2018-11-13T07:28:49-06:00 2017-12-31 381357951 PLANTE & MORAN PLLC 750 TRADE CENTRE WAY STE 300 PORTAGE MI 49002 990 2017-01-01 350868133 THE METHODIST HOSPITALS INC METH 2198864402 600 GRANT STREET GARY IN 46402 RAYMOND GRADY CHIEF EXECUTIVE OFFICER 2198864549 2018-11-07 1 CAROL LALONDE CPA P00181637 2695674500 2018-11-07 67.59.56.31 2018-11-07 12:50:50 ES P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 58F74DC53CB874483B207ADF23CD6921384352E9 2017 2019-02-21 02:37:17Z RAYMOND GRADY 600 GRANT STREET GARY IN 46402 497151149 0 X WWW.METHODISTHOSPITALS.ORG X 1941 IN THE METHODIST HOSPITALS, INC. (METHODIST) IS AN INDIANA NONPROFIT CORPORATION OPERATING TWO GENERAL ACUTE CARE HOSPITALS IN NORTHWEST INDIANA. AS GENERAL ACUTE CARE FACILITIES, METHODIST PROVIDES A BROAD RANGE OF DIAGNOSTIC, THERAPEUTIC, EMERGENCY, REHABILITATION, INPATIENT, OUTPATIENT, AND ANCILLARY SERVICES. METHODIST'S MISSION IS TO PROVIDE HIGH QUALITY HEALTHCARE TO ALL PERSONS REGARDLESS OF THEIR RACE, RELIGION, SEX, NATIONAL ORIGIN, HANDICAP, AGE, OR ABILITY TO PAY. METHODIST STRIVES TO PROVIDE APPROPRIATE HEALTH EDUCATION, WELLNESS, AND PREVENTATIVE SERVICES. IN ADDITION, METHODIST IS COMMITTED TO BEING A RESPONSIBLE MEMBER OF THE COMMUNITY, OFFERING ITS RESOURCES TO ASSIST IN THE ACCOMPLISHMENT OF COMMUNITY OBJECTIVES. 19 15 3060 75 24357 0 166793 2264124 367806353 366765983 5417616 13752802 295700 145069 373686462 382927978 416761 319801 0 0 184269723 189405742 0 0 0 180129659 187781146 364816143 377506689 8870319 5421289 380551178 365300464 144646799 121300488 235904379 243999976 X THE METHODIST HOSPITALS, INC'S MISSION IS TO PROVIDE COMPASSIONATE, QUALITY HEALTH CARE SERVICES TO ALL THOSE IN NEED. 0 0 337615453 319801 366741626 THE METHODIST HOSPITALS, INC. HAS A COMMITMENT TO RESPOND TO THE NEEDS OF ITS DIVERSE COMMUNITIES THROUGH QUALITY SERVICES. ITS REGIONAL REPUTATION FOR EXCELLENCE SINCE 1923 CONTINUES TO SUPPORT THE MARKET POSITION.METHODIST HOSPITALS IS AN INDIANA NOT-FOR-PROFIT CORPORATION, 616 BED COMMUNITY-BASED HEALTHCARE SYSTEMS GOVERNED BY A BOARD OF DIRECTORS. STEWARDS OF THE MISSION, REINVESTMENT IN THE COMMUNITIES IS CARRIED OUT THROUGH CHARITABLE GIVING, COMMUNITY EDUCATION PROGRAMS, ECONOMIC DEVELOPMENT FORUMS, SUPPORT SERVICES, SCREENINGS, AND ADVOCATING QUALITY CARE FOR THE MOST VULNERABLE AND UNDERSERVED. METHODIST HOSPITALS CONTINUES TO BE A FRONTRUNNER IN PROMOTING COMMUNITY HEALTH INITIATIVES AND SERVING POPULATIONS WITH HIGH INCIDENTS OF ACUTE ILLNESSES. METHODIST HOSPITALS HAS TWO FULL SERVICE ACUTE CARE CAMPUSES, 14 MILES APART. NORTHLAKE IS THE URBAN CAMPUS IN GARY, WHILE SOUTHLAKE CAMPUS IN MERRILLVILLE IS LOCATED NEAR ONE OF THE MIDWEST'S BUSIEST RETAIL AREAS. COMBINED CAMPUS BED CAPACITY IS 616 INCLUDING NURSERIES. METHODIST PROVIDES A BROAD RANGE OF DIAGNOSTIC, THERAPEUTIC, EMERGENCY, REHABILITATION, INPATIENT, OUTPATIENT AND ANCILLARY SERVICES.MIDLAKE CAMPUS IS AN OUTPATIENT FACILITY IN GARY CONVENIENTLY LOCATED BETWEEN NORTHLAKE AND SOUTHLAKE CAMPUSES, PARALLEL TO INTERSTATE 94. THE REHAB CENTERS, PROVIDING OUTPATIENT REHABILITATION SERVICES AT MIDLAKE, OPENED IN 2003. LOCATED ADJACENT TO THE MAIN ENTRANCE OF THE SOUTHLAKE CAMPUS IN MERRILLVILLE, IS THE DIAGNOSTIC OUTPATIENT CENTER AND MEDICAL OFFICE BUILDING. THIS FACILITY PROVIDES ADVANCED DIAGNOSTIC, IMAGING SERVICES, AND LABORATORY SERVICES AS WELL AS PROFESSIONAL OFFICES FOR MANY OF THE MEDICAL STAFF.THE MEDICAL STAFF OF MORE THAN 500 PHYSICIANS REPRESENTS NEARLY 40 MEDICAL SPECIALTIES. METHODIST HOSPITALS IS ONE OF THE TOP EMPLOYERS IN NORTHWEST INDIANA WITH OVER 2,500 EMPLOYEES. MISSIONTHE MISSION IS TO PROVIDE COMPASSIONATE, QUALITY HEALTH CARE SERVICES TO ALL THOSE IN NEED.VISIONTHE VISION IS TO BE THE BEST PLACE FOR EMPLOYEES TO WORK, THE BEST PLACE FOR PATIENTS TO RECEIVE CARE AND THE BEST PLACE FOR PHYSICIANS TO PRACTICE MEDICINE. 337615453 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 1 1 0 0 1 253 0 1 3060 1 1 1 0 0 0 0 0 0 0 0 0 X 19 15 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 0 IN X RAYMOND GRADY 2198864000 600 GRANT STREET GARY IN 46402 MAMON POWERS JR BOARD CHAIRMAN 2.20 0.00 X X 0 0 0 SCOTT T RIBORDY BOARD VICE-CHAIRMAN 2.00 0.20 X X 6000 0 0 ROBERT E JOHNSON III BOARD SECRETARY 2.00 0.10 X X 6000 0 0 JOHN A LOWENSTINE CPA BOARD TREASURER 2.00 0.00 X X 6000 0 0 FRANCES TAYLOR BOARD SECRETARY - PART YEAR 2.00 0.00 X X 4000 0 0 RAIED ABDULLAH MD BOARD MEMBER 2.00 0.00 X 5975 0 0 FADI ALZEIDAN MD BOARD MEMBER 2.00 0.00 X 484966 0 28243 BHARAT H BARAI MD BOARD MEMBER 2.00 0.00 X 85105 0 0 DOUGE BARTHELEMY MD BOARD MEMBER 2.00 0.00 X 9375 0 0 WILLIAM BRAMAN BOARD MEMBER 2.00 0.00 X 6000 0 0 CHARLES D BROOKS JR BOARD MEMBER 2.00 0.00 X 6000 0 0 ANGELIQUE BROWN MD BOARD MEMBER 2.00 0.00 X 314728 0 10144 MATTISON DILTS BOARD MEMBER 2.00 0.00 X 6000 0 0 F RITCHEY EIBEL BOARD MEMBER 2.00 0.00 X 0 0 0 RITA R JACKSON BOARD MEMBER 2.00 0.00 X 5000 0 0 HEATHER MCCARTHY BOARD MEMBER 2.00 0.50 X 6000 0 0 DR CHERYL L PRUITT BOARD MEMBER 2.00 0.00 X 5000 0 0 GLENN S VICIAN BOARD MEMBER 2.00 0.10 X 6000 0 0 REV LARRY WHITEHEAD BOARD MEMBER 2.00 0.00 X 5000 0 0 KATRINA WRIGHT MD BOARD MEMBER 2.00 0.00 X 6700 0 0 RAYMOND GRADY CHIEF EXECUTIVE OFFICER 40.00 0.00 X 677529 0 24789 MATTHEW DOYLE CHIEF FINANCIAL OFFICER 40.00 0.00 X 380293 0 21044 WRIGHT ALCORN VP OF OPERATIONS 40.00 0.00 X 301400 0 19903 TRACY CRANDALL VP OF HUMAN RESOURCES 40.00 0.00 X 257192 0 16461 JAMES KIRCHNER VP PHYSICIAN INTEGRATION 40.00 0.00 X 295076 0 22666 VINCENT SEVIER CHIEF QUALITY OFFICER 40.00 0.00 X 361611 0 26329 SHELLY MAJOR CHIEF NURSING OFFICER (JAN-OCT) 40.00 0.00 X 300597 0 24191 ANDRE ARTIS PHYSICIAN 40.00 0.00 X 885873 0 22635 MIHAS KODENCHERY PHYSICIAN 40.00 0.00 X 733467 0 24829 ASHISH PATEL PHYSICIAN 40.00 0.00 X 733934 0 18198 VINEET SHAH PHYSICIAN 40.00 0.00 X 667923 0 29055 RAY SAWAQED PHYSICIAN 40.00 0.00 X 647347 0 18849 7216091 0 307336 142 0 1 0 COMPREHENSIVE PHARMACY SERVICES LLC 6409 QUAIL HOLLOW ROAD MEMPHIS TN 38120 PHARMACY SERVICES 14393499 AMERICAN ANESTHESIA ASSOCIATES OF ILLINO PO BOX 281034 ATLANTA GA 30384 ANESTHESIOLOGY SERVICES 5691743 CROTHALL CLINICAL EQUIPMENT SERVICES 955 CHESTERBROOK BLVD WAYNE PA 19087 BIOMEDICAL SERVICES 4915712 SKANSKA USA BUILDING INC 350 FIFTH AVENUE 32ND FLOOR NEW YORK NY 10118 CONSTRUCTION SERVICES 4251426 POWERS & SONS CONSTRUCTION 2636 WEST 15TH AVENUE GARY IN 46404 CONSTRUCTION SERVICES 3305593 29 121132 31834 2111158 2264124 HEALTHCARE AND SOCIAL ASSISTANCE 621500 310939690 310939690 DISPROPORTIONATE SHARE 621500 52277548 52277548 OTHER PATIENT SERVICES 621500 3492305 3492305 EMR INCENTIVE PAYMENTS 900099 32083 32083 PARTNERSHIP INCOME 621500 24357 24357 366765983 4118795 4118795 819209 674140 145069 145069 145069 122991371 191667 113515880 33151 9475491 158516 9634007 9634007 382927978 366741626 24357 13897871 X 319801 319801 3741317 903163 2838154 148478746 134182672 14296074 2689484 2414084 275400 24059985 21333734 2726251 10436210 9206233 1229977 859456 822697 36759 973281 864183 109098 193130 171435 21695 201363 178743 22620 134958 134958 38450279 34495213 3955066 1127677 1001764 125913 64116350 58254423 5861927 5800728 5149273 651455 13469181 8824951 4644230 269871 241390 28481 118280 98363 19917 3429469 3077392 352077 18770349 16861892 1908457 3556741 3270119 286622 BAD DEBT EXPENSE 20384296 20384296 MEDICAID ASSESSMENT FEE 13881669 13881669 REORGANIZATION COSTS 956977 849475 107502 DUES & SUBSCRIPTIONS 753567 510492 243075 333524 317996 15528 377506689 337615453 39891236 0 1673084 309841 8980721 9998092 79537438 71650207 11126424 11414094 3423144 3616215 493753374 347883258 141237536 145870116 128116583 116462557 245976 0 6210272 5979342 380551178 365300464 38166611 28637069 47253929 44830834 19297239 19125222 39929020 28707363 144646799 121300488 X 235578132 243685752 301247 289224 25000 25000 235904379 243999976 380551178 365300464 X 5421289 2620238 54070 X X 0 1 X 1 0 X 0 0 0 0 0 0 1 126720 0 1 74643 201363 0 PART II-B, LINE 1: ENGAGED FAEGRE BAKER DANIELS, LLP AND BARNES AND THORNBURG AS FEDERAL LOBBYING COUNCIL TO REVIEW, DISCUSS, AND ADVOCATE RELATIVE TO MEDICARE GEOGRAPHICAL REIMBURSEMENT ISSUES. IN ADDITION, THEY WILL DRAFT LEGISLATION OR AMENDMENTS TO LEGISLATION, REVIEW PROPOSED RULES & REGULATIONS AND FILE ALL NECESSARY FORMS TO ENSURE THE HOSPITAL IS PROPERLY REGISTERED UNDER FEDERAL LOBBYING LAWS. IN ADDITION, THE CHIEF CONSULTANT OF GOVERNMENTAL AFFAIRS MEETS WITH STATE AND LOCAL LEGISLATORS ON ISSUES AFFECTING THE ORGANIZATION. A PORTION OF MEMBERSHIP DUES PAID TO THE INDIANA HOSPITAL ASSOCIATION (IHA) IS ATTRIBUTABLE TO LOBBYING ACTIVITIES. THE RESPECTIVE PERCENTAGES HAVE BEEN APPLIED, AS PROVIDED BY THE RESPECTIVE ORGANIZATIONS. PART II-B, LINE 1(G): THE CHIEF CONSULTANT OF GOVERNMENTAL AFFAIRS MEETS WITH STATE AND LOCAL LEGISLATORS ON ISSUES AFFECTING THE ORGANIZATION. 5373674 5373674 279747909 210162457 69585452 2606826 388576 2218250 200130110 137332225 62797885 5894855 5894855 145870116 THIRD PARTY PAYOR SETTLEMENT 7711723 ESTIMATED SELF INSURANCE LIABILITY 7864669 ASBESTOS MITIGATION LIABILITY 608895 PENSION & POST RETIREMENT OBLIGATIONS 12461605 OTHER LIABILITES 60471 28707363 366158331 2620238 -20064025 -17443787 383602118 -674140 -674140 382927978 358029065 906672 906672 357122393 20384296 20384296 377506689 PART XI, LINE 2D - OTHER ADJUSTMENTS: REVENUE FROM FOUNDATION 266,201. BAD DEBT EXPENSE -20,384,296. PENSION-RELATED CHANGES OTHER THAN NET PERIODIC COST 54,070. PART XI, LINE 4B - OTHER ADJUSTMENTS: RENTAL EXPENSE -674,140. PART XII, LINE 2D - OTHER ADJUSTMENTS: FOUNDATION EXPENSES 232,532. RENTAL EXPENSE 674,140. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 20,384,296. 1 1 X 1 X 1 X 1 1 1 0 1 1 10214523 10214523 0.02860 104388906 88825218 15563688 0.04360 114603429 88825218 25778211 0.07220 21 6523 387033 387033 0.00110 3 73 644721 181965 462756 0.00130 1 11 319801 319801 0.00090 25 6607 1351555 181965 1169590 0.00330 25 6607 115954984 89007183 26947801 0.07550 1 20384296 2702970 90682104 96180386 -5498282 X 1 1 2 1 THE METHODIST HOSPITALS INC 600 GRANT STREET GARY IN 46402 WWW.METHODISTHOSPITALS.ORG 15-005002-1 X X X 2 THE METHODIST HOSPITALS INC 8701 BROADWAY MERRILLVILLE IN 46410 WWW.METHODISTHOSPITALS.ORG 15-005002-1 X X X THE METHODIST HOSPITALS INC 1 0 0 1 X X X X X X X X X X 16 1 1 0 1 X SEE PART V, PAGE 8 X 1 16 0 1 0 1 X 200.000000000000 400.000000000000 X X X X X X X 1 1 X X X X 1 X SEE PART V, PAGE 8 X SEE PART V, PAGE 8 X SEE PART V, PAGE 8 X X X X X X X 1 X 0 X X X X 1 X 0 0 THE METHODIST HOSPITALS INC 2 0 0 1 X X X X X X X X X X 16 1 1 0 1 X SEE PART V, PAGE 8 X 1 16 0 1 0 1 X 200.000000000000 400.000000000000 X X X X X X X 1 1 X X X X 1 X SEE PART V, PAGE 8 X SEE PART V, PAGE 8 X SEE PART V, PAGE 8 X X X X X X X 1 X 0 X X X X 1 X 0 0 THE METHODIST HOSPITALS, INC. PART V, SECTION B, LINE 3J: THE CHNA THAT WAS CONDUCTED CONTAINED: THE TOP COMMUNITY HEALTH AND SOCIAL PROBLEMS; BARRIERS TO GOOD HEALTH; DEMOGRAPHICS OF THE PRIMARY SERVICE AREAS AS COMPARED TO THE STATE AND COUNTY THE HOSPITAL IS LOCATED IN; DEATH, DISEASE, AND CHRONIC CONDITIONS THAT ARE PREVALENT IN THE PRIMARY SERVICE AREA. THE SURVEY ALSO DEFINES THE SAMPLE AND DATA COLLECTION METHODOLOGY USED ALONG WITH A COPY OF THE SURVEY. THE METHODIST HOSPITALS, INC. PART V, SECTION B, LINE 3J: THE CHNA THAT WAS CONDUCTED CONTAINED: THE TOP COMMUNITY HEALTH AND SOCIAL PROBLEMS; BARRIERS TO GOOD HEALTH; DEMOGRAPHICS OF THE PRIMARY SERVICE AREAS AS COMPARED TO THE STATE AND COUNTY THE HOSPITAL IS LOCATED IN; DEATH, DISEASE, AND CHRONIC CONDITIONS THAT ARE PREVALENT IN THE PRIMARY SERVICE AREA. THE SURVEY ALSO DEFINES THE SAMPLE AND DATA COLLECTION METHODOLOGY USED ALONG WITH A COPY OF THE SURVEY. THE METHODIST HOSPITALS, INC. PART V, SECTION B, LINE 5: THE COMMUNITY HEALTH NEEDS ASSESSMENT WAS COMPRISED OF A SERIES OF ONLINE INTERVIEWS WITH COMMUNITY AND HEALTH CARE LEADERS, SECONDARY ANALYSIS OF THE REGIONAL DEMOGRAPHICS AND HEALTH TRENDS, AND A QUANTITATIVE SURVEY OF RESIDENTS OF THE REGION USING BOTH AN ONLINE AND PAPER-BASED SURVEY THAT WAS DISTRIBUTED AT LOCATIONS AND EVENTS SUCH AS: SENIOR CENTERS, FQHCS, LOCAL COLLEGES, HEALTH FAIRS, PHYSICIAN SEMINARS, AND CHURCHES. OUTREACH TO DISTRIBUTE PAPER SURVES WAS USED SO AS TO IMPROVE THE SURVEY SCOPE TO THOSE THAT MAY BE UNDER-REPRESENTED IN A TRADITIONAL SURVEY RESEARCH PROJECT. THE METHODIST HOSPITALS, INC. PART V, SECTION B, LINE 5: THE COMMUNITY HEALTH NEEDS ASSESSMENT WAS COMPRISED OF A SERIES OF ONLINE INTERVIEWS WITH COMMUNITY AND HEALTH CARE LEADERS, SECONDARY ANALYSIS OF THE REGIONAL DEMOGRAPHICS AND HEALTH TRENDS, AND A QUANTITATIVE SURVEY OF RESIDENTS OF THE REGION USING BOTH AN ONLINE AND PAPER-BASED SURVEY THAT WAS DISTRIBUTED AT LOCATIONS AND EVENTS SUCH AS: SENIOR CENTERS, FQHCS, LOCAL COLLEGES, HEALTH FAIRS, PHYSICIAN SEMINARS, AND CHURCHES. OUTREACH TO DISTRIBUTE PAPER SURVES WAS USED SO AS TO IMPROVE THE SURVEY SCOPE TO THOSE THAT MAY BE UNDER-REPRESENTED IN A TRADITIONAL SURVEY RESEARCH PROJECT. THE METHODIST HOSPITALS, INC. PART V, SECTION B, LINE 6A: THE METHODIST HOSPITALS, INC'S CHNA WAS CONDUCTED JOINTLY WITH THE FOLLOWING OTHER HOSPITAL ORGANIZATIONS: COMMUNITY HEALTHCARE SYSTEMS AND FRANCISCAN ALLIANCE OF NORTHWEST INDIANA. THE METHODIST HOSPITALS, INC. PART V, SECTION B, LINE 6A: THE METHODIST HOSPITALS, INC'S CHNA WAS CONDUCTED JOINTLY WITH THE FOLLOWING OTHER HOSPITAL ORGANIZATIONS: COMMUNITY HEALTHCARE SYSTEMS AND FRANCISCAN ALLIANCE OF NORTHWEST INDIANA. THE METHODIST HOSPITALS, INC. PART V, SECTION B, LINE 11: METHODIST HOSPITALS USED THE CHNA TO IDENTIFY ISSUES OF GREATEST CONCERN AND DEVELOPED ACTION PLANS ON KEY FOCUS AREAS IN WHICH TO COMMIT RESOURCES IN ORDER TO IMPROVE RESIDENT'S HEALTH , IMPROVE QUALITY OF LIFE, REDUCE HEALTH DISPARITIES AND TO INCREASE ACCESSIBILITY TO PREVENTATIVE SERVICES. IN 2016 PROGRAMS AND SERVICES ENACTED BASED ON NEEDS IDENTIFIED IN THE CHNA INCLUDED THE FOLLOWING FOCUS AREAS: DIABETES PREVENTION, IMPROVING NUTRITION AND PHYSICAL ACTIVITY, EXPANSION AND IMPROVE ACCESS TO BEHAVIORAL HEALTH SERVICES. IN ADDITION,METHODIST MAINTAINED ONGOING INITIATIVES IN THE ARES OF: HEART DISEASE AND STROKE, VIOLENCE PREVENTION, DIABETES, AND ACCESS TO CARE PROGRAMS. METHODIST HOSPITALS DOES NOT CURRENTLY HAVE PROGRAMS THAT SPECIFICALLY ADDRESS THE REGION'S HIGHER THAN AVERAGE TOBACCO USE RATES OR PERCEIVED LACK OF DENTAL CARE. THE TASK FORCE CHARGED WITH DEVELOPING ACTION PLANS BASED ON THE COMMUNITY HEALTH NEEDS ASSESSMENT WILL DEVELOP PRIORITIES AND FUTURE PLANS FOR ADDRESSING THESE UNMET NEEDS. THE METHODIST HOSPITALS, INC. PART V, SECTION B, LINE 11: METHODIST HOSPITALS USED THE CHNA TO IDENTIFY ISSUES OF GREATEST CONCERN AND DEVELOPED ACTION PLANS ON KEY FOCUS AREAS IN WHICH TO COMMIT RESOURCES IN ORDER TO IMPROVE RESIDENT'S HEALTH , IMPROVE QUALITY OF LIFE, REDUCE HEALTH DISPARITIES AND TO INCREASE ACCESSIBILITY TO PREVENTATIVE SERVICES. IN 2016 PROGRAMS AND SERVICES ENACTED BASED ON NEEDS IDENTIFIED IN THE CHNA INCLUDED THE FOLLOWING FOCUS AREAS: DIABETES PREVENTION, IMPROVING NUTRITION AND PHYSICAL ACTIVITY, EXPANSION AND IMPROVE ACCESS TO BEHAVIORAL HEALTH SERVICES. IN ADDITION,METHODIST MAINTAINED ONGOING INITIATIVES IN THE ARES OF: HEART DISEASE AND STROKE, VIOLENCE PREVENTION, DIABETES, AND ACCESS TO CARE PROGRAMS. METHODIST HOSPITALS DOES NOT CURRENTLY HAVE PROGRAMS THAT SPECIFICALLY ADDRESS THE REGION'S HIGHER THAN AVERAGE TOBACCO USE RATES OR PERCEIVED LACK OF DENTAL CARE. THE TASK FORCE CHARGED WITH DEVELOPING ACTION PLANS BASED ON THE COMMUNITY HEALTH NEEDS ASSESSMENT WILL DEVELOP PRIORITIES AND FUTURE PLANS FOR ADDRESSING THESE UNMET NEEDS. THE METHODIST HOSPITALS, INC. PART V, SECTION B, LINE 13B: METHODIST HOSPITALS PROVIDES EMERGENCY AND OTHER MEDICALLY NECESSARY SERVICES AT NO CHARGE TO THE PATIENT IF THE FAMILY INCOME IS AT OR BELOW 200% OF THE FEDERAL POVERTY GUIDELINES (FPG). PATIENTS WHOSE FAMILY INCOME IS BETWEEN 200 - 400% OF FPG ARE ELIGIBLE FOR SLIDING-SCAL FINANCIAL RELIEF. ALL OTHER APPLICANTS WILL BE SCREENED FOR OTHER SOURCES OF PAYMENT TO DETERMINE WHAT LEVEL OF FINANCIAL ASSISTANCE MAY BE GRANTED. THE METHODIST HOSPITALS, INC. PART V, SECTION B, LINE 13B: METHODIST HOSPITALS PROVIDES EMERGENCY AND OTHER MEDICALLY NECESSARY SERVICES AT NO CHARGE TO THE PATIENT IF THE FAMILY INCOME IS AT OR BELOW 200% OF THE FEDERAL POVERTY GUIDELINES (FPG). PATIENTS WHOSE FAMILY INCOME IS BETWEEN 200 - 400% OF FPG ARE ELIGIBLE FOR SLIDING-SCAL FINANCIAL RELIEF. ALL OTHER APPLICANTS WILL BE SCREENED FOR OTHER SOURCES OF PAYMENT TO DETERMINE WHAT LEVEL OF FINANCIAL ASSISTANCE MAY BE GRANTED. THE METHODIST HOSPITALS, INC. PART V, SECTION B, LINE 13H: FAMILY SIZE AND COMPOSITION. THE METHODIST HOSPITALS, INC. PART V, SECTION B, LINE 13H: FAMILY SIZE AND COMPOSITION THE METHODIST HOSPITALS, INC. PART V, SECTION B, LINE 15E: METHODIST HOSPITALS MAY UTILIZE OTHER SOURCES OF INFORMATION TO MAKE INDIVIDUAL ASSESSMENTS OF FINANCIAL NEED. METHODIST MAY UTILIZE A THIRD-PARTY TO CONDUCT AN ELECTRONIC REVIEW OF PATIENT INFORMATION TO ASSESS FINANCIAL NEED USING A HEALTHCARE INDUSTRY-RECOGNIZED MODEL BASED ON PUBLIC RECORD DATABASES. IN ADDITION, METHODIST HOSPITALS PROVIDES WEB LINKS TO STATE AND FEDERAL INSURANCE PROGRAMS GEARED TOWARDS THE UNINSURED. THE METHODIST HOSPITALS, INC. PART V, SECTION B, LINE 15E: METHODIST HOSPITALS MAY UTILIZE OTHER SOURCES OF INFORMATION TO MAKE INDIVIDUAL ASSESSMENTS OF FINANCIAL NEED. METHODIST MAY UTILIZE A THIRD-PARTY TO CONDUCT AN ELECTRONIC REVIEW OF PATIENT INFORMATION TO ASSESS FINANCIAL NEED USING A HEALTHCARE INDUSTRY-RECOGNIZED MODEL BASED ON PUBLIC RECORD DATABASES. IN ADDITION, METHODIST HOSPITALS PROVIDES WEB LINKS TO STATE AND FEDERAL INSURANCE PROGRAMS GEARED TOWARDS THE UNINSURED. THE METHODIST HOSPITALS, INC. PART V, SECTION B, LINE 16J: METHODIST HOSPITALS' FINANCIAL ASSISTANCE POLICY AND INSTRUCTIONS ON HOW TO CONTACT METHODIST FOR ASSISTANCE AND FURTHER INFORMATION IS POSTED IN THE HOSPITAL AND CLINIC REGISTRATION AND ADMITTING LOCATIONS, AND IN THE EMERGENCY DEPARTMENT AND ON THE HOSPITAL'S WEBSITE. INFORMATION MAY ALSO BE OBTAINED FROM FINANCIAL COUNSELORS. IN ADDITION, METHODIST HOSPITALS INCLUDES A REFERENCE TO THE PAYMENT POLICIES AND FINANCIAL ASSISTANCE ON ALL PRINTED MONTHLY STATEMENTS AND COLLECTION LETTERS. THE METHODIST HOSPITALS, INC. PART V, SECTION B, LINE 16J: METHODIST HOSPITALS' FINANCIAL ASSISTANCE POLICY AND INSTRUCTIONS ON HOW TO CONTACT METHODIST FOR ASSISTANCE AND FURTHER INFORMATION IS POSTED IN THE HOSPITAL AND CLINIC REGISTRATION AND ADMITTING LOCATIONS, AND IN THE EMERGENCY DEPARTMENT AND ON THE HOSPITAL'S WEBSITE. INFORMATION MAY ALSO BE OBTAINED FROM FINANCIAL COUNSELORS. IN ADDITION, METHODIST HOSPITALS INCLUDES A REFERENCE TO THE PAYMENT POLICIES AND FINANCIAL ASSISTANCE ON ALL PRINTED MONTHLY STATEMENTS AND COLLECTION LETTERS. PART V, LINE 7: THE COMMUNITY HEALTH NEEDS ASSESSMENT REPORT CAN BE LOCATED AT THE FOLLOWING WEB ADDRESS:HTTP://WWW.METHODISTHOSPITALS.ORG/ABOUT_METHODIST/COMMUNITY-HEALTH-NEEDS-ASSESSMENT/ PART V, LINE 7: THE COMMUNITY HEALTH NEEDS ASSESSMENT REPORT CAN BE LOCATED AT THE FOLLOWING WEB ADDRESS:HTTP://WWW.METHODISTHOSPITALS.ORG/ABOUT_METHODIST/COMMUNITY-HEALTH-NEEDS-ASSESSMENT/ PART V, LINES 16A, 16B, AND 16C: THE FAP, FAP APPLICATION, AND FAP PLAIN LANGUAGE SUMMARY CAN BE LOCATED AT THE FOLLOWING WEB ADDRESS:HTTP://WWW.METHODISTHOSPITALS.ORG/BILLING_INFO/OBTAINING-FINANCIAL-ASSISTANCE/ PART V, LINES 16A, 16B, AND 16C: THE FAP, FAP APPLICATION, AND FAP PLAIN LANGUAGE SUMMARY CAN BE LOCATED AT THE FOLLOWING WEB ADDRESS:HTTP://WWW.METHODISTHOSPITALS.ORG/BILLING_INFO/OBTAINING-FINANCIAL-ASSISTANCE/ 28 1 - METHODIST HOSPITALS MEDICAL OFFICE BUILDIN 101 E 87TH AVE MERRILLVILLE IN 46410 IMAGING AND LAB SERVICES; OUTPATIENT SURGERY CENTER; BREAST CENTER; PHYSICIA 2 - METHODIST HOSPITALS ENDOSCOPY CENTER 8895 BROADWAY MERRILLVILLE IN 46410 OUTPATIENT ENDOSCOPY CENTER 3 - METHODIST HOSPITALS INC 2269 WEST 25TH STREET GARY IN 46404 OUTPATIENT REHAB/PHYSICIAN OFFICES 4 - METHODIST HOSPITALS PHYSICIAN GROUP 5800 BROADWAY MERRILLVILLE IN 46410 PHYSICIAN OFFICES-CARDIOLOGY 5 - METHODIST HOSPITALS PHYSICIAN GROUP 202 E 86TH BROADWAY STES 200 201 202-B MERRILLVILLE IN 46410 PHYSICIAN OFFICES-CARDIOLOGY 6 - METHODIST HOSPITALS PHYSICIAN GROUP 8777 BROADWAY MERRILLVILLE IN 46410 PHYSICIAN OFFICES-FAMILY MEDICINE & INTERNAL MEDICINE 7 - METHODIST HOSPITALS NORTHLAKE PHYSICIANS C 650 GRANT ST GARY IN 46408 HOME HEALTH SERVICES & PHYSICIAN OFFICES-UROLOGY & FAMILY MEDICINE 8 - METHODIST HOSPITALS REHAB CENTER 303 E 89TH AVE MERRILLVILLE IN 46410 OUTPATIENT REHAB 9 - METHODIST HOSPITALS CARE FIRST 751-761 EAST 81ST AVE MERRILLVILLE IN 46410 OUTPATIENT CARDIAC REHAB, IMMEDIATE CARE CLINIC, AND PHYSICIAN OFFICES-FAMIL 10 - METHODIST HOSPITALS PHYSICIAN GROUP 3195 BROADWAY GARY IN 46403 PHYSICIAN OFFICE-INTERNAL MEDICINE 11 - METHODIST HOSPITALS PHYSICIAN GROUP 311 E 89TH AVE MERRILLVILLE IN 46410 PHYSICIAN OFFICES-FAMILY MEDICINE 12 - METHODIST HOSPITALS PHYSICIAN GROUP 6111 HARRISON ST - STE 252 MERRILLVILLE IN 46410 PHYSICIAN OFFICE-GENERAL SURGERY 13 - METHODIST HOSPITALS PHYSICIAN GROUP 9105-A INDIANAPOLIS BLVD HIGHLAND IN 46322 PHYSICIAN OFFICE-PODIATRY 14 - METHODIST HOSPITALS PHYSICIAN GROUP 1275 E NORTH STREET CROWN POINT IN 46307 IMMEDIATE CARE CLINIC AND PHYSICIAN OFFICES 15 - METHODIST HOSPITALS CENTER FOR ADVANCED CL 200 E 89TH AVE MERRILLVILLE IN 46410 PHYSICIAN OFFICES-NEUROSCIENCES 16 - METHODIST HOSPITALS PHYSICIAN GROUP 801 WEST GLEN PARK AVE GRIFFITH IN 46319 PHYSICIAN OFFICE-GENERAL SURGERY 17 - METHODIST HOSPITALS PHYSICIAN GROUP 10 NMICHIGAN HOBART IN 46342 PHYSICIAN OFFICE-INTERNAL MEDICINE 18 - METHODIST HOSPITALS PHYSICIAN GROUP 704 SOUTH STATE ROAD 2 HEBRON IN 46341 PHYSICIAN OFFICE-FAMILY MEDICINE 19 - SCHERERVILLE IMAGING CENTER 7860 BURR ST SCHERERVILLE IN 46375 IMAGING CENTER 20 - METHODIST HOSPITALS PHYSICIAN GROUP 2200 GRANT ST GARY IN 46404 PHYSICIAN OFFICE-OB/GYN 21 - METHODIST HOSPITALS PHYSICIAN GROUP 6101 MILLER AVE GARY IN 46403 PHYSICIAN OFFICE-INTERNAL MEDICINE 22 - METHODIST HOSPITALS PHYSICIAN GROUP 206 E 86TH ST MERRILLVILLE IN 46410 PHYSICIAN OFFICE-GENERAL SURGERY 23 - METHODIST HOSPITALS PHYSICIAN GROUP 3229 BROADWAY - STE 104 GARY IN 46409 PHYSICIAN OFFICES-CARDIOLOGY 24 - METHODIST HOSPITALS PHYSICIAN GROUP 9250 COLUMBIA AVE MUNSTER IN 46321 PHYSICIAN OFFICES-NEUROSCIENCES 25 - METHODIST HOSPITALS PHYSICIAN GROUP 11496 BROADWAY CROWN POINT IN 46307 PHYSICIAN OFFICES-FAMILY MEDICINE 26 - METHODIST HOSPITALS PHYSICIAN GROUP 1903 SOUTH HEATON ST KNOX IN 46534 PHYSICIAN OFFICES-CARDIOLOGY 27 - METHODIST HOSPITALS PHYSICIAN GROUP 8733 W 400 N MICHIGAN CITY IN 46360 PHYSICIAN OFFICES-BARIATRIC 28 - METHODIST HOSPITALS PHYSICIAN GROUP 1212 BROAD ST GRIFFITH IN 46319 PHYSICIAN OFFICES-CARDIOLOGY PART I, LINE 3C: METHODIST HOSPITALS USES PUBLISHED FEDERAL POVERTY GUIDELINES TO DETERMINE ELIGIBILITY FOR CHARITY OR MAY BE ELIGIBLE FOR SLIDING-SCALE FINANCIAL RELIEF. IF A PATIENT IS DEEMED TO HAVE A CATASTROPHIC BALANCE WHICH IS A BALANCE DUE TO METHODIST HOSPITALS THAT IS GREATER THAN 25% OF THE PATIENT'S ANNUAL FAMILY INCOME AS DETERMINED OVER A 12 MONTH PERIOD, THE PATIENT MAY BE ELIGIBLE FOR FINANCIAL ASSISTANCE. PART I, LINE 7: THE METHODOLOGY USED IS A COST-TO-CHARGE RATIO. PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 20,384,296. PART II, COMMUNITY BUILDING ACTIVITIES: METHODIST HOSPITALS' COMMUNITY ENGAGEMENT INCLUDES A BROAD RANGE OF AFFILIATIONS AND PARTNERSHIPS INCLUDING THE CITY OF GARY, GARY LITERACY COALITION, YWCA OF GARY, LOCAL CHAMBERS OF COMMERCE, COMMUNITY ORGANIZATIONS FOR FAMILIES AND YOUTH, AND THE MERRILLVILLE HIGH SCHOOL INTERNSHIP PROGRAM. THE HOSPITAL IS ALSO A LEADER IN THE SUPPORT OF A NUMBER OF HEALTH ADVOCACY ORGANIZATION INCLUDING THE AMERICAN HEART ASSOCIATION, AMERICAN CANCER SOCIETY, PINK RIBBON SOCIETY, NATIONAL MULTIPLE SCLEROSIS SOCIETY, PARKINSON'S FOUNDATION, AND THE MARCH OF DIMES. METHODIST ALSO DEMONSTRATES ITS COMMITMENT TO THE HEALTH OF ITS SURROUNDING COMMUNITIES THROUGH A WIDE ARRAY OF COMMUNITY OUTREACH PROGRAMS INCLUDING: VARIOUS SCREENING PROGRAMS, SUPPORT GROUPS, FREE HEALTH FAIRS, AND EDUCATION SEMINARS. PART III, LINE 2: A SIGNIFICANT PORTION OF UNINSURED PATIENTS ARE UNABLE OR UNWILLING TO PAY FOR SERVICES RENDERED BY THE HOSPITAL. FOR THOSE PATIENTS THAT DO NOT QUALIFY FOR CHARITY CARE, BASED ON HISTORICAL EXPERIENCE, A PROVISION FOR BAD DEBTS IS RECORDED RELATED TO THESE PARTICULAR PATIENTS. PART III, LINE 3: FOR UNINSURED AND UNDERINSURED PATIENTS WHO DO NOT QUALIFY FOR CHARITY CARE DUE TO INCOMPLETE APPLICATIONS, A PROVISON FOR BAD DEBT IS RECORDED BASED UPON HISTORICAL EXPERIENCE. PART III, LINE 4: ACCOUNTS RECEIVABLE FOR PATIENTS, INSURANCE COMPANIES, AND GOVERNMENTAL AGENCIES ARE BASED ON GROSS CHARGES. AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS IS ESTABLISHED ON AN AGGREGATE BASIS BY USING HISTORICAL WRITE-OFF RATE FACTORS APPLIED TO UNPAID ACCOUNTS BASED ON AGING. LOSS RATE FACTORS ARE BASED ON HISTORICAL LOSS EXPERIENCE AND ADJUSTED FOR ECONOMIC CONDITIONS AND OTHER TRENDS AFFECTING THE HOSPITAL'S ABILITY TO COLLECT OUTSTANDING AMOUNTS. UNCOLLECTIBLE AMOUNTS ARE WRITTEN OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS IN THE PERIOD THEY ARE DETERMINED TO BE UNCOLLECTIBLE. AN ALLOWANCE FOR CONTRACTUAL ADJUSTMENTS AND INTERIM PAYMENT ADVANCES IS BASED ON EXPECTED PAYMENT RATES FROM PAYORS BASED ON CURRENT REIMBURSEMENT METHODOLOGIES. THIS AMOUNT ALSO INCLUDES AMOUNTS RECEIVED AS INTERIM PAYMENTS AGAINST UNPAID CLAIMS BY CERTAIN PAYORS. PART III, LINE 8: THE HOSPITAL DOES NOT REPORT ANY SHORTFALL WITH MEDICARE AS A COMMUNITY BENEFIT. PART III, LINE 9B: LIABILITIES FOR NON-COVERED SERVICES, INSURANCE RESIDUALS AND PURE SELF PAY LIABILITIES ARE DUE WITHIN 30 DAYS OF DISCHARGE. ATTEMPTS ARE MADE TO COLLECT DEDUCTIBLES PRE-SERVICE AND DEPOSITS OR PAYMENT IN-FULL PRE-SERVICE FOR SELF-PAY PATIENTS. IF A PATIENT CANNOT PAY THE ENTIRE BALANCE WITHIN 30 DAYS, PAYMENT PLANS ARE AVAILABLE. IF THE PATIENT CANNOT PAY AT ALL, THE HOSPITAL OFFERS NEED-BASED FINANCIAL ASSISTANCE BASED ON HOUSEHOLD INCOME AS A PERCENT OF THE FPL. PATIENTS WHO HAVE THE ABILITY TO PAY, YET DEFAULT ON PAYMENT PLANS ARE SENT TO COLLECTIONS (BAD DEBT). ACCOUNTS EVALUATED FOR BAD DEBT ARE PERIODICALLY RE-SCREENED FOR PRESUMPTIVE CHARITY QUALIFICATION AND IF QUALIFIED, ARE REMOVED FROM THE COLLECTION PROCESS. MEDICARE RESIDUALS ARE INVOICED TO THE PATIENT AND SENT THROUGH A BAD DEBT COLLECTION CYCLE. IF COLLECTION ATTEMPTS ARE UNSUCCESSFUL, THE MEDICARE ACCOUNT IS REMOVED FROM COLLECTIONS AND IS REPORTED AS MEDICARE BAD DEBT. PART VI, LINE 2: METHODIST HOSPITALS, INC. ASSESSES THE SERVICES NEEDED BASED UPON A REVIEW OF DEMOGRAPHIC AND CLINICAL FACTORS. BASED UPON THE DATA, THE HEALTHCARE NEEDS ARE THEN COMPARED TO THE SERVICES CURRENTLY PROVIDED OR AVAILABLE IN THE IMMEDIATE AREA AND SURROUNDING COMMUNITIES. METHODIST HOSPITAL ALSO HAD AN INDEPENDENT COMMUNITY HEALTH NEEDS ASSESSMENT PERFORMED TO DETERMINE THE HEALTH STATUS, BEHAVIORS, AND NEEDS FOR RESIDENTS IN THE HOSPITAL'S SERVICE AREAS. PART VI, LINE 3: METHODIST PROVIDES PATIENTS WITH A PAYMENT OPTIONS BROCHURE AND "FINANCIALLY CLEARS" PATIENTS PRIOR TO SERVICE DELIVERY. FINANCIAL CLEARANCE INVOLVES ESTIMATING THE PATIENT LIABILITY, EDUCATING THE PATIENT ABOUT INSURANCE BENEFITS AND OUT-OF-POCKET EXPENSES AND AGREEING TO A PLAN WITH THE PATIENT FOR HOW THAT LIABILITY WILL BE COVERED. SELF PAY PATIENTS ARE SCREENED FOR ELIGIBILITY FOR FEDERAL, STATE AND LOCAL PAYMENT SOURCES. IN ADDITION, METHODIST PUBLICIZES ON ITS WEBSITE INFORMATION ABOUT THE VARIOUS FINANCIAL ASSISTANCE PLANS THAT A PATIENT MAY BE ELIGIBLE FOR ALONG WITH THE NECESSARY APPLICATIONS. PART VI, LINE 4: METHODIST HOSPITALS SERVES NORTHWEST INDIANA WITH THE PRIMARY GEOGRAPHIC AREA BEING SERVED AS LAKE COUNTY, INDIANA. PORTER COUNTY, INDIANA COMPRISES MOST OF THE SECONDARY SERVICE AREA. THE DEMOGRAPHIC AREA OF THE REGION IS VERY DIVERSE, RANGING FROM THE VERY AFFLUENT TO A SIGNIFICANT INDIGENT POPULATION. PART VI, LINE 5: METHODIST HOSPITALS, INC. PROVIDES MONTHLY STROKE AND CANCER SCREENINGS, AND THROUGHOUT THE YEAR OFFERS: PREVENTATIVE HEALTHCARE SCREENINGS, WORKSHOPS, INTERNSHIPS FOR HIGHSCHOOL STUDENTS, EDUCATIONAL SEMINARS, AND HOSTS VARIOUS SUPPORT GROUPS THAT COMMUNITY MEMBERS CAN ATTEND. THE MAJORITY OF THE GOVERNING BODY MEMBERS LIVE AND/OR WORK WITHIN METHODIST HOSPITALS'S SERVICE AREAS. PART VI, LINE 6: N/A PART VI, LINE 7, REPORTS FILED WITH STATES IN 0 GARY LITERACY COALITION 650 GRANT STREEET SUITE 8 GARY IN 46402 201323689 501(C)(3) 94361 SUPPORT LOCAL LITERACY PROGRAMS AMERICAN HEART ASSOCIATION 405 BOARDWALK HEBRON IN 46341 135613797 501(C)(3) 25000 HEART DISEASE AWARENESS/PREVENTION PROGRAMS INDIAN AMERICAN CULTURAL CENTER 8605 MERRILLVILLE ROAD MERRILLVILLE IN 46410 351981658 501(C)(3) 21000 SUPPORT CULTURAL ARTS PROGRAMS INDIAN MEDICAL ASSOC OF NWI 8605 MERRILLVILLE ROAD MERRILLVILLE IN 46410 314130002 501(C)(3) 21000 SCHOLARSHIP PROGRAMS CROSSROADS REGIONAL CHAMBER OF COMMERCE 9101 TAFT STREET MERRILLVILLE IN 46410 356043684 501(C)(6) 5700 SUPPORT LOCAL PROGRAMS GARY CHAMBER OF COMMERCE 839 BROADWAY GARY IN 46402 350329470 501(C)(6) 7000 SUPPORT LEADERSHIP AND CIVILITY EDUCATION PROGRAMS ASIAN AMERICAN MEDICAL SOCIETY PO BOX 10039 MERRILLVILLE IN 46411 351487544 501(C)(6) 6600 SUPPORT UNITY PROGRAMS RICHARD GORDON HATCHER LEGACY 7420 ASH AVENUE GARY IN 46403 822558118 501(C)(3) 15000 SUPPORT LOCAL COMMUNITY PROGRAM 5 3 PART I, LINE 2: THE ORGANIZATION DOES NOT MONITOR HOW THE GRANTS ARE USED BY THE ORGANIZATION RECEIVING THE FUNDS. X X X 0 1 0 0 0 0 0 0 0 FADI ALZEIDAN MD BOARD MEMBER 384966 0 100000 0 0 0 8100 0 20143 0 513209 0 0 0 ANGELIQUE BROWN MD BOARD MEMBER 282017 0 32711 0 0 0 8100 0 2044 0 324872 0 0 0 RAYMOND GRADY CHIEF EXECUTIVE OFFICER 564127 0 113402 0 0 0 8100 0 16689 0 702318 0 0 0 MATTHEW DOYLE CHIEF FINANCIAL OFFICER 326166 0 54127 0 0 0 4500 0 16544 0 401337 0 0 0 WRIGHT ALCORN VP OF OPERATIONS 262329 0 39071 0 0 0 0 0 19903 0 321303 0 0 0 TRACY CRANDALL VP OF HUMAN RESOURCES 247192 0 10000 0 0 0 0 0 16461 0 273653 0 0 0 JAMES KIRCHNER VP PHYSICIAN INTEGRATION 249742 0 45334 0 0 0 6546 0 16120 0 317742 0 0 0 VINCENT SEVIER CHIEF QUALITY OFFICER 330724 0 30887 0 0 0 6029 0 20300 0 387940 0 0 0 SHELLY MAJOR CHIEF NURSING OFFICER (JAN-OCT) 257881 0 42716 0 0 0 6615 0 17576 0 324788 0 0 0 ANDRE ARTIS PHYSICIAN 688341 0 197532 0 0 0 5400 0 17235 0 908508 0 0 0 MIHAS KODENCHERY PHYSICIAN 543190 0 190277 0 0 0 4050 0 20779 0 758296 0 0 0 ASHISH PATEL PHYSICIAN 656753 0 77181 0 0 0 8100 0 10098 0 752132 0 0 0 VINEET SHAH PHYSICIAN 667923 0 0 0 0 0 8100 0 20955 0 696978 0 0 0 RAY SAWAQED PHYSICIAN 618825 0 28522 0 0 0 8100 0 10749 0 666196 0 0 0 PART I, LINE 4B RAYMOND GRADY $54,000 A INDIANA FINANCE AUTHORITY 351602316 45471AMK5 2014-08-27 52517507 REFUND PRIOR ISSUE DATED 8/15/2001 0 0 0 A 2145000 52252853 4426379 425250 2005 1 0 1 1 A 0 0 1 0 0 0 0 1 1 A 0 MAMON POWERS BOARD MEMBER 3305593 OWNS POWERS & SONS CONSTRUCTION WHICH PROVIDED SERVICES 0 FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS REVIEWED BY THE CONTROLLER AND CFO OF THE ORGANIZATION AND THEN SENT TO MEMBERS OF THE GOVERNING BODY FOR REVIEW PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C THE BOARD PASSED A RESOLUTION IN 1994 WHICH REQUIRES EACH BOARD MEMBER TO ANNUALLY DISCLOSE ALL SITUATIONS WHERE A POTENTIAL CONFLICT OF INTEREST MAY EXIST. THE CONFLICT OF INTEREST/RELATED PARTY QUESTIONNAIRES ARE COMPLETED AND REVIEWED ON AN ANNUAL BASIS. ANY POTENTIALLY CONFLICTED DIRECTORS ARE PROHIBITED FROM PARTICIPATING IN THE DISCUSSION ABOUT OR VOTING ON ANY CONFLICTED ISSUE. FORM 990, PART VI, SECTION B, LINE 15 THE HR AND GOVERNANCE COMMITTEE USES INDEPENDENT AND EXTERNAL RESOURCES FOR THE ESTABLISHMENT OF COMPENSATION FOR OFFICERS AND OTHER KEY EMPLOYEES. THE COMMITTEE USES COMPARABILITY DATA AND MARKET COMPARISONS INCLUDING COMPENSATION SURVEYS AND FORM 990 INFORMATION FROM OTHER ORGANIZATIONS AS PART OF THE COMPENSATION DETERMINATION PROCESS. THE COMPENSATION APPROACH, PROCESS, AND DATA ARE THOROUGHLY DISCUSSED IN THE COMMITTEE MEETINGS AND THE REVIEW AND APPROVALS ARE DOCUMENTED THROUGHOUT THE PROCESS. THE MOST RECENT YEAR THIS PROCESS WAS UNDERTAKEN WAS 2017. FORM 990, PART VI, SECTION C, LINE 19 DOCUMENTS ARE AVAILABLE UPON REQUEST. FORM 990, PART IX, LINE 11G CONTRACT LABOR: PROGRAM SERVICE EXPENSES 1,278,125. MANAGEMENT AND GENERAL EXPENSES 527,114. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,805,239. CONSULTING: PROGRAM SERVICE EXPENSES 388,590. MANAGEMENT AND GENERAL EXPENSES 50,887. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 439,477. PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 9,696,965. MANAGEMENT AND GENERAL EXPENSES 56,455. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 9,753,420. PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 20,005,693. MANAGEMENT AND GENERAL EXPENSES 2,557,604. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 22,563,297. BILLING: PROGRAM SERVICE EXPENSES 149,894. MANAGEMENT AND GENERAL EXPENSES 559,297. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 709,191. SECURITY: PROGRAM SERVICE EXPENSES 7,697. MANAGEMENT AND GENERAL EXPENSES 36,736. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 44,433. MARKETING: PROGRAM SERVICE EXPENSES 113,383. MANAGEMENT AND GENERAL EXPENSES 14,349. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 127,732. TRANSCRIPT: PROGRAM SERVICE EXPENSES 216,621. MANAGEMENT AND GENERAL EXPENSES 27,213. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 243,834. REFERENCE: PROGRAM SERVICE EXPENSES 1,396,053. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,396,053. TRANSPORT: PROGRAM SERVICE EXPENSES 192,868. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 192,868. RECRUITMENT: PROGRAM SERVICE EXPENSES 282,441. MANAGEMENT AND GENERAL EXPENSES 28,361. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 310,802. FEES: PROGRAM SERVICE EXPENSES 766,883. MANAGEMENT AND GENERAL EXPENSES 97,050. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 863,933. FORM 990, PART XI, LINE 9: PENSION RELATED CHANGES OTHER THAN NET PERIODIC COST 54,070. FORM 990, PART XII, LINE 2C: THERE HAS BEEN NO CHANGE IN PROCESS FROM PRIOR YEAR. 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