2020-11-13T09:40:34-06:00 2019-12-31 ERNST & YOUNG US LLP 111 MONUMENT CIR STE 4000 INDIANAPOLIS IN 46204 990 2019-01-01 263162145 INDIANA UNIVERSITY HEALTH ARNETT INC % CRAIG J JONES INDI 3179634842 950 N MERIDIAN STREET Suite 300 INDIANAPOLIS IN 46204 TODD A WILLIAMS CFO 3179634842 2020-11-08 JENNIFER D RHODERICK P00395735 3176817000 162.1.179.250 35198520203185000015 2020-11-13 P EC0F867CDA2A68A93B900C7968EA20F6D551AC78 6C5B360722C3FFAFCFE5827037413334CAD8ED04 2019 2021-01-29 14:40:06Z DANIEL E NEUFELDER 950 N MERIDIAN ST STE 300 INDIANAPOLIS IN 46204 519461146 false X SEE SCHEDULE O X 2008 IN Improve the health of our patients and community through innovation and excellence in care, education, research and service. 13 8 2750 162 512581 278697 14370 1296595 485176268 511000319 3226930 4872296 2825770 2291936 491243338 519461146 429174 478793 0 0 216276004 228781611 0 0 0 247496476 260006119 464201654 489266523 27041684 30194623 460062267 475189520 269170267 254113168 190892000 221076352 X IMPROVE THE HEALTH OF OUR PATIENTS AND COMMUNITY THROUGH INNOVATION AND EXCELLENCE IN CARE, EDUCATION, RESEARCH AND SERVICE. false false 448140011 478793 500036075 Indiana University Health Arnett, Inc. ("IU Health Arnett") is an integrated health care system that offers a comprehensive range of services to care for its patients without regard to their ability to pay. IU Health Arnett, located in Lafayette, Indiana, is a 191-bed full-service hospital that includes an adjacent outpatient surgery center. With six technologically advanced surgical suites, IU Health Arnett can accommodate complex surgeries, such as open heart, neurosurgical procedures and minimally invasive da Vinci surgery. IU Health Arnett Physicians has more than 250 employed physicians and healthcare providers with an unwavering commitment to better healthcare for the people of west central Indiana. As part of its commitment to the community, IU Health Arnett offers the following programs to benefit residents of the greater Lafayette area: - Walking Groups - Read to Succeed - Health and Safety Fair - Strong Schools - Farmers Market at 4H Fair - Car Seat Safety Checks - Day of Service - Meals on Wheels - Kindergarten Countdown Camps 4856011 5418353 Our network of pharmacies offers the convenience of one-stop shopping. We provide expert care and help patients make the best use of their medications. 4067953 4539035 IU Health Arnett provides services to related tax-exempt organizations. 889647 0 992671 INCOME (LOSS) FROM PASS-THROUGH ENTITIES 9159 0 10220 RENT FROM RELATED 501(C)(3) ORGANIZATIONS 3554 0 3965 Electronic Health Records Incentive 902360 0 1006856 457966335 true true false true false false false false false false true false false false 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 true false false false true true true true false false true 69 0 true 2750 true true true false false false false false false false false false false false X 13 8 false false true false true true true true true false false true true true true true true false true true true IN X CRAIG J JONES 3179634842 950 N MERIDIAN STREET SUITE 300 INDIANAPOLIS IN 46204 X ALFONSO W GATMAITAN FORMER Officer 0.0 0.0 X 0 1406476 4922 JOSEPH E HUBBARD MD PHY. DEPT. CHAIRPERSON 55.0 0.0 X 1111038 0 47819 Cheng Du MD Physician - CAH 55.0 0.0 X 909005 0 56076 Stanton M Regan MD Physician - CAH 55.0 0.0 X 905646 0 49843 PETER A SEYMOUR MD PHY. DIVISION DIRECTOR 55.0 0.0 X 797008 0 47816 RUBAN NIRMALAN MD DIRECTOR 51.0 4.0 X 793692 0 41752 Naveed Ahmad MD PHY. DEPT. CHAIRPERSON 55.0 0.0 X 774863 0 47603 DANIEL E NEUFELDER PRESIDENT 35.0 20.0 X 0 653485 137797 Brian T Shockney Former Key Employee 0.0 55.0 X 0 662735 125994 ROGER G BANGS MD DIRECTOR 51.0 4.0 X 754478 0 29102 CHRISTOPHER A MANSFIE DIRECTOR/Vice Chair 51.0 4.0 X X 490434 0 48014 WILLIAM Y LI MD Director (Part Year) 51.0 4.0 X 449760 0 47651 MICHELE S SAYSANA M Director (Part Year) 2.0 53.0 X 0 463278 9426 JAMES P BIEN MD CMO - VP Quality & Safety 35.0 20.0 X 414510 0 45939 ANDREW K EDWARDS MD FORMER Officer 55.0 0.0 X 403118 0 42151 CARA L BREIDSTER Former Officer 0.0 55.0 X 0 321381 41748 JEFFREY C ZEH COO 35.0 20.0 X 324863 0 18711 TODD A WILLIAMS CFO/TREASURER 35.0 20.0 X 0 293058 40463 DEREK E EMPIE SECRETARY 2.0 53.0 X 0 268309 45346 Brian M Weirich CNO 35.0 20.0 X 246496 0 40004 KENNETH E MARNOCHA M DIRECTOR (Part Year) 51.0 4.0 X 250801 0 25348 KOREEN C KYHNELL VP - HUMAN RESOURCES 35.0 20.0 X 0 197647 40279 JAMES H PARSONS CHIEF PRACTICE OFFICER 55.0 0.0 X 189836 0 41341 DONALD E CLAYTON MD Former Officer 55.0 0.0 X 186972 0 34117 RANDALL R MITCHELL DIRECTOR 5.0 4.0 X 13500 0 0 REV KATE L WALKER DIRECTOR 5.0 4.0 X 13500 0 0 SHAN SHERIDAN DIRECTOR 5.0 4.0 X 9000 0 0 GARY D HENRIOTT DIRECTOR 5.0 4.0 X 7500 0 0 RANDY W PRICE DIRECTOR 5.0 4.0 X 4500 0 0 VICTOR L LECHTENBERG Director/CHAIR 5.0 4.0 X X 3750 0 0 DAVID HUMMELS Director (Part Year) 5.0 4.0 X 2250 0 0 AMANDA WHITLOCK Director (Part Year) 5.0 4.0 X 750 0 0 9016020 4266369 1109262 330 true true false WURSTER CONSTRUCTION CO INC 8463 Castlewood Dr 100 INDIANAPOLIS IN 46250 CONSTRUCTION 2291363 TRIMEDX LLC 5451 LAKEVIEW PKWY S DR INDIANAPOLIS IN 46268 CLINICAL ENGINEERING 2007636 KETTELHUT CONSTRUCTION 740 SAGAMORE PARKWAY SOUTH LAFAYETTE IN 47905 Construction 1962138 INDIANA HAND SHOULDER CENTER 8501 HARCOURT ROAD INDIANAPOLIS IN 46260 MEDICAL 1462492 WEATHERBY LOCUMS INC PO BOX 972633 DALLAS TX 753972633 MEDICAL STAFFING 967636 43 121789 1174294 512 1038109 1296595 NET PATIENT SERVICE REVENUE 622110 500036075 500036075 SHARED SERVICES 541900 4539035 4539035 PHARMACY 446110 5418353 5196193 222160 INCOME (LOSS) FROM PASS-THROUGH ENTITIES 900099 992671 702250 290421 RENT FROM RELATED 501(C)(3) ORGS. 532000 10220 10220 3965 3965 511000319 4854743 4854743 0 0 341 341 0 341 341 17553 0 17553 17553 17553 0 0 0 0 0 0 0 0 0 CAFETERIA/FOOD SERVICE 722320 765925 765925 GIFT SHOP 453220 179527 179527 VENDING 900099 11486 11486 1334657 1334657 2291595 519461146 510487738 512581 7164232 X 478793 478793 0 0 0 4307482 4197961 109521 666357 649414 16943 185294118 181114010 4180108 9279698 9070354 209344 18565841 18147008 418833 10668115 10427450 240665 21345 21345 130 130 6790 6790 2857 2857 0 0 92650106 81313314 11336792 0 77035 74439 2596 1473258 1165351 307907 1158269 1075435 82834 0 11052247 10939011 113236 277350 227712 49638 0 34244 24446 9798 11336383 11336383 0 13022506 12748350 274156 4829733 2450015 2379718 DRUGS AND MEDICAL SUPPLIES 76073996 76073996 BAD DEBT 29403591 29403591 HOSPITAL ASSESSMENT FEE 16421959 16421959 INSTITUTIONAL DUES/LICENSES 69294 69294 2095026 1894302 200724 489266523 457966335 31300188 0 0 0 181275193 197094235 0 112737 61964566 62353959 0 0 0 0 1016387 985413 5150335 5245655 2955617 2734835 319467765 116265046 204868323 203202719 0 0 0 0 2831846 3459967 0 0 0 0 460062267 475189520 51896442 45072808 0 0 0 0 0 0 0 0 0 0 0 0 0 0 217273825 209040360 269170267 254113168 X 190892000 221076352 0 0 190892000 221076352 460062267 475189520 X 30194623 -10271 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 2857 2857 false Schedule C, Part II-B, Lines 1i - Other Activities IU Health Arnett paid institutional membership dues to the Indiana Hospital Association ("IHA") and Greater Lafayette Commerce during 2019 in the amount of $40,693 and $10,000, respectively. Each membership organization notified IU Health Arnett that a portion of the dues it paid were used for lobbying purposes. The IHA used 6.53%, or $2,657 of the 2019 membership dues paid by IU Health Arnett, for lobbying expenditures. Greater Lafayette Commerce used 2.00%, or $200 of 2019 membership dues paid by IU Health Arnett, for lobbying expenditures. The total membership dues paid to these organizations by IU Health Arnett during 2019 that were attributable to lobbying expenditures was $50,693. 3859567 3859567 215286879 53547942 161738937 52897 52897 0 86274551 62286523 23988028 13993871 377684 13616187 203202719 0 INTERCOMPANY PAYABLES (NET) 205231989 DUE TO THIRD-PARTY PAYERS 2653175 SELF-INSURANCE LIABILITIES 717819 OPERATING LEASE LIABILITIES 437377 209040360 X Schedule D, Part X, Line 2 - FIN 48 (ASC 740) Footnote IU Health Arnett 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. The Tax Cuts and Jobs Act (TCJA) was enacted on December 22, 2017. For tax-exempt entities, TCJA requires organizations to pay an excise tax on compensation above certain thresholds and record income or losses for tax determination purposes from unrelated business activities on an activity-by-activity basis, among other provisions. Proposed regulations and interim guidance, necessary for implementation, have been issued on most aspects of TCJA. It is expected that proposed regulations will be issued as final regulations by the IRS in 2020. As of and for the year ended December 31, 2019, Indiana University Health has made reasonable estimates of the provision for income taxes, the compensation excise tax, and the effects, if any, on existing deferred tax balances. Indiana University Health will continue to refine its calculations in future periods, as additional regulations and guidance are issued by the IRS. Deferred income taxes that, as of December 31, 2019 and 2018, 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, 2019 and 2018, the Indiana University Health System had gross deferred tax assets of $143,157,000 and $119,965,000 respectively, primarily relating to net operating loss carryovers. Management determined that a full valuation allowance at December 31, 2019 and 2018, 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 change in the valuation allowance for the current year is $23,192,000. At December 31, 2019, the Indiana University Health System has available net operating loss carryforwards of $575,596,000. Net operating losses generated from 1999 through 2017 will expire between 2020 and 2037. Net operating losses generated after 2017 do not expire. Certain subsidiaries of Indiana University Health are taxable entities. The tax expense and liabilities of these subsidiaries are not material to the consolidated financial statements. true true X true X false true true true false true true 3894 9508834 9508834 0.02070 7206 75067070 51064874 24002196 0.05220 11100 84575904 51064874 33511030 0.07290 8 13574 2194098 12390 2181708 0.00470 1 4 2544942 448476 2096466 0.00460 1 178 1195803 47490 1148313 0.00250 1 35 288746 288746 0.00060 3 750 1569743 518268 1051475 0.00230 14 14541 7793332 1026624 6766708 0.01470 14 25641 92369236 52091498 40277738 0.08760 2 4083 4083 0.00000 2 4083 4083 0.00000 false 8041882 73447468 88593257 -15145789 X true true 1 1 IU HEALTH ARNETT HOSPITAL 5165 MCCARTY LANE LAFAYETTE IN 47905 SEE PART V, SECTION C 20-011506-1 X X X X X IU HEALTH ARNETT HOSPITAL 1 false false true X X X X X X X X X 18 true false false true X SEE PART V, SECTION C true 19 true SEE PART V, SECTION C false true X 200. 0. X X X X X X true true X X X true X SEE PART V, SECTION C X SEE PART V, SECTION C X SEE PART V, SECTION C X X X X X X X true X false X X X X true X false false Schedule H, Part V, Section A, Line 1 Primary Website Address https://iuhealth.org/find-locations/iu-health-arnett-hospital Schedule H, Part V, Section B, Line 3e Prioritized Health Needs IU Health Arnett'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 Arnett - Access to Health Care Services - Drug and Substance Abuse - Health Care and Social Services for Seniors - Mental Health - Obesity and Diabetes - Smoking - Social Determinants of Health Schedule H, Part V, Section B, Line 5 Input from Community In conducting its most recent Community Health Needs Assessment ("CHNA") IU Health Arnett Hospital took into account input from persons who represent the broad interests of the communities it serves. Primary data were gathered in three ways: Community Meetings, Key Stakeholder Interviews, and a Community Survey. For purposes of this CHNA, IU Health Arnett Hospital's community is defined as Benton, Carroll, and Tippecanoe counties, Indiana. These three counties accounted for over 67 percent of the hospital's inpatient cases in 2016. Community Meetings - Tippecanoe County On May 8, 2018, a meeting of community representatives was held at IU Health Arnett Hospital in Lafayette, the county seat of Tippecanoe County. The meeting was attended by 22 community members invited by IU Health because they represent important community organizations and sectors such as: local health departments, non-profit organizations, local businesses, health care providers, local policymakers, parks and recreation departments, and schools. Through this meeting, IU Health sought a breadth of perspectives on the community's health needs. The specific organizations represented at the meeting are listed below. - City of Lafayette - Food Finders Food Bank - Hanna Community Center - Heartford House Child Advocacy Center - Henriott Group, Inc. - IU Health - IU Health Arnett Hospital - IU Health West Central Region - LTHC Homeless Services - Lafayette Family YMCA - North Central Health Services - Purdue Extension - Riggs Community Health Center - Sycamore Springs - Tippecanoe Arts Federation - Tippecanoe County CASA - Tippecanoe County - Tippecanoe Health Department - United Way of Greater Lafayette - YWCA Greater Lafayette - YWCA Foundation 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 Tippecanoe County, those indicators were (in alphabetical order): - Cancer incidence and mortality - Diabetes - Physical inactivity and access to exercise opportunities - Physically and mentally unhealthy days - Preventable hospital stays - Sexually transmitted diseases - Smoking, including during pregnancy - Supply of primary care physicians and mental health providers 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: opioid abuse, the number of uninsured, childhood trauma, and suicide. Obesity was added as a factor that contributes to diabetes. During the meeting, a range of other topics was discussed, including: - Access to healthy food - Suicide (not related to overdoses) among the younger population - Teen pregnancy - Screen time - Purdue University students contributing to the poverty rate 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" they consider to be most significant. From this process, the group identified the following needs as most significant in Tippecanoe County: - Diabetes and obesity - Opioid abuse - Supply of primary care physicians - Supply of mental health providers The group decided it would be best to split the supply of primary care physicians and the supply of mental health providers into two distinct needs. Community Meetings - Carroll County On April 16, 2018, a meeting of community representatives was held at Wabash & Erie Canal Conference Center in Delphi, the county seat of Carroll County. The meeting was attended by 12 community members invited by IU Health because they represent important community organizations and sectors such as: non-profit organizations, local business, health care providers, local policymakers, and schools. Through this meeting, IU Health sought a breadth of perspectives on the community's health needs. The specific organizations represented at the meeting are listed below. - Carroll County Chamber of Commerce - Carroll County Council - Carroll White Rural Electric Membership Corporation (REMC) - Delphi Community Elementary School - Family Health Clinics (North Central Nursing Clinics) - IU Health Arnett Hospital - IU Health West Central Region - North Central Health Services 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 Carroll County, those indicators were (in alphabetical order): - Cancer incidence and mortality - Diabetes - Physical inactivity and access to exercise opportunities - Physically and mentally unhealthy days - Preventable hospital stays - Sexually transmitted diseases - Smoking, including during pregnancy - Supply of primary care physicians and mental health providers 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: opioid use, pharmacy care, and urgent/emergency care. During the meeting, a range of other topics was discussed, including: - Children/youth - Follow up care - Pharmacy access - Transportation 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" they consider to be most significant. From this process, the group identified the following needs as most significant for Carroll County: - Supply of primary care physicians and mental health providers - Physical inactivity and access to exercise opportunities - Opioid use - Urgent/Emergency Care - Physically and mentally unhealthy days - Pharmacy Care - Cancer Incidence and Mortality - Diabetes Key Stakeholder Interviews An interview was conducted with a representative from the Benton County Health Department, and the feedback was consistent with the input received during the Community Meetings. An interview was conducted with a representative of the Tippecanoe County Health Department. The interview was conducted to assure that appropriate and additional input was received from a governmental public health official. The individual that was interviewed for Tippecanoe County participated in the community meeting. Accordingly, the results of the community meeting were discussed and insights were sought regarding significant community health needs, why such needs are present, and how they can be addressed. The interview was guided by a structured protocol that focused on opinions regarding significant community health needs, describing why such needs are present, and seeking ideas for how to address them. The interviewee confirmed that the four needs identified by the community meeting participants were significant, adding that all four rank fairly evenly in terms of their prevalence and significance. These four needs were: - Diabetes and obesity - Opioid abuse - Supply of primary care physicians - Supply of mental health providers "Diabetes and obesity" was identified as particularly prevalent in low income populations who struggle to afford and access healthy foods. The shortage of primary care and mental health providers is "realis made more challenging because existing professionals typically only are available to patients during business hours. The supply of mental health providers contributes to opioid abuse, because those unable to access mental health services may be self-medicating. Homelessness also was described as a contributing factor to substance abuse. Many recovering or suffering from addiction have trouble finding stable housing, leading to continued drug abuse. Affordable housing for low income and Section 8 residents is needed. Many residents are uninsured or underinsured, leading to inadequate access to care. For underinsured individuals, many providers are out of network, presenting significant access barriers. Many community residents do not own cars. A lack of transportation options presents another barrier to accessing care. Bringing health services to people in their homes would be helpful. Due to inadequate access to primary care, many use emergency departments for basic health care service. This is particularly true for low income residents who, at the end of the month, exhaust their food, medication, and other basic-needs assistance. Programs that seek to improve the health of low income populations would enhance job retention, education levels, and housing stability. Maternal and child health services also are needed. Pregnant women in Tippecanoe County (and Indiana in Schedule H, Part V, Section B, Line 7a CHNA Website A copy of IU Health Arnett's CHNA is available on its website at the following URL: https://iuhealth.org/in-the-community/community-benefit Schedule H, Part V, Section B, Line 10a Implementation Strategy Website A copy of IU Health Arnett's CHNA implementation strategy is available on its website at the following URL: https://iuhealth.org/in-the-community/community-benefit Schedule H, Part V, Section B, Line 11 Addressing Identified Needs In conjunction with the CHNA, IU Health Arnett's Board adopted an implementation strategy in April 2019 related to the 2018 CHNA. IU Health Arnett prioritized and determined which of the community health needs identified in its most recently conducted CHNA were most critical for it to address. IU Health Arnett will address the following community health needs between 2019 and 2021: - Access to Healthcare Services - Drug and Substance Abuse (including Opioids, Alcohol and Tobacco) - Healthcare and Social Services for Seniors - Mental Health - Smoking - Obesity and Diabetes - Social Determinatns 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 IU Health Arnett's implementation strategy to address the identified need of Access to Healthcare includes the following: - Provide scholarships for the Purdue University behavioral health nurse practitioner program. - IU Health funding supported 4 scholarships to the BHNPP at Purdue University - Support telemedicine virtual visits with primary care physicians and behavioral health specialists. - Expand virtual peer recovery coaches - Continue/expand quick response team (QRT)/paramedicine model. - Provide funding to support recovery coach and certified recovery specialist training. - Support youth career events and organizations. - IU Health is the healthcare sponsor for Junior Achievement's BizTown - Execute IU Health's five-year recruitment plan. - Explore the option to become a National Health Service Corps Site - IU Health Arnett is not eligible. - Provide windshield tours for physician recruits. -None needed - Provide internships and onsite/offsite learning opportunities for future professionals. - IU Health Arnett Family Medicine Residency Program consists of annual cohorts of 5 residents. Pharmacy provided over 300 student contact hours along with more than $2 million in overall health professional education investment Behavioral Health (includes Drug & Substance Abuse and Mental Health) IU Health Arnett's implementation strategy to address the identified need of Behavioral Health includes the following: - Create support groups for parents, families and those struggling with behavioral health issues. - Support the Mental Health America Crisis Center. - IU Health partnered with Mental Health America on numerous initiatives, including the Crisis Center, by providing $40,000 in funding during 2019. - Support local schools on North Central Health Services Youth Resilience grant project. - IU Health provided $2,500 in grants to 2 local school corporations to provide additional professional development to staff, students and parents to increase resiliency. - Support integrated care programs. - IU Health Arnett served 178 patients in our integrated behavioral health program. - Support Willowstone Active Parenting classes. - Willowstone Family Services received $4,500 to support Active Parenting classes, in which 33 parents of 58 children enrolled in programming. - Provide health insurance navigation. - Provide behavioral health navigation services. - Provide trainings to hospital staff and community members (Question, Persuade, Refer (QPR) training, Mental Health First Aid, Applied Suicide Intervention Skills Training (ASIST), etc.). - Create/support awareness campaigns or events. - Increase youth education programs to prevent substance use. - Encourage proper storage and safe disposal of prescription medication through participation in drug take-back activities. - IU Health Arnett Retail Pharmacy partnered with Purdue University's BoilerWoRx program to distribute Deterra medication disposal packets to patients. Hundreds of the packets were distributed in 2019. The pharmacy also has a medication disposal box for community members to drop off unwanted medications for safe disposal. - Support opportunities for physician training and continuing education on substance use disorders (SUD). - Support community naloxone training. - Increase the number of trained peer recovery coaches and certified recovery specialists. - Support existing and research expansion of Quick Response Team (QRT)/community paramedicine programs. - IU Health referred fewer than 10 patients to the QRT during 2019. - Refer patients to local treatment facilities. - Accept primary care provider patients from local treatment facilities. - Create/support local support groups. - Support tobacco cessation program. - IU Health Arnett hosted tobacco cessation programs throughout 2019. - Support recovery housing options. - Support Recovery Cafe model. - Recovery Caf Lafayette opened in 2019. - Collaborate with local initiatives. - IU Health team members participate in the Tippecanoe Opioid Task Force with representation on the prevention workgroup. - Partner with local recovery houses to provide "soft skills" training and support. - In 2019, IU Health Arnett team members participated in a Day of Service project at Home with Hope, a local recovery residence. Team members worked side-by-side with the residents to build benches and clean out an abandoned house. Healthcare and Social Services for Seniors IU Health Arnett's implementation strategy to address the identified need of Healthcare and Social Services for Seniors include the following: - Provide insurance navigation for seniors. - Support Food Finders Senior Shopping Day. - Continue Meals on Wheels program. - IU Health Arnett Hospital prepares and packages meals for the Lafayette Meals on Wheels program. In 2019, staff dedicated more than 4,000 hours to prepare and package 750 meals. - Support organizations that provide programming or services to seniors. - Participate in senior outreach activities (Senior Games, Lafayette Senior Expo, and Area IV walking groups). - IU Health provided free screenings to seniors at the Lafayette Senior Games, Lafayette Senior Expo and the Area IV walking groups, serving more than 100 seniors in 2019. - Support Senior Wellness Center Activities (Tai Chi, etc.) - Support the "Stepping On" classes (fall prevention). - IU Health Arnett Trauma Services served 365 seniors in fall prevention outreach courses in 2019. Smoking IU Health Arnett's implementation strategy to address the identified need of Smoking includes the following: - To help address needs associated with smoking and tobacco use, IU Health Arnett partnered with the Lafayette School Corporation DARE, granting them $2,000 to purchase the workbooks for the 1,500 middle schoolers going through the program. IU Health Arnett is unable to address those community health needs that do not relate directly to the Hospital's mission to deliver healthcare. These are needs that other governmental agencies and/or community organizations have the most appropriate expertise and resources to address. IU Health Arnett is unable to address the following community health needs identified in the 2018 Community Health Needs Assessment: Maternal and Child Health The Nurse Family Partnership provides in-home services to qualifying families. Healthy Communities of Clinton County Coalition offers numerous health services to new and expecting mothers. IU Health Arnett provides maternity services in the region, as well as post-partum and breastfeeding support groups for new mothers. As a system, IU Health is addressing maternal and child health by focusing on infant mortality, creating a system-wide collaborative to focus on this issue. Obesity and Diabetes IU Health Arnett focused on obesity prevention as one of the priority health needs from 2015-2018. The hospital supported many activities in the community. However, during the 2018 community health needs assessment, other needs arose as more necessary to address. There are other community resources that continue to address obesity and diabetes, including Healthy Active Tippecanoe. The hospital provides diabetes education programs. The local YMCA provides a Diabetes Prevention Program. Purdue Extension is another community resource that addresses obesity and diabetes. IU Health team members will continue to participate in the Healthy Active Tippecanoe, which addresses healthy eating and active living. Social Determinants of Health Many of the strategies will indirectly address various social determinants of health. IU Health team members often serve on agency boards or participate in local coalitions addressing the social determinants of health. Schedule H, Part V, Section B, Line 13b Income Level Other than FPG In addition to FPG, IU Health Arnett 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 13h Other FAP Factors IU Health Arnett takes into consideration several other factors in determining patient eligibility for financial assistance. These factors include the following: 1. IU Health's Individual Solutions Department Prior to seeking Financial Assistance under the FAP, all patients or their guarantors must consult with a member of IU Health's Individual Solutions department to determine if healthcare coverage may be obtained from a government insurance/assistance product or from the Health Insurance Exchange Marketplace. 2. Alternate Sources of Assistance When technically feasible, a patient will exhaust all other state and federal assistance programs prior to receiving an award from IU Health Arnett's Financial Assistance Program. Patients who may be eligible for coverage under an applicable insurance policy, including, but not limited to, health, automobile, and homeowner's, must exhaust all insurance benefits prior to receiving an award from IU Health Arnett's Financial Assistance Program. This includes patients covered under their own policy and those who may be entitled to benefits from a third-party policy. Patients may be asked to show proof that such a claim was properly submitted to the proper insurance provider at the request of IU Health Arnett. Eligible patients who receive medical care from IU Health Arnett 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 to which IU Health Arnett is entitled. In the event a Financial Assistance Award has already been granted in such circumstances, IU Health Arnett reserve the right to reverse the award in an amount equal to the amount IU Health Arnett would be entitled to receive had no Financial Assistance been awarded. 3. Alternate Methods of Eligibility Determination IU Health Arnett will conduct a quarterly review of all accounts placed with a collection agency partner for a period of no less than one hundred and twenty (120) days after the account is eligible for an Extraordinary Collection Action ("ECA"). Said accounts may be eligible for assistance under the FAP based on the patient's individual scoring criteria. To ensure all patients potentially eligible for Financial Assistance under the FAP may receive Financial Assistance, IU Health Arnett will deem patients/guarantors to be presumptively eligible for Financial Assistance if they are found to be eligible for one of the following programs, received emergency or direct admit care, and satisfied his/her required copay/deductible: - Indiana Children's Special Health Care Services - Medicaid - Healthy Indiana Plan - Patients who are awarded Hospital Presumptive Eligibility (HPE) - Enrolled in a state and/or federal program that verifies the patient's gross household income is less than or equal to 200% of the Federal Poverty Level 4. Additional Considerations Financial Assistance may be granted to a deceased patient's account if said patient is found to have no estate. Additionally, IU Health Arnett will deny or revoke Financial Assistance for any patient or guarantor who falsifies any portion of a Financial Assistance application. 5. Non-Emergent Services Down Payment Uninsured Patients presenting for scheduled or other non-emergent services will not be charged more than the Amounts Generally Billed ("AGB") AGB for their services. Patients will receive an estimated AGB cost of their care prior to IU Health Arnett rendering the services and will be asked to pay a down-payment percentage of the AGB adjusted cost prior to receiving services. In the event a patient is unable to fulfill the down-payment, their service may be rescheduled for a later date as medically prudent and in accordance with all applicable federal and state laws and/or regulations. 6. Emergency Services Non-Refundable Deposit This section will be implemented with a strict adherence to EMTALA and IU Health Policy ADM 1.32, Screening and Transfer of Emergency or Unstable Patients. Amount of Non-Refundable Deposit All Uninsured Patients presenting for services at IU Health Arnett's Emergency Department, via transfer from another hospital facility, or direct admission, will be responsible for a one-hundred dollar ($100.00) non-refundable deposit for services rendered. Patients/guarantors will be responsible for any copays and/or deductibles required by their plan prior to full Financial Assistance being applied. Uninsured Patients wishing to make an application for Financial Assistance greater than the AGB must fulfill their non-refundable deposit prior to IU Health Arnett processing said application. Uninsured Patients making payments toward their outstanding non-refundable deposit balance will have said payments applied to their oldest application on file, if applicable. Schedule H, Part V, Section B, Line 16a FAP Website A copy of IU Health Arnetts FAP is available on the following URL: https://iuhealth.org/pay-a-bill/financial-assistance Schedule H, Part V, Section B, Line 16b FAP Application Website A copy of IU Health Arnett's FAP Application is available on the following URL: https://iuhealth.org/pay-a-bill/financial-assistance Schedule H, Part V, Section B, Line 16c FAP PLS Website A plain language summary of the FAP, including translated copies, is available on the following website: https://iuhealth.org/pay-a-bill/financial-assistance Schedule H, Part V, Section B, Line 16j Other Measures to Publicize IU Health Arnett takes several other measures to publicize its FAP within the community. These measures include the following: 1. Conspicuous public displays will be posted in appropriate acute care settings such as the emergency department and registration areas describing the available assistance and directing eligible patients to the Financial Assistance Application. 2. IU Health Arnett will include a conspicuous written notice on all patient billing statements that notifies the patient about the availability of this Policy, and the telephone number of its Customer Service Department which can assist patients with any questions they may have regarding this Policy. 3. IU Health Customer Service representatives will be available via telephone Monday through Friday, excluding major holidays, from 8:00 a.m. to 7:00 p.m. Eastern Time to address questions related to this Policy. 4. IU Health Arnett will broadly communicate this Policy as part of its general outreach efforts. 5. IU Health Arnett will educate its patient facing team members of the FAP and the process for referring patients to the Program. 45 IU HEALTH ARNETT HOSP OUTPAT SURG CTR 1327 S 500 E LAFAYETTE IN 47905 DIAGNOSTIC AND OTHER OUTPATIENT IUH ARNETT MOB - ONSITE 5177 MCCARTY LANE LAFAYETTE IN 47905 DIAGNOSTIC AND OTHER OUTPATIENT IU HEALTH ARNETT CARDIOLOGY 1116 N 16TH ST STE A LAFAYETTE IN 47904 DIAGNOSTIC AND OTHER OUTPATIENT IU HEALTH ARNETT HOSPITAL SLEEP CENTER 3900 MCCARTY LANE STE 101 LAFAYETTE IN 47905 DIAGNOSTIC AND OTHER OUTPATIENT IU HEALTH ARNETT MED OFFICES -FERRY ST 2600 FERRY ST LAFAYETTE IN 47904 DIAGNOSTIC AND OTHER OUTPATIENT ARNETT RETAIL PHARMACY 2600 GREENBUSH ST LAFAYETTE IN 47904 PHARMACY IUH ARNETT MED OFFICES - GREENBUSH ST 2600 GREENBUSH ST LAFAYETTE IN 47905 DIAGNOSTIC AND OTHER OUTPATIENT DSI LAFAYETTE DIALYSIS 915 MEZZANINE DR LAFAYETTE IN 47905 DIAGNOSTIC AND OTHER OUTPATIENT IU HEALTH ARNETT NEPHROLOGY 915 MEZZANINE DR LAFAYETTE IN 47905 DIAGNOSTIC AND OTHER OUTPATIENT IU HEALTH ARNETT MED OFFICE - OTTERBEIN 407 N MEADOW ST OTTERBEIN IN 47970 DIAGNOSTIC AND OTHER OUTPATIENT IUH ARNETT MED OFFICES - W LAFAYETTE 253 SAGAMORE PKWY W WEST LAFAYETTE IN 47906 DIAGNOSTIC AND OTHER OUTPATIENT IU HEALTH ARNETT FAMILY MEDICINE 2800 FERRY ST LAFAYETTE IN 47904 DIAGNOSTIC AND OTHER OUTPATIENT IU HEALTH ARNETT PHYSICIANS CANCER SERV 720 S 6TH ST MONTICELLO IN 47960 SPECIALTY CARE IU HEALTH ARNETT PHYSICIANS CANCER SERV 420 N 26TH ST LAFAYETTE IN 47904 SPECIALTY CARE IU HEALTH ARNETT RETAIL PHARMACY 5165 MCCARTY LN ENTRANCE 4 LAFAYETTE IN 47905 PHARMACY IU HEALTH ARNETT MEDICAL OFFICE - DELPHI 651 ARMORY ROAD DELPHI IN 46923 DIAGNOSTIC AND OTHER OUTPATIENT IU HEATLH ARNETT MED OFF - LAFAYETTE 1 WALTER SCHOLER DR LAFAYETTE IN 47909 DIAGNOSTIC AND OTHER OUTPATIENT IUH ARNETT OCCUPATIONAL HEALTH SERVICES 2600 GREENBUSH ST LAFAYETTE IN 47905 DIAGNOSTIC AND OTHER OUTPATIENT IUH ARNETT OUTPATIENT SURGERY CENTER 1327 VETERANS MEMORIAL PKWY E LAFAYETTE IN 47905 DIAGNOSTIC AND OTHER OUTPATIENT IU HEALTH ARNETT PAIN MEDICINE 415 N 26TH ST STE 202 LAFAYETTE IN 47904 DIAGNOSTIC AND OTHER OUTPATIENT IUH ARNETT URGENT CARE - W LAFAYETTE 253 SAGAMORE PKWY W WEST LAFAYETTE IN 47906 DIAGNOSTIC AND OTHER OUTPATIENT WELLBOUND OF LAFAYETTE 2 EXECUTIVE DR STE B LAFAYETTE IN 47905 DIAGNOSTIC AND OTHER OUTPATIENT IU HEALTH ARNETT MCCARTY PHARMACY 5165 MCCARTY LN RM AG320 LAFAYETTE IN 47905 PHARMACY IU HEALTH ARNETT PHYSICIANS FAMILY MED 810 S SIXTH ST MONTICELLO IN 47960 PRIMARY CARE IU HEALTH ARNETT PHYSICIANS GEN SURGERY 810 S SIXTH ST MONTICELLO IN 47960 SPECIALTY CARE IU HEALTH ARNETT PHYSICIANS CARDIOLOGY 810 S SIXTH ST MONTICELLO IN 47960 SPECIALTY CARE IU HEALTH ARNETT PHYSICIANS NEPHROLOGY 810 S SIXTH ST MONTICELLO IN 47960 SPECIALTY CARE IUH ARNETT PHYS ORTHO & SPORTS MED 810 S SIXTH ST MONTICELLO IN 47960 SPECIALTY CARE IUH ARNETT PHYS PRIMARY CARE WALK-IN 810 S SIXTH ST MONTICELLO IN 47960 PRIMARY CARE IUH ARNETT PHYSICIANS WOMEN'S HEALTH 810 S SIXTH ST MONTICELLO IN 47960 SPECIALTY CARE RILEY PHYSICIANS AT IU HEALTH ARNETT 810 S SIXTH ST MONTICELLO IN 47960 SPECIALTY CARE IU HEALTH ARNETT PHYSICIANS GEN SURGERY 1458 S JACKSON ST SUITE A FRANKFORT IN 46041 SPECIALTY CARE IU HEALTH ARNETT OBGYN 550 S HOKE AVE FRANKFORT IN 46041 SPECIALTY CARE IU HEALTH ARNETT PHYSICIANS CANCER SERV 550 S HOKE AVE FRANKFORT IN 46041 SPECIALTY CARE IU HEALTH ARNETT PHYSICIANS FAMILY MED 550 S HOKE AVE FRANKFORT IN 46041 PRIMARY CARE IUH ARNETT PHYSICIANS INTERNAL MED & PED 550 S HOKE AVE FRANKFORT IN 46041 PRIMARY CARE IU HEALTH ARNETT PHYSICIANS NEPHROLOGY 550 S HOKE AVE FRANKFORT IN 46041 SPECIALTY CARE IUH ARNETT PHYS ORTHO & SPORTS MED 550 S HOKE AVE FRANKFORT IN 46041 SPECIALTY CARE IUH ARNETT PHYSICIANS ANESTHESIOLOGY 1300 S JACKSON ST FRANKFORT IN 46041 SPECIALTY CARE IUH ARNETT PHYSICIANS GASTROENTEROLOGY 1300 S JACKSON ST FRANKFORT IN 46041 SPECIALTY CARE IU HEALTH ARNETT PHYSICIANS RADIOLOGY 1300 S JACKSON ST FRANKFORT IN 46041 RADIOLOGY IU HEALTH ARNETT PAIN MGMT-FRANKFORT 1458 S JACKSON ST FRANKFORT IN 46041 SPECIALTY CARE IU HEALTH ARNETT CARDIOLOGY 1458 S JACKSON ST FRANKFORT IN 46041 SPECIALTY CARE IUH ARNETT PHYSICIAN MEDICAL WEIGHT LOSS 1458 S JACKSON ST SUITE A FRANKFORT IN 46041 SPECIALTY CARE IUH ARNETT PHYSICIANS ALLERGY & ASTHMA 1458 S JACKSON ST FRANKFORT IN 46041 SPECIALTY CARE Schedule H, Part I, Line 3c - Other Factors Used in Determining Elig. IU Health Arnett uses several factors other than Federal Poverty Guidelines ("FPGs") in determining eligibility for free care under its FAP. These factors include the following: 1. Indiana Residency Requirement Financial Assistance will only be made available to residents of the State of Indiana and those eligible for assistance under 42 U.S.C.A. 1396b(v). IU Health Arnett will employ the same residency test as set forth in Indiana Code 6-3-1-12 to define an Indiana resident. The term Resident includes any individual who was domiciled in Indiana during the taxable year, or any individual who maintains a permanent place of residence in Indiana and spends more than one hundred eight-three (183) days of the taxable year in Indiana. Patients residing in the state of Indiana while attending an institution of higher education may be eligible for assistance under the FAP if they meet the aforementioned residency test and are not claimed as a dependent on a parent's or guardians' federal income tax return. 2. IU Health's Individual Solutions Department Prior to seeking Financial Assistance under the FAP, all patients or their guarantors must consult with a member of IU Health's Individual Solutions department to determine if healthcare coverage may be obtained from a government insurance/assistance product or from the Health Insurance Exchange Marketplace. 3. Uninsured Patients All Uninsured Patients presenting for services at IU health Arnett eligible under the FAP will not be charged more than the AGB as described in the FAP. 4. Services Rendered by Individual Providers The FAP does not cover services rendered by individual providers. A full listing of providers and services not covered by the FAP is available at https://iuhealth.org/pay-a-bill/financial-assistance and is updated on a quarterly basis. 5. Alternate Sources of Assistance When technically feasible, a patient will exhaust all other state and federal assistance programs prior to receiving an award from IU Health Arnett's Financial Assistance Program. Patients who may be eligible for coverage under an applicable insurance policy, including, but not limited to, health, automobile, and homeowner's, must exhaust all insurance benefits prior to receiving an award from IU Health Arnett's Financial Assistance Program. This includes patients covered under their own policy and those who may be entitled to benefits from a third-party policy. Patients may be asked to show proof that such a claim was properly submitted to the proper insurance provider at the request of IU Health Arnett. Eligible patients who receive medical care from IU Health Arnett 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 to which IU Health Arnett is entitled. In the event a Financial Assistance Award has already been granted in such circumstances, IU Health Arnett reserves the right to reverse the award in an amount equal to the amount IU Health Arnett would be entitled to receive had no Financial Assistance been awarded. 6. Alternate Methods of Eligibility Determination IU Health Arnett will conduct a quarterly review of all accounts placed with a collection agency partner for a period of no less than one hundred and twenty (120) days after the account is eligible for an ECA. Said accounts may be eligible for assistance under the FAP based on the patient's individual scoring criteria. To ensure all patients potentially eligible for Financial Assistance under the FAP may receive Financial Assistance, IU Health Arnett will deem patients/guarantors to be presumptively eligible for Financial Assistance if they are found to be eligible for one of the following programs, received emergency or direct admit care, and satisfied his/her required co-pay/deductible: - Indiana Children's Special Health Care Services - Medicaid - Healthy Indiana Plan - Patients who are awarded Hospital Presumptive Eligibility (HPE) - Enrolled in a state and/or federal program that verifies the patient's gross household income is less than or equal to 200% of the Federal Poverty Level 7. Additional Considerations Financial Assistance may be granted to a deceased patient's account if said patient is found to have no estate. Additionally, IU Health Arnett will deny or revoke Financial Assistance for any patient or guarantor who falsifies any portion of a Financial Assistance application. 8. Patient Assets IU Health Arnett may consider patient/guarantor Assets in the calculation of a patient's true financial burden. A patient's/guarantor's primary residence and one (1) motor vehicle will be exempted from consideration in most cases. A patient's primary residence is defined as the patient's principal place of residence and will be excluded from a patient's extraordinary asset calculation so long as the patient's equity is less than five-hundred thousand dollars ($500,000) and the home is occupied by the patient/guarantor, patient's/guarantor's spouse or child under twenty-one (21) years of age. One (1) motor vehicle may be excluded as long as the patient's equity in the vehicle is less than fifty-thousand dollars ($50,000). IU Health Arnett reserves the right to request a list of all property owned by the patient/guarantor and adjust a patient's award of Financial Assistance if the patient demonstrates a claim or clear title to any extraordinary Asset not excluded from consideration under the above guidance. 9. Non-Emergent Services Down Payment Uninsured Patients presenting for scheduled or other non-emergent services will not be charged more than the AGB for their services. Patients will receive an estimated AGB cost of their care prior to IU Health Arnett rendering the services and will be asked to pay a down-payment percentage of the AGB adjusted cost prior to receiving services. In the event a patient is unable to fulfill the down-payment, their service may be rescheduled for a later date as medically prudent and in accordance with all applicable federal and state laws and/or regulations. 10. Emergency Services Non-Refundable Deposit This section will be implemented with a strict adherence to EMTALA and IU Health Policy ADM 1.32, Screening and Transfer of Emergency or Unstable Patients. Amount of Non-Refundable Deposit All Uninsured Patients presenting for services at IU Health Arnett's Emergency Department, via transfer from another hospital facility, or direct admission, will be responsible for a one-hundred dollar ($100.00) non-refundable deposit for services rendered. Patients/guarantors will be responsible for any copays and/or deductibles required by their plan prior to full Financial Assistance being applied. Uninsured Patients wishing to make an application for Financial Assistance greater than the AGB must fulfill their non-refundable deposit prior to IU Health Arnett processing said application. Uninsured Patients making payments toward their outstanding non-refundable deposit balance will have said payments applied to their oldest application on file, if applicable. Schedule H, Part I, Line 6a - C.B. Report Prepared by a Related Org. IU Health Arnett'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 7, column (f) - 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 $29,403,591. BAD DEBT EXPENSE IS REPORTED AT COST BASED ON THE COST-TO-CHARGE RATIO DERIVED FROM WORKSHEET 2, RATIO OF PATIENT CARE COST-TO-CHARGES. Schedule H, Part I, Line 7, column (c) - Total community benefit expense Percentage of Total Expenses listed on Schedule H, Part I, Line 7, Column (f) is calculated based on Net Community Benefit Expense. The Percentage of Total Expenses calculated based on Total Community Benefit Expense is 20.09%. SCHEDULE H, PART I, LINE 7G - SUBSIDIZED HEALTH SERVICES IU HEALTH DOES NOT INCLUDE ANY COSTS ASSOCIATED WITH PHYSICIAN CLINICS AS SUBSIDIZED HEALTH SERVICES. Schedule H, Part II - Promotion of Health in Communities Served IU Health participates in a variety of community-building activities that address the social determinants of health in the communities it serves. IU Health 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 that addressed economic development, community support and workforce development. Several examples include IU Health's support of the following organizations and initiatives that focus on some of the root causes of health issues, such as lack of education, employment and poverty: - Riggs Community Health Center - Starfish Initiative - Teach for America - United Way Additionally, through the IU Health Statewide System's team member community benefit service program team members across the state make a difference in the lives of thousands of Hoosiers every year. Schedule H, Part III, Line 2 - Bad Debt Expense Methodology 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 attributable to patients eligible under the Financial Assistance Policy an uninsured patient and/or guarantor who was admitted through an eligible facility's emergency department via a direct admission from a physician's office, or transfer from another hospital facility, and whose household income is less than or equal to 200% of the federal poverty level may be eligible for full charity assistance after the successful completion of the financial assistance application and satisfaction of his/her non-refundable deposit. To capture all patients who are potentially eligible for financial assistance under the IU Health Financial Assistance Policy, IU Health will deem patients/guarantors to be presumptively eligible for financial assistance if they are found to be eligible for one of the following programs, received emergency or direct admit care, and satisfied the required co-pay/deductible. 1. Indiana Children's Special Health Care Services 2. Medicaid 3. Healthy Indiana Plan 4. Patients who are awarded hospital presumptive eligibility 5. Enrolled in a state and/or federal program that verifies the patient's gross household income is less than or equal to 200% of the federal poverty level (FPL). IU Health also conducts a quarterly review of all accounts placed with a collection agency partner for a period of no less than one hundred and twenty (120) days after the account is eligible for an extraordinary collection actions. Said accounts may be eligible for assistance under the financial assistance policy based on the patient's individual scoring criteria and are not included in bad debt. Due to this comprehensive methodology. IU Health 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 IU Health Arnett 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. Under its financial assistance policy, the Indiana University Health System provides medically necessary care to uninsured patients with inadequate financial resources at charitable discounts equivalent to the amounts generally billed, and it provides eligibility for full charity for emergent encounters for uninsured patients who earn less than 200% of the federal poverty level and who meet application criteria. Patients whose liability is deemed catastrophic relative to their annual household income are also eligible for reduced charges. 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 free care 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 $96,693,000 and $94,886,000 in 2019 and 2018, respectively. Schedule H, Part III, Line 8 - Medicare Shortfall 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 Arnett Medicare Cost Report. "Allowable costs" for Medicare Cost Report purposes, however, are not reflective of all costs associated with IU Health Arnett'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 Arnett's participation in Medicare programs would significantly increase the Medicare shortfall reported on Schedule H, Part III, Line 7. IU Health Arnett'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 Arnett 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. Schedule H, Part III, Line 9b - Written Debt Collection Policy IU Health Arnett'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 Patients or their guarantors wishing to apply for Financial Assistance are encouraged to submit a Financial Assistance Application within ninety (90) days of their discharge. Patients or their guarantors may submit an application up to two-hundred and forty (240) days from the date of their first billing statement from IU Health, however, accounts may be subject to ECA as soon as one hundred and twenty (120) days after having received their first billing statement. Patients or their guarantors submitting an incomplete application will receive written notification of the application's deficiency upon discovery by IU health.The application will be pended for a period of forty-five (45) days from the date the notification is mailed. IU Health will suspend any ECA until the application is complete, or the patient fails to cure any deficiencies in their application in the allotted period. Patients with limited English proficiency may request to have a copy of the FAP, a FAP Application, and FAP Plain Language Summary in one of the below languages: - Arabic - Burmese - Burmese-Falam - Burmese-Hakha Chin - Mandarin/Chinese - 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 FAP Application to be mailed to a patient's primary mailing address free of charge. IU Health keeps all applications and supporting documentation confidential. Patients applying for assistance under the FAP will be required to complete a Financial Assistance Application. Patients must include the following documentation with their Financial Assistance Application: - 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 a patient's and/or guarantor's income does not warrant the filing of a federal tax return, the patient 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; and - If applicable, divorce/dissolution decrees and child custody order 2. Eligibility Determination IU Health Arnett 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. If a patient or guarantor is granted less than full charity assistance and the patient or guarantor provides additional information for reconsideration, IU Health Revenue Cycle Services may amend a prior Financial Assistance Determination. If a patient or guarantor seeks to appeal the Financial Assistance Determination further, a written request must be submitted, along with the supporting documentation, to the Financial Assistance Committee for additional review/reconsideration. All decisions of the Financial Assistance Committee are final. A patient's Financial Assistance Application and eligibility determination are specific to each individual date(s) of service and related encounters. 3. Extraordinary Collection Actions IU Health Arnett may refer delinquent patient accounts to a third-party collection agency after utilizing reasonable efforts to determine a patient's eligibility for assistance under the FAP. IU Health and its third-party collection agencies may initiate ECA against a patient or their guarantor in accordance with this Policy and 26 C.F.R. 1.501(r). Said ECA may include the following: - Selling a patient's 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's or their guarantor's nonpayment of one or more bills for previously provided care covered under the FAP. - Actions requiring a legal or judicial process, including but not limited to placing a lien on 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 Arnett and its third party collection agencies, will engage in fair, respectful and transparent collections activities. Patients or guarantors currently subject to an ECA who have not previously applied for Financial Assistance may apply for assistance up to two-hundred and forty (240) days of the date of their first billing statement from IU Health. IU Health and their third-party collection agencies will suspend any ECA engaged on a patient or their guarantor while an Application is being processed and considered. 4. Refunds Patients eligible for assistance under the FAP who remitted payment to IU Health Arnett 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 on a separate account not eligible for assistance under the FAP 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 VI, Line 2 - Needs Assessment COMMUNITIES ARE MULTIFACETED AND SO ARE THEIR HEALTH NEEDS. IU HEALTH ARNETT 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 ARNETT ASSESSES THE HEALTH CARE NEEDS OF THE COMMUNITIES IT SERVES BY CONDUCTING A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA). FOR THE 2018 CHNA, IU HEALTH ARNETT 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 ARNETT 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 ARNETT 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 believes its CHNA process is comprehensive and additional assessments are not required. Schedule H, Part VI, Line 3 - Patient Education of Elgibility for Assis. IU Health Arnett is committed to serving the healthcare needs of all of its patients regardless of their ability to pay for such services. To assist in meeting those needs, IU Health Arnett has established a FAP to provide Financial Assistance to Uninsured Patients. IU Health Arnett is committed to ensuring its patients are compliant with all provisions of the Patient Protection & Affordable Care Act. To that end, IU Health Arnett will make a good faith effort to locate and obtain health insurance coverage for patients prior to considering patients for coverage under the FAP. IU Health Arnett takes several measures to inform its patients of the FAP and FAP-eligibility. These measures include the following: 1. Conspicuous public displays will be posted in appropriate acute care settings such as the emergency department and registration areas describing the available assistance and directing eligible patients to the Financial Assistance Application. 2. IU Health Arnett will include a conspicuous written notice on all patient billing statements that notifies the patient about the availability of this Policy, and the telephone number of its Customer Service Department which can assist patients with any questions they may have regarding this Policy. 3. IU Health Customer Service representatives will be available via telephone Monday through Friday, excluding major holidays, from 8:00 a.m. to 7:00 p.m. Eastern Time to address questions related to this Policy. 4. IU Health Arnett will broadly communicate this Policy as part of its general outreach efforts. 5. IU Health Arnett will educate its patient facing team members of the FAP and the process for referring patients to the Program. Schedule H, Part VI, Line 4 - Community Information IU Health Arnett is primarily located in Tippecanoe County but also has medical offices and serves patients in Benton, Carroll, Clinton, and White counties. Tippecanoe County includes ZIP codes within the towns of Battle Ground, Clarks Hill, Dayton, Lafayette, Romney, West Lafayette and West Point. Based on the most recent Census Bureau (2019 estimate) statistics, Tippecanoe County's population is 195,732 persons with approximately 49% being female and 51% male. The county's population estimates by race are 75.8% White, 8.7% Hispanic or Latino, 8.8% Asian, 5.9% Black, 0.4% American Indian or Alaska Native, and 2.2% persons reporting two or more races. Tippecanoe County has relatively moderate levels of educational attainment. Among residents ages 25 and up, 91.7% ended their formal education with a high school diploma or equivalent. Among residents ages 25 and up, 37.7% earned a bachelor's degree or higher. Schedule H, Part VI, Line 5 - Promotion of Community Health IU Health Arnett 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. In 2018, IU Health Arnett completed a community health needs assessment which identified 4 priority health needs: Access to Healthcare, Health and Social Services for Seniors, Mental Health and Substance Use. The Community Outreach and Engagement Committee worked to identify major community partners to assist with education, outreach, programs and services to address these priority needs. IU Health committed $387,000 to 17 major partners, including local school corporations, community YMCAs and Purdue University, among others. Additionally, to assist with accessing healthcare, IU Health Arnett provided free health screenings at many community events, including the Lafayette Senior Expo and the Area IV Senior Games. Team members participated in a community initiative, Workforce 2030 Council, in order to build more interest and capacity in healthcare careers. The COE Committee provided $14,500 in grant funding to organize a regional Fetal Infant Mortality Review team. For mental health, IU Health supported evidence-based parenting classes through Willowstone Family Services. IU Health also partnered with Mental Health America Wabash Valley Region to fund different programs and services, including the Crisis Center and community education sessions. IU HEALTH ARNETT HOSPITAL IS A SUBSIDIARY OF IU HEALTH. IU HEALTH AND ITS RELATED HOSPITAL ENTITIES ACROSS THE STATE OF INDIANA EXTEND MEDICAL PRIVILEGES TO ALL PHYSICIANS WHO MEET THE CREDENTIALING QUALIFICATIONS NECESSARY FOR APPOINTMENT TO ITS MEDICAL STAFF. IU HEALTH DOES NOT DENY APPOINTMENT ON THE BASIS OF GENDER, RACE, CREED, OR NATIONAL ORIGIN. IU HEALTH, IN CONJUNCTION WITH THE IU SCHOOL OF MEDICINE, TRAINS THE NEXT GENERATION OF PHYSICIANS IN AN EXCEPTIONAL ENVIRONMENT, BLENDING BREAKTHROUGH RESEARCH AND TREATMENTS WITH THE HIGHEST QUALITY OF PATIENT CARE. Schedule H, Part VI, Line 6 - Affiliated Health Care System IU Health Arnett is part of the IU Health Statewide System. The IU Health Statewide system is Indiana's most comprehensive healthcare system. With hospitals, physician offices and allied services, IU Health provides access to a full range of specialty and primary care services for adults and children. A unique partnership with Indiana University School of Medicine - one of the nation's leading medical schools - gives patients access to groundbreaking research and innovative treatments to complement high-quality care. National Recognition - Eight hospitals designated as Magnet by the American Nurses Credentialing Center recognizing excellence in nursing care. - IU Health Medical Center is honored to be nationally ranked by U.S. News & World Report for the 22nd year in a row. According to the U.S. News rankings, IU Health Medical Center is the No. 1 ranked hospital in Indiana and Indianapolis and the only nationally ranked adult hospital in the state. For 2019-2020, IU Health Medical Center was rated as high performing nationally in five specialties, with a sixth specialty achieving a top 50 national ranking: - Cancer - high performing - Gastroenterology - high performing - Geriatrics - ranked 45th in nation - Nephrology - high performing - Neurology & Neurosurgery - high performing - Urology - high performing Besides IU Health Medical Center, IU Health has three other hospitals among the 10 top ranked hospitals in Indiana: IU Health Ball Memorial (#5), IU Health Arnett (#8) and IU Health Bloomington (#8) hospitals. The annual rankings, now in their 30th year, are designed to assist patients and their doctors in making informed decisions about where to receive care for challenging health conditions or for common elective procedures. Education and Research As an academic health center, IU Health 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, 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: - Cancer: One of the initiative's primary goals is to enable the IU Health Melvin and Bren Simon Cancer Center to attain the National Cancer Institute's (NCI) top status of "comprehensive," which would recognize it as one of the top-tier cancer centers in the nation. 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. - Neuroscience: The neurosciences research program tackles a broad range of brain injuries, neurodegenerative disorders and neurodevelopmental disorders. - Cardiovascular: The cardiovascular research initiative develops a comprehensive program for the study and treatment of heart failure, from newborns to older adults. A top priority is developing a cardiovascular genetics program. The Strategic Research Initiative provides patients with access to internationally renowned physicians and to new therapies developed through translational research and clinical trials, and will make use of the latest genetic tools to develop personalized therapies that are more effective for individuals and efficient for healthcare providers. IU Health Statewide System IU Health is a part of the IU Health Statewide System which continues to broaden its reach and positive impact throughout the state of Indiana. IU Health is Indiana's most comprehensive academic health center and consists of IU Health Methodist Hospital, IU Health University Hospital, Riley Hospital for Children at IU Health, and IU Health Saxony Hospital. Other hospitals in the IU Health Statewide System include the following: - IU Health Arnett Hospital - IU Health Ball Memorial Hospital - IU Health Bedford Hospital - IU Health Blackford Hospital - IU Health Bloomington Hospital - IU Health Frankfort Hospital - IU Health Jay Hospital - IU Health North Hospital - IU Health Paoli Hospital - IU Health Tipton Hospital - IU Health West Hospital - IU Health White Memorial Hospital Although each hospital in the IU Health Statewide System prepares and submits its own community benefit plan relative to the local community, the IU Health Statewide System considers the sum of these plans part of a statewide vision for strengthening Indiana's overall health. A comprehensive community outreach strategy and community benefit plan is in place that encompasses the academic medical center downtown Indianapolis, suburban Indianapolis and statewide entities around priority areas that focus on health improvement efforts statewide. IU Health is keenly aware of the positive impact it can have on the communities of need in the state of Indiana by focusing on the most pressing needs in a systematic and strategic way. In 2019, IU Health provided more than $738 million in total community benefit and served more than one million individuals. Some ways we address our community health priorities as a system include: IU Health Day of Service The annual IU Health Days of Service is a high-impact event aimed at engaging IU Health team members in activities that address an identified community priority health need. Each year, more than 2,000 IU Health team members volunteer during the Days of Service. Community Health Initiatives With investments in high-quality and impactful initiatives to address community health needs statewide, IU Health is helping Indiana residents improve their health and their quality of life. In 2019, IU Health impacted many people statewide through educational presentations, health risk screenings, health education programs, and additional health educational opportunities made available to the community, especially to our community members in the greatest need of such services. Twenty-four local organizations are benefitting from grants awarded by IU Health. In 2019, IU Health Community Outreach and Engagement awarded more than $900,000 to community organizations and institutions which - like IU Health - are addressing the health needs of the community. These needs include access to affordable healthcare, behavioral health and substance abuse, healthy weight and nutrition and social determinants of health. The grants, administered by the Indiana University Health Foundation, were awarded to the following: Behavioral Health and Substance Abuse - Volunteers of America Ohio & Indiana's (https://www.voaohin.org/) (VOAOHIN) Fresh Start Recovery Center received a $75,000 grant to provide residential addiction treatment to pregnant women and mothers. It also allows up to two children ages 5 and under to live with their mother while they receive services. - Goodwill Foundation of Central and Southern Indiana(https://www.goodwillindy.org/foundation/) received $75,000 to help Goodwill Education Initiatives (GEI) Resilience Initiative support resilience work across 15 Excel Center locations by leveraging groundbreaking research on neuroplasticity - the ability of the brain to reorganize itself - and to train staff and students on enhancing their resilience and mitigating the effects of trauma. - Additional grant winners: - Reach for Youth (https://www.reachforyouth.org/) - Lutheran Foundation (https://thelutheranfoundation) - Indy Public Safety Foundation (https://indypsf.org/) Healthy Weight and Nutrition - United Way of Central Indiana, Inc.'s (https://uwci.org/) initiative Jump IN for Healthy Kids received a $50,000 grant to address the epidemic of childhood obesity with a specific focus on implementing strategies that create healthy places, healthy neighborhoods, and healthy communities in Marion County. - Playworks (https://www.playworks.org/indiana/), a national non-profit organization that partners with Indianapolis schools and youth organizations to help them leverage play for positive outcomes, received a $23,000 grant. - Additional grant winners: - Indianapolis Parks Foundation (https://www.indyparksfoundation.org/) Social Determinants of Health - A $100,250 grant was awarded to Gleaners Food Bank Schedule H, Part VI, Line 7 - State Filing of Community Benefit Report IN true UNITED WAY OF GREATER LAFAYETTE 1114 E STATE ST LAFAYETTE IN 47905 350891621 501(C)(3) 25250 GENERAL SUPPORT IU HEALTH FOUNDATION INC 1633 N Capitol Ave 1200 INDIANAPOLIS IN 46202 356043086 501(C)(3) 38981 EDUCATION FUND PURDUE RESEARCH FOUNDATION 403 W WOOD ST LAFAYETTE IN 47907 310958507 501(C)(3) 100000 Med. Edu. Facility YMCA of LAFAYETTE 1950 south 18th street lafayette IN 47905 350868213 501(C)(3) 123700 Community Campaign MENTAL HEALTH AMERICA OF TIPPECANOE COUNTY 914 South St Lafayette IN 47901 383653969 501(c)(3) 40000 General Support Healthy Communities of Clinton County 1458 OAK ST STE B Frankfort IN 46041 462835793 501(c)(3) 44147 General Support Learning Network of Clinton County Inc 1111 South Jackson St Frankfort IN 46041 721543172 501(c)(3) 21946 General Support Open Door Health Clinic Inc 59 S Hoke Avenue Frankfort IN 46041 351882919 501(c)(3) 17325 General Support Greater Lafayette Commerce and Economic Dev Fdn PO BOX 348 Lafayette IN 47902 813745360 501(c)(6) 10000 General Support Tippecanoe County 20 N 3rd Street Lafayette IN 47901 356000202 GOVT 20000 Fetal-Infant Mortality Rev Team Purdue University School of Nursing 502 N University St West Lafayette IN 47907 356002041 GOVT 10000 Scholarship Fund 10 1 Schedule I, Part I, Line 2 - Org.'s Proc. for Mon. the Use of Grant Funds Although IU Health Arnett 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. X true true true true false false false false false true false CHRISTOPHER A MANSFIELD MD DIRECTOR/Vice Chair 463635 0 8259 0 18540 0 18075 0 29939 0 538448 0 0 0 ROGER G BANGS MD DIRECTOR 722483 0 10431 0 21564 0 18075 0 11027 0 783580 0 0 0 KENNETH E MARNOCHA MD DIRECTOR (Part Year) 226725 0 4888 0 19188 0 16168 0 9180 0 276149 0 0 0 RUBAN NIRMALAN MD DIRECTOR 773652 0 500 0 19540 0 16832 0 24920 0 835444 0 0 0 DONALD E CLAYTON MD Former Officer 177893 0 500 0 8579 0 17481 0 16636 0 221089 0 0 0 DEREK E EMPIE SECRETARY 0 231195 0 36357 0 757 0 14967 0 30379 0 313655 0 0 CARA L BREIDSTER Former Officer 0 268020 0 40264 0 13097 0 18008 0 23740 0 363129 0 0 JEFFREY C ZEH COO 286519 0 37102 0 1242 0 18484 0 227 0 343574 0 0 0 JOSEPH E HUBBARD MD PHY. DEPT. CHAIRPERSON 1091998 0 500 0 18540 0 18075 0 29744 0 1158857 0 0 0 PETER A SEYMOUR MD PHY. DIVISION DIRECTOR 771077 0 7121 0 18810 0 18075 0 29741 0 844824 0 0 0 Stanton M Regan MD Physician - CAH 886660 0 500 0 18486 0 18075 0 31768 0 955489 0 0 0 Cheng Du MD Physician - CAH 888263 0 500 0 20242 0 22610 0 33466 0 965081 0 0 0 Naveed Ahmad MD PHY. DEPT. CHAIRPERSON 754560 0 500 0 19803 0 18075 0 29528 0 822466 0 0 0 ANDREW K EDWARDS MD FORMER Officer 383808 0 500 0 18810 0 17047 0 25104 0 445269 0 0 0 JAMES P BIEN MD CMO - VP Quality & Safety 344644 0 48634 0 21232 0 18075 0 27864 0 460449 0 0 0 ALFONSO W GATMAITAN FORMER Officer 0 0 0 490998 0 915478 0 4922 0 0 0 1411398 0 915479 TODD A WILLIAMS CFO/TREASURER 0 263340 0 9890 0 19828 0 11200 0 29263 0 333521 0 0 DANIEL E NEUFELDER PRESIDENT 0 509494 0 121427 0 22564 0 112923 0 24874 0 791282 0 0 Brian T Shockney Former Key Employee 0 468991 0 159543 0 34201 0 99076 0 26918 0 788729 0 0 JAMES H PARSONS CHIEF PRACTICE OFFICER 168289 0 19072 0 2475 0 12073 0 29268 0 231177 0 0 0 Brian M Weirich CNO 217167 0 28950 0 379 0 15816 0 24188 0 286500 0 0 0 WILLIAM Y LI MD Director (Part Year) 430018 0 500 0 19242 0 18075 0 29576 0 497411 0 0 0 MICHELE S SAYSANA MD Director (Part Year) 0 365503 0 97197 0 578 0 9426 0 0 0 472704 0 0 KOREEN C KYHNELL VP - HUMAN RESOURCES 0 172712 0 21815 0 3120 0 13298 0 26981 0 237926 0 0 SCHEDULE J, PART I, LINE 1 - LISTED BENEFITS Tax gross-ups were provided to one key employee listed on IU Health Arnett's Form 990, Part VII, Section A. The tax gross-ups were treated as taxable compensation. Schedule J, Part I, Line 3 - Comp. of the Org.'s CEO/Executive Director IU Health Arnett's Regional President is employed by IU Health, Inc. IU Health, Inc., IU Health Arnett, and other related entities have a process in place to determine the compensation for the other 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. Please see schedule O for additional details. SCHEDULE J, PART I, LINE 4A - SEVERANCE Alfonso W. Gatmaitan entered into a severance agreement with IU Health during 2018. Severance of $915,479 that was received during 2019 is included in column B(III), other reportable compensation. Deferred severance of $999,283 was disclosed in 2018 in column C, retirement and other deferred compensation. Schedule J, Part I, Line 4b - Supplemental Nonqualified Retirement Plan Daniel E. Neufelder and Brian T. Shockney participate in an IU Health supplemental executive retirement plan, provisions of which are designed to retain its 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. Daniel E. Neufelder and Brian T. Shockney 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 these executives during the year. Schedule J, Part I, Line 7 - Non-Fixed Payments Amounts disclosed in Column B(ii) include a long-term and short-term incentive for certain executives and short-term incentive for other employees. Although these plans are based on a fixed formula that has been approved by the Board of Directors based upon certain qualitative and quantitative factors and goals, all discretionary incentive plans must be approved by the Board of Directors prior to any incentive payout. X 1 1038109 FMV 0 false true false FORM 990, SCHEDULE M, PART II - NONCASH CONTRIBUTIONS THE NUMBER REPORTED IN COLUMN B OF PART I REPRESENTS THE NUMBER OF ITEMS CONTRIBUTED. Page 1, Line J Web Site: https://iuhealth.org/find-locations/iu-health-arnett-hospital Part VI, Section A - Governing Body and Management Line 4 - Significant Changes to Organizational Documents Indiana University Health Arnett, Inc. filed Amended and Restated Bylaws in order to reflect its change in operations following the boards merger with IU Health White Memorial Hospital and IU Health Frankfort. A detail summary of the updated changes to Section 4.2 Appointment and Section 4.4 Member Approval Required are shown on Schedule O, lines 7a and 7b. New Section 4.2 Duties of the Board of Directors highlights the board's annual duties. Summary of this change is as follows: Board's duties shall include, but are not limited to, the following: - To acquire by purchase or lease materials, serv1ces, equipment and supplies for use by the Hospital; - To contract for serv1ces of professionals or firms when considered necessary by the Hospital; - To require that accounting records be kept in the manner prescribed by generally accepted accounting principles; - To provide for institutional planning to meet the health needs of the community; - To require the Medical Staff to develop, adopt and periodically review Medical Staff Bylaws (as described in Section 9 .1 ), rules and regulations that are consistent with Hospital policies, these Bylaws and applicable legal or other requirements, including the applicable accreditation requirements, Indiana State Department of Health regulations and Medicare and Medicaid conditions of participation; - To hold the Medical Staff responsible for making recommendations concerning initial Medical Staff appointments, reappointments, termination of appointments, delineation of clinical privileges and the curtailment of clinical privileges; - To require the Medical Staff to establish mechanisms designed to assure the achievement and maintenance of a standard of medical practice and patient care that is consistent with generally accepted medical standards; and - To be responsible for oversight of the adequacy of the Hospital's physical plant. Part VI, Section A, Lines 6, 7a and 7b Members or Stockholders Line 6: The sole member of IU Health Arnett is IU Health, a 501(c)(3) tax-exempt hospital. Line 7a: The control and management of the affairs of IU Health Arnett is vested in a board of up to fourteen (14) voting directors whom are appointed by IU Health, as the sole member of the organization. Four (4) of the voting Directors will be physician representatives from the West Central Region. The Physician Directors will be identified through a nomination process developed by the West Central Region and submitted to IU Health for consideration and approval. Line 7b: The board of directors may not undertake certain actions without the prior approval of IU Health, as the sole member. Actions that require prior approval include the following: -Any proposed amendment to the Corporation's Articles of Incorporation or these Bylaws; -Adoption of the Corporation's annual capital and operating budgets; -Approval of any unbudgeted operating or capital budget items or deviations, including any issuance or guarantee of any unbudgeted debt; -Approval of any strategic plan for the Corporation, including any amendments to a strategic plan; -Approval of any encumbrance, sale or conveyance of assets; -Any merger, consolidation, joint venture or affiliation involving the Corporation or any of its affiliates and any other entity; -Appointment and removal of the Corporation's President and other officers; -Construction, acquisition or lease of Hospital buildings; -Projects or contracts that require Member approval in accordance with the Member's resolution and policy governing system-wide Contract Execution Authority and Payment Approval Limits; and -The dissolution of the Corporation or any of its affiliates. Part VI, Section B, Line 11b Review of Form 990 The CFO reviewed and approved the Form 990. Following the CFO's review and approval, 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. Part VI, Section B, Lines 12, 13, 14, and 16b Policies IU Health Arnett is part of the IU Health system. As the sole member and controlling parent of IU Health Arnett, IU Health and its Board of Directors have mandated that certain policies be followed to ensure greater standardization throughout the system. Thus, IU Health Arnett'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. Part VI, Section B, Line 12c Conflict of Interest Policy IU Health Arnett 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. Part VI, Section B, Line 15a & 15b Process for Determining Compen. IU Health Arnett's 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 (Senior Vice Presidents and above) 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 Arnett and other related entities have a process in place to determine the compensation for the other 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. Part VI, Section C, Line 19 Public Disclosure IU Health Arnett's Articles of Incorporation are available for public inspection through the Indiana Secretary of State's website. IU Health Arnett's conflict of interest procedures are disclosed on the Form 990, Schedule O. IU Health Arnett 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 Arnett's Form 990. Part VII, Section B, Attach 2 Comp of the Five Highest Pd Ind. Contractors The amounts paid to Wurster Construction totaling $2,291,363 include both goods and services associated with the construction of West Lafayette MOB Lab/ Exam renovation and IUH Arnett Cancer Care Pharmacy. The amounts for goods vs. services were not easily separated for reporting on the 990, Part VII, Section B, Independent contractors. The amounts paid to Kettlehut Construction totaling $1,962,138 include both goods and services associated with the construction of IU Health Arnett Ferry Street Lab. The amounts for goods vs. services were not easily separated for reporting on the 990, Part VII, Section B, Independent contractors. PART XI, LINE 9 - OTHER CHANGES IN NET ASSETS OR FUND BALANCES IU Health Arnett Hospital recorded the following other changes in net assets or fund balances in 2019: EQUITY TRANSFER (SETTLEMENT OF DEBT): $ (10,271) FORM 990 PART IX LINE 11G DESCRIPTION:SHARED SERVICES/PROF FEES TOTAL FEES:92650106 ARNETT CLINIC LLC 950 N MERIDIAN ST STE 800 INDIANAPOLIS IN 46204 352030653 HEALTHCARE IN 7310793 86422376 IUHA CAH PHYSICIANS LLC 950 N MERIDIAN ST STE 800 INDIANAPOLIS IN 46204 262769447 HEALTHCARE IN 0 0 IUHA CLARIAN-ARNETT OCCUP HEALTH CTRS LLC 950 N MERIDIAN ST STE 800 INDIANAPOLIS IN 46204 271973115 HEALTHCARE IN -14965 44069 IUHA Clarian Transplant Institute Inc 950 N Meridian St Ste 800 Indianapolis IN 46204 134350599 Healthcare IN 501(c)(3) 10 IUH true Indiana Health Info Exchange Inc 846 N Senate Ave Indianapolis IN 46202 364550324 Healthcare IN 501(c)(3) 12 I NA false Indiana University Health Inc 950 N Meridian St Ste 300 Indianapolis IN 46204 351955872 Healthcare IN 501(c)(3) 3 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