNITY HOUSEHOLDS. THE COMMUNITY SURVEY INDICATES THAT SUBSTANCE USE OR ABUSE, OBESITY, POVERTY, AND MENTAL HEALTH REPRESENT TOP CONCERNS IN THE COMMUNITY SERVED BY IU HEALTH BLOOMINGTON HOSPITAL. Schedule H, Part V, Section B, Line 11 Facility , 1 Facility , 1 - IU HEALTH BLOOMINGTON HOSPITAL. In conjunction with the CHNA, IU Health Bloomington's Board adopted an implementation strategy in April 2019 relating to the 2018 CHNA. IU Health Bloomington prioritized and determined which of the community health needs identified in its most recently conducted CHNA was most critical for it to address. IU Health Bloomington will address the following community health needs between 2019 and 2021: - Access to Healthcare Services - Chronic Disease and Chronic Disease Management - Drug and Substance Abuse (including Opioids and Alcohol) * - Obesity, Diabetes and Physical Inactivity - Mental Health* - Senior Health - Social Determinants of Health *IU Health uses the term Behavioral Health to refer to Mental Health and Drug and Substance Abuse (including Opioids and Alcohol). Access to Healthcare - Medical neighborhood and team-based care approach to healthcare. Staff who participated in work to define and develop a scoring tool to measure work developing the Medical Neighborhood learned the importance of thinking outside the hospital and clinic walls to develop support for clients and patients within the community. Members of Community Health and members of the Regional Academic Health Center planning groups supported this work. Community partners total five (Wheeler Mission, Redeemer Congregation, Purdue Extension, Boys and Girls Club and Monroe County EMS). Work continues to decrease our median lag time to primary care provider appointment. Care maps were designed to guide clinical teams in care for chronic conditions such as COPD, hypertension and diabetes. This map supports referral to ancillary services such as pharmacy, dietitians and health educators. The SCR worked on the redesign of Primary Care, setting each clinic up with needed support to provide state of the art care and increase access to services. Community Health partnered in these initiatives and oriented new primary care providers to the available services. - Community access portal was supported by IU Health through findhelp.org or iuhealthconnect.org. The SCR led the efforts of the system to roll this out to community partners engaging them in uploading information about their free or reduced cost programs and services to support those in need. IUhealthconnect.org was a helpful site for team members and community members to find the appropriate healthcare resources. Community Health partnered with the IU School of Public Health to analyze the greatest needs of patients and to determine if they received the appropriate services. - Faith based partnership between IU Health and Bloomington churches. In 2020, Community Health provided support for a drive through flu clinic in October vaccinating 88 people at Redeemer Church. This was open to the community and helped reach those in that area of town who were unable to come to the IU Health site. Behavioral Health: Senior Health - Alzheimer's Resource Services (ARS) has12 formal partnerships in Lawrence County adding to the support the county receives for those living with or caring for a loved one with some form of dementia. Providing early diagnosis and connection to resources is key. It is also important to help a person with dementia remain connected and engaged in their community for as long as possible. For this reason, the Dementia Friendly training was developed and offered in the community. Due a train the trainer model implemented in 2019, at this point, there are 80 trainers. Monroe County is well supported in terms of these services. 2020 slowed down in-person interaction with this population. ARS received an HRSA grant that led to the opening of new services in Lawrence and Orange counties. Much of the work was done virtually including Dementia Friendly Training of the community and partners in 2020. - A partnership exists to support the Memory Clinic within the IU Health Southern Indiana Physicians Neurology Office in Bloomington. On Wednesday mornings, the staff from the Alzheimer's Resource Services attends the clinic. The provider schedules new patients on this day, so the majority are receiving a diagnosis of some form of dementia. Following the appointment with the provider, a meeting with the ARS staff follows the debriefing, and then a referral to community services and support. This provides wrap around care for the patient and family and enables the provider to move to the next patient. This not only adds a layer of support for the families but supports access to care. In 2020, there were 75 patients and the satisfaction scores for this service were at 100 percent both years. Behavioral Health: Substance Use Disorder - Family Vitality Program is now in its second year, referring at risk pregnant women to care. Partnerships exist with Centerstone, Indiana Center for Recovery, Fresh Start and IU Health Behavioral Health able to enroll pregnant women into recovery or treatment programs. Within the IU Health Bloomington Hospital, the Women and Children's department have provided education and support to new parents. Safe Sleep Education, Car Seat resources, Eat, Sleep and Console are a few of the resources our clients receive. Other supports provided by this program include 4 new processes built in our OB/GYN offices that connect a client at risk to care by following early identification and referral process to Centerstone or to care by a provider who will prescribe and follow an MAT prescription. Another process identified alerts our pediatric office when a baby born with Neonatal Abstinence Syndrome. Once discharged, a call is initiated to schedule the pediatric visits. If these visits are not attended, the pediatric staff will follow up with the parents. Work continues to ensure these families keep up with their pediatric appointments. In 2020, the COVID-19 pandemic brought more attention to this program from referral sources and increased participant referrals. The additional HRSA grant funding allowed this program to reach more rural areas such as Lawrence and Orange counties. - A Drug Take Back Program is located in the IU Health Bloomington Hospital lobby and is available 24/7. Community partners include Centerstone, Law Enforcement and EMS. In Monroe County in 2020, there were 692.5 pounds of medication turned in through this program. - Behavioral Health access for Positive Link clients is an active program. The partnership with Volunteers of America ended in 2020 as they were unable to hire the needed team members. Chronic Disease: Obesity and Diabetes - The IU Health Diabetes and Medical Nutrition Center served 211 clients in an outpatient setting in 2019 and 975 patients with 281 being seen virtually in 2020. The comparison of pre-education and post education A1C testing shows an average decrease of 1.15-1.2 percent in A1C levels in 2019-2020. The impact: for every 1 percent reduction in A1C there is a 37 percent decrease in microvascular disease. This would include risks to eyes, kidney and other nerve issues. IU Health Southern Indiana Primary Care partners developed a care map for Type 2 diabetes in Primary Care. The pathway was put into place in 2020 and increased access to dieticians and certified Diabetes Educators providing evidence-based education and care. IU Health Bloomington Hospital provided a Certified Diabetic Educator to its Endocrinology practice that was available two-days per week to support the most complicated patients. Through this work, those patients in care saw an average decrease of 1.9 percent in their A1C. - Prediabetes screenings have been held previously for people and referrals to care due to high risk levels of A1C. Collaborations with community partners for this service have totaled seven. The screenings have been held in the community reaching those most at risk. There has been no charge to our clients for this service. These in person screenings were cancelled in 2020 due to the COVID-19 pandemic. Schedule H, Part V, Section B, Line 11 Facility , 2 Facility , 2 - IU HEALTH BLOOMINGTON HOSPITAL (Continued). - Getting Onboard Active Living program (GOAL) community partners have grown to ten enabling this program to continue to be offered at no charge to our families. GOAL University served 1,200 elementary school children across the state in 45 after school-based programs through a partnership with IUPUI School of Nursing, Purdue Timmy Foundation and IU School of Nursing and School of Public Health. There were 1,000 college students involved equal 1,000 and the curriculum provided practical information about activity, self-esteem and nutrition. Students in all programs report an increase in fruits and vegetables consumed, decrease in screen time and increased activity levels. GOAL changed to virtual groups in 2020. The referral process continued with initial education by the dietitian and group meetings/classes happening through Zoom. Videos were filmed and sent to families to learn how to cook from their pantry and how to make three ingredient pancakes and more. - Monroe County Tobacco Coalition met 11 times in 2020 with an average of 6 members attending when able to meet in person. For this initiative the virtual option that COVID-19 provided really helped to grow the participation with an average of 12 virtual participants. Schedule H, Part V, Section B, Line 13 Facility , 1 Facility , 1 - IU HEALTH BLOOMINGTON HOSPITAL. IN ADDITION TO FPG, IU HEALTH BLOOMINGTON MAY TAKE INTO CONSIDERATION A PATIENT'S INCOME AND/OR ABILITY TO PAY IN CALCULATION OF A FINANCIAL ASSISTANCE AWARD. Schedule H, Part V, Section B, Line 13 Facility , 1 Facility , 1 - IU HEALTH BLOOMINGTON HOSPITAL. IU Health Bloomington takes into consideration several other factors in determining patient eligibility for financial assistance. These factors include the following: 1. Eligibility for Financial Assistance due to Financial or Personal Hardship In order to be eligible for Financial Assistance due to Financial or Personal Hardship under this Policy, a patient or guarantor must: - Submit a completed Financial Assistance Application with all supporting documentation and be approved in accordance with this Policy; - Be an Indiana Resident as defined in this Policy; and - If Uninsured, consult with a member of IU Health's Individual Solutions department to determine if health care coverage may be obtained from a government insurance or assistance product, the Health Insurance Marketplace, or from any other source of coverage. Financial Assistance due to Financial Hardship is only available for encounters where care was initiated via an eligible facility's emergency department, direct admission from a physician's office, or transfer from another hospital facility. 2. Financial Assistance due to Financial Hardship The FPL income threshold under this section is as follows: - If one or more adults and zero dependents are in the household, the FPL Income Threshold is 200%. - If two or more adults and one or more dependents are in the household, the FPL Income Threshold is 250%. - If one adult and one or more dependents are in the household, the FPL Income Threshold is 300%. In some instances, an adult will also qualify as a dependent. When this occurs, IU Health Bloomington will treat the adult as a dependent for purposes of the FPL calculation. IU Health Bloomington will utilize the most recent FPL data available and will apply the FPL data to a patient or guarantor's account balance based upon the calendar date a completed Financial Assistance Application was received, not a patient's date of service. An Uninsured Patient or their guarantor whose household income is less than or equal to the FPL income threshold may be eligible for full Financial Assistance up to 100% of Gross Charges if approved. An Underinsured Patient or their guarantor whose household income is less than or equal to the FPL income threshold may be eligible for full Financial Assistance up to 100% of Patient Responsibility if approved. 3. Financial Assistance due to Personal Hardship An Uninsured or Underinsured patient or their guarantor whose household income is above the FPL income threshold may be eligible for Financial Assistance if the patient's outstanding Patient Responsibility exceeds 20% of the patient's or their guarantor's annual household income. - If approved, the patient's balance will be reduced to 20% of the patient or guarantor's annual household income or the Amounts Generally Billed, whichever is less. - IU Health will work with the patient or guarantor to identify a reasonable payment plan on the remainder of the balance. 4. Eligibility Period If approved for financial assistance by IU Health Bloomington, the patient will be guaranteed financial assistance for treatment related to the underlying condition, for which the patient was originally screened and approved, through the remainder of the calendar year. As a condition of extending the on-going Financial Assistance, the patient must comply with requests from IU Health to verify that the patient continues to meet the conditions for qualification. 5. Appeals and Assistance Granted By the Financial Assistance Committee The Financial Assistance Committee will review and make determinations on all requests for appeals related to Financial Assistance. If a patient or guarantor seeks to appeal a Financial Assistance Determination, a written request must be submitted, along with the supporting documentation. The Financial Assistance Committee will review requests for and may grant additional Financial Assistance, including but not limited to, the following: - Assistance to patients who are seeking treatment that can only be provided in Indiana by IU Health or who would benefit from continued medical services from IU Health for continuity of care; - Care approved by the IU Health Chief Medical Officer (CMO) or the Chief Executive Officer (CEO) or CMO of an IU Health facility or region, including medically necessary non-elective services for which no payment source can be identified; - Care provided when it is known no payment source exists; - International humanitarian aid; and - Other care identified by the Financial Assistance Committee that fulfills the IU Health Mission. All decisions of the Financial Assistance Committee are final. 6. Presumptive Eligibility No Financial Assistance Application is required to receive Financial Assistance under this Presumptive Eligibility section. IU Health will deem patients or their guarantors presumptively eligible for Financial Assistance if they are found to be eligible for one of the following programs and care was initiated via an eligible facility's emergency department, direct admission from a physician's office, or transfer from another hospital facility: - Medicaid (any state) - Indiana Children's Special Health Care Services - Healthy Indiana Plan - Patients who are awarded Hospital Presumptive Eligibility (HPE) - A state and/or federal program that verifies the patient or guarantor's gross household income meets the FPL income threshold. IU Health will conduct a quarterly review of all accounts placed with a collection agency partner for at least one hundred and twenty (120) days after the account is eligible for an ECA as set forth in this Policy. If the patient or guarantor's individual scoring criteria demonstrates the patient has a low likelihood and/or propensity to pay or no credit, the patient or guarantor may be deemed presumptively eligible for Financial Assistance. Financial Assistance may additionally be granted in the following circumstances: - If the patient or their guarantor is found to have filed a petition for bankruptcy. - If the patient is deceased and found to have no estate. - If the patient is deceased and was under 21 years of age at the time of death. 7. Exhaustion of Alternate Sources of Assistance Patients must exhaust all other state and federal assistance programs prior to receiving Financial Assistance due to Financial or Personal Hardship under this Policy including, but not limited to, Medicaid. Patients who may be eligible for coverage under an applicable health insurance policy must exhaust all insurance benefits. - This includes patients covered under their own policy and those who may be entitled to benefits from a third-party policy. - IU Health may request patients show proof that such a claim was properly submitted to the appropriate insurance provider before awarding Financial Assistance. Eligible patients who receive medical care from an IU Health facility as a result of an injury proximately caused by a third party, and later receive a monetary settlement or award from said third party, may receive Financial Assistance for any outstanding balance not covered by the settlement or award. In the event Financial Assistance has already been granted in the above circumstances, IU Health reserves the right to reverse the Financial Assistance Determination in an amount equal to the amount IU Health would be entitled to receive had no Financial Assistance been awarded. 8. Patient Assets There are situations where a patient or their guarantor may have significant income or assets available to pay for healthcare services such as a legal settlement. The Financial Assistance Committee may evaluate the income or assets in determining Financial Hardship. IU Health Bloomington may require a list of all property owned by the patient or guarantor and adjust a Financial Assistance Determination as a result. Schedule H, Part V, Section B, Line 16 Facility , 1 Facility , 1 - IU HEALTH BLOOMINGTON HOSPITAL. IU Health Bloomington takes several other measures to broadly publicize its FAP within the community. These measures include the following: 1. Post this Policy, a Plain Language Summary of this Policy, and the Financial Assistance Application on its website. 2. Provide patients with a Plain Language Summary of this Policy during registration and/or discharge. 3. Post conspicuous displays in appropriate acute care settings such as emergency departments and registration areas describing the available assistance and directing eligible patients to the Financial Assistance Application. 4. Include a conspicuous written notice on all patient post-discharge billing statements notifying the patient about this Policy and the telephone number of the Customer Service Department which can assist patients with questions regarding this Policy. 5. Make available Customer Service representatives via telephone during normal business hours. 6. Mail copies of this Policy, a Plain Language Summary of this Policy, and a Financial Assistance Application to patients or their guarantor free of charge upon request. 7. Broadly communicate this Policy as a part of its general outreach efforts. 8. Educate patient-facing team members on this Policy and the process for referring patients to the program. 99 BLOOMINGTON ENDOSCOPY CENTER 550 LANDMARK AVE BLOOMINGTON IN 47402 AMBULATORY SURGERY SOUTHERN INDIANA SURGERY CENTER 2800 REX GROSSMAN BLVD BLOOMINGTON IN 47403 AMBULATORY SURGERY IU HEALTH ANTICOAGULATOIN CLINIC 727 W 2ND STREET FIRST FLOOR BLOOMINGTON IN 47403 DIAGNOSTIC AND OTHER OUTPATIENT IU HEALTH BEHAVIORAL HEALTH 727 W 2ND STREET FIRST FLOOR BLOOMINGTON IN 47404 SPECIALTY CARE IU HEALTH PAIN CENTER 888 AUTO MALL RD BLOOMINGTON IN 47401 SPECIALTY CARE IU HEALTH WOUND CENTER 2920 MCINTIRE DR BLOOMINGTON IN 47404 SPECIALTY CARE SIRA IMAGING CENTER 500 S LANDMARK AVE BLOOMINGTON IN 47403 DIAGNOSTIC AND OTHER OUTPATIENT BROWN COUNTY MEDICAL COOPERATIVE 103 WILLOW ST NASHVILLE IN 47448 DIAGNOSTIC AND OTHER OUTPATIENT IU HEALTH CANCER RADIATION CENTER 9149 SR 37 RR11 BOX 493 BEDFORD IN 47421 SPECIALTY CARE IU HEALTH DIABETES CENTER 727 W 2ND STREET FIRST FLOOR BLOOMINGTON IN 47403 SPECIALTY CARE IU HEALTH REHABILITATION AND SPORT 2499 W COTA DR BLOOMINGTON IN 47403 SPECIALTY CARE IU HEALTH CHILDREN'S THERAPY CENTER 4935 W ARLINGTON ROAD SUITE B C BLOOMINGTON IN 47404 SPECIALTY CARE IU HEALTH CANCER CENTER INFUSION THERAPY 508 W 2ND STREET BLOOMINGTON IN 47403 SPECIALTY CARE IU HEALTH REHABILITATION AND SPORT EAST 328 S WOODCREST DR BLOOMINGTON IN 47401 SPECIALTY CARE IU HEALTH CANCER RADIATION CENTER 2620 W COTA DR BLOOMINGTON IN 47404 SPECIALTY CARE IU HEALTH REHABILITATION AND SPORT 926 W SR46 SUITE 200 SPENCER IN 47460 SPECIALTY CARE IUH BLOOM ADDICTION TREATMENT AND RECOV 727 W 2ND STREET SUITE 202 BLOOMINGTON IN 47403 SPECIALTY CARE IU HEALTH ONCOLOGY AND HEMATOLOGY CLINIC 514 W 2ND STREET BLOOMINGTON IN 47403 SPECIALTY CARE IU HEALTH BLOOMINGTON WALK-IN 550 S LANDMARK AVE BLOOMINGTON IN 47403 PRIMARY CARE IU HEALTH BLOOMINGTON RETAIL PHARMACY 601 W 2ND STREET BLOOMINGTON IN 47403 PHARMACY SOUTHERN INDIANA PHYSICIANS CARDIOLOGY 2209 JOHN R WOODEN DR MARTINSVILLE IN 46151 SPECIALTY CARE SIP EAR NOSE & THROAT 2209 JOHN R WOODEN DR MARTINSVILLE IN 46151 SPECIALTY CARE SIP FAMILY & INTERNAL MEDICINE 2209 JOHN R WOODEN DR MARTINSVILLE IN 46151 PRIMARY CARE SIP FOOT & ANKLE 2209 JOHN R WOODEN DR MARTINSVILLE IN 46151 SPECIALTY CARE SIP GENERAL SURGERY 2209 JOHN R WOODEN DR MARTINSVILLE IN 46151 DIAGNOSTIC AND OTHER OUTPATIENT SIP MEDICAL ONCOLOGY AND HEMATOLOGY 2209 JOHN R WOODEN DR MARTINSVILLE IN 46151 DIAGNOSTIC AND OTHER OUTPATIENT SIP NUEROLOGY 2209 JOHN R WOODEN DR MARTINSVILLE IN 46151 SPECIALTY CARE SIP ORTHOPEDICS & SPORTS MEDICINE 2209 JOHN R WOODEN DR MARTINSVILLE IN 46151 SPECIALTY CARE SIP PULMONOLOGY 2209 JOHN R WOODEN DR MARTINSVILLE IN 46151 SPECIALTY CARE SIP RILEY PHYSICIANS PEDIATRICS 2209 JOHN R WOODEN DR MARTINSVILLE IN 46151 SPECIALTY CARE SOTHERN INDIANA PHYSICIANS UROLOGY 2209 JOHN R WOODEN DR MARTINSVILLE IN 46151 SPECIALTY CARE IU SIP WOMEN'S HEALTH 2209 JOHN R WOODEN DR MARTINSVILLE IN 46151 SPECIALTY CARE SIP FAMILY & INTERNAL MEDICINE 3 E MAIN STREET GOSPORT IN 47433 PRIMARY CARE SIP FAMILY & INTERNAL MEDICINE 103 W WILLOW STREET SUITE A NASHVILLE IN 47448 PRIMARY CARE SIP FAMILY & INTERNAL MEDICINE 5921 W STATE ROAD 46 BLOOMINGTON IN 47404 PRIMARY CARE SIP RILEY PHYSICIANS PEDIATRICS 4935 W ARLINGTON ROAD BLOOMINGTON IN 47404 SPECIALTY CARE SOUTHERN INDIANA PHYSICIANS FOOT & ANKLE 583 S CLARIZZ BLVD BLOOMINGTON IN 47401 SPECIALTY CARE SOUTHERN INDIANA PHYSICIANS NUEROLOGY 583 S CLARIZZ BLVD BLOOMINGTON IN 47401 SPECIALTY CARE SIP RILEY PHYSICIANS PEDIATRICS 651 S CLARIZZ BLVD BLOOMINGTON IN 47401 SPECIALTY CARE SIP FAMILY & INTERNAL MEDICINE 995 S CLARIZZ BLVD BLOOMINGTON IN 47401 PRIMARY CARE SOUTHERN INDIANA PHYSICIANS CARDIOLOGY 926 W SR46 SUITE 100 SPENCER IN 47460 SPECIALTY CARE SIP FAMILY & INTERNAL MEDICINE 926 W SR46 SUITE 100 SPENCER IN 47460 PRIMARY CARE SOUTHERN INDIANA PHYSICIANS NEPHROLOGY 926 W SR46 SUITE 100 SPENCER IN 47460 SPECIALTY CARE SIP PALLIATIVE CARE 514 W 2ND STREET BLOOMINGTON IN 47403 SPECIALTY CARE SIP WOMEN'S HEALTH 1010 W 2ND STREET BLOOMINGTON IN 47403 SPECIALTY CARE IU HEALTH SIP NEUROSURGERY 719 W 2ND STREET BLOOMINGTON IN 47403 SPECIALTY CARE SIP MEDICAL ONCOLOGY AND HEMATOLOGY 601 W 2ND STREET BLOOMINGTON IN 47403 SPECIALTY CARE IUH SIP RILEY PHYSICIANS NEONATOLOGY 601 W 2ND STREET BLOOMINGTON IN 47403 SPECIALTY CARE IU HEALTH SIP CARDIOTHORACIC SURGERY 601 W 2ND STREET BLOOMINGTON IN 47403 SPECIALTY CARE SIP FAMILY & INTERNAL MEDICINE 642 S WALKER STREET BLOOMINGTON IN 47403 PRIMARY CARE SIP WOMEN'S HEALTH 642 S WALKER STREET BLOOMINGTON IN 47403 SPECIALTY CARE SIP RILEY PHYSICIANS PEDIATRICS 350 S LANDMARK AVE BLOOMINGTON IN 47403 SPECIALTY CARE SIP ORTHOPEDICS & SPORTS MEDICINE 1375 N WELLNESS WAY BLOOMINGTON IN 47404 SPECIALTY CARE SOUTHERN INDIANA PHYSICIANS RHEUMATOLOGY 1000 W 1ST STREET BLOOMINGTON IN 47403 SPECIALTY CARE SOUTHERN INDIANA PHYSICIANS CARDIOLOGY 1312 W ARCH HAVEN AVE SUITE A BLOOMINGTON IN 47403 SPECIALTY CARE SOUTHERN INDIANA PHYSICIANS CARDIOLOGY 550 S LANDMARK AVE BLOOMINGTON IN 47403 SPECIALTY CARE SIP ENDOCRINOLOGY 550 S LANDMARK AVE BLOOMINGTON IN 47403 SPECIALTY CARE SIP FAMILY & INTERNAL MEDICINE 550 S LANDMARK AVE BLOOMINGTON IN 47403 PRIMARY CARE SIP GASTROENTEROLOGY 550 S LANDMARK AVE BLOOMINGTON IN 47403 SPECIALTY CARE SIP INFECTIOUS DISEASE 550 S LANDMARK AVE BLOOMINGTON IN 47403 SPECIALTY CARE SIP LONG TERM CARE 550 S LANDMARK AVE BLOOMINGTON IN 47403 DIAGNOSTIC AND OTHER OUTPATIENT SOUTHERN INDIANA PHYSICIANS PULMONOLOGY 550 S LANDMARK AVE BLOOMINGTON IN 47403 SPECIALTY CARE SOUTHERN INDIANA PHYSICIANS NEPHROLOGY 550 S LANDMARK AVE BLOOMINGTON IN 47403 SPECIALTY CARE SIP VASCULAR SURGERY 550 S LANDMARK AVE BLOOMINGTON IN 47403 SPECIALTY CARE SOUTHERN INDIANA PHYSICIANS CARDIOLOGY 1302 S ROGERS STREET BLOOMINGTON IN 47403 SPECIALTY CARE SIP FAMILY & INTERNAL MEDICINE 1302 S ROGERS STREET BLOOMINGTON IN 47403 PRIMARY CARE SIP FAMILY & INTERNAL MEDICINE 1520 S LIBERTY DRIVE 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INDIANA PHYSICIANS CARDIOLOGY 2900 W 16TH STREET BEDFORD IN 47421 SPECIALTY CARE IU HEALTH SIP LAB 2900 W 16TH STREET BEDFORD IN 47421 DIAGNOSTIC AND OTHER OUTPATIENT IU HEALTH SIP EAR NOSE & THROAT 2900 W 16TH STREET BEDFORD IN 47421 SPECIALTY CARE IU HEALTH SIP FAMILY & INTERNAL MEDICINE 2900 W 16TH STREET BEDFORD IN 47421 PRIMARY CARE IU HEALTH SIP FAMILY & INTERNAL MEDICINE 2900 W 16TH STREET BEDFORD IN 47421 PRIMARY CARE IU HEALTH SIP FOOT & ANKLE 2900 W 16TH STREET BEDFORD IN 47421 SPECIALTY CARE IU HEALTH SIP GASTROENTEROLOGY 2900 W 16TH STREET BEDFORD IN 47421 PRIMARY CARE IU HEALTH SIP LONG TERM CARE 2900 W 16TH STREET BEDFORD IN 47421 DIAGNOSTIC AND OTHER OUTPATIENT IUH SIP MEDICAL ONCOLOGY AND HEMATOLOGY 2900 W 16TH STREET BEDFORD IN 47421 SPECIALTY CARE IU HEALTH SIP NEPHROLOGY 2900 W 16TH STREET BEDFORD IN 47421 SPECIALTY CARE IU HEALTH SIP NEUROLOGY OUTPATIENT 2900 W 16TH STREET BEDFORD IN 47421 SPECIALTY CARE IUH SIP ORTHOPEDICS & SPORTS MEDICINE 2900 W 16TH STREET BEDFORD IN 47421 SPECIALTY CARE IU HEALTH SIP SURGERY 2900 W 16TH STREET BEDFORD IN 47421 DIAGNOSTIC AND OTHER OUTPATIENT IU HEALTH SIP UROLOGY 2900 W 16TH STREET BEDFORD IN 47421 SPECIALTY CARE IU HEALTH SIP WOMEN'S HEALTH 2900 W 16TH STREET BEDFORD IN 47421 SPECIALTY CARE SIP RILEY PHYSICIANS PEDIATRICS 1614 25TH STREET BEDFORD IN 47421 SPECIALTY CARE SOUTHERN INDIANA PHYSICIANS CARDIOLOGY 642 W HOSPITAL ROAD PAOLI IN 47454 SPECIALTY CARE SIP FOOT & ANKLE 642 W HOSPITAL ROAD PAOLI IN 47454 SPECIALTY CARE SIP GASTROENTEROLOGY 642 W HOSPITAL ROAD PAOLI IN 47454 SPECIALTY CARE SIP MEDICAL ONCOLOGY AND HEMATOLOGY 642 W HOSPITAL ROAD PAOLI IN 47454 SPECIALTY CARE IU HEALTH SIP FAMILY & INTERNAL MEDICINE 560 LONGEST STREET PAOLI IN 47454 PRIMARY CARE Schedule H, Part I, Line 6a C.B. REPORT PREPARED BY A RELATED ORG. IU HEALTH BLOOMINGTON'S COMMUNITY BENEFIT AND OTHER INVESTMENTS, ENCOMPASSING ITS TOTAL COMMUNITY INVESTMENT, ARE INCLUDED IN THE IU HEALTH COMMUNITY BENEFIT REPORT WHICH IS PREPARED ON BEHALF OF AND INCLUDES IU HEALTH AND ITS RELATED HOSPITAL ENTITIES IN THE STATE OF INDIANA. THE IU HEALTH COMMUNITY BENEFIT REPORT IS MADE AVAILABLE TO THE PUBLIC ON IU HEALTH'S WEBSITE AT HTTPS://IUHEALTH.ORG/IN-THE-COMMUNITY/COMMUNITY-BENEFIT. THE IU HEALTH COMMUNITY BENEFIT REPORT IS ALSO DISTRIBUTED TO NUMEROUS KEY ORGANIZATIONS THROUGHOUT THE STATE OF INDIANA IN ORDER TO BROADLY SHARE THE IU HEALTH STATEWIDE SYSTEM'S COMMUNITY BENEFIT EFFORTS. IT IS ALSO AVAILABLE BY REQUEST THROUGH THE INDIANA STATE DEPARTMENT OF HEALTH OR IU HEALTH. Schedule H, Part I, Line 7c TOTAL COMMUNITY BENEFIT EXPENSE SCHEDULE H, PART I, LINE 7, COLUMN (F), PERCENT OF TOTAL EXPENSE, IS BASED ON COLUMN (E) NET COMMUNITY BENEFIT EXPENSE. THE PERCENT OF TOTAL EXPENSE BASED ON COLUMN (C) TOTAL COMMUNITY BENEFIT EXPENSE, WHICH EXCLUDES DIRECT OFFSETTING REVENUE, IS 25.62%. Schedule H, Part I, Line 7f PERCENT OF TOTAL EXPENSE THE AMOUNT OF BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE OF TOTAL EXPENSE ON LINE 7, COLUMN (F) IS 33,531,546. Schedule H, Part II PROMOTION OF HEALTH IN COMMUNITIES SERVED IU Health Bloomington participates in a variety of community-building activities that address the social determinants of health in the communities it serves. IU Health Bloomington and its related hospital entities across the state of Indiana ("IU Health Statewide System") invest in economic development efforts across the state, collaborate with like-minded organizations through coalitions that address key issues, and advocate for improvements in the health status of vulnerable populations. This includes making contributions to community-building activities by providing investments and resources to local community initiatives. Several examples include IU Health Bloomington's support of the following organizations' efforts that focus on some of the root causes of health issues, such as access to healthcare, lack of education, insufficient access to resources, employment and poverty: -Monroe County Public Health Clinic -Monroe County Community School System -Monroe County Opioid Commission -Early Learning Indiana -United Way Additionally, through the IU Health Statewide System's team member volunteer program, IU Health Serves, team members across the state positively impact the health of the community and foster a culture of engagement and social responsibility. In 2020, more than 1,400 team members throughout the statewide system dedicated time to support over 49 projects to positively impact the community. Schedule H, Part I, Line 3c Eligibility criteria for free or discounted care IU Health Bloomington uses several factors other than federal poverty guidelines ("FPG") in determining eligibility for free care under its FAP. These factors include the following: 1. Eligibility for Financial Assistance due to Financial or Personal Hardship In order to be eligible for Financial Assistance due to Financial or Personal Hardship under this Policy, a patient or guarantor must: - Submit a completed Financial Assistance Application with all supporting documentation and be approved in accordance with this Policy; - Be an Indiana Resident as defined in this Policy; and - If Uninsured, consult with a member of IU Health's Individual Solutions department to determine if health care coverage may be obtained from a government insurance or assistance product, the Health Insurance Marketplace, or from any other source of coverage. Financial Assistance due to Financial Hardship is only available for encounters where care was initiated via an eligible facility's emergency department, direct admission from a physician's office, or transfer from another hospital facility. 2. Financial Assistance due to Financial Hardship The FPL income threshold under this section is as follows: - If one or more adults and zero dependents are in the household, the FPL Income Threshold is 200%. - If two or more adults and one or more dependents are in the household, the FPL Income Threshold is 250%. - If one adult and one or more dependents are in the household, the FPL Income Threshold is 300%. In some instances, an adult will also qualify as a dependent. When this occurs, IU Health Bloomington will treat the adult as a dependent for purposes of the FPL calculation. IU Health Bloomington will utilize the most recent FPL data available and will apply the FPL data to a patient or guarantor's account balance based upon the calendar date a completed Financial Assistance Application was received, not a patient's date of service. An Uninsured Patient or their guarantor whose household income is less than or equal to the FPL income threshold may be eligible for full Financial Assistance up to 100% of Gross Charges if approved. An Underinsured Patient or their guarantor whose household income is less than or equal to the FPL income threshold may be eligible for full Financial Assistance up to 100% of Patient Responsibility if approved. 3. Financial Assistance due to Personal Hardship An Uninsured or Underinsured patient or their guarantor whose household income is above the FPL income threshold may be eligible for Financial Assistance if the patient's outstanding Patient Responsibility exceeds 20% of the patient's or their guarantor's annual household income. - If approved, the patient's balance will be reduced to 20% of the patient or guarantor's annual household income or the Amounts Generally Billed, whichever is less. - IU Health will work with the patient or guarantor to identify a reasonable payment plan on the remainder of the balance. 4. Eligibility Period If approved for financial assistance by IU Health, the patient will be guaranteed financial assistance for treatment related to the underlying condition, for which the patient was originally screened and approved, through the remainder of the calendar year. As a condition of extending the on-going Financial Assistance, the patient must comply with requests from IU Health to verify that the patient continues to meet the conditions for qualification. 5. Appeals and Assistance Granted By the Financial Assistance Committee The Financial Assistance Committee will review and make determinations on all requests for appeals related to Financial Assistance. If a patient or guarantor seeks to appeal a Financial Assistance Determination, a written request must be submitted, along with the supporting documentation. The Financial Assistance Committee will review requests for and may grant additional Financial Assistance, including but not limited to, the following: - Assistance to patients who are seeking treatment that can only be provided in Indiana by IU Health or who would benefit from continued medical services from IU Health for continuity of care; - Care approved by the IU Health Chief Medical Officer (CMO) or the Chief Executive Officer (CEO) or CMO of an IU Health facility or region, including medically necessary non-elective services for which no payment source can be identified; - Care provided when it is known no payment source exists; - International humanitarian aid; and - Other care identified by the Financial Assistance Committee that fulfills the IU Health Mission. All decisions of the Financial Assistance Committee are final. 6. Presumptive Eligibility No Financial Assistance Application is required to receive Financial Assistance under this Presumptive Eligibility section. IU Health will deem patients or their guarantors presumptively eligible for Financial Assistance if they are found to be eligible for one of the following programs and care was initiated via an eligible facility's emergency department, direct admission from a physician's office, or transfer from another hospital facility: - Medicaid (any state) - Indiana Children's Special Health Care Services - Healthy Indiana Plan - Patients who are awarded Hospital Presumptive Eligibility (HPE) - A state and/or federal program that verifies the patient or guarantor's gross household income meets the FPL income threshold. IU Health will conduct a quarterly review of all accounts placed with a collection agency partner for at least one hundred and twenty (120) days after the account is eligible for an ECA as set forth in this Policy. If the patient or guarantor's individual scoring criteria demonstrates the patient has a low likelihood and/or propensity to pay or no credit, the patient or guarantor may be deemed presumptively eligible for Financial Assistance. Financial Assistance may additionally be granted in the following circumstances: - If the patient or their guarantor is found to have filed a petition for bankruptcy. - If the patient is deceased and found to have no estate. - If the patient is deceased and was under 21 years of age at the time of death. 7. Exhaustion of Alternate Sources of Assistance Patients must exhaust all other state and federal assistance programs prior to receiving Financial Assistance due to Financial or Personal Hardship under this Policy including, but not limited to, Medicaid. Patients who may be eligible for coverage under an applicable health insurance policy must exhaust all insurance benefits. - This includes patients covered under their own policy and those who may be entitled to benefits from a third-party policy. - IU Health may request patients show proof that such a claim was properly submitted to the appropriate insurance provider before awarding Financial Assistance. Eligible patients who receive medical care from an IU Health facility as a result of an injury proximately caused by a third party, and later receive a monetary settlement or award from said third party, may receive Financial Assistance for any outstanding balance not covered by the settlement or award. In the event Financial Assistance has already been granted in the above circumstances, IU Health reserves the right to reverse the Financial Assistance Determination in an amount equal to the amount IU Health would be entitled to receive had no Financial Assistance been awarded. 8. Patient Assets There are situations where a patient or their guarantor may have significant income or assets available to pay for healthcare services such as a legal settlement. The Financial Assistance Committee may evaluate the income or assets in determining Financial Hardship. IU Health Bloomington may require a list of all property owned by the patient or guarantor and adjust a Financial Assistance Determination as a result. Schedule H, Part I, Line 7g Subsidized Health Services IU HEALTH Bloomington DOES NOT INCLUDE ANY COSTS ASSOCIATED WITH PHYSICIAN CLINICS AS SUBSIDIZED HEALTH SERVICES. Schedule H, Part I, Line 7 Bad Debt Expense excluded from financial assistance calculation 33531546 Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount THE AMOUNT REPORTED ON LINE 2 AS BAD DEBT IS REPORTED AT COST, AS CALCULATED USING THE COST TO CHARGE RATIO METHODOLOGY. Schedule H, Part III, Line 3 Bad Debt Expense Methodology IU Health Bloomington will deem patients or their guarantors presumptively eligible for Financial Assistance if they are found to be eligible for one of the following programs and care was initiated via an eligible facility's emergency department, direct admission from a physician's office, or transfer from another hospital facility: 1. Medicaid (any state) 2. Indiana Children's Special Health Care Services 3. Healthy Indiana Plan 4. Patients who are awarded Hospital Presumptive Eligibility (HPE) 5. A state and/or federal program that verifies the patient or guarantor's gross household income meets the FPL income threshold. No Financial Assistance Application is required to receive Financial Assistance under this Presumptive Eligibility section. IU Health Bloomington will conduct a quarterly review of all accounts placed with a collection agency partner for at least one hundred and twenty (120) days after the account is eligible for an ECA as set forth in this Policy. If the patient or guarantor's individual scoring criteria demonstrates the patient has a low likelihood and/or propensity to pay or no credit, the patient or guarantor may be deemed presumptively eligible for Financial Assistance. Financial Assistance may additionally be granted in the following circumstances: a) If the patient or their guarantor is found to have filed a petition for bankruptcy. b) If the patient is deceased and found to have no estate. c) If the patient is deceased and was under 21 years of age at the time of death. Due to this comprehensive methodology, IU Health Bloomington does not believe any amount of bad debt is attributable to patients who may be eligible under the financial assistance policy and no portion of bad debt is included as community benefit. Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote IU Health Bloomington IS A SUBSIDIARY IN THE CONSOLIDATED FINANCIAL STATEMENTS OF IU HEALTH. IU HEALTH'S BAD DEBT EXPENSE FOOTNOTE IS AS FOLLOWS: The Indiana University Health System does not require collateral or other security from its patients, substantially all of whom are residents of the State, for the delivery of health care services. However, consistent with industry practice, the Indiana University Health System routinely obtains assignment of (or is otherwise entitled to receive) patients' benefits payable under their health insurance programs, plans, or policies (e.g., Medicare, Medicaid, managed care payers, and commercial insurance policies). The Indiana University Health System uses a portfolio approach to account for categories of patient contracts as a collective group, rather than recognizing revenue on an individual contract basis. The portfolios consist of major payer classes for inpatient revenue and outpatient revenue. Based on the historical collection trends and other analysis, the Indiana University Health System believes that revenue recognized by utilizing the portfolio approach approximates the revenue that would have been recognized if an individual contract approach were used. In support of its mission, the Indiana University Health System provides care to uninsured and underinsured patients. The Indiana University Health System provides charity care to patients who lack financial resources and are deemed to be medically indigent. Financial assistance is available to qualifying uninsured and underinsured patients receiving care at an Indiana University Health System hospital location. Under its financial assistance policy, the Indiana University Health System provides medically necessary care to uninsured patients. Financial assistance up to the full amount of patient financial responsibility is available for uninsured and underinsured patients receiving care via the emergency department, direct admission from a physician's office, or transfer from another hospital. The federal poverty level (FPL) thresholds for this type of financial assistance are based on household makeup. Households without dependents are eligible for assistance if household income is less than or equal to 200% FPL, two adults and at least one dependent are eligible if household income is less than or equal to 250% FPL, and households with one adult and at least one dependent are eligible if household income is less than or equal to 300% FPL. Individuals with medical bills totaling more than 20% of annual household income, regardless of FPL, qualify for catastrophic assistance and are eligible for a reduction in patient financial responsibility to 20% of annual household income. Since the Indiana University Health System does not pursue collection of these amounts, the discounted amounts are not reported as patient service revenue. The Indiana University Health System uses presumptive eligibility screening procedures for some forms of financial assistance and recognizes net patient service revenue on services provided to self-pay patients at the discounted rate at the time services are rendered. The estimated cost of charity care, using the consolidated cost to charge ratio, was $90,358,000 and $96,693,000 in 2020 and 2019, respectively. Schedule H, Part III, Line 8 Community benefit & methodology for determining medicare costs IU HEALTH BLOOMINGTON'S MEDICARE SHORTFALL IS ATTRIBUTABLE TO REIMBURSEMENTS THAT ARE LESS THAN THE COST OF PROVIDING PATIENT CARE AND SERVICES TO MEDICARE BENEFICIARIES AND DOES NOT INCLUDE ANY AMOUNTS THAT RESULT FROM INEFFICIENCIES OR POOR MANAGEMENT. IU HEALTH BLOOMINGTON ACCEPTS ALL MEDICARE PATIENTS KNOWING THAT THERE MAY BE SHORTFALLS; THEREFORE IT HAS TAKEN THE POSITION THAT ANY SHORTFALL SHOULD BE COUNTED AS PART OF ITS COMMUNITY BENEFIT. ADDITIONALLY, IT IS IMPLIED IN INTERNAL REVENUE SERVICE REVENUE RULING 69-545 THAT TREATING MEDICARE PATIENTS IS A COMMUNITY BENEFIT. REVENUE RULING 69-545, WHICH ESTABLISHED THE COMMUNITY BENEFIT STANDARD FOR NONPROFIT HOSPITALS, STATES THAT IF A HOSPITAL SERVES PATIENTS WITH GOVERNMENTAL HEALTH BENEFITS, INCLUDING MEDICARE, THEN THIS IS AN INDICATION THAT THE HOSPITAL OPERATES TO PROMOTE THE HEALTH OF THE COMMUNITY. THE AMOUNT REPORTED ON SCHEDULE H, PART III, LINE 6 IS CALCULATED, IN ACCORDANCE WITH THE FORM 990 INSTRUCTIONS, USING "ALLOWABLE COSTS" FROM THE IU HEALTH BLOOMINGTON MEDICARE COST REPORT. "ALLOWABLE COSTS" FOR MEDICARE COST REPORT PURPOSES, HOWEVER, ARE NOT REFLECTIVE OF ALL COSTS ASSOCIATED WITH IU HEALTH BLOOMINGTON'S PARTICIPATION IN MEDICARE PROGRAMS. FOR EXAMPLE, THE MEDICARE COST REPORT EXCLUDES CERTAIN COSTS SUCH AS BILLED PHYSICIAN SERVICES, THE COSTS OF MEDICARE PARTS C AND D, FEE SCHEDULE REIMBURSED SERVICES, AND DURABLE MEDICAL EQUIPMENT SERVICES. INCLUSION OF ALL COSTS ASSOCIATED WITH IU HEALTH BLOOMINGTON'S PARTICIPATION IN MEDICARE PROGRAMS WOULD SIGNIFICANTLY INCREASE THE MEDICARE SHORTFALL REPORTED ON SCHEDULE H, PART III, LINE 7. Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance IU Health Bloomington's FAP and written debt collection policy describe the collection practices applicable to patients, including those who may qualify for financial assistance. 1. Financial Assistance Application Financial Assistance Applications must include the following documentation: - All sources of Income for the last three (3) months. - Most recent three (3) months of pay stubs or Supplemental Security Income via Social Security. - Most recent three (3) statements from checking and savings accounts, certificates of deposit, stocks, bonds and money market accounts. - Most recent state and Federal Income Tax forms including Schedules C, D, E, and F. In the event the patient or guarantor's income does not warrant the filing of a federal tax statement, the individual may submit a notarized affidavit attesting to the foregoing. - Most recent W-2 statement. - For patients or members of the Household who are currently unemployed, Wage Inquiry from WorkOne. - If applicable, divorce/dissolution decrees and child custody order. Patients or their guarantors wishing to apply for Financial Assistance due to Financial Hardship are encouraged to submit an Application within ninety (90) days of discharge. Patients or their guarantors may submit an Application up to two-hundred and forty (240) days from the date of their initial post-discharge billing statement from IU Health Bloomington, however, accounts may be subject to Extraordinary Collection Actions (ECA) as soon as one-hundred and twenty (120) days after receipt of the initial post-discharge billing statement. Patients or their guarantors submitting an incomplete Financial Assistance Application will receive written notification of the Application's deficiency upon discovery by IU Health Bloomington. The Application will be pended for a period of forty-five (45) days from the date the notification is mailed. IU Health Bloomington will suspend any ECA until the Application is complete or the expiration of the forty-five (45) day period. Patients with limited English proficiency may request a copy of this Policy, a Financial Assistance Application, and a Plain Language Summary in one of the below languages: - Arabic; - Burmese; - Burmese - Falam; - Burmese - Hakha Chin; - Mandarin/Chinese; or - Spanish The patient, and/or their representative, such as the patient's physician, family members, legal counsel, community or religious groups, social services or hospital personnel may request a Financial Assistance Application be mailed to a patient's primary mailing address free of charge. IU Health Bloomington maintains the confidentiality of all Financial Assistance Applications and supporting documentation. IU Health Bloomington will deny or revoke Financial Assistance for any patient or guarantor who falsifies any portion of a Financial Assistance Application. 2. Financial Assistance Determinations IU Health Bloomington will inform patients or guarantors of the results of their Application by providing the patient or guarantor with a Financial Assistance Determination within ninety (90) days of receiving a completed Application and all requested documentation. A patient's Financial Assistance Application and Financial Assistance Determination are specific to each date(s) of service and approved related encounters. If a patient or guarantor is granted less than full charity assistance and the patient or guarantor provides additional information for reconsideration, Revenue Cycle Services may amend a prior Financial Assistance Determination. 3. Extraordinary Collection Actions IU Health Bloomington may refer delinquent patient accounts to a third-party collection agency after utilizing reasonable efforts to determine a patient's eligibility for assistance under this Policy. Reasonable efforts include the following: - IU Health Bloomington will notify the patient of this Policy at least thirty (30) days prior to initiating an ECA. - IU Health Bloomington will not initiate an ECA for at least one-hundred and twenty (120) days after the patient's initial post-discharge billing statement. - IU Health Bloomington will review all Financial Assistance Applications received up to and including two-hundred and forty (240) days after the patient's initial post-discharge billing statement. IU Health will cease any ECAs it has initiated upon receipt of a Financial Assistance Application until a Financial Assistance Determination is made under this policy. - If an Application is Approved, IU Health will issue a revised statement, issue refunds, and make reasonable efforts to reverse ECAs as necessary. IU Health and its third-party collection agencies may initiate an ECA against a patient or their guarantor in accordance with this Policy and 26 C.F.R. § 1.501(r). ECAs may include the following: - Selling a patient or their guarantor's outstanding financial responsibility to a third party. - Reporting adverse information about the patient or their guarantor to consumer credit reporting agencies or credit bureaus. - Deferring or denying, or requiring a payment before providing, medically necessary care because of a patient or their guarantor's nonpayment of one or more bills for previously provided care covered under this Policy. - Actions requiring a legal or judicial process, including but not limited to placing a lien on a patient's or their guarantor's property, foreclosing on a patient's or their guarantor's real property, attaching or seizing a patient's or their guarantor's bank account or other personal property, commencing a civil action against a patient or their guarantor, causing a patient or guarantor's arrest, causing a patient and/or guarantor to be subject to a writ of body attachment, and garnishing a patient or guarantor's wages When it is necessary to engage in such action, IU Health and its third party collection agencies, will engage in fair, respectful and transparent collections activities. 4. Refunds Patients eligible for Financial Assistance under this Policy who remitted payment to IU Health in excess of their Patient Responsibility will be alerted to the overpayment as promptly after discovery as is reasonable given the nature of the overpayment. Patients with an outstanding account balance due on a separate account will have their refund applied to the outstanding balance. Patients without an outstanding account balance described above will be issued a refund check for their overpayment as soon as technically feasible. Schedule H, Part V, Section B, Line 16a FAP website - IU HEALTH BLOOMINGTON HOSPITAL: Line 16a URL: HTTPS://IUHEALTH.ORG/PAY-A-BILL/FINANCIAL-ASSISTANCE; Schedule H, Part V, Section B, Line 16b FAP Application website - IU HEALTH BLOOMINGTON HOSPITAL: Line 16b URL: HTTPS://IUHEALTH.ORG/PAY-A-BILL/FINANCIAL-ASSISTANCE; Schedule H, Part V, Section B, Line 16c FAP plain language summary website - IU HEALTH BLOOMINGTON HOSPITAL: Line 16c URL: HTTPS://IUHEALTH.ORG/PAY-A-BILL/FINANCIAL-ASSISTANCE; Schedule H, Part VI, Line 2 Needs assessment COMMUNITIES ARE MULTIFACETED AND SO ARE THEIR HEALTH NEEDS. IU HEALTH BLOOMINGTON UNDERSTANDS THAT THE HEALTH OF INDIVIDUALS AND COMMUNITIES ARE SHAPED BY VARIOUS SOCIAL AND ENVIRONMENTAL FACTORS, ALONG WITH HEALTH BEHAVIORS AND ADDITIONAL INFLUENCES. IU HEALTH BLOOMINGTON ASSESSES THE HEALTH CARE NEEDS OF THE COMMUNITIES IT SERVES BY CONDUCTING A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA). FOR THE 2018 CHNA, IU HEALTH BLOOMINGTON CONDUCTED THE COMMUNITY SURVEY DATA COLLECTION IN COLLABORATION WITH INDIANA UNIVERSITY, UNIVERSITY OF EVANSVILLE AND AN INDIANA HOSPITAL COLLABORATIVE, INCLUDING COMMUNITY HEALTH NETWORK, FRANCISCAN ALLIANCE, ST. VINCENT HEALTH AND OTHER HOSPITAL PARTNERS. AFTER COMPLETION OF THE CHNA, IU HEALTH BLOOMINGTON REVIEWED SECONDARY DATA, FINDINGS FROM OTHER COMMUNITY HEALTH ASSESSMENTS OF AREAS SERVED BY THE HOSPITAL, INPUT OBTAINED FROM INDIVIDUALS WHO PARTICIPATED IN COMMUNITY MEETINGS, INPUT OBTAINED FROM KEY STAKEHOLDERS, AND A COMMUNITY SURVEY TO IDENTIFY AND ANALYZE THE NEEDS IDENTIFIED BY EACH SOURCE. THE TOP HEALTH NEEDS OF THE IU HEALTH BLOOMINGTON COMMUNITY ARE THOSE THAT ARE SUPPORTED BY MULTIPLE DATA SOURCES. ADDITIONALLY, THE EFFECTIVENESS OF AN INTERVENTION FOR EACH NEED AND IU HEALTH'S ABILITY TO IMPACT POSITIVE CHANGE WAS EVALUATED. IU HEALTH BLOOMINGTON BELIEVES ITS CHNA PROCESS IS COMPREHENSIVE AND ADDITIONAL ASESSMENTS ARE NOT REQUIRED. Schedule H, Part VI, Line 3 Patient education of eligibility for assistance IU Health Bloomington takes several measures to inform its patients of the FAP and FAP-eligibility. These measures include the following: 1. Post this Policy, a Plain Language Summary of this Policy, and the Financial Assistance Application on its website. 2. Provide patients with a Plain Language Summary of this Policy during registration and/or discharge. 3. Post conspicuous displays in appropriate acute care settings such as emergency departments and registration areas describing the available assistance and directing eligible patients to the Financial Assistance Application. 4. Include a conspicuous written notice on all patient post-discharge billing statements notifying the patient about this Policy and the telephone number of the Customer Service Department which can assist patients with questions regarding this Policy. 5. Make available Customer Service representatives via telephone during normal business hours. 6. Mail copies of this Policy, a Plain Language Summary of this Policy, and a Financial Assistance Application to patients or their guarantor free of charge upon request. 7. Broadly communicate this Policy as a part of its general outreach efforts. 8. Educate patient-facing team members on this Policy and the process for referring patients to the program. Schedule H, Part VI, Line 4 Community information IU HEALTH BLOOMINGTON HOSPITAL IS LOCATED IN MONROE COUNTY, A COUNTY LOCATED IN SOUTH CENTRAL INDIANA. MONROE COUNTY INCLUDES ZIP CODES WITHIN THE TOWNS OF BLOOMINGTON, ELLETTSVILLE AND UNIONVILLE. BASED ON THE MOST RECENT CENSUS BUREAU (2020) STATISTICS, MONROE COUNTY'S POPULATION IS 139,718 AND APPROXIMATELY 50.3% WERE FEMALE AND 49.7% MALE. THE COUNTY'S POPULATION ESTIMATES BY RACE ARE 86% WHITE, 3.7% BLACK, 7.3% ASIAN, 0.3% AMERICAN INDIAN OR ALASKA NATIVE AND 2.6% PERSONS REPORTING TWO OR MORE RACES. IN THE COUNTY, IN ADDITION TO THE ABOVE CATEGORIZATIONS, 3.6% REPORTED HISPANIC OR LATINO HERITAGE. MONROE COUNTY HAS RELATIVELY HIGH LEVELS OF EDUCATIONAL ATTAINMENT, AS COMPARED TO OTHER INDIANA COUNTIES. ALMOST HALF (45.7%) OF THE POPULATION HAS A BACHELOR'S DEGREE OR GRADUATE/PROFESSIONAL DEGREE, WHILE 92.7% OF THE POPULATION HAS OBTAINED A HIGH SCHOOL DEGREE. Schedule H, Part VI, Line 5 Promotion of community health IU Health Bloomington is a subsidiary of Indiana University Health, Inc., a tax-exempt healthcare organization, whose Board of Directors is composed of members, of which substantially all are independent community members. IU Health Bloomington Community Health offers a wide variety of programs and services to the community. From work with the local school systems, to programs that help those living with HIV/AIDS and Alzheimer's disease, our goal is to help our community live healthier. Schedule H, Part VI, Line 6 Affiliated health care system IU Health Bloomington is part of the IU Health Statewide System ("the system"), which is Indiana's most comprehensive healthcare system. A unique partnership with the Indiana University School of Medicine ("IU School of Medicine"), one of the nation's leading medical schools, gives patients access to innovative treatments and therapies. The system is comprised of hospitals, physicians and allied services dedicated to providing preeminent care throughout Indiana and beyond. National Recognition - Eight hospitals designated as Magnet by the American Nurses Credentialing Center recognizing excellence in nursing care. - U.S. News & World Report - Annual Rankings - IU Health Medical Center is nationally ranked for the 23rd year in a row. IU Health Medical Center is nationally ranked in 3 adult specialties and 10 pediatric specialties and rated high performing in 5 adult specialties and 6 procedures and conditions. - IU Health has five hospitals that are considered high performing in certain procedures and conditions: IU Health Ball, IU Health Arnett, IU Health North, IU Health West, and IU Health Bloomington hospitals. - Riley Hospital for Children at IU Health is nationally ranked in 10 pediatric specialties. IU Health Statewide System Hospitals in the system include the following: - IU Health Inc. (i.e., the IU Health Academic Health Center consists of IU Health Methodist Hospital, IU Health University Hospital, Riley Hospital for Children at IU Health, and IU Health Saxony Hospital) - IU Health Arnett - IU Health Ball - IU Health Bedford Hospital - IU Health Blackford - IU Health Bloomington Hospital - IU Health Frankfort - IU Health Jay - IU Health North Hospital - IU Health Paoli Hospital - IU Health Tipton Hospital - IU Health West Hospital - IU Health White Memorial Hospital The system is divided into five regions that serve communities in Northwest, Northeast, Central, and Southern Indiana. IU Health Inc. has significant statewide reach as a: 1) teaching hospital, 2) research activities with the IU School of Medicine and other national collaborations, 3) Riley's network of locations throughout the state due to its pediatric expertise, and 4) Riley's trauma department is the only Level I Pediatric Trauma Center in Indiana. Although each hospital in the system conducts and adopts its own CHNA and implementation strategy, the system considers the sum of these plans part of a system wide goal of making Indiana one of the healthiest states in the nation. The hospitals are guided by a system wide mission to improve the health of our patients and community through innovation, and excellence in care, education, research, and service. The system is keenly aware of the positive impact it can have on improving the health of communities throughout the state of Indiana by aligning resources in a system-level and strategic way. Education and Research The system includes the Academic Health Center that works in partnership with the IU School of Medicine to train physicians, blending breakthrough research and treatments with the highest quality of patient care. Each year, more than 1,000 residents and fellows receive training in IU Health hospitals. Research conducted by IU School of Medicine faculty gives IU Health physicians and patients access to the most leading-edge and comprehensive treatment options. In 2017, IU Health and the IU School of Medicine announced that they would invest $50 million over six years in the Strategic Research Initiative (SRI), a new research collaboration that has enhanced the institutions' joint capabilities in fundamental scientific investigation, translational research and clinical trials. The initial focus is on projects in the fields of neuroscience, cancer and cardiovascular disease with the goal to fund transformative proposals that will fundamentally change the understanding of these diseases and lead to important new therapies for patients. The three target research areas represent research strengths at IU School of Medicine, key strategic service lines for IU Health, and important medical needs in a time of an aging population and rising healthcare costs. One of the most significant outcomes of this initiative includes the Indiana University Melvin and Bren Simon Cancer Center receiving the National Cancer Institute's (NCI)-designated status of "comprehensive." This designation was achieved in August 2019 making the center the only NCI-designated Comprehensive Cancer Center in Indiana and one of just 51 in the nation. Community Health To further promote the health of the communities served by the system, the system-level Community Health team builds the capabilities and competencies to impact team members, risk lives, and patients throughout the system. Additionally, the team partners with state and local community-based organizations, community coalitions, and governmental agencies to pursue a system-level advocacy/collaboration strategy that seeks to improve the health of communities. All hospitals in the system identify and address significant health needs unique to the community it serves. However, because some of these health needs are common in communities served by multiple hospitals in the system, they warrant a system level strategy. Community Health plans and provides technical assistance for system-level strategies that address these common health needs including health equity, tobacco treatment, behavioral health access, and social needs. Each hospital works collaboratively with the Community Health team to operationalize system-level strategies through the implementation of specific activities that align and activate local resources. This benefits the community each hospital serves and works towards a statewide impact (system-level) on health outcomes. IU Health Serves IU Health Serves, a system-level team member volunteer program, seeks to positively impact the health of communities the IU Health Statewide System serves and fosters a culture of engagement and social responsibility. IU Health Bloomington coordinates the different initiatives of the program, including Days of Service. This is the largest volunteer event of the year, consisting of projects designed to engage IU Health Bloomington team members in activities that address local, identified community health priorities. Community Impact Investment (CII) Fund The CII Fund is a $100 million board designated fund to be managed and overseen by the IU Health Foundation to financially support high impact community investing designed to address social determinants of health in communities IU Health serves. Each IU Health hospital has a significant impact on and are deeply invested in their local communities. Through the grants provided by this CII Fund, IU Health can strategically and intentionally address the social, economic and environmental factors that impact the health of our surrounding communities. Each IU Health hospital and its team members are eligible for this grant opportunity. Schedule H, Part VI, Line 7 State filing of community benefit report IN true bloomington health foundation 320 W 8th st suite 116 Bloomington IN 47404 351720795 501(C)(3) 29371 FMV General Support 1 0 Schedule I, Part I, Line 2 Procedures for monitoring use of grant funds. ALTHOUGH IU HEALTH BLOOMINGTON DOES NOT MONITOR THE USE OF GRANT FUNDS ONCE DISTRIBUTED, THROUGH DUE DILIGENCE THE ORGANIZATION HAS REASONABLY CONFIRMED THAT THE ENTITIES TO WHICH THE CONTRIBUTIONS ARE MADE ARE HIGHLY REPUTABLE IN THE COMMUNITY AND USE THE FUNDS FOR THE PURPOSES INTENDED. false true false false false false false true false BRIAN T SHOCKNEY DIRECTOR/REGIONAL PRESIDENT (SCR) 0 555231 0 263743 0 30294 0 112183 0 29309 0 990760 0 0 DAVID L BEACHY DO DIRECTOR 199086 0 23975 0 11538 0 15930 0 21134 0 271663 0 0 0 JAMES J LAUGHLIN MD DIRECTOR 329992 0 56032 0 6858 0 18400 0 0 0 411282 0 0 0 HOJJAT M SHAMLOO MD DIRECTOR 536238 0 81394 0 21822 0 18400 0 32985 0 690839 0 0 0 JOHN S STROBEL MD DIRECTOR 551810 0 56840 0 92144 0 18400 0 27597 0 746791 0 0 0 BLAKE A DYE DIRECTOR 0 540929 0 231572 0 8658 0 114703 0 21828 0 917690 0 0 MICHAEL L CRAIG VP & CFO (SCR) 0 245882 0 38119 0 31708 0 18512 0 18049 0 352270 0 0 LARRY R BAILEY FORMER KEY EMPLOYEE 7239 232489 1030 33088 951 30531 545 17499 531 17041 10295 330649 0 0 DEREK B FIELDS FORMER KEY EMPLOYEE 181848 0 21222 0 300 0 13297 0 13654 0 230321 0 0 0 KENNETH E MARSHALL MD FORMER KEY EMPLOYEE 198509 0 15564 0 5484 0 14737 0 34170 0 268464 0 0 0 WENDY S HERNANDEZ FORMER KEY EMPLOYEE 0 201911 0 38711 0 25620 0 15020 0 23122 0 304383 0 0 DANIEL A HANDEL MD VP & CMO (SCR) 370437 0 45598 0 51657 0 14816 0 25170 0 507678 0 0 0 CYNTHIA R HERRINGTON VP & CNO (SCR) 187353 0 32608 0 39329 0 14972 0 20119 0 294380 0 0 0 BRUCE R WADE VP - HUMAN RESOURCES (SCR) 0 178315 0 32427 0 45828 0 15720 0 26426 0 298715 0 0 ALAN W BIGGS COO (SCR) 260022 0 41620 0 32075 0 16554 0 9108 0 359379 0 0 0 BRET J SPIER MD PHYSICIAN 571994 0 266425 0 20036 0 18400 0 48557 0 925412 0 0 0 FRED Y WU MD PHYSICIAN 498000 0 375113 0 0 0 18400 0 19287 0 910800 0 0 0 DAVID J LICINI MD PHYSICIAN 633580 0 157177 0 540 0 18400 0 31359 0 841055 0 0 0 TODD EADS MD PHYSICIAN 866603 0 479864 0 20040 0 11400 0 33159 0 1411066 0 0 0 JASON VOORHIES MD PHYSICIAN 852717 0 158484 0 35091 0 11400 0 51691 0 1109383 0 0 0 Schedule J, Part I, Line 3 Arrangement used to establish the top management official's compensation IU HEALTH'S BLOOMINGTON'S REGIONAL PRESIDENT IS EMPLOYED BY IU HEALTH. IU HEALTH, IU HEALTH BLOOMINGTON AND OTHER RELATED ORGANIZATIONS HAVE A PROCESS IN PLACE TO DETERMINE THE COMPENSATION FOR ITS OFFICERS AND KEY EMPLOYEES. IU HEALTH HUMAN RESOURCES USES MARKET DATA FROM MULTIPLE COMPENSATION EXPERTS/VENDORS WHO UTILIZE A VARIETY OF METHODS AND PROCEDURES TO OBTAIN COMPENSATION RANGES FOR COMPARABLE OFFICERS AND EMPLOYEE POSITIONS. THIS MARKET DATA AND MULTIPLE OTHER FACTORS (INCLUDING MARKET PAY BENCHMARKS, INTERNAL EQUITY, CANDIDATE/EMPLOYEE QUALIFICATIONS & PERFORMANCE, AND BUSINESS NEEDS) ARE USED TO RECOMMEND COMPENSATION RANGES FOR ITS OFFICERS AND OTHER EMPLOYEES, WHICH ARE THEN USED AS A GUIDE FOR SETTING REASONABLE COMPENSATION BY MANAGEMENT. PLEASE SEE SCHEDULE O FOR ADDITIONAL DETAILS. Schedule J, Part I, Line 4b Supplemental nonqualified retirement plan BRIAN T. SHOCKNEY and Blake Dye PARTICIPATE IN A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN, PROVISIONS OF WHICH ARE DESIGNED TO RETAIN THESE CRITICAL EMPLOYEES. THE PLAN PROVIDES FOR AN ADDITIONAL RETIREMENT BENEFIT FOR SERVICE THROUGH NORMAL RETIREMENT OR OTHER KEY DATES. IF THE EXECUTIVE LEAVES PRIOR TO RETIREMENT OR OTHER KEY DATES, THE BENEFIT MAY BE FORFEITED OR REDUCED. BRIAN T. SHOCKNEY and Blake Dye HAve AN AMOUNT INCLUDED IN COLUMN C, DEFERRED COMPENSATION, REPRESENTING THE CURRENT YEAR UNVESTED CONTRIBUTIONS MADE UNDER THE SUPPLEMENTAL RETIREMENT PLAN. NO AMOUNTS WERE ACTUALLY PAID TO THIS EXECUTIVE DURING THE YEAR. Schedule J, Part I, Line 7 Non-fixed payments AMOUNTS DISCLOSED IN COLUMN (II) INCLUDE INCENTIVES FOR CERTAIN EXECUTIVES. AS PART OF IU HEALTH BLOOMINGTON'S EXECUTIVE COMPENSATION PLAN, ANNUAL GOALS ARE SET FOR EACH MEMBER OF THE SENIOR LEADERSHIP GROUP WITH EACH MEMBERS' ANNUAL INCENTIVE DETERMINED UPON THE DEGREE OF SUCCESSFUL COMPLETION OF HIS OR HER SET GOALS. ANY INCENTIVE PAYOUTS ARE MADE IN THE FORM OF A LUMP SUM PAYMENT AND DO NOT AFFECT THE EXECUTIVE'S BASE PAY. ALTERNATIVELY, THE EXECUTIVE MAY ELECT TO DEFER ANY OR ALL OF THE INCENTIVE COMPENSATION THROUGH IU HEALTH BLOOMINGTON'S 457(F) PLAN, SUBJECT TO ANY PLAN RESTRICTIONS. ANY INCENTIVE AMOUNTS FOR THE PRESIDENT MUST RECEIVE APPROVAL FROM THE COMPENSATION COMMITTEE. ALL OTHER INCENTIVE AMOUNTS MUST RECEIVE APPROVAL FROM THE PRESIDENT AND THE COMPENSATION COMMITTEE. Form 990, Part III, Line 4d Description of other program services (Expenses $ 571,827 including grants of $)(Revenue $ 757,668) IU HEALTH BLOOMINGTON RECEIVES REVENUE FROM THE FOLLOWING PASS-THROUGH ENTITIES: BROWN COUNTY MEDICAL COOPERATIVE, LLC, SIRA IMAGING CENTER, LLC, SOUTHERN INDIANA SURGERY CENTER, LLC AND PIMCO BRAVO FUND. Form 990, Part III, Line 4d Description of other program services (Expenses $ 6,621 including grants of $)(Revenue $ 8,773) RENTAL INCOME FROM RELATED TAX-EXEMPT ENTITIES Form 990, Part VI, Line 13 PART VI, SECTION B, LINES 12, 13, 14, AND 16B - POLICIES IU HEALTH BLOOMINGTON IS PART OF THE IU HEALTH SYSTEM. AS THE SOLE MEMBER AND CONTROLLING PARENT OF IU HEALTH BLOOMINGTON, IU HEALTH AND ITS BOARD OF DIRECTORS HAVE MANDATED THAT CERTAIN POLICIES BE FOLLOWED TO ENSURE GREATER STANDARDIZATION THROUGHOUT THE SYSTEM. THUS, IU HEALTH BLOOMINGTON'S BOARD OF DIRECTORS WAS NOT REQUIRED TO SEPARATELY ADOPT A CONFLICT OF INTEREST, WHISTLEBLOWER, DOCUMENT RETENTION AND DESTRUCTION AND JOINT VENTURE POLICIES BECAUSE IU HEALTH'S BOARD OF DIRECTORS HAD ALREADY ADOPTED AND REQUIRED THESE POLICIES TO BE FOLLOWED BY ITS SUBSIDIARIES. Form 990, Part VI, Line 15 PROCESS FOR DETERMINING COMP THE PRESIDENT OF IU HEALTH BLOOMINGTON, WHO IS ALSO THE REGIONAL PRESIDENT, IS EMPLOYED BY IU HEALTH. IU HEALTH'S PROCESS FOR DETERMINING COMPENSATION IS AS FOLLOWS: (1) THE BOARD OF DIRECTORS ("BOARD") HAS ESTABLISHED A TALENT MANAGEMENT AND EXECUTIVE COMPENSATION COMMITTEE ("TMECC"), THE PURPOSE OF WHICH INCLUDES REVIEWING AND MAKING RECOMMENDATIONS REGARDING EXECUTIVE PAY AND BENEFITS (COLLECTIVELY REFERRED TO AS "COMPENSATION") ON AN ANNUAL BASIS. THE TMECC IS MADE UP OF MEMBERS OF THE BOARD THAT ARE NEITHER PHYSICIANS NOR EMPLOYEES AND DO NOT OTHERWISE HAVE A CONFLICT OF INTEREST REGARDING ANY OF IU HEALTH'S COMPENSATION ARRANGEMENTS. THE TMECC REVIEWS AN EXECUTIVE'S ENTIRE COMPENSATION PACKAGE INCLUDING BASE SALARY, SHORT-TERM AND LONG-TERM INCENTIVES, HEALTH AND WELFARE BENEFITS, QUALIFIED AND NONQUALIFIED RETIREMENT PLANS, AS WELL AS ANY ADDITIONAL FRINGE BENEFITS. AS DEEMED APPROPRIATE, THE COMMITTEE ON FINANCE, WHICH IS ALSO MADE UP OF MEMBERS OF THE BOARD, MAY ALSO REVIEW EXECUTIVE COMPENSATION AND BENEFITS. (2) THE TMECC ENGAGES AN INDEPENDENT COMPENSATION CONSULTING FIRM ON AN ANNUAL BASIS TO CONDUCT A COMPENSATION ANALYSIS FOR ITS EXECUTIVE GROUP, WHICH CONSISTS OF EMPLOYEES AT THE LEVEL OF SENIOR VICE PRESIDENT AND ABOVE. THE CURRENT COMPENSATION ADVISOR IS SULLIVAN COTTER. SULLIVAN COTTER PERFORMS ITS ANALYSIS IN THE FORM OF A COMPENSATION SURVEY ("SURVEY") THAT INCLUDES RELEVANT COMPARABILITY DATA FOR COMPENSATION LEVELS PAID BY SIMILARLY SITUATED ORGANIZATIONS (BOTH GOVERNMENTAL AND TAX EXEMPT) FOR FUNCTIONALLY COMPARABLE POSITIONS AS WELL AS THE AVAILABILITY OF SIMILAR SERVICES IN THE GEOGRAPHIC AREA. SULLIVAN COTTER THEN PREPARES A SURVEY REPORT AND PROVIDES RECOMMENDATIONS TO THE TMECC, IF DEEMED APPROPRIATE, ON CHANGES IN EXECUTIVE COMPENSATION. A SEPARATE ANALYSIS USING THE SAME METHODOLOGY IS DONE FOR THE PRESIDENT AND CHIEF EXECUTIVE OFFICER. (3) THE TMECC THEN REVIEWS SULLIVAN COTTER'S REPORT AND RECOMMENDATIONS AND, IF APPROPRIATE, VOTES ON WHETHER TO RECOMMEND ANY CHANGES IN EXECUTIVE COMPENSATION TO THE BOARD. THE TMECC WILL ONLY RECOMMEND CHANGES TO THE BOARD IF THEY ARE CONSISTENT WITH THE BOARD'S PHILOSOPHY ON COMPENSATION MATTERS AND ARE DEEMED REASONABLE BASED UPON THE INDEPENDENT ANALYSIS PROVIDED BY SULLIVAN COTTER. THE TMECC'S REVIEW, DISCUSSION AND VOTE ARE DOCUMENTED IN THE MINUTES FOR THE MEETING. THERE ARE NO EXECUTIVES PRESENT DURING THE FINAL DISCUSSION AND APPROVAL. (4) THE BOARD THEN REVIEWS THE REPORT PREPARED BY SULLIVAN COTTER AS WELL AS THE RECOMMENDATIONS OF THE TMECC AS TO ANY CHANGES IN EXECUTIVE COMPENSATION. AS DEEMED APPROPRIATE, THE COMMITTEE ON FINANCE MAY ALSO PROVIDE ITS REVIEW OF THE TMECC'S RECOMMENDATIONS ON ANY CHANGES IN EXECUTIVE COMPENSATION. THIS REVIEW AND DISCUSSION ARE DOCUMENTED IN THE MINUTES. (5) THE BOARD THEN VOTES ON WHETHER TO ACCEPT THE TMECC'S RECOMMENDATIONS ON ANY CHANGES IN EXECUTIVE COMPENSATION. CHANGES IN EXECUTIVE COMPENSATION ARE MADE IF APPROVED BY THE TMECC AND BOARD ON AN ANNUAL BASIS, OR AS NECESSARY THROUGHOUT THE YEAR. THE DISCUSSION AND APPROVAL ARE DOCUMENTED IN THE MINUTES OF THE MEETING. THERE ARE NO EXECUTIVES PRESENT DURING THE FINAL DISCUSSION AND APPROVAL. IU HEALTH'S GENERAL COUNSEL ALSO PREPARES A FORMAL WRITTEN OPINION REVIEWING THE EXECUTIVE COMPENSATION APPROVAL PROCESS, COMPARING IT TO THE INTERMEDIATE SANCTIONS TEST OF IRC SECTION 4958. IF WARRANTED, IU HEALTH'S GENERAL COUNSEL MAY ALSO PROVIDE COMMENTS REGARDING THE EXECUTIVE COMPENSATION APPROVAL PROCESS AS IT RELATES TO MEETING THE REQUIREMENTS FOR A REBUTTABLE PRESUMPTION OF REASONABLENESS AS PROVIDED IN THE INTERMEDIATE SANCTIONS TEST. (6) AFTER THE END OF EACH YEAR, THE TMECC AND BOARD ALSO REVIEW THE ACHIEVEMENTS OF THE EXECUTIVE GROUP AS IT RELATES TO THE LONG-TERM AND SHORT-TERM SHARED AND INDIVIDUAL GOALS DEVELOPED BY THE EXECUTIVES AND THE BOARD. THESE ACHIEVEMENTS MAY ALSO BE REVIEWED WITH THE COMMITTEE ON FINANCE. THE BOARD, AT ITS DISCRETION, MAY APPROVE BONUS PAYMENTS BASED UPON THE ACHIEVEMENT OF THE GOALS. THE DISCUSSION AND VOTE OF THE TMECC AND BOARD IS DOCUMENTED IN THE MINUTES FOR EACH SUCH MEETING. THE BONUSES ARE NOT PAID UNTIL APPROVAL IS MADE BY THE BOARD. (7) THE TMECC AND AUDIT COMMITTEE ALSO REVIEW FORM 990 DISCLOSURES RELATED TO EXECUTIVE COMPENSATION AS WELL AS THE ORGANIZATION'S PRACTICES AND APPROVAL PROCESSES PRIOR TO THE FILING OF THE FORM 990 RETURN WITH THE INTERNAL REVENUE SERVICE. IU HEALTH, IU HEALTH BLOOMINGTON AND OTHER RELATED ENTITIES HAVE A PROCESS IN PLACE TO DETERMINE THE COMPENSATION FOR THE OFFICERS AND KEY EMPLOYEES. IU HEALTH HUMAN RESOURCES USES MARKET DATA FROM MULTIPLE COMPENSATION EXPERTS/VENDORS WHO UTILIZE A VARIETY OF METHODS AND PROCEDURES TO OBTAIN COMPENSATION RANGES FOR COMPARABLE OFFICER AND EMPLOYEE POSITIONS. THIS MARKET DATA AND MULTIPLE OTHER FACTORS (INCLUDING MARKET PAY BENCHMARKS, INTERNAL EQUITY, CANDIDATE/EMPLOYEE QUALIFICATIONS & PERFORMANCE, AND BUSINESS NEEDS) ARE USED TO RECOMMEND COMPENSATION RANGES FOR ITS OFFICERS AND OTHER EMPLOYEES, WHICH ARE THEN USED AS A GUIDE FOR SETTING REASONABLE COMPENSATION BY MANAGEMENT. Form 990, Part VI, Line 6 Classes of members or stockholders THE SOLE MEMBER OF IU HEALTH BLOOMINGTON IS IU HEALTH, A 501(C)(3) TAX-EXEMPT ORGANIZATION. Form 990, Part VI, Line 7a Members or stockholders electing members of governing body THE BOARD OF DIRECTORS SHALL CONSIST OF THIRTEEN (13) MEMBERS. TO BE ELIGIBLE FOR BOARD MEMBERSHIP, A DIRECTOR CANDIDATE SHALL SATISFY THE SELECTION CRITERIA AND PERSONAL CHARACTERISTICS AS MAY BE ESTABLISHED BY IU HEALTH FROM TIME TO TIME. IT IS PREFERRED THAT AT LEAST THREE (3) OF THE DIRECTORS ARE PHYSICIAN MEMBERS, BUT IT IS NOT REQUIRED. THE COMPOSITION OF THE BOARD OF DIRECTORS SHALL BE CONSISTENT WITH THE FOLLOWING CRITERIA: I. TWO (2) MEMBERS SHALL BE REPRESENTATIVES OF INDIANA UNIVERSITY HEALTH BEDFORD, INC.; II. TWO (2) MEMBERS SHALL BE REPRESENTATIVES OF INDIANA UNIVERSITY HEALTH PAOLI, INC.; III. TWO (2) MEMBERS SHALL BE REPRESENTATIVES OF INDIANA UNIVERSITY HEALTH MORGAN, INC.; IV. FIVE (5) MEMBERS SHALL BE REPRESENTATIVES OF INDIANA UNIVERSITY HEALTH BLOOMINGTON, INC.; AND V. TWO (2) MEMBERS SHALL BE THE PRESIDENT OF THE IU HEALTH SOUTH CENTRAL REGION AND AN IU HEALTH EXECUTIVE LEADERSHIP REPRESENTATIVE Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders THE FOLLOWING MATTERS REQUIRE THE APPROVAL OF IU HEALTH, AS THE MEMBER, BEFORE BECOMING EFFECTIVE: (A) AUTHORIZE THE ESTABLISHMENT OR ACQUISITION OF ANY SUBSIDIARIES, AFFILIATES OR JOINT VENTURE ARRANGEMENTS OR ACQUISITIONS OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF ANY OTHER BUSINESS OR ENTITY; (B) RECOMMEND AND RATIFY OR AMEND AND OPERATING AND CAPITAL BUDGETS OF THE CORPORATION; (C) AUTHORIZE ANY UNBUDGETED OPERATING OR CAPITAL BUDGET ITEMS OR DEVIATIONS, INCLUDING ANY ISSUANCE OR GUARANTEE OF ANY UNBUDGETED DEBT, GREATER THAN THE BUDGETED AMOUNT OF $100,000 FOR ANY INDIVIDUAL ITEM OR $300,000 PER FISCAL YEAR IN THE AGGREGATE; (D) AUTHORIZE THE INCURRENCE OF DEBT BY THE CORPORATION IN ACCORDANCE WITH POLICIES AND PROCEDURES ISSUED BY IU HEALTH, INCLUDING TO SERVE AS A GUARANTOR, SURETY OR CO-OBLIGOR; (E) AUTHORIZE ANY MERGER, CONSOLIDATION, REORGANIZATION, SALE OR TRANSFER OF ALL OR SUBSTANTIALLY ALL OF THE CORPORATION'S ASSETS OR A SUBSIDIARY ORGANIZATION OF THE CORPORATION; (F) AUTHORIZE ANY VOLUNTARY DECLARATION OF BANKRUPTCY, PLAN OF DISSOLUTION, ANY LIQUIDATING DISTRIBUTION OF ASSETS OR OTHER ACTION RELATED TO THE DISSOLUTION OR LIQUIDATION OF THE CORPORATION OR A SUBSIDIARY ORGANIZATION OF THE CORPORATION; (G) APPROVE ANY MANAGEMENT AGREEMENT FOR THE MANAGEMENT OF ALL OR A SUBSTANTIAL PART OF THE CORPORATION'S OPERATIONS; (H) APPROVE, UPON RECOMMENDATION OF THE NOMINATING COMMITTEE, THE MEMBERS OF THE BOARD OF DIRECTORS OF THE CORPORATION; (I) RECOMMEND AND RATIFY ANY STRATEGIC PLANS AND AMENDMENTS THERETO, WHICH WILL BE ALIGNED WITH IU HEALTH; (J) APPROVE ANY ACTION TO TERMINATE ACUTE CARE SERVICES OR CLOSE THE HOSPITAL OPERATED BY THE CORPORATION (THE "HOSPITAL"); AND (K) APPROVE ANY AMENDMENTS TO THE ARTICLES OF INCORPORATION AND BYLAWS OF THE CORPORATION OR A SUBSIDIARY ORGANIZATION OF THE CORPORATION. Form 990, Part VI, Line 11b Review of form 990 by governing body THE VP & CFO REVIEWED AND APPROVED THE FORM 990. A COMPLETE COPY OF THE FORM 990 WAS MADE AVAILABLE TO EACH BOARD MEMBER PRIOR TO ITS FILING. EACH MEMBER WAS ALSO INFORMED OF THE AVAILABILITY OF IU HEALTH'S TAX DEPARTMENT TO ANSWER ANY QUESTIONS. Form 990, Part VI, Line 12c Conflict of interest policy IU HEALTH Bloomington FOLLOWS IU HEALTH'S CONFLICT OF INTEREST POLICY. IU HEALTH'S CONFLICT OF INTEREST POLICY INCLUDES THE FOLLOWING PROVISIONS: ALL IU HEALTH EMPLOYEES, ASSOCIATES, COLLEAGUES AND CONTRACTED PERSONNEL, INCLUDING EMPLOYED PHYSICIANS AND PAID MEDICAL DIRECTORS ("IU HEALTH REPRESENTATIVES") ARE COVERED BY AND SUBJECT TO ITS CONFLICT OF INTEREST POLICY. IU HEALTH REGULARLY AND CONSISTENTLY MONITORS AND ENFORCES COMPLIANCE WITH THE POLICY THROUGH THE FOLLOWING PROCEDURES: (A) ON AN ANNUAL BASIS, EACH IU HEALTH REPRESENTATIVE AT THE LEVEL OF MANAGER OR ABOVE, TOGETHER WITH EVERY OTHER PERSON DESIGNATED BY THE CORPORATE COMPLIANCE DEPARTMENT ("DEPARTMENT"), MUST COMPLETE, SIGN AND SUBMIT A CONFLICT OF INTEREST QUESTIONNAIRE ("QUESTIONNAIRE") TO THE DEPARTMENT. GOVERNING BOARD MEMBERS, COMMITTEE MEMBERS, CORPORATE OFFICERS, MEDICAL STAFF AND RESEARCHERS MUST COMPLY WITH THE ADMINISTRATIVE REQUIREMENTS NOTED IN THE RESPECTIVE POLICIES AND PROCEDURES RELATIVE TO THOSE AREAS. (B) AN IU HEALTH REPRESENTATIVE MUST SUPPLEMENT A QUESTIONNAIRE IN WRITING, IF AFTER COMPLETION OF THE ORIGINAL QUESTIONNAIRE, A SITUATION ARISES, OR MAY REASONABLY BE EXPECTED TO ARISE, THAT WOULD CHANGE ANY ANSWER OR INFORMATION ON THE ORIGINAL QUESTIONNAIRE IF THE SITUATION HAD EXISTED OR BEEN ANTICIPATED AT THE TIME OF COMPLETION OF THE ORIGINAL QUESTIONNAIRE. (C) IF A FULLY AND PROPERLY COMPLETED QUESTIONNAIRE REVEALS FACTS OR OTHER INFORMATION THAT MIGHT REASONABLY INDICATE A CONFLICT OF INTEREST OR VIOLATION OF THE POLICY, THE IU HEALTH REPRESENTATIVE COMPLETING THE QUESTIONNAIRE MUST SECURE APPROVAL BY HIS/HER SUPERVISOR, EVIDENCED IN WRITING. (D) THE DEPARTMENT WILL REVIEW EACH QUESTIONNAIRE AND DETERMINE WHETHER A CONFLICT OF INTEREST EXISTS AND, IF SO, WHETHER AND HOW IT SHOULD OR MAY BE ELIMINATED, AVOIDED OR MANAGED IN ORDER TO COMPLY WITH THE SPIRIT OF THE POLICY AND WITH THE BEST INTERESTS OF IU HEALTH AND ITS PATIENTS. IN MAKING THE DETERMINATION, THE CORPORATE COMPLIANCE DEPARTMENT MAY CONSULT WITH THE IU HEALTH REPRESENTATIVE'S SUPERVISOR AND OTHER APPROPRIATE INDIVIDUALS AND GROUPS. (E) THE SCOPE OF THE POLICY IS NOT LIMITED TO THOSE WHO ARE REQUIRED TO COMPLETE QUESTIONNAIRES. IF AN IU HEALTH REPRESENTATIVE IS INVOLVED IN A SITUATION OR RELATIONSHIP THAT WOULD CONSTITUTE A VIOLATION OF THE POLICY IN THE ABSENCE OF DISCLOSURE AND APPROVAL AS DESCRIBED ABOVE, THEN THE IU HEALTH REPRESENTATIVE MUST DISCLOSE THE MATTER TO HIS/HER SUPERVISOR, SECURE HIS/HER SUPERVISOR'S APPROVAL IN WRITING, AND DISCLOSE THE MATTER TO THE DEPARTMENT. OTHERWISE, THE IU HEALTH REPRESENTATIVE IS IN VIOLATION OF THE POLICY AND SUBJECT TO CORRECTIVE ACTION, UP TO AND INCLUDING TERMINATION. (F) THE CHIEF COMPLIANCE OFFICER, IN CONSULTATION WITH ONSITE COMPLIANCE PERSONNEL, MAY FROM TIME TO TIME APPOINT STANDING OR AD HOC COMMITTEES TO ASSIST IN RESOLVING ISSUES THAT ARISE UNDER PROVISIONS OF THE POLICY. Form 990, Part VI, Line 15b Process to establish compensation of other employees THE PRESIDENT OF IU HEALTH BLOOMINGTON, WHO IS ALSO THE REGIONAL PRESIDENT, IS EMPLOYED BY IU HEALTH. IU HEALTH'S PROCESS FOR DETERMINING COMPENSATION IS AS FOLLOWS: (1) THE BOARD OF DIRECTORS ("BOARD") HAS ESTABLISHED A TALENT MANAGEMENT AND EXECUTIVE COMPENSATION COMMITTEE ("TMECC"), THE PURPOSE OF WHICH INCLUDES REVIEWING AND MAKING RECOMMENDATIONS REGARDING EXECUTIVE PAY AND BENEFITS (COLLECTIVELY REFERRED TO AS "COMPENSATION") ON AN ANNUAL BASIS. THE TMECC IS MADE UP OF MEMBERS OF THE BOARD THAT ARE NEITHER PHYSICIANS NOR EMPLOYEES AND DO NOT OTHERWISE HAVE A CONFLICT OF INTEREST REGARDING ANY OF IU HEALTH'S COMPENSATION ARRANGEMENTS. THE TMECC REVIEWS AN EXECUTIVE'S ENTIRE COMPENSATION PACKAGE INCLUDING BASE SALARY, SHORT-TERM AND LONG-TERM INCENTIVES, HEALTH AND WELFARE BENEFITS, QUALIFIED AND NONQUALIFIED RETIREMENT PLANS, AS WELL AS ANY ADDITIONAL FRINGE BENEFITS. AS DEEMED APPROPRIATE, THE COMMITTEE ON FINANCE, WHICH IS ALSO MADE UP OF MEMBERS OF THE BOARD, MAY ALSO REVIEW EXECUTIVE COMPENSATION AND BENEFITS. (2) THE TMECC ENGAGES AN INDEPENDENT COMPENSATION CONSULTING FIRM ON AN ANNUAL BASIS TO CONDUCT A COMPENSATION ANALYSIS FOR ITS EXECUTIVE GROUP, WHICH CONSISTS OF EMPLOYEES AT THE LEVEL OF SENIOR VICE PRESIDENT AND ABOVE. THE CURRENT COMPENSATION ADVISOR IS SULLIVANCOTTER. SULLIVANCOTTER PERFORMS ITS ANALYSIS IN THE FORM OF A COMPENSATION SURVEY ("SURVEY") THAT INCLUDES RELEVANT COMPARABILITY DATA FOR COMPENSATION LEVELS PAID BY SIMILARLY SITUATED ORGANIZATIONS (BOTH GOVERNMENTAL AND TAX EXEMPT) FOR FUNCTIONALLY COMPARABLE POSITIONS AS WELL AS THE AVAILABILITY OF SIMILAR SERVICES IN THE GEOGRAPHIC AREA. SULLIVANCOTTER THEN PREPARES A SURVEY REPORT AND PROVIDES RECOMMENDATIONS TO THE TMECC, IF DEEMED APPROPRIATE, ON CHANGES IN EXECUTIVE COMPENSATION. A SEPARATE ANALYSIS USING THE SAME METHODOLOGY IS DONE FOR THE PRESIDENT AND CHIEF EXECUTIVE OFFICER. (3) THE TMECC THEN REVIEWS SULLIVANCOTTER'S REPORT AND RECOMMENDATIONS AND, IF APPROPRIATE, VOTES ON WHETHER TO RECOMMEND ANY CHANGES IN EXECUTIVE COMPENSATION TO THE BOARD. THE TMECC WILL ONLY RECOMMEND CHANGES TO THE BOARD IF THEY ARE CONSISTENT WITH THE BOARD'S PHILOSOPHY ON COMPENSATION MATTERS AND ARE DEEMED REASONABLE BASED UPON THE INDEPENDENT ANALYSIS PROVIDED BY SULLIVANCOTTER. THE TMECC'S REVIEW, DISCUSSION AND VOTE ARE DOCUMENTED IN THE MINUTES FOR THE MEETING. THERE ARE NO EXECUTIVES PRESENT DURING THE FINAL DISCUSSION AND APPROVAL. (4) THE BOARD THEN REVIEWS THE REPORT PREPARED BY SULLIVANCOTTER AS WELL AS THE RECOMMENDATIONS OF THE TMECC AS TO ANY CHANGES IN EXECUTIVE COMPENSATION. AS DEEMED APPROPRIATE, THE COMMITTEE ON FINANCE MAY ALSO PROVIDE ITS REVIEW OF THE TMECC'S RECOMMENDATIONS ON ANY CHANGES IN EXECUTIVE COMPENSATION. THIS REVIEW AND DISCUSSION ARE DOCUMENTED IN THE MINUTES. (5) THE BOARD THEN VOTES ON WHETHER TO ACCEPT THE TMECC'S RECOMMENDATIONS ON ANY CHANGES IN EXECUTIVE COMPENSATION. CHANGES IN EXECUTIVE COMPENSATION ARE MADE IF APPROVED BY THE TMECC AND BOARD ON AN ANNUAL BASIS, OR AS NECESSARY THROUGHOUT THE YEAR. THE DISCUSSION AND APPROVAL ARE DOCUMENTED IN THE MINUTES OF THE MEETING. THERE ARE NO EXECUTIVES PRESENT DURING THE FINAL DISCUSSION AND APPROVAL. IU HEALTH'S GENERAL COUNSEL ALSO PREPARES A FORMAL WRITTEN OPINION REVIEWING THE EXECUTIVE COMPENSATION APPROVAL PROCESS, COMPARING IT TO THE INTERMEDIATE SANCTIONS TEST OF IRC SECTION 4958. IF WARRANTED, IU HEALTH'S GENERAL COUNSEL MAY ALSO PROVIDE COMMENTS REGARDING THE EXECUTIVE COMPENSATION APPROVAL PROCESS AS IT RELATES TO MEETING THE REQUIREMENTS FOR A REBUTTABLE PRESUMPTION OF REASONABLENESS AS PROVIDED IN THE INTERMEDIATE SANCTIONS TEST. (6) AFTER THE END OF EACH YEAR, THE TMECC AND BOARD ALSO REVIEW THE ACHIEVEMENTS OF THE EXECUTIVE GROUP AS IT RELATES TO THE LONG-TERM AND SHORT-TERM SHARED AND INDIVIDUAL GOALS DEVELOPED BY THE EXECUTIVES AND THE BOARD. THESE ACHIEVEMENTS MAY ALSO BE REVIEWED WITH THE COMMITTEE ON FINANCE. THE BOARD, AT ITS DISCRETION, MAY APPROVE BONUS PAYMENTS BASED UPON THE ACHIEVEMENT OF THE GOALS. THE DISCUSSION AND VOTE OF THE TMECC AND BOARD IS DOCUMENTED IN THE MINUTES FOR EACH SUCH MEETING. THE BONUSES ARE NOT PAID UNTIL APPROVAL IS MADE BY THE BOARD. (7) THE TMECC AND AUDIT COMMITTEE ALSO REVIEW FORM 990 DISCLOSURES RELATED TO EXECUTIVE COMPENSATION AS WELL AS THE ORGANIZATION'S PRACTICES AND APPROVAL PROCESSES PRIOR TO THE FILING OF THE FORM 990 RETURN WITH THE INTERNAL REVENUE SERVICE. IU HEALTH, IU HEALTH BLOOMINGTON AND OTHER RELATED ENTITIES HAVE A PROCESS IN PLACE TO DETERMINE THE COMPENSATION FOR THE OFFICERS AND KEY EMPLOYEES. IU HEALTH HUMAN RESOURCES USES MARKET DATA FROM MULTIPLE COMPENSATION EXPERTS/VENDORS WHO UTILIZE A VARIETY OF METHODS AND PROCEDURES TO OBTAIN COMPENSATION RANGES FOR COMPARABLE OFFICER AND EMPLOYEE POSITIONS. THIS MARKET DATA AND MULTIPLE OTHER FACTORS (INCLUDING MARKET PAY BENCHMARKS, INTERNAL EQUITY, CANDIDATE/EMPLOYEE QUALIFICATIONS & PERFORMANCE, AND BUSINESS NEEDS) ARE USED TO RECOMMEND COMPENSATION RANGES FOR ITS OFFICERS AND OTHER EMPLOYEES, WHICH ARE THEN USED AS A GUIDE FOR SETTING REASONABLE COMPENSATION BY MANAGEMENT. Form 990, Part VI, Line 19 Required documents available to the public IU HEALTH BLOOMINGTON'S ARTICLES OF INCORPORATION ARE AVAILABLE FOR PUBLIC INSPECTION THROUGH THE INDIANA SECRETARY OF STATE'S WEBSITE. IU HEALTH BLOOMINGTON'S CONFLICT OF INTEREST PROCEDURES ARE DESCRIBED ON FORM 990, SCHEDULE O. IU HEALTH BLOOMINGTON IS A SUBSIDIARY IN IU HEALTH'S CONSOLIDATED AUDITED FINANCIAL STATEMENTS. IU HEALTH'S CONSOLIDATED AUDITED FINANCIAL STATEMENTS ARE AVAILABLE FOR PUBLIC INSPECTION THROUGH ITS BOND FILINGS AND AS AN ATTACHMENT TO IU HEALTH'S FORM 990 AS WELL AS IU HEALTH BLOOMINGTON'S FORM 990. Form 990, Part VII, Section B, Line 1 COMP OF FIVE HIGHEST PAID IND. CON FA WILHELM CONSTRUCTION COMPANY, INC. INCLUDES GOODS AND SERVICES ASSOCIATED WITH THE CONSTRUCTION OF THE IU Health Bloomington Hospital and Regional Academic Health Center. THESE WERE NOT EASILY SEPARATED FOR REPORTING ON THE 990. THE $151,599,050 BEING REPORTED INCLUDES BOTH GOODS AND SERVICES PAID. Weddle Bros. Building Group LLC INCLUDES GOODS AND SERVICES ASSOCIATED WITH THE CONSTRUCTION OF THE IU Health Bloomington Hospital and Regional Academic Health Center. THESE WERE NOT EASILY SEPARATED FOR REPORTING ON THE 990. THE $3,590,266 BEING REPORTED INCLUDES BOTH GOODS AND SERVICES PAID. Form 990, Part VIII, Line 11d Other Miscellaneous Revenue all other revenue - Total Revenue: 1408471, Related or Exempt Function Revenue: , Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: 1408471; Form 990, Part IX, Line 11g Other Fees PROF. FEES/SHARED SERVICES - Total Expense: XXX-XX-XXXX, Program Service Expense: 26890113, Management and General Expenses: 92949061, Fundraising Expenses: ; Form 990, Part XI, Line 9 Other changes in net assets or fund balances CHANGE IN INTEREST IN NET ASSETS OF FOUNDATION - -2334835; BLOOMINGTON ENDOSCOPY CENTER LLC 950 N MERIDIAN ST STE 800 INDIANAPOLIS IN 46204 352117943 HEALTHCARE IN 3411975 5092337 IUHB IU HEALTH SOUTHERN INDIANA PHYSICIANS L 951 N MERIDIAN ST STE 800 INDIANAPOLIS IN 46204 351913875 HEALTHCARE IN 131864423 52785807 IUHB ORTHOPEDICS OF SOUTH CENTRAL INDIANA LL 952 N MERIDIAN ST STE 800 INDIANAPOLIS IN 46204 753089189 HEALTHCARE IN 2924389 192740 IUHSIP IU HEALTH BEDFORD PHYSICIANS LLC 953 N MERIDIAN ST STE 800 INDIANAPOLIS IN 46204 461036643 HEALTHCARE IN 5446869 438661 IUHSIP IU HEALTH MORGAN PHYSICIANS LLC 954 N MERIDIAN ST STE 800 INDIANAPOLIS IN 46204 461509294 HEALTHCARE IN 1658160 180471 IUHSIP SOUTHERN INDIANA PEDIATRICS LLC 955 N MERIDIAN ST STE 800 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