2019-11-14T17:55:05-06:00 2018-12-31 ERNST & YOUNG US LLP 111 MONUMENT CIRCLE SUITE 4000 INDIANAPOLIS IN 46204 990 2018-01-01 351814660 INDIANA UNIVERSITY HEALTH WEST HOSPITAL INC % CRAIG J JONES INDI 3179634842 950 N MERIDIAN STREET Suite 300 INDIANAPOLIS IN 46204 CARA L BREIDSTER CFO 3179634842 2019-11-15 JENNIFER D RHODERICK P00395735 3176817000 162.1.129.128 35198520193185000022 2019-11-14 P E86E71EDF6F7DFE9336F32ED7F8459C58967F52A EDBC7A9300E18FC3AE89303A319F5354A19FC7EF 2018 2020-03-31 21:24:44Z KENNETH D PUCKETT 950 N MERIDIAN ST STE 300 INDIANAPOLIS IN 46204 248086495 false X SEE SCHEDULE O X 1990 IN Improve the health of our patients and community through innovation and excellence in care, education, research and service. 9 5 1235 30 0 98712 21714 259 223750030 239113407 705329 6843697 1690889 1727372 226167962 247684735 22500 20000 0 0 58695019 61297448 0 0 0 116255481 127925448 174973000 189242896 51194962 58441839 464063976 521438931 121431762 120515303 342632214 400923628 X IMPROVE THE HEALTH OF OUR PATIENTS AND COMMUNITY THROUGH INNOVATION AND EXCELLENCE IN CARE, EDUCATION, RESEARCH AND SERVICE. false false 155483010 20000 238439781 Indiana University Health West Hospital, Inc. ("IU Health West Hospital") is 142-bed multidisciplinary healthcare facility located in Avon, IN. The hospital offers a full range of services, including maternity, orthopedics and cancer care. Built with a specific goal to meet the needs of our patients, families and visitors, IU Health West Hospital includes features designed to ensure privacy and create a quiet, soothing atmosphere in patient spaces. From all-private rooms and intimate, comfortable family waiting areas to separate corridors and elevators away from public spaces for staff and supply movement, IU Health West Hospital delivers on our goals to create a healing sanctuary for patients. 291419 446903 IU Health West Hospital receives rent from a related exempt organization, Indiana University Health Care Associates ("IU Health Physicians"), for space in their Medical Office Building that's connected to the Hospital and the Ortho, Sport & Spine Center. 147842 226723 IU Health West Hospital provides services to related tax-exempt organizations. 155922271 true false 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 false false false false false true true true false false true 70 0 true 1235 true true true false false false false false false false false false false false X 9 5 false false false false true true true true true false false true true true true true true false true false IN X CRAIG J JONES 3179634842 950 N MERIDIAN ST STE 300 INDIANAPOLIS IN 46204 X MARSHA A STONE CHAIRMAN 5.0 0.0 X X 4500 0 0 MARK R BENSON DO DIRECTOR 5.0 0.0 X 4500 0 0 REV KAREN E DEVAISHER DIRECTOR 5.0 0.0 X 4500 0 0 CINDA L KELLEY DIRECTOR 5.0 0.0 X 3750 0 0 MEGAN CRITTENDON MD DIRECTOR 5.0 50.0 X 0 358965 24636 Elizabeth Dunlap Director 5.0 50.0 X 0 767220 34402 Michelle A Janney Director 5.0 50.0 X 0 1017028 126964 Jill McCrory Director 5.0 0.0 X 3750 0 0 David A Ingram MD Director 5.0 50.0 X 0 539320 111083 KENNETH D PUCKETT PRESIDENT - ISR 10.0 45.0 X 0 525684 97308 DEREK E EMPIE SECRETARY 5.0 50.0 X 0 226820 40289 ARTHUR VASQUEZ President/Treasurer 55.0 0.0 X 0 268019 41667 CARA L BREIDSTER CFO - ISR (PARTIAL YEAR) 10.0 45.0 X 0 313895 36365 Harpreetinder Singh MD VP & CMO (Partial Year) 25.0 30.0 X 228539 233217 37087 LISA A SPARKS RN VP & CNO 55.0 0.0 X 202295 0 38589 PAMELA CHAPMAN DIRECTOR, OR SERVICES(Part Yr) 55.0 0.0 X 15830 143812 38588 JAMES R BILLMAN PHARMACIST 55.0 0.0 X 158109 0 27281 ANNE K STEGEMOLLER DIRECTOR, PHARMACY 55.0 0.0 X 165473 0 36471 LAURA A ROGGY PHARMACIST 55.0 0.0 X 154699 0 25963 Eric D Peak Pharmacist, Senior 55.0 0.0 X 153744 0 14921 Jamie L Conley-Lebeter Mgr, Pharmacy Oprs 55.0 0.0 X 143536 0 30052 JUDITH L COLEMAN FORMER TREASURER 0.0 55.0 X 0 297648 33403 MATTHEW D BAILEY FORMER PRESIDENT 0.0 55.0 X 0 1493222 329267 GREGORY A SPURGIN MD FOMER CMO 0.0 55.0 X 0 301623 21425 1243225 6486473 1145761 38 true true false ARAMARK HEALTHCARE MANAGEMENT SERVI 2300 WARRENVILLE RD DOWNERS GROVE IL 60515 FACILITIES 4800480 Cornerstone Medical Construction L 8902 N Meridian St Ste 205 INDIANAPOLIS IN 46260 Construction 1398748 MESSER CONSTRUCTION COMPANY 2445 N MERIDIAN STREET INDIANAPOLIS IN 46208 CONSTRUCTION 815775 Ermco Inc 1625 Thompson Rd INDIANAPOLIS IN 46217 Maintenance 973199 MEDEFIS CONSOLIDATED PO BOX 5068 NEW YORK NY 10087 Staffing 802141 17 259 259 NET PATIENT SERVICE REVENUE 622110 238439781 238439781 SHARED SERVICES 541900 226723 226723 RENT FROM RELATED 501(C)(3) ORGS. 532000 446903 446903 239113407 6689781 6689781 0 0 377705 401760 -24055 0 -24055 -24055 153916 153916 153916 153916 0 0 0 0 0 0 0 0 0 CAFETERIA/FOOD SERVICE 721110 884996 884996 GIFT SHOP 453220 304750 304750 TELEPHONE 517000 102785 102785 458896 458896 1751427 247684735 239113407 8571069 X 20000 20000 0 0 0 528435 491638 36797 0 48819467 45419985 3399482 1669440 1553191 116249 6767516 6296269 471247 3512590 3267995 244595 0 125275 125275 10230 10230 6298 6298 0 0 50211885 24225072 25986813 0 400936 400936 548763 427294 121469 194057 186217 7840 0 3630812 3329319 301493 27849 18299 9550 0 42025 4783 37242 5539546 5539546 0 7869586 6484201 1385385 1244835 296992 947843 DRUGS AND MEDICAL SUPPLIES 26907166 26907166 BAD DEBT 19200087 19200087 HOSPITAL ASSESSMENT FEE 10863905 10863905 INSTITUTIONAL DUES/LICENSES 90703 90703 1011490 898673 112817 189242896 155922271 33320625 0 4750 0 338891877 391044274 0 0 31939139 30077475 0 0 0 0 781984 792506 1521470 1420805 832880 761440 195362763 98020332 90091876 97342431 0 0 0 0 0 0 0 0 0 0 464063976 521438931 14509341 15072181 0 0 255666 131478 0 0 0 0 0 0 0 0 0 0 106666755 105311644 121431762 120515303 X 342612401 400923628 19813 0 0 0 342632214 400923628 464063976 521438931 X 58441839 -150425 X false true X true false X false false false false false false false false true 6298 6298 false Schedule C, Part II-B, Lines 1i - Other Activities IU Health West Hospital paid institutional membership dues to the American Hospital Association ("AHA") and Indiana Hospital Association ("IHA") during 2018 in the amount of $22,761 and $14,999, respectively. Each membership organization notified IU Health West Hospital that a portion of the dues it paid were used for lobbying purposes. The AHA used 22.98%, or $5,230 of 2018 membership dues paid by IU Health West Hospital, for lobbying expenditures. The IHA used 7.12%, or $1,068 of the 2018 membership dues paid by IU Health West Hospital, for lobbying expenditures. The total membership dues paid to these organizations by IU Health West Hospital during 2018 that were attributable to lobbying expenditures was $6,298. 103892736 37793927 66098809 1188609 626525 562084 69906308 54278868 15627440 20375110 5321012 15054098 97342431 0 INTERCOMPANY PAYABLES (NET) 103379800 DUE TO THIRD-PARTY PAYERS 1723938 SELF-INSURANCE LIABILITIES 207906 105311644 X Schedule D, Part X, Line 2 - FIN 48 (ASC 740) Footnote IU Health West Hospital is a subsidiary in Indiana University Health, Inc.'s ("IU Health") Consolidated Audited Financial Statements. The Internal Revenue Service (IRS) has determined that IU Health and certain of its affiliated entities are tax-exempt organizations as defined in Section 501(c)(3) of the Internal Revenue Code (IRC). IU Health and its tax-exempt affiliates are, however, subject to federal and state income taxes on unrelated business income under the provision 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 CATEGORIZE CERTAIN FRINGE BENEFIT EXPENSES AS A SOURCE OF UNRELATED BUSINESS INCOME SUBJECT TO TAX, 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. REGULATIONS NECESSARY TO IMPLEMENT CERTAIN ASPECTS OF TCJA ARE EXPECTED TO BE PROMULGATED BY THE IRS IN 2019. AS OF AND FOR THE YEAR ENDED DECEMBER 31, 2018, 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 BASED ON ACCOUNTING GUIDANCE INCLUDED IN ACCOUNTING STANDARDS CODIFICATION (ASC) 740, INCOME TAXES. 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, WHICH AS OF DECEMBER 31, 2018 AND 2017, 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 AMOUNT USED FOR INCOME TAX PURPOSES. AS OF DECEMBER 31, 2018 AND 2017, THE INDIANA UNIVERSITY HEALTH SYSTEM HAD GROSS DEFERRED TAX ASSETS OF $119,965,000 AND $93,794,000, RESPECTIVELY, PRIMARILY RELATING TO NET OPERATING LOSS CARRYOVERS. MANAGEMENT DETERMINED THAT A FULL VALUATION ALLOWANCE AT BOTH DECEMBER 31, 2018 AND 2017 WAS NECESSARY TO REDUCE THE DEFERRED TAX ASSETS TO THE AMOUNT THAT WOULD MORE LIKELY THAN NOT BE REALIZED. ACCOUNTING STANDARDS CODIFICATION (ASC) 740, INCOME TAXES, REQUIRES A VALUATION ALLOWANCE TO REDUCE THE DEFERRED TAX ASSETS REPORTED IF, BASED ON THE WEIGHT OF THE EVIDENCE, IT IS MORE LIKELY THAN NOT THAT SOME PORTION OR ALL OF THE DEFERRED TAX ASSETS WILL NOT BE REALIZED. THE CHANGE IN VALUATION ALLOWANCE FOR THE CURRENT YEAR IS $26,171,000. AT DECEMBER 31, 2018, THE INDIANA UNIVERSITY HEALTH SYSTEM HAS AVAILABLE NET OPERATING LOSS CARRYFORWARDS OF $482,349,000. NET OPERATING LOSSES GENERATED FROM 1999 THROUGH 2017 WILL EXPIRE BETWEEN 2019 AND 2037. NET OPERATING LOSSES GENERATED DURING 2018 DO NOT EXPIRE. CERTAIN SUBSIDIARIES OF IU 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 4132 3749657 3749657 0.02210 5819 31683936 18890058 12793878 0.07520 9951 35433593 18890058 16543535 0.09730 6 4387 1541330 1541330 0.00910 2 494 234043 234043 0.00140 2 5480 133887 133887 0.00080 10 10361 1909260 1909260 0.01130 10 20312 37342853 18890058 18452795 0.10860 1 25 15500 15500 0.00010 1 25 15500 15500 0.00010 false 3523216 39499942 42601997 -3102055 X true true 1 1 IU HEALTH WEST HOSPITAL 1111 N RONALD REAGAN PKWY AVON IN 46123 SEE PART V, SECTION C 19-003776-1 X X X X IU HEALTH WEST 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 X 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-west-hospital Schedule H, Part V, Section B, Line 3e Prioritized Health Needs IU HEALTH WEST HOSPITAL'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 WEST HOSPITAL: - Access to Health Care Services - Drug and Substance Abuse - Food Insecurity - Mental Health - Obesity and Diabetes - Smoking and Tobacco Usage - 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 West Hospital took into account input from persons who represent the broad interests of the communities it serves. Primary data were gathered in three different methodologies for this assessment: Community Meetings, Key Stakeholder Interviews, and a Community Survey. For purposes of this CHNA, IU Health West Hospitals community is defined as Hendricks and Marion Counties, Indiana. These two counties accounted for 87.8 percent of the hospitals inpatient cases in 2016. Community Meetings Hendricks County On July 24, 2018, a meeting of community representatives was held at the IU Health West Hospital in Avon, which is part of Hendricks County. The meeting was attended by 15 community members invited by IU Health because they represent important community organizations and sectors such as: local health departments, police/fire departments, non-profit organizations, business community, health care providers, local policymakers, faith-based organizations, and schools. Through this meeting, IU Health sought a breadth of perspectives on the communitys health needs. The specific organizations represented at the meeting are listed below. - American Lung Association - Avon Community School Corporation - Avon Washington Township Fire Department - Franciscan Alliance - HOPE Healthcare Services - Hendricks County Health Department - Hendricks County Senior Services - Hendricks County Substance Abuse Task Force - Hendricks County Tobacco Coalition - Hendricks Regional Health - IU Health West Hospital - Kids Count - Mental Health American Hendricks County - Susies Place The meeting was requested by IU Health to obtain community input into the communitys health needs. The session 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 Hendricks County those indicators were (in alphabetical order): - Access to healthy food - Air pollution - Crime (violent crime) - Excessive drinking - Mental health and supply of mental health providers - Obesity and lack of physical activity 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: tobacco use, low income housing, access to affordable healthcare, adverse childhood events, and aging population. Air pollution was removed from the list, and the excessive drinking line item was amended to include substance abuse. During the meeting, a range of other topics was discussed, including: - Poverty rate numbers and relationship to 'ALICE' data - Immigrants in the community and representation in data - Western part of Hendricks County where food deserts are a bigger issue that didnt seem to come through in secondary data - Social associations data compared to abundance of churches and civic clubs in Hendricks County - Mental health services issues facing the sheriffs department/jail population - Low numbers of providers compared to the population and low number of providers who have spots available for Medicaid patients - Vaping - Trauma in childhood as a leading indicator of many of the adult issues discussed - Challenge of finding affordable housing After discussing the needs identified through secondary data and adding others to the list, each participant was asked to identify "three" that are most significant. From this process, the group identified the following needs as most significant in Hendricks County: - Mental health and supply of mental health providers - Access to affordable healthcare - Adverse childhood events - Tobacco use - Tied for fifth: Access to healthy food, excessive drinking & substance abuse, and aging population Interviews Hendricks County An interview was also conducted with a representative of the Hendricks county health department. The interview was conducted to assure that appropriate and additional input was received from governmental public health officials. The results of the community meetings were discussed and insights were sought regarding significant community health needs, why such needs are present, and how they can be addressed. The interview was guided by a structured protocol. 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 needs identified by the community meeting participants were significant. These needs were: - Mental health and supply of mental health providers - Access to affordable healthcare - Adverse childhood events There is a lack of mental and behavioral health providers, including psychiatrists, substance abuse specialists, inpatient care, and others. It is often difficult to locate resources for those with substance abuse issues or suicidal ideations. In general, there is an undersupply of providers in the county, and more programs may be needed to incentivize providers to practice locally. Access to affordable care is an issue, especially with a recent closure of a facility that provided services for lower-income residents. Low income populations and those that do not receive healthcare benefits through their employers are disproportionately affected. The need for affordable primary care also generates a need for more preventive health care and screenings, as many residents do not go to a provider unless an emergency situation occurs. Substance abuse and drug addiction is a major concern, particularly around opioids. Availability of opioids is high and the cost of these drugs has decreased, leading to increased usage. Additionally, pill abuse is also rising as it is often easy to get a prescription for an opioid. Pain management treatment in general is difficult to access in the county. Obesity and physical inactivity are concerns in the community. Certain areas of the county do not live close to stores selling healthy foods, so often go to fast food instead. Additionally, sidewalks and other healthy-living infrastructure are in short supply. Obesity is also leading to chronic issues as the population ages, including bad knees, bad backs, diabetes, hypertension, and other conditions. Housing is a concern in the community, particularly affordable housing for low income residents. Current rental units can be unclean, and environmental health issues are common. More resources are needed for public health programming, as there are fewer low income clinics, staffing issues exist, and programs are not as widely disseminated as possible. Community Meetings Marion County Between May 7 and 9, 2018, three meetings of community representatives were held in Indianapolis, the county seat of Marion County. In total, the meetings were attended by 42 community members invited by IU Health because they represent important community organizations and sectors such as: local health departments, police/fire departments, non-profit organizations, local business, health care providers, mayors/local policymakers, faith-based organizations, parks and recreation departments, and schools. Through the meetings, IU Health sought a breadth of perspectives on the communitys health needs. The specific organizations represented at the meetings are listed below. - Adult and Child Health - All Senior Citizens Connect - Central Indiana Council on Aging (CICOA) - City of Indianapolis - Coburn Place - Community Health Network - Gennesaret Free Clinics - Gleaners Food Bank - Health by Design - IU Health Methodist Hospital - IU Health University Hospital - Indiana Youth Institute - Indianapolis Fire Department - Indianapolis Metropolitan Police Department - Indy Hunger Network - Indianapolis Parks and Recreation - Irvington Development Organization - Jump IN for Healthy Kids - Lawrence Community Gardens - Marion County Public Health Department - New Beginnings Church - Paramount Schools of Excellence - Progress House - Purdue Extension - The Polis Center - University of Indianapolis The meeting began with a presentation that discussed the goals and status of the CHNA process and the purpose of the community meetings. Then, secondary data were presented, along with a summary of the most unfavorable community health indicators. For Marion County, those indicators were (in alphabetical order): - Air pollution - Communicable diseases and STDs - Crime - Mental health and supply of mental health providers - Obesity and lack of physical activity - Poverty and high 'Community Need Index' - Smoking and tobacco use Meeting participants then were asked to discuss whether the identified, unfavorable indicators accurately identified the most significant Schedule H, Part V, Section B, Line 7a CHNA Website A COPY OF IU HEALTH WEST HOSPITAL'S CHNA IS AVAILABLE ON ITS WEBSITE AT THE FOLLOWING URL: https://iuhealth.org/in-the-community Schedule H, Part V, Section B, Line 10a Implementation Strategy Website A COPY OF IU HEALTH WEST HOSPITAL'S CHNA IMPLEMENTATION STRATEGY IS AVAILABLE ON ITS WEBSITE AT THE FOLLOWING URL: https://iuhealth.org/in-the-community Schedule H, Part V, Section B, Line 11 Addressing Identified Needs In conjunction with the CHNA, IU Health West Hospitals Board adopted an implementation strategy in April 2019 related to the 2018 CHNA. IU Health West Hospital 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 West Hospital will address the following community health needs between 2019 and 2021: - Access to Healthcare Services - Drug and Substance Abuse (including Opioids and Alcohol) - Food Insecurity - Mental Health - Obesity and Diabetes - Smoking and Tobacco Usage - Social Determinants of Health IU Health uses the term "Behavioral Health" to refer to Mental Health and Drug and Substance Abuse (including Opioids and Alcohol). Access to Healthcare IU Health West Hospitals implementation strategy to address the identified need of Access to Healthcare includes the following: - Provide operational funding to support HOPE Healthcare Services. - Participate in or support 4-6 Healthy Indiana Plan (HIP)/Medicaid/Medicare registration events with the Hendricks County Health Partnership. Behavioral Health (includes Drug & Substance Abuse and Mental Health) IU Health West Hospitals implementation strategy to address the identified need of Behavioral Health includes the following: - Partner with the Hendricks County Health Partnership to create a three-minute education video for student athletes. - Partner with the Hendricks County Health Partnership to create a three-minute education video for providers and parents. - Partner with the Hendricks County Health Partnership to host public forums about the stigma of substance use disorders. Include live testimonials from individuals with substance use disorders (SUD). - Provide funding to support safe shelter for and evaluation of Sheltering Wings residents. - Support Sheltering Wings educational outreach efforts. - Provide funding to support counseling for Susies Place clients. - Replicate the Academic Health Centers successful Addictions and Pain Management Program in the IU Health West service area. Provide 24/7 peer counseling via telemedicine for patients who present in the emergency department (ED) with substance use disorders (SUD). Food Insecurity IU Health West Hospitals implementation strategy to address the identified need of Food Insecurity includes the following: - Make fresh produce affordable and accessible to low-income residents. - Support Women, Infants, and Children (WIC) and Supplemental Nutrition Assistance Program (SNAP) acceptance at all county farmers markets. - Fund Double Up Bucks program to increase value of vouchers for participants. Obesity and Diabetes IU Health West Hospitals implementation strategy to address the identified need of Obesity and Diabetes include the following: - Continue current partnership with Brownsburg Farmers Market. - Utilize bushel builders cards to encourage regular attendance. - Provide 50 Hendricks County residents with a free 10-week program to improve their overall health through fitness and nutrition. - Provide three health screenings during the 10-week period to measure changes in cholesterol, triglycerides, glucose, A1C, blood pressure, weight and Body Mass Index (BMI). - Support state grant to fund ten mile section of trail expansion. - Fund a 5K event and offer prep/training tips to encourage new walkers and runners. - Partner with the Brownsburg Parks & Recreation to make improvements to local parks, thus encouraging greater physical activity in the parks by Hendricks County residents and visitors. Smoking and Tobacco Usage IU Health West Hospitals implementation strategy to address the identified need of Smoking and Tobacco Usage include the following: - Collaborate with the Hendricks County Health Partnership to present a template of a comprehensive smoke-free workplace policy to the Town of Brownsburg. - Collaborate with the Hendricks County Health Partnership to reinitiate contact with school administrators and guidance counselors to ensure educational posters are displayed in schools. - Write and distribute press release about student outreach program. - Encourage school administrators to send educational material to all parents. Social Determinants of Health IU Health West Hospitals implementation strategy to address the identified need of Social Determinants of Health include the following: - Provide operational funding to support HOPE Healthcare Services. - Make fresh produce affordable and accessible to low-income residents. - Support Women, Infants, and Children (WIC) and Supplemental Nutrition Assistance Program (SNAP) acceptance at all county farmers markets. - Fund Double Up Bucks program to increase value of vouchers for participants. - Support state grant to fund ten mile section of trail expansion. - Fund a 5K event and offer prep/training tips to encourage new walkers and runners. - Partner with the Brownsburg Parks & Recreation to make improvements to local parks, thus encouraging greater physical activity in the parks by Hendricks County residents and visitors. IU West Hospital will address all community health needs based on their 2018 Community Health Needs Assessment. There were no identified needs that will not be addressed. Schedule H, Part V, Section B, Line 13b Income Level Other than FPG IN ADDITION TO FPG, IU HEALTH WEST HOSPITAL 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 West Hospital takes into consideration several other factors in determining patient eligibility for financial assistance. These factors include the following: 1. IU Healths Individual Solutions Department Prior to seeking Financial Assistance under the FAP, all patients or their guarantors must consult with a member of IU Healths 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 West Hospitals Financial Assistance Program. Patients who may be eligible for coverage under an applicable insurance policy, including, but not limited to, health, automobile, and homeowners, must exhaust all insurance benefits prior to receiving an award from IU Health West Hospitals 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 West Hospital. Eligible patients who receive medical care from IU Health West Hospital 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 West Hospital is entitled. In the event a Financial Assistance Award has already been granted in such circumstances, IU Health West Hospital reserves the right to reverse the award in an amount equal to the amount IU Health West Hospital would be entitled to receive had no Financial Assistance been awarded. 3. Alternate Methods of Eligibility Determination IU Health West Hospital 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 patients individual scoring criteria. To ensure all patients potentially eligible for Financial Assistance under the FAP may receive Financial Assistance, IU Health West Hospital 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 Childrens 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 patients account if said patient is found to have no estate. Additionally, IU Health West Hospital 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 West Hospital 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 West Hospitals 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 West Hospital 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 West Hospitals FAP is available on the following website: https://iuhealth.org/pay-a-bill/financial-assistance Schedule H, Part V, Section B, Line 16b FAP Application Website A copy of IU Health West Hospitals FAP Application is available on the following website: 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 West Hospital 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 West Hospital 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 West Hospital will broadly communicate this Policy as part of its general outreach efforts. 5. IU Health West Hospital will educate its patient facing team members of the FAP and the process for referring patients to the Program. 4 IU HEALTH WEST CARDIACPULMONARY REHAB 1115 N RONALD REAGAN PKWY STE M AVON IN 46123 DIAGNOSTIC AND OTHER OUTPATIENT IU HEALTH WEST ORTHO SPORT & SPINE CTR 1115 N RONALD REAGAN PKWY AVON IN 46123 DIAGNOSTIC AND OTHER OUTPATIENT IU HEALTH WEST REHABILITATION SERVICES 1115 N RONALD REAGAN PKWY STE G AVON IN 46123 DIAGNOSTIC AND OTHER OUTPATIENT IU HEALTH WEST SLEEP DISORDERS CENTER 1115 N RONALD REAGAN PKWY STE 3 AVON IN 46123 DIAGNOSTIC AND OTHER OUTPATIENT Schedule H, Part I, Line 3c - Other Factors Used in Determining Elig. IU Health West Hospital 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 West Hospital 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 parents or guardians federal income tax return. 2. IU Healths Individual Solutions Department Prior to seeking Financial Assistance under the FAP, all patients or their guarantors must consult with a member of IU Healths 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 West Hospital 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 West Hospitals Financial Assistance Program. Patients who may be eligible for coverage under an applicable insurance policy, including, but not limited to, health, automobile, and homeowners, must exhaust all insurance benefits prior to receiving an award from IU Health West Hospitals 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 West Hospital. Eligible patients who receive medical care from IU Health West Hospital 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 West Hospital is entitled. In the event a Financial Assistance Award has already been granted in such circumstances, IU Health West Hospital reserves the right to reverse the award in an amount equal to the amount IU Health West Hospital would be entitled to receive had no Financial Assistance been awarded. 6. Alternate Methods of Eligibility Determination IU Health West Hospital 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 patients individual scoring criteria. To ensure all patients potentially eligible for Financial Assistance under the FAP may receive Financial Assistance, IU Health West Hospital 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 Childrens 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 patients account if said patient is found to have no estate. Additionally, IU Health West Hospital 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 West Hospital 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 West Hospital 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 West Hospital 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 West Hospitals 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 West Hospital 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 West Hospital'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 Healths website at https://iuhealth.org/in-the-community. 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 Systems 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) - Bad Debt 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 $19,200,087. 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 - Total Community Benefit Expense Schedule H, Part I, Line 7, Column (f), Percent of Total Expense, is based on column (e) Net Community Benefit Expense. The percent of total expense based on column (c) Total Community Benefit Expense, which does not include direct offsetting revenue, is 21.96%. 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: - Hope HEALTHCARE SERVICES - SHELTERING WINGS - AVON AND BROWNSBURG EDUCATION FOUNDATIONS - United Way ADDITIONALLY, THROUGH THE IU HEALTH STATEWIDE SYSTEM'S TEAM MEMBER COMMUNITY BENEFIT SERVICE PROGRAM, "IU HEALTH SERVES", TEAM MEMBERS ACROSS THE STATE MAKE A DIFFERENCE IN THE LIVES OF THOUSANDS OF HOOSIERS EVERY YEAR. Schedule H, Part III, Line 2 - Methodology Used to Est. Bad Debt Exp. The bad debt expense of $3,523,216 reported on Schedule H, Part III, Line 2 is reported at cost, as calculated using the cost to charge ratio methodology. SCHEDULE H, PART III, LINE 3 - EST. BAD DEBT ATTR. TO PATIENTS UNDER FAP 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'S CONSOLIDATED FINANCIAL STATEMENTS, FOOTNOTE 4, ADDRESSES BAD DEBT EXPENSE 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 $94,886,000 AND $85,295,000 IN 2018 AND 2017, 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 West Hospital Medicare Cost Report. "Allowable costs" for Medicare Cost Report purposes, however, are not reflective of all costs associated with IU Health West Hospitals 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 Wests participation in Medicare programs would significantly increase the Medicare shortfall reported on Schedule H, Part III, Line 7. IU Health West Hospital's Medicare shortfall is attributable to reimbursements that are less than the cost of providing patient care and services to Medicare beneficiaries and does not include any amounts that result from inefficiencies or poor management. IU Health West Hospital 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 West Hospitals 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 applications 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 patients physician, family members, legal counsel, community or religious groups, social services or hospital personnel may request a FAP Application to be mailed to a patients primary mailing address free of charge. IU Health West Hospital 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 patients and/or guarantors 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 West Hospital 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 patients Financial Assistance Application and eligibility determination are specific to each individual date(s) of service and related encounters. 3. Extraordinary Collection Actions IU Health West Hospital may refer delinquent patient accounts to a third-party collection agency after utilizing reasonable efforts to determine a patients eligibility for assistance under the FAP. IU Health West Hospital 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 patients or their guarantors 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 patients or their guarantors 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 patients or their guarantors property, foreclosing on a patients or their guarantors real property attaching or seizing a patients or their guarantors bank account or other personal property, commencing a civil action against a patient or their guarantor, causing a patient or guarantors arrest, causing a patient and/or guarantor to be subject to a writ of body attachment, and garnishing a patient or guarantors wages. When it is necessary to engage in such action, IU Health West Hospital 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 West Hospital. IU Health West Hospital 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 West Hospital 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 West Hospital 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 West Hospital assesses the health care needs of the communities it serves by conducting a Community Health Needs Assessment (CHNA). For the 2018 CHNA, IU Health West Hospital 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 West Hospital 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 West Hospital community are those that are supported by multiple data sources. Additionally, the effectiveness of an intervention for each need and IU Healths ability to impact positive change was evaluated. Schedule H, Part VI, Line 3 - Patient Education of Eligibility for Assist. IU Health West Hospital 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 West Hospital has established a FAP to provide Financial Assistance to Uninsured Patients. IU Health West Hospital is committed to ensuring its patients are compliant with all provisions of the Patient Protection & Affordable Care Act. To that end, IU Health West Hospital 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 West Hospital 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 West Hospital 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 West Hospital will broadly communicate this Policy as part of its general outreach efforts. 5. IU Health West Hospital 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 West Hospital is located in Hendricks County, Indiana, a county located in central Indiana. Based on the most recent Census Bureau (2018) statistics, Hendricks Countys population is 167,009 persons with approximately 50% being female and 50% male. The countys population estimates by race are 83.8% White, 7.4% Black, 4.0% Hispanic or Latino, 3.0% Asian, 0.3% American Indian or Alaska Native, 0.1% Native Hawaiian or Other Pacific Islander and 2.1% persons reporting two or more races. Hendricks County has relatively moderate levels of educational attainment. Among adults 25 and above, 94% completed their education with a high school diploma or equivalent. 35% had a bachelors degree or higher. About 6% ended their formal education before finishing high school. Schedule H, Part VI, Line 5 - Promotion of Community Health IU HEALTH WEST HOSPITAL 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 ORDER TO HELP THE COMMUNITY IN ACCESSING HEALTHCARE, IU HEALTH WEST HOSPITAL PARTNERS WITH HOPE HEALTHCARE SERVICES IN AVON, INDIANA, TO HELP MEET THE NEEDS OF HENDRICKS COUNTY RESIDENTS WHO CONTINUE TO BE UN- OR UNDER-INSURED. HOPE HEALTHCARE SERVICES SERVES MORE THAN 800 PEOPLE EACH YEAR WITH PRIMARY MEDICAL AND DENTAL CARE, CHRONIC DISEASE MANAGEMENT, AND MEDICATION MANAGEMENT. MULTIPLE IU HEALTH WEST PHYSICIANS VOLUNTEER AT THE CLINIC, WHERE MEDICAL AND DENTAL CARE IS SUPPORTED ENTIRELY BY VOLUNTEER HEALTHCARE PROVIDERS. ADDITIONALLY TO ASSIST WITH OBESITY PREVENTION, IU HEALTH WEST HOSPITAL AND THE TOWN OF BROWNSBURG, IN PARTNER TO PRESENT THE TOWN'S FARMERS MARKET FROM MAY-SEPTEMBER ON THE TOWN HALL GREEN. IN ADDITION TO CREATING A VENUE FOR RESIDENTS TO ACCESS LOCALLY GROWN FRESH PRODUCE, THE HOSPITAL AND TOWN ARE COMMITTED TO SUPPORTING AT RISK INDIVIDUALS AND FAMILIES, BY ACCEPTING WIC AND SNAP PAYMENTS FOR PRODUCE, AND BY PROVIDING A COLLECTION LOCATION FOR PRODUCE DONATIONS TO BROWNSBURG AREA FOOD PANTRIES. TO IMPROVE THE PRE K-12TH EDUCATION, IU HEALTH WEST HOSPITAL AND THE AVON SCHOOL CORPORATION HOST A FREE, FOUR WEEK KINDERGARTEN PREPARATORY PROGRAM EVERY JUNE. THE CHILDREN INVITED TO PARTICIPATE HAVE BEEN IDENTIFIED THROUGH THE DISTRICT'S KINDERGARTEN ASSESSMENT AS NEEDING A BOOST IN ORDER TO BE READY TO SUCCEED IN THE CLASSROOM. KINDERGARTEN TEACHERS STAFF THE CLASSROOM, WITH THE HELP OF 40+ HOSPITAL VOLUNTEERS OVER THE COURSE OF FOUR WEEKS, ALL OF WHOM HELP CHILDREN LEARN THE CLASSROOM BASICS, SUCH AS RAISING HANDS AND WALKING IN LINES, AND HELP SET THE STAGE FOR READING, WRITING AND MATH SUCCESS IN THE YEARS AHEAD. Schedule H, Part VI, Line 6 - Affiliated Health Care System IU Health West Hospital is part of the IU Health Statewide System. The IU Health Statewide system is Indianas 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 - Indiana University Health Medical Center is honored to be nationally ranked by U.S. News & World Report for the 21st year in a row. That means IU Health continues to be ranked among the best healthcare systems in the nation and the top healthcare system in Indiana. This ranking recognizes the exceptional care, unmatched expertise and continued excellence of our entire team of caregivers, while giving you confidence that you made the right choice in trusting IU Health with your care. - IU Health Medical Center was among the 4 percent of U.S. hospitals to earn a national ranking and has the most nationally ranked specialties in Indiana. - Nine out of ten specialty programs at Riley Hospital for Children at IU Health ranked among the top 50 childrens hospitals in the nation 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 2012, IU HEALTH COMMITTED TO A STRATEGIC RESEARCH INITIATIVE TO SUPPORT RATABLY FOR A FIVE-YEAR PERIOD ENDED DECEMBER 31, 2016, CERTAIN BASIC, CLINICAL, AND TRANSLATIONAL RESEARCH PROGRAMS OF THE IU SCHOOL OF MEDICINE. THE TOTAL COMMITMENT AGGREGATED $75,000,000. IN 2017, A NEW FIVE-YEAR TERM OF $55,000,000 WAS AGREED UPON EFFECTIVE JULY 1, 2017 THROUGH JUNE 30, 2022. FOR THE YEARS ENDED DECEMBER 31, 2018 AND 2017, THE INDIANA UNIVERSITY HEALTH SYSTEM EXPENSED $11,000,000 AND $5,000,000, RESPECTIVELY, UNDER THESE AGREEMENTS WITHIN SUPPLIES, DRUGS, PURCHASED SERVICES, AND OTHER EXPENSES IN THE ACCOMPANYING CONSOLIDATED STATEMENTS OF OPERATIONS AND CHANGES IN NET ASSETS, OF WHICH $25,652,000 AND $32,875,000 WAS ACCRUED RELATED TO THESE AGREEMENTS WITHIN ACCOUNTS PAYABLE AND ACCRUED EXPENSES AT DECEMBER 31, 2018 AND 2017, RESPECTIVELY. 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 top status of "comprehensive," which would recognize it as one of the top-tier cancer centers in the nation. - Neuroscience: The neurosciences research program will tackle a broad range of brain injuries, neurodegenerative disorders and neurodevelopmental disorders. - Cardiovascular: The cardiovascular research initiative will develop 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 will provide 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 Indianas 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 benefits plan relative to the local community, the IU Health Statewide System considers its community benefit plan as part of an overall vision for strengthening Indianas 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 2018, IU Health provided more than $711 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. IN 2018, MORE THAN 2,848 IU HEALTH TEAM MEMBERS DEDICATED MORE THAN 9,694 VOLUNTEER HOURS IN THEIR COMMUNITIES. 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 2018, IU Health impacted many people statewide through 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. The Indiana University Health Board of Directors also approved Community Health Improvement Grants. With these grants, nearly $750,000 will fund projects that address IU Health priorities - behavioral health/substance abuse, obesity, tobacco use, and infant mortality - as well as community-specific needs. The grants, administered by the Indiana University Health Foundation, were awarded to the following: - Family Vitality Initiative development and implementation, IU Health South Central Region, $230,000 over two years. By bringing together existing healthcare providers, social workers and researchers, this integrated program will take a holistic approach to addressing substance-related healthcare issues, especially among the most vulnerable populations of women and children. The South Central Region has seen alarming increases in the numbers of infants who test positive for opiates at birth, opioid-related encounters in each emergency department, and mothers struggling with addiction including smoking. - Hope Healthcare Services Program, IU Health West, $203,000 over two years. Hope Healthcare Services in Avon is the only entity in Hendricks County that provides primary medical and dental care to uninsured patients. It is staffed entirely by volunteer clinicians, many of them IU Health team members, and helps more than 900 patients a year out of nearly 15,000 uninsured adults in Hendricks County. This grant will fund the clinics first-ever employee, a nurse practitioner, allowing for consistent operating hours, and behavioral health services on-site and via tele-health. With this staffed clinic, they anticipate seeing more than 4,000 patients per year. - Perinatal Coordinator to address infant mortality, IU Health East Central Region, $124,000 over two years. This grant funds a new staff member who will focus on infants and children in Delaware, Blackford and Jay counties. This includes facilitating inter-professional collaboration, educating hospital staff, increasing collaboration with supporting agencies involved with bereavement, safe sleep, tobacco-free and addiction programs, and tracking outcomes in the areas of birthweight, birth defects and mortality. - Continuum of Mental Health Care Program, IU Health West Central Region, $85,247 for one year. In terms of mental illness and access to mental health care, Indiana ranks 48th out of 51 states. In its pilot year, this project will increase capaci true HENDRICKS COUNTY ECONOMIC DEVELOPMENT PARTNERSHIP 5250 E US HIGHWAY 36 AVON IN 46123 351817139 501(C)(6) 20000 COMMUNITY ECONOMIC DEV 1 Schedule I, Part I, Line 2 - Org.'s Proc. for Mon. the Use of Grant Funds Although IU Health West Hospital 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. true true false false false false false true false KENNETH D PUCKETT PRESIDENT - ISR 0 371435 0 134940 0 19309 0 69054 0 28254 0 622992 0 0 DEREK E EMPIE SECRETARY 0 193647 0 32625 0 548 0 11674 0 28615 0 267109 0 0 ARTHUR VASQUEZ President/Treasurer 0 228525 0 39050 0 444 0 13147 0 28520 0 309686 0 0 Harpreetinder Singh MD VP & CMO (Partial Year) 205294 209496 13688 13968 9557 9753 6064 6188 12292 12543 246895 251948 0 0 MEGAN CRITTENDON MD DIRECTOR 0 329163 0 29262 0 540 0 17463 0 7173 0 383601 0 0 LISA A SPARKS RN VP & CNO 181838 0 19539 0 918 0 10408 0 28181 0 240884 0 0 0 PAMELA CHAPMAN DIRECTOR, OR SERVICES(Part Yr) 14683 133398 1102 10010 45 404 837 7602 2989 27160 19656 178574 0 0 JAMES R BILLMAN PHARMACIST 153194 0 206 0 4709 0 1696 0 25585 0 185390 0 0 0 ANNE K STEGEMOLLER DIRECTOR, PHARMACY 147305 0 17868 0 300 0 8612 0 27859 0 201944 0 0 0 LAURA A ROGGY PHARMACIST 149748 0 0 0 4951 0 7976 0 17987 0 180662 0 0 0 JUDITH L COLEMAN FORMER TREASURER 0 242034 0 53304 0 2310 0 13691 0 19712 0 331051 0 0 GREGORY A SPURGIN MD FOMER CMO 0 227977 0 62522 0 11124 0 17875 0 3550 0 323048 0 0 MATTHEW D BAILEY FORMER PRESIDENT 0 287416 0 158544 0 1047262 0 322129 0 7138 0 1822489 0 343365 Elizabeth Dunlap Director 0 500462 0 242162 0 24596 0 11000 0 23402 0 801622 0 0 Michelle A Janney Director 0 502367 0 371179 0 143482 0 121065 0 5899 0 1143992 0 0 David A Ingram MD Director 0 457117 0 79034 0 3169 0 111083 0 0 0 650403 0 0 CARA L BREIDSTER CFO - ISR (PARTIAL YEAR) 0 272747 0 37215 0 3933 0 13532 0 22833 0 350260 0 0 Eric D Peak Pharmacist, Senior 151422 0 0 0 2322 0 7721 0 7200 0 168665 0 0 0 Jamie L Conley-Lebeter Mgr, Pharmacy Oprs 130907 0 12509 0 120 0 5928 0 24124 0 173588 0 0 0 Schedule J, Part I, Line 3 - Comp. of the Org.'s CEO/Executive Director IU HEALTH WEST HOSPITAL'S PRESIDENT IS EMPLOYED BY IU HEALTH. IU HEALTH'S PROCESS FOR DETERMINING COMPENSATION INCLUDES THE USE OF A COMPENSATION SURVEY/STUDY CONDUCTED BY AN INDEPENDENT COMPENSATION CONSULTANT WITH REVIEW AND APPROVAL BY THE COMMITTEE ON PERSONNEL AND COMPENSATION AND THE BOARD OF DIRECTORS. PLEASE SEE SCHEDULE O FOR ADDITIONAL DETAILS. SCHEDULE J, PART I, LINE 4A - SEVERANCE MATTHEW D. BAILEY ENTERED INTO A SEVERANCE AGREEMENT WITH IU HEALTH DURING 2018. SEVERANCE OF $190,847 THAT WAS RECEIVED DURING 2018 IS INCLUDED IN COLUMN B(III), OTHER REPORTABLE COMPENSATION. DEFERRED SEVERANCE OF $308,429 IS INCLUDED IN COLUMN C, RETIREMENT AND OTHER DEFERRED COMPENSATION. Schedule J, Part I, Line 4b - Supplemental Nonqualified Retirement Plan KENNETH D. PUCKETT, MATTHEW D. BAILEY, MICHELLE A. JANNEY, AND DAVID A. INGRAM 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. EACH OF THESE EXECUTIVES HAS AMOUNTS 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. Page 1, Line J Web Site: https://iuhealth.org/find-locations/iu-health-west-hospital Part VI, Section A, Lines 6, 7a and 7b Members or Stockholders Line 6: The sole member of IU Health West Hospital is IU Health, a 501(c)(3) tax-exempt organization. Line 7A: The Board of Directors of IU Health West Hospital shall consist of from three (3) to twelve (12) voting members appointed by IU Health, including up to four (4) directors who are members of the Medical Staff in good standing or physicians employed by IU Health West Hospital or IU Health. Line 7B: The Board of Directors shall not, without the prior approval of the IU Health: - Authorize any merger, consolidation, reorganization, sale or transfer of all or substantially all of the assets of IU Health West Hospital; - Authorize any plan of dissolution of IU Health West Hospital, any liquidating distribution of the IU Health West Hospitals assets or other action related to the dissolution or liquidation of IU Health West Hospital; - Authorize any voluntary declaration of bankruptcy of IU Health West Hospital; - Amend, repeal, revise or adopt changes to the organizational documents of IU Health West Hospital; - Authorize the consolidation of any entity with, or acquisition of any entity by, IU Health West Hospital; - Authorize any agreement to act as primary obligor, or to serve as a guarantor, surety or co-obligor with respect to the indebtedness of any other party, to borrow amounts from third-party lenders or to loan money to any person or entity; - Authorize any pledge of, or grant any security interest or mortgage in, or otherwise encumber, any tangible assets in excess of an appropriate monetary threshold, other than in the ordinary course of business or pursuant to an approved budget or strategic plan; - Authorize any agreement to act as primary obligor, or to serve as a guarantor, surety or co-obligor with respect to the indebtedness of any other party, to borrow amounts from third-party lenders or to loan money to any person or entity; - Approve any management agreement for the management of all or substantial part of IU Health West Hospitals operations; - Authorize the establishment or acquisition by IU Health West Hospital of any subsidiaries, affiliates or joint venture arrangements or the acquisition by IU Health West Hospital of the stock or other equity interest or substantially all the assets of any other business or entity, or - Adopt or amend an operating budget, capital budget, strategic plan, or long-range plan, or significantly deviate therefrom. Part VI, Section A, Line 11b Review of Form 990 The Indianapolis Suburban Region Chief Financial Officer 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 the IU Health Tax Department to answer any questions. Part VI, Section B, Lines 12, 13, and 14 Policies IU Health West Hospital is part of the IU Health system. As the sole member and controlling parent of IU Health West Hospital, IU Health and its board of directors have mandated that certain policies be followed to ensure greater standardization throughout the system. Thus, IU Health West Hospitals Board of Directors was not required to separately adopt a conflict of interest, whistleblower, document retention and destruction and joint venture policies because IU Healths 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 West Hospital follows IU Healths Conflict of Interest Policy. IU Healths 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: (1) 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. (2) 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. (3) 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. (4) 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 Representatives supervisor and other appropriate individuals and groups. (5) 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 supervisors 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. (6) 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 15 Process for Determining Compen. IU Health West Hospitals President is employed by IU Health. IU Healths process for determining compensation is as follows: (1) The Board of Directors has established a Committee on Personnel and Compensation. The individuals on this Committee are made up of individuals who are on the Board and who do not have a conflict of interest with IU Health. There are no physicians or employees on this Committee. This Committee develops and reviews annually the executive compensation philosophy, market analysis as to comparability and reasonableness. One of the purposes of this Committee is to review, approve and make recommendations regarding executive compensation and benefits to the IU Health Board. As deemed appropriate, this Committee also reviews the same detail with the Committee on Finance. The Committee on Finance is represented by certain members of the Board as well. (2) Each year the Committee on Personnel and Compensation engages an outside compensation consulting firm to conduct a compensation and benefits study for all senior vice presidents and above. The current compensation advisor is SullivanCotter. SullivanCotter performs an independent compensation survey. The relevant comparability data includes: compensation and benefit 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. The Committee reviews the entire compensation package including: base compensation, short term and long term incentive plans, basic health and welfare benefits, qualified and nonqualified plans as well as any additional fringe benefits. Further, SullivanCotter will provide recommendations based upon the reasonable compensation information as it relates to salary increases, bonuses and benefits that are consistent with the compensation philosophy of the Committee. A separate analysis using the same methodology is done for the Chief Executive Officer. (3) The Committee reviews the salary survey and, if appropriate, makes recommendations on increases in salary and any changes in bonuses or benefits. The Committee's goal is to ensure that the total compensation and benefits package is reasonable based upon the independent data provided by SullivanCotter. The Committee votes on any changes in compensation or benefits. This review, discussion and vote are documented in the minutes for the meeting. There are no executives present during the final discussion and approval of compensation. (4) The Board reviews the report prepared by SullivanCotter as well as the recommendations of the Committee on Personnel and Compensation as to changes in compensation approved by the Committee. As requested, the Committee on Finance also provides its review of recommendations on changes in executive compensation and benefits. This review, discussion and vote are documented in the minutes. (5) The Board then reviews the recommendations provided by the Committee on Personnel and Compensation and votes on the changes as well. No additional compensation or benefits are paid to the executives until the changes have been approved by the Committee and the Board. The discussion and approval are documented in the minutes of the meeting. There are no executives present during the final discussion and approval of compensation. The General Counsel prepares a formal written opinion reviewing the compensation and benefits approval process, comparing that process to the Intermediate Sanctions Test of IRC Section 4958 and, if the facts warrant, provides comments regarding the compensation and benefits approval process as this 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 Committee and Board also reviews the achievements of the executive group as it relates to the long-term and short-term shared and individual goals developed by the executive 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 and the compensation survey. The discussion and vote of the Committee 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 Committee on Personnel and Compensation and Audit Committee also review the required Form 990 disclosures related to executive compensation and benefits as well as compensation practices and approval processes prior to the filing of the Form 990 return with the Internal Revenue Service. IU Health West Hospital has a process in place to determine the compensation for the other officers and key employees. IU Health West Hospital uses an independent compensation consultant who utilizes a variety of methods and procedures to obtain compensation ranges for comparable officer and employee positions. The independent compensation consultant provides IU Health West Hospital with recommended compensation ranges for its officers and other employees, which are then used as a guide for setting reasonable compensation by management. Management decisions with regard to determining compensation are subject to the review and approval of the Compensation Committee and Board of Directors. Part VI, Section C, Line 19 Public Disclosure IU Health West Hospital's Articles of Incorporation are available to the public through the Indiana Secretary of State's web-site. IU Health West Hospitals conflict of interest policy is described on Form 990, Schedule O. IU Health West Hospital is a consolidated subsidiary in the consolidated financial statements for IU Health. The consolidated financial statements for IU Health are available to the public through its bond filings. PART XI, LINE 9 - OTHER CHANGES IN NET ASSETS OR FUND BALANCES DURING 2018, IU HEALTH WEST HOSPITAL RECORDED THE FOLLOWING OTHER CHANGES IN NET ASSETS OR FUND BALANCES: Equity Transfer (Settlement of Debt): (130,354) IU HEALTH FOUNDATION - RESTRICTED INVESTMENTS: (20,071) TOTAL OTHER CHANGES IN NET ASSETS: (150,425) FORM 990 PART IX LINE 11G DESCRIPTION:SHARED SERVICES/PROF. 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