2017-11-03T09:55:39-05:00 2016-12-31 352032768 CASKEY & DAILY PC 4745 STATESMEN DRIVE SUITE C INDIANAPOLIS IN 46250 990 2016-01-01 351094734 INDIANAPOLIS OSTEOPATHIC HOSPITAL INC INDI 3179208439 3630 GUION ROAD INDIANAPOLIS IN 46222 JASON FAHRLANDER NETWORK CHIEF OP OFF 3179208439 2017-10-25 true JAMES A CASKEY CPA CFP P00172185 3175852647 2017-11-02 9B095E6EB8FEEDD76144B834BDE29E92059B38C1 9B095E6EB8FEEDD76144B834BDE29E92059B38C1 2016 2018-03-14 21:41:22Z COMMUNITY WESTVIEW HOSPITAL JASON FAHRLANDER 7330 SHADELAND STATION SUITE 200 INDIANAPOLIS IN 46256 27951661 false X WWW.ECOMMUNITY.COM X 1961 IN TO PROVIDE QUALITY HEALTHCARE TO THE CENTRAL INDIANA COMMUNITY - REGARDLESS OF THEIR ABILITY TO PAY - WITH FACILITIES, SUPPORT AND GROWTH FOR THE OSTEOPATHIC PROFESSION THROUGH OUR INTERN/RESIDENT EDUCATION PROGRAMS, INCREASED PHYSICIAN PRACTICES, PRESENCE AND EXPERTISE. 14 10 220 21 0 370000 7285 34550340 27068024 -26271 -2366191 770230 724888 35664299 25434006 0 0 14993284 13291013 0 0 24669732 37872049 39663016 51163062 -3998717 -25729056 29698856 5996723 22802730 24829653 6896126 -18832930 X TO PROVIDE QUALITY HEALTHCARE TO THE CENTRAL INDIANA COMMUNITY - REGARDLESS OF THEIR ABILITY TO PAY - WITH FACILITIES, SUPPORT AND GROWTH FOR THE OSTEOPATHIC PROFESSION THROUGH OUR INTERN/RESIDENT EDUCATION PROGRAMS, INCREASED PHYSICIAN PRACTICES, PRESENCE AND EXPERTISE. false true 24962322 27709112 AT INDIANAPOLIS OSTEOPATHIC HOSPITAL, INC. ("IOH") OUR OSTEOPATHIC PHILOSOPHY OF CARE MEANS WE TREAT YOU AS A WHOLE PERSON AND ASSESS YOUR ENTIRE LIFESTYLE. IN 2016, THE HOSPITAL OFFERED AN ARRAY OF SERVICES ON THE WESTSIDE OF INDIANAPOLIS, INDIANA, INCLUDING A 24-HOUR EMERGENCY ROOM, INTENSIVE ACUTE CARE NURSING UNITS, SURGICAL SERVICES, IMAGING SERVICES, LABORATORY SERVICES, CANCER CARE, CARDIOPULMONARY REHABILITATION, SLEEP LAB, RENAL/DIALYSIS SERVICES, INPATIENT AND OUTPATIENT REHABILITATION SERVICES, AND GERIATRIC PSYCHIATRIC CARE. THE HOSPITAL OFFERED A FULL RANGE OF DIAGNOSTIC, TREATMENT, MEDICAL AND SURGICAL SERVICES WITH A MEDICAL STAFF COMPRISED OF OVER 30 MEDICAL AND SURGICAL SPECIALTIES. THE HOSPITAL SERVED 180 INPATIENTS AND PROVIDED 59,776 OUTPATIENT VISITS, WHICH INCLUDED 10,230 EMERGENCY VISITS. THE IOH SURGERY DEPARTMENT PERFORMED 1,844 SURGERIES IN 2016. 24962322 true true false false false false false false false false true false false false true false false true false false false false false false false false true true false false true false false false false false false false false false false false false false true true true false false true X 0 0 true 220 true false false false false false false false false false false X 14 10 true true false false true false true true true false false false true true true true true false false true false IN X BRIAN MCCONNELL 3173554212 8180 CLEARVISTA PWKY 200 INDIANAPOLIS IN 46256 BRYAN A MILLS DIRECTOR 1.00 59.00 X 0 1427576 452142 ANNETTE M MOORE MD DIRECTOR 1.00 54.00 X 0 577241 15900 HANY HADDAD MD DIRECTOR 1.00 54.00 X 0 492775 41264 KENNETH SHAVER MD DIRECTOR 1.00 54.00 X 0 342021 106359 CHARLES SCOTT VORE MD DIRECTOR 1.00 40.00 X 0 227500 0 JASON BECKER DIRECTOR 1.00 7.00 X 0 0 0 KATHRYN G BETLEY DIRECTOR 1.00 5.00 X 0 0 0 BRUCE F KING VICE CHAIRMA 1.00 6.00 X X 0 0 0 JEFFREY MOSSLER MD DIRECTOR 1.00 5.00 X 0 0 0 MICHAEL PETERSON DIRECTOR 1.00 5.00 X 0 0 0 STEVEN R PLUMP DIRECTOR 1.00 7.00 X 0 0 0 JAY RICKER DIRECTOR 1.00 7.00 X 0 0 0 YVONNE SHAHEEN SECRETARY 1.00 5.00 X X 0 0 0 KRISTIN T SHERMAN TREASURER 1.00 5.00 X X 0 0 0 RUSSELL SWAN JR CHAIRMAN 1.00 5.00 X X 0 0 0 BRIAN K WILLIAMS DIRECTOR 1.00 5.00 X 0 0 0 DAVID C WILLIAMS DO PRES - WEST 45.00 5.00 X 0 570923 182915 DOUG PENLEY COO - WEST R 45.00 0.00 X 192958 0 100207 DEBORAH LEE EXEC DIR NUR 45.00 X 78161 0 4693 MARY CATHERINE FORD CLINICAL PHA 45.00 0.00 X 123362 0 7957 EMILY AHRENS HUMAN RESOUR 45.00 0.00 X 108486 0 20674 KATHY COMPTON REHAB SERVIC 45.00 0.00 X 105803 0 30166 LYNN NICKOL MANAGER FOOD 45.00 0.00 X 105020 0 37704 ANGELA WATSON IMAGING SPEC 45.00 0.00 X 100220 0 3208 JEFFERY KIRKHAM FORMER OFFIC 0.00 50.00 X 0 334499 90253 ELIZABETH HALL FORMER FINAN 0.00 45.00 X 0 104518 40067 814010 4077053 1133509 7 true true false K DONALD SHELBOURNE MD LLC 1500 NORTH RITTER 500 INDIANAPOLIS IN 46219 PHYSICIAN 1570466 EMCARE 7032 COLLECTION CENTER DRIVE CHICAGO IL 60693 STAFFING 918449 WESTVIEW ANESTHESIA GROUP 8736 SANTANA LANE INDIANAPOLIS IN 46278 MEDICAL 900300 ACCELECARE WOUND CENTERS INC PO BOX 671242 DALLAS TX 752671242 MEDICAL 626287 MID AMERICA CLINICAL LAB PO BOX 19163 INDIANAPOLIS IN 46219 LAB SERVICES 585109 14 7285 7285 PATIENT REVENUE 622110 26882069 26882069 RENT - RELATED PURPOSE 531120 185955 185955 27068024 235 235 151229 2517655 -2366426 -2366426 -2366426 HOSP ASSESSMENT FEE TRUE-UP 900099 397573 397573 VOLUNTEER SERVICS 900099 91927 91927 CAFETERIA SALES 722514 83800 83800 151588 151588 724888 25434006 27709112 -2282391 X 376019 376019 10333498 7876525 2456973 347183 255343 91840 1423814 1047172 376642 810499 592491 218008 969 969 12950367 5469854 7480513 11280 4718 6562 1011881 635485 376396 32129 7282 24847 2116661 1556740 559921 23603 22223 1380 940 940 1100 1100 1490928 140516 1350412 154704 154704 RESTRUCTURING EXPENSE 13999421 1319408 12680013 MEDICAL SUPPLIES 6011004 6011004 MEMBERSHIP DUES/LICENSING 20567 11009 9558 CAFE SUPPLIES/MEAL TICKET 12867 2916 9951 33628 8696 24932 51163062 24962322 26200740 0 X 260465 197623 6642596 2729632 444960 75716 25508 18521155 15735823 21065217 2785332 363983 230418 421094 424825 28210 29698856 5996723 2599946 1234128 20202784 23595525 22802730 24829653 X 6896126 -18832930 6896126 -18832930 29698856 5996723 -25729056 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1710000 1710000 16187534 15374767 812767 111424 44570 66854 357979 312268 45711 154218 4218 150000 2785332 DUE TO AFFILIATES 21086422 RESTRUCTURING ACCRUAL 2226224 THIRD PARTY SETTLEMENTS 282879 23595525 true true X true X true X true true false true true 63562 63562 0.00120 9283080 2300418 6982662 0.13650 9346642 2300418 7046224 0.13770 9346642 2300418 7046224 0.13770 true 1985010 true true NORTHWEST SURG CTR SURGERY 0.20000 0.43000 1 1 INDIANAPOLIS OSTEOPATHIC HOSPITAL 3630 GUION ROAD INDIANAPOLIS IN 46222 WWW.ECOMMUNITY.COM 16-005068-1 X X X X INDIANAPOLIS OSTEOPATHIC HOSPITAL 1 false false true X X X X X X X X X 15 true true true true X WEBAPP.ECOMMUNITY.COM/ABOUTUS/ X true 15 true WEBAPP.ECOMMUNITY.COM/ABOUTUS/ true false true X 200.000000000000 300.000000000000 X X X X true true X X X true X SEE PART V, SECTION C X SEE PART V, SECTION C X X X X X X true X false X X X X true X false false FACILITY 1, INDIANAPOLIS OSTEOPATHIC HOSPITAL - PART V, LINE 5 IN 2015, COMMUNITY HEALTH NETWORK CONDUCTED A CHNA TO UNDERSTAND THE GREATEST HEALTH NEEDS IN THE COMMUNITIES SERVED BY OUR HOSPITALS. THIS ASSESSMENT WAS IN LARGE PART A JOINT PROCESS AMONG FOUR INDIANA HEALTH SYSTEMS: COMMUNITY HEALTH NETWORK, IU HEALTH, ST. FRANCIS ALLIANCE, AND ST. VINCENT. COMBINED, THESE ARE THE LARGEST HEALTH SYSTEMS IN INDIANA. THROUGH THIS COLLABORATIVE PARTNERSHIP, COMMUNITY HEALTH DATA WAS COLLECTED IN THREE WAYS: 1. SECONDARY DATA COLLECTION: DATA ON HEALTH AND WELLNESS ISSUES WAS COLLECTED. SOURCES INCLUDE COUNTY HEALTH RANKINGS, CENSUS BUREAU DATA, VARIOUS REPORTS FROM THE INDIANA STATE DEPARTMENT OF HEALTH, AND OTHER NATIONAL REPORTS. INDIANA INDICATORS, COMMUNITY COMMONS, AND HEALTHY COMMUNITIES INSTITUTE DATA MANAGEMENT SYSTEMS ALSO CONTRIBUTED TO THE SECONDARY DATA USED. SOURCES OF THE SECONDARY DATA ARE IDENTIFIED THROUGHOUT THE COMMUNITY BENEFITS REPORT. 2. COMMUNITY HEALTH SURVEY: A CORE OF 20 MANDATORY QUESTIONS BASED ON PERCEPTION OF COMMUNITY AND PERSONAL NEEDS WERE CREATED. IN ADDITION, PROFESSIONALS ASSIGNED TO EACH COUNTY WORKED WITH ESTABLISHED COMMUNITY HEALTH COLLABORATIVES, LOCAL HOSPITALS, AND THE LOCAL HEALTH DEPARTMENT TO DEVELOP VOLUNTARY COMMUNITY HEALTH NEEDS ASSESSMENT TO CREATE 9 QUESTIONS SPECIFIC TO THE COUNTY. THIS RESULTED IN A SURVEY WITH 20 TO 29 QUESTIONS, DEPENDENT ON THE RESPONDENT'S COUNTY OF RESIDENCE. THE SURVEY WAS DISTRIBUTED ELECTRONICALLY AND ON PAPER. IN ADDITION TO THE QUANTITATIVE DATA, FREE TEXT RESPONSES WERE CODED AND CALCULATED TO PROVIDE FURTHER CLARIFICATION OF THE QUANTITATIVE DATA. 3. FOCUS GROUPS: IN ADDITION TO THE SURVEY THE PARTNERSHIP HOSTED FOCUS GROUPS THAT INCLUDED 15-60 COMMUNITY LEADERS FROM GOVERNMENTAL PUBLIC HEALTH, HEALTH CARE, SOCIAL SERVICE AGENCIES, RELATED NONPROFITS, CIVIC ORGANIZATIONS, AND GRASSROOTS/NEIGHBORHOOD ORGANIZATIONS. IN LARGER FOCUS GROUPS, SUB-GROUPS WERE UTILIZED TO GIVE ALL PARTICIPANTS A VOICE. EACH FOCUS GROUP DETERMINED THE TOP FOUR TO SIX HEALTH NEEDS IN THE COMMUNITY; POTENTIAL RESOURCES OR PARTNERS; AND SOME ACTIONS/INTERVENTIONS THAT MIGHT WORK BEST. OUTSIDE OF THE COLLABORATIVE, COMMUNITY HEALTH NETWORK INVITED KEY PUBLIC HEALTH INFORMANTS TO PROVIDE THEIR INPUT ON COMMUNITY HEALTH NEEDS. THE FOLLOWING INFORMANTS WERE INTERVIEWED: DUANE KRAMBECK - PRINCIPAL OF CHRISTIAN PARK ELEMENTARY SCHOOL IN INDIANAPOLIS PUBLIC SCHOOLS; MARY CONWAY, MSN, RN ADMINISTRATIVE COORDINATOR FOR NURSING SERVICES IN INDIANAPOLIS PUBLIC SCHOOLS; AND RANDY MILLER EXECUTIVE DIRECTOR OF DRUG FREE MARION COUNTY. THESE QUANTITATIVE AND QUALITATIVE DATA COLLECTION MECHANISMS HELPED IDENTIFY COMMUNITY HEALTH NEEDS AND SECONDARY DATA CONFIRMED THE NEEDS PERFORM BELOW STATE AVERAGES. FURTHER REVIEW OF THE HEALTH NEEDS DETERMINED THE EXTENT TO WHICH HEALTH INEQUITIES MAY EXIST AND WHICH SEGMENTS OF THE POPULATION ARE MORE NEGATIVELY IMPACTED. FACILITY 1, INDIANAPOLIS OSTEOPATHIC HOSPITAL - PART V, LINE 6A THE CHNA FOR INDIANAPOLIS OSTEOPATHIC HOSPITAL, INC. WAS A JOINT PROCESS AMONG ALL OF THE COMMUNITY HEALTH NETWORK HOSPITALS WHICH INCLUDES: COMMUNITY HEALTH NETWORK, INC. (NORTH, EAST, & INDIANA HEART HOSPITAL, LLC), COMMUNITY HOSPITAL SOUTH, INC., COMMUNITY HOSPITAL OF ANDERSON AND MADISON COUNTY, INC., COMMUNITY HOWARD REGIONAL HEALTH, INC., AND INDIANAPOLIS OSTEPATHIC HOSPITAL, INC. IN ADDITION, THE HOSPITAL COLLABORATED WITH FRANCISCAN ST. FRANCIS HEALTH, IU HEALTH UNIVERSITY HOSPITAL, AND ST. VINCENT HOSPITAL. FACILITY 1, INDIANAPOLIS OSTEOPATHIC HOSPITAL - PART V, LINE 6B THE CHNA WAS ALSO CONDUCTED WITH HEALTHY COMMUNITIES INSTITUTE. FACILITY 1, INDIANAPOLIS OSTEOPATHIC HOSPITAL - PART V, LINE 11 IOH IS ADDRESSING THE SIGNIFICANT NEEDS OF THE COMMUNITY BASED ON INPUT PROVIDED BY COMMUNITY RESIDENTS, PUBLIC HEALTH PARTNERS, INTERNAL AND EXTERNAL LEADERSHIP WHO PARTICIPATED IN FOCUS GROUPS, STAKEHOLDER INTERVIEWS OR COMPLETED THE CHNA SURVEY THROUGHOUT THE CENTRAL INDIANA REGION. CHNA DATA WAS ANALYZED AND PRIORITIZED USING THESE KEY FACTORS: FEASIBILITY FOR OUR HOSPITALS TO IMPACT CHANGE, HEALTH SYSTEM EXPERTISE IN THE FIELD OF THE ASSESSED NEED, AND THE HOSPITALS ABILITY TO BE THE MOST EFFECTIVE WITH THE RESOURCES AVAILABLE. THE FOUR SIGNIFICANT HEALTH NEEDS IDENTIFIED IN ALL OUR COMMUNITIES WERE: ACCESS TO HEALTHCARE; OBESITY; PEDIATRIC ASTHMA AND COMMUNITY DRIVEN INITIATIVES. A MISSION CENTERED ON HELPING OTHERS IS THE FOUNDATION OF EVERYTHING WE DO AT COMMUNITY HEALTH NETWORK - AND EXTENDS FROM THE CARE WE PROVIDE TO THE COMMUNITIES WE SERVE THROUGH A BROAD SPECTRUM OF COMMUNITY BENEFIT ACTIVITIES OR PROGRAMS. OUR COMMUNITY BENEFIT RESPONDS TO IDENTIFIED COMMUNITY NEEDS AND MEETS AT LEAST ONE OF THE FOLLOWING CRITERIA: 1. IMPROVES ACCESS TO HEALTH CARE SERVICES. 2. ENHANCES HEALTH OF THE COMMUNITY. 3. ADVANCES MEDICAL OR HEALTH KNOWLEDGE. 4. RELIEVES OR REDUCES THE BURDEN OF GOVERNMENT OR OTHER COMMUNITY EFFORTS. OUR COMMUNITY BENEFIT IS ORGANIZED IN THREE CATEGORIES: CATEGORY 1: FINANCIAL ASSISTANCE-FREE OR DISCOUNTED HEALTH SERVICES PROVIDED TO PERSONS WHO CANNOT AFFORD TO PAY AND WHO MEET THE ELIGIBILITY CRITERIA OF THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY. FINANCIAL ASSISTANCE IS REPORTED IN TERMS OF COSTS, NOT CHARGES. FINANCIAL ASSISTANCE DOES NOT INCLUDE BAD DEBT. CATEGORY 2: GOVERNMENT-SPONSORED MEANS-TESTED HEALTH CARE-UNPAID COSTS OF PUBLIC PROGRAMS FOR LOW-INCOME PERSONS - THE SHORTFALL CREATED WHEN A FACILITY RECEIVES PAYMENTS THAT ARE LESS THAN THE COST OF CARING FOR PUBLIC PROGRAM BENEFICIARIES. THIS PAYMENT SHORTFALL IS NOT THE SAME AS A CONTRACTUAL ALLOWANCE, WHICH IS THE FULL DIFFERENCE BETWEEN CHARGES AND GOVERNMENT PAYMENTS. CATEGORY 3: COMMUNITY BENEFIT SERVICES- PROGRAMS THAT RESPOND TO AN IDENTIFIED COMMUNITY HEALTH NEED AND ARE DESIGNED TO ACCOMPLISH ONE OR MORE COMMUNITY BENEFIT OBJECTIVES; PROGRAMS AND ACTIVITIES DIRECTED TO OR INCLUDING AT-RISK PERSONS, SUCH AS UNDERINSURED AND UNINSURED PERSONS AND PROGRAMS OFFERED TO THE BROAD COMMUNITY (INCLUDING AT-RISK PERSONS) DESIGNED TO IMPROVE COMMUNITY HEALTH. HIGHLIGHTS FOR COMMUNITY BENEFIT SERVICES THAT ALIGN WITH THE IDENTIFIED NEEDS INCLUDES: ACCESS TO HEALTHCARE: COMMUNITY HEALTH NETWORK SUPPORTS THE JANE PAULEY COMMUNITY HEALTH CENTER WHICH OPENED ITS DOORS IN SEPTEMBER 2009 TO PROVIDE PRIMARY HEALTH SERVICES TO EASTSIDE RESIDENTS, REGARDLESS OF INCOME OR INSURANCE COVERAGE. WITH 16 LOCATIONS, THE CENTER SERVES IN PARTNERSHIP WITH THE METROPOLITAN SCHOOL DISTRICT OF WARREN TOWNSHIP, COMMUNITY HEALTH NETWORK, THE COMMUNITY HEALTH NETWORK FOUNDATION, IU SCHOOL OF DENTISTRY AND HANCOCK REGIONAL HOSPITAL. SERVICES ARE PROVIDED ON A DISCOUNTED BASIS BASED ON THE PATIENT'S HOUSEHOLD INCOME. EASTSIDE INDIANAPOLIS NATIVE AND FORMER NBC NEWS ANCHOR JANE PAULEY LENT HER NAME TO THE FACILITY AS AN ADVOCATE FOR ACCESSIBLE HEALTHCARE SERVICES FOR PEOPLE UNDERSERVED BY TRADITIONAL HEALTHCARE MODELS. THE CENTER OFFERS A FULL RANGE OF SERVICES INCLUDING PRIMARY HEALTHCARE, CASE MANAGEMENT, PRESCRIPTION ASSISTANCE AND BEHAVIORAL HEALTH SERVICES, WHILE ALSO FOCUSING ON THE MANAGEMENT OF CHRONIC DISEASES. THE CENTER IS ABLE TO PROVIDE ALL OF THESE IN BOTH ENGLISH AND SPANISH. COMMUNITY HEALTH NETWORK'S SCHOOL-BASED PROGRAMS COVER A WIDE RANGE OF NEEDS FOR YOUTH ACROSS CENTRAL INDIANA. ONSITE NURSES, THERAPISTS AND PHYSICIANS ADDRESS STUDENTS' NEEDS IN THE SCHOOL AND AFTER-SCHOOL SETTING, HELPING TO ENSURE CONSISTENCY IN CARE AND LESS TIME AWAY FROM THE CLASSROOM OR PLAYING FIELD. THE VAST MAJORITY OF THESE SERVICES, INCLUDING ANY NURSING OR BEHAVIORAL HEALTH SUPPORT, ARE OFFERED FREE OF CHARGE TO SCHOOLS THANKS TO COMMUNITY'S ON-GOING COMMITMENT TO ENHANCING HEALTH FOR FUTURE GENERATIONS. FROM EVERYDAY SCRAPES AND BRUISES ON THE PLAYGROUND TO MANAGING CHRONIC ILLNESSES LIKE ASTHMA AND DIABETES, COMMUNITY NURSES OFFER SUPPORT FOR STUDENTS AT MORE THAN 100 SCHOOLS IN THE COMMUNITIES WE SERVE. THEIR WORK ENSURED A 95.1 PERCENT RETURN TO CLASSROOM RATE FOR STUDENTS WHO CAME TO THEM FOR CARE IN 2016. SPECIFIC SERVICES OFFERED TO STUDENTS INCLUDE: 1. MANAGEMENT OF INJURIES REQUIRING FIRST AID; 2. MANAGEMENT OF LIFE-THREATENING ALLERGIES, ASTHMA, DIABETES AND SEIZURES; 3. MANAGEMENT OF ANY HEALTH CONCERN AND REFERRAL TO APPROPRIATE CARE WHEN NEEDED; AND 4. EMERGENCY RESPONSE TO ANY HEALTH-RELATED CONCERN WITHIN THE SCHOOL BUILDING. IN ADDITION, FOR STUDENTS FACING CHRONIC HEALTH CONDITIONS AND ONGOING HEALTH NEEDS, MEDICATIONS PRESCRIBED BY PHYSICIANS ARE ADMINISTERED BY COMMUNITY'S SCHOOL-BASED NURSING STAFF. IN THE INSTANCE OF OCCASIONAL MEDICATION NEEDS, PARENTS FURNISH OVER-THE-COUNTER MEDICATIONS THAT ARE THEN ADMINISTERED BY NURSING STAFF. AND, FOR PREVENTATIVE CARE PURPOSES, NURSING STAFF ADMINISTER FLU VACCINES AT A NUMBER OF LOCAL CHARTER SCHOOLS TO ENSURE THE WELLNESS OF STUDENTS THROUGHOUT THE SCHOOL YEAR. OBESITY (ACCESS TO HEALTHY FOODS): COMMUNITY HEALTH NETWORK TOOK OVER THE DAY-TO-DAY OPERATIONAL MANAGEMENT OF THE CUPBOARD, A FOOD PANTRY THAT SERVES RESIDENTS OF LAWRENCE TOWNSHIP OF INDIANAPOLIS, AND ASSISTS AN ESTIMATED 300 FAMILIES PER WEEK, PROVIDES HEALTHIER FOOD OPTIONS AND HELPS RELIEVE THE STRAIN CAUSED BY FOOD INSECURITY. IN 2016, THE CUPBOARD PROVIDED SERVICES TO APPROXIMATELY 57,000 PERSONS. THE CUPBOARD IS A CLIENT-CHOICE FOOD PANTRY, SERVING RESIDENTS THROUGH PARTNERSHIPS WITH GLEANERS FOOD BANK OF INDIANA, MIDWEST FOOD BANK, AND LOCAL RELIGIOUS INSTITUTIONS AND BUSINESSES. THE FOOD PANTRY IS OPEN WEDNESDAYS FROM 10 A.M. TO 4 P.M. AND 6 P.M. TO 8 P.M., FRIDAYS FROM 10 A.M. TO 4 P.M. AND THE THIRD SATURDAY OF THE MONTH FROM 10 A.M. TO NOON. COMMUNITY HEALTH NETWORK SUPPORTS MANY URBAN FARMING AND FARMERS MARKET INITIATIVES THAT PROVIDE FRESH PRODUCE AND HEALTHY OPTIONS. FARMERS MARKETS ARE FOR EVERYONE. ACCESS TO AFFORDABLE, FRESH, AND HEALTHY WHOLE FOODS IS A CHALLENGE FOR MANY PEOPLE WHO RELY ON FOOD ASSISTANCE PROGRAMS LIKE SNAP THAT HELP LOW-INCOME FAMILIES AND INDIVIDUALS BUY FRESH, INDIANA-GROWN FOOD THAT PROVIDES REAL SUSTENANCE FOR THEMSELVES AND THEIR COMMUNITIES. FOR INSTANCE, COMMUNITY EMPLOYEES ALSO VOLUNTEER AND SUPPORT INDY URBAN ACRES WHICH IS AN ORGANIC FARM THAT DONATES 100% OF THE FRESH FRUITS AND VEGETABLES HARVESTED TO LOCAL FOOD PANTRIES THROUGH A PARTNERSHIP WITH GLEANERS FOOD BANK. SINCE 2011, INDY URBAN ACRES HAS GROWN INTO A MULTI- DISCIPLINARY FARM THAT PROVIDES FOOD EQUALITY FOR LOW-INCOME FAMILIES, EDUCATES THOUSANDS OF YOUTH THROUGH TOURS AND FARM-TO-PLATE WORKSHOPS, PROVIDES COMMUNITY ENGAGEMENT TO THOUSANDS OF VOLUNTEERS AND GROUPS, TEACHES TEENS VALUABLE JOB SKILLS AND HELPS IMPROVE INDY'S FOOD SYSTEM. ASTHMA: OUR PRESIDENT AND CEO, BRYAN MILLS, HAS JOINED WITH A NUMBER OF PARTNERS FROM HEALTHCARE AND THE BUSINESS COMMUNITY-INCLUDING THE INDIANA HOSPITAL ASSOCIATION, THE INDIANA STATE MEDICAL ASSOCIATION AND THE INDIANA CHAMBER OF COMMERCE-TO CREATE A NEW ORGANIZATION KNOWN AS THE ALLIANCE FOR A HEALTHIER INDIANA. IN 2016, THE GROUP ANNOUNCED PLANS TO TACKLE ITS FIRST CHALLENGE: THE HIGH RATE OF TOBACCO USE IN OUR STATE. TOBACCO USE LEADS TO DISEASE AND DISABILITY AND HARMS NEARLY EVERY ORGAN OF THE BODY. IT IS THE LEADING CAUSE OF PREVENTABLE DEATH. RESEARCH HAS SHOWN THAT SMOKE FROM CIGARS, CIGARETTES, AND PIPES HARMS YOUR BODY IN MANY WAYS, BUT IT IS ESPECIALLY HARMFUL TO THE LUNGS OF A PERSON WITH ASTHMA. TOBACCO SMOKE - INCLUDING SECONDHAND SMOKE - IS ONE OF THE MOST COMMON ASTHMA TRIGGERS. THE ALLIANCE ASKED INDIANA'S STATE LEGISLATURE TO CONSIDER A VARIETY OF MEASURES, INCLUDING HIGHER TOBACCO TAXES, AN INCREASE IN THE SMOKING AGE AND A REPEAL OF THE SMOKERS' BILL OF RIGHTS. COMMUNITY HEALTH NETWORK MADE A MAJOR INVESTMENT OF TIME AND RESOURCES INTO A COMBINED TOBACCO CAMPAIGN THIS YEAR, AND WHILE WE DID NOT GET THE TOBACCO TAX INCREASE WE SOUGHT, WE DID MOVE THE BALL FORWARD ON A TAX AND SECURE A PARTIAL VICTORY ON TOBACCO CESSATION FUNDING. INDIANA LEGISLATORS PROVIDED A 50% INCREASE IN STATE FUNDING FOR TOBACCO CESSATION SERVICES, BRINGING THE ANNUAL TOBACCO CESSATION BUDGET TO 7.5 MILLION. THE NEW ALLIANCE FOR A HEALTHIER INDIANA IS A GREAT EXAMPLE OF HOW WE AT COMMUNITY PARTNER WITH OTHERS TO FURTHER OUR WORK. FROM FOOD INSECURITY TO EDUCATIONAL CHALLENGES TO SUICIDE TO SMOKING AND OTHER ADDICTIONS, WE'RE COMMITTED TO TACKLING SOCIETAL ISSUES THAT AFFECT HEALTH AND QUALITY OF LIFE. COMMUNITY-DRIVEN INITIATIVES COMMUNITY HEALTH NETWORK, CENTRAL INDIANA'S LARGEST PROVIDER OF BEHAVIORAL HEALTH SERVICES, ANNOUNCED ITS COMMITMENT TO BECOMING THE FIRST HEALTH CARE SYSTEM IN THE COUNTRY TO FULLY IMPLEMENT THE ZERO SUICIDE MODEL, DEVELOPED BY THE NATIONAL ACTION ALLIANCE FOR SUICIDE PREVENTION AND OT 1 SPEEDWAY FAMILY PHYSICIANS 1011 N MAIN STREET SUITE 110 INDIANAPOLIS IN 46224 PRIMARY CARE CLINIC PART I, LINE 6A - RELATED ORGANIZATION INFORMATION A COMMUNITY BENEFIT REPORT IS COMPLETED FOR THE COMMUNITY HEALTH NETWORK INCLUDING INDIANAPOLIS OSTEOPATHIC HOSPITAL, INC. AND OTHER TAX-EXEMPT AFFILIATES OF THE NETWORK. PART I, LINE 7 - COSTING METHODOLOGY EXPLANATION A COST TO CHARGE RATIO WAS UTILIZED TO DETERMINE COSTS FOR LINES A THROUGH C IN THE TABLE. THE COST TO CHARGE RATIO WAS DERIVED FROM WORKSHEET 2. LINES E THROUGH I OF THE TABLE ARE BASED ON ACTUAL INCURRED EXPENSES. PART III, LINE 2 - BAD DEBT EXPENSE METHODOLOGY THE COST TO CHARGE RATIO UTILIZED FOR PURPOSES OF REPORTING BAD DEBT COSTS WAS DERIVED FROM WORKSHEET 2 AND IS BASED ON THE ORGANIZATION'S AUDITED FINANCIAL STATEMENTS. PART III, LINE 4 - BAD DEBT EXPENSE EXPLANATION THE AUDITED FINANCIAL STATEMENTS CONTAIN THE FOLLOWING TEXT WITHIN THE FOOTNOTES TO DESCRIBE BAD DEBT EXPENSE: THE NETWORK'S PATIENT ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND CONTRACTUAL ADJUSTMENTS. IN EVALUATING THE COLLECTABILITY OF ACCOUNTS RECEIVABLE, THE NETWORK ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR CONTRACTUAL ADJUSTMENTS AND PROVISION FOR BAD DEBTS. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD PARTY COVERAGE, THE NETWORK ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR CONTRACTUAL ADJUSTMENTS. GENERALLY, FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS, INCLUDING PATIENT DEDUCTIBLES AND CO-INSURANCE, THE NETWORK RECORDS A PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS ADJUSTED THROUGH THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. CERTAIN ACCOUNTS THAT ARE SENT TO COLLECTION COMPANIES REMAIN AS ACCOUNTS RECEIVABLE ON THE BALANCE SHEET. THESE ACCOUNTS ARE NOT WRITTEN OFF UNLESS RETURNED FROM THE COLLECTION COMPANY. HOWEVER, THEY ARE FULLY RESERVED WITHIN THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. THE NETWORK RECOGNIZES PATIENT SERVICE REVENUE ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY PAYOR COVERAGE ON THE BASIS OF CONTRACTUAL RATES FOR THE SERVICES RENDERED. FOR UNINSURED PATIENTS THAT DO NOT QUALIFY FOR CHARITY CARE, THE NETWORK RECOGNIZES REVENUE ON THE BASIS OF ITS STANDARD RATES FOR SERVICES PROVIDED OR ON THE BASIS OF DISCOUNTED RATES IF IN ACCORDANCE WITH POLICY. ON THE BASIS OF HISTORICAL EXPERIENCE, A PORTION OF THE NETWORK'S UNINSURED PATIENTS WILL BE UNABLE OR UNWILLING TO PAY FOR THE SERVICES PROVIDED. THUS, THE NETWORK RECORDS A PROVISION FOR BAD DEBTS RELATED TO UNINSURED PATIENTS IN THE PERIOD THE SERVICES ARE PROVIDED. PATIENT SERVICE REVENUE, NET OF CONTRACTUAL ALLOWANCES AND DISCOUNTS RECOGNIZED IN THE PERIOD FROM THESE MAJOR PAYOR SOURCES, IS AS FOLLOWS FOR THE YEARS ENDED DECEMBER 31, 2016 AND 2015, RESPECTIVELY: THIRD PARTY PAYORS SELF-PAY TOTAL ALL PAYORS 2016 PATIENT SERVICE REVENUE(NET OF CONTRACTUAL ALLOWANCES AND DISCOUNTS) 2,100,098 80,151 2,180,249 ========== ======== ========== 2015 PATIENT SERVICE REVENUE(NET OF CONTRACTUAL ALLOWANCES AND DISCOUNTS) 1,985,324 118,573 2,103,897 ========== ======== ========== THE NETWORK MAINTAINS RECORDS TO IDENTIFY AND MONITOR THE LEVEL OF CHARITY CARE IT PROVIDES. THE NETWORK PROVIDES 100% CHARITY CARE TO PATIENTS WHOSE INCOME LEVEL IS EQUAL TO OR BELOW 200% OF THE FEDERAL POVERTY LEVEL. PATIENTS WITH INCOME LEVELS RANGING FROM 200% - 300% OF THE CURRENT YEAR'S FEDERAL POVERTY LEVEL WILL QUALIFY FOR PARTIAL ASSISTANCE DETERMINED BY A SLIDING SCALE. THE NETWORK USES COST AS THE MEASUREMENT BASIS FOR CHARITY CARE DISCLOSURE PURPOSES WITH THE COST BEING IDENTIFIED AS THE DIRECT AND INDIRECT COSTS OF PROVIDING THE CHARITY CARE. CHARITY CARE AT COST WAS 6,426000 AND 10,566000 FOR THE YEARS ENDED DECEMBER 31, 2016 AND 2015, RESPECTIVELY. CHARITY CARE COST WAS ESTIMATED ON THE APPLICATION OF THE ASSOCIATED COST-TO-CHARGE RATIOS. THE DECREASE IN CHARITY CARE IS THE RESULT OF MORE PATIENTS BEING COVERED UNDER HEALTH EXCHANGE PROGRAMS MANDATED BY THE AFFORDABLE HEALTH CARE ACT AND THE HEALTHY INDIANA PLAN 2.0. BEGINNING JUNE 2012, THE STATE OF INDIANA OFFERED VOLUNTARY PARTICIPATION IN THE STATE OF INDIANA'S HOSPITAL ASSESSMENT FEE ("HAF") PROGRAM. THE STATE OF INDIANA IMPLEMENTED THIS PROGRAM TO UTILIZE SUPPLEMENTAL REIMBURSEMENT PROGRAMS FOR THE PURPOSE OF PROVIDING REIMBURSEMENT TO PROVIDERS TO OFFSET A PORTION OF THE COST OF PROVIDING CARE TO MEDICAID AND INDIGENT PATIENTS. THIS PROGRAM IS DESIGNED WITH INPUT FROM CENTERS FOR MEDICARE AND MEDICAID SERVICES AND IS FUNDED WITH A COMBINATION OF STATE AND FEDERAL RESOURCES, INCLUDING FEES OR TAXES LEVIED ON THE PROVIDERS. THE NETWORK RECOGNIZES REVENUES AND RELATED FEES ASSOCIATED WITH THE HAF PROGRAM IN THE PERIOD IN WHICH AMOUNTS ARE ESTIMABLE AND COLLECTION OF PAYMENT IS REASONABLY ASSURED. REIMBURSEMENT UNDER THE PROGRAM IS REFLECTED WITHIN NET PATIENT SERVICE REVENUE AND THE FEES PAID FOR PARTICIPATION IN THE HAF PROGRAM ARE RECORDED IN SUPPLIES AND OTHER EXPENSES WITHIN THE CONSOLIDATED STATEMENTS OF OPERATIONS AND CHANGES IN NET ASSETS. THE FEES AND REIMBURSEMENTS ARE SETTLED MONTHLY. REVENUE RECOGNIZED RELATED TO THE HAF PROGRAM WAS 69,047000 AND 71,953000 FOR THE YEARS ENDED DECEMBER 31, 2016 AND 2015, RESPECTIVELY. EXPENSE FOR FEES RELATED TO THE HAF PROGRAM WAS 40,627000 AND 41,044000 FOR THE YEARS ENDED DECEMBER 31, 2016 AND 2015, RESPECTIVELY. THE HAF PROGRAM RUNS ON AN ANNUAL CYCLE FROM JULY 1 TO JUNE 30 AND IS EFFECTIVE UNTIL JUNE 30, 2019. THE CONSOLIDATED BALANCE SHEET AT DECEMBER 31, 2016 INCLUDES LESS THAN ONE MONTH OF HAF ACTIVITY, OR 3,470000 AND 4,202000 IN ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS RECEIVABLE AND PAYABLE, RESPECTIVELY, RELATED TO THE HAF PROGRAM. ADJUSTMENTS TO THE ALLOWANCE FOR DOUBTFUL ACCOUNTS ARE MADE AFTER THE NETWORK HAS ANALYZED HISTORICAL CASH COLLECTIONS AND CONSIDERED THE IMPACT OF ANY KNOWN MATERIAL EVENTS. UNCOLLECTIBLE ACCOUNTS ARE WRITTEN-OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS AFTER EXHAUSTING COLLECTION EFFORTS. ANY SUBSEQUENT RECOVERIES ARE RECORDED AGAINST THE PROVISION FOR BAD DEBTS. PART III, LINE 9B - COLLECTION PRACTICES EXPLANATION SEE ATTACHED FINANCIAL ASSISTANCE POLICY. ADDITIONAL INFORMATION PART VI, ITEMS 2 THROUGH 5 ARE DISCUSSED WITHIN THE ATTACHED IRS 990 SCHEDULE H SUPPLEMENTAL INFORMATION REPORT. FOR A COPY OF THIS REPORT, PLEASE CONTACT HOLLY MILLARD AT (317) 355-5860. PART VI, ITEM 6 - AFFILIATED HEALTH CARE SYSTEM INDIANAPOLIS OSTEOPATHIC HOSPITAL, INC. ("IOH") IS PART OF AN AFFILIATED HEALTH CARE SYSTEM. SEE THE ATTACHED IRS 990 SCHEDULE H SUPPLEMENTAL INFORMATION REPORT FOR HOW IOH IS INVOLVED IN PROMOTING THE HEALTH OF THE COMMUNITY IT SERVES. PART VI, ITEM 7 - STATE FILING OF COMMUNITY BENEFIT REPORT INDIANA true true false false false false false true false BRYAN A MILLS DIRECTOR 1233291 73920 120365 417734 34408 1879718 73920 ANNETTE M MOORE MD DIRECTOR 557901 19340 15900 593141 HANY HADDAD MD DIRECTOR 473546 19229 15900 25364 534039 KENNETH SHAVER MD DIRECTOR 215013 8552 118456 83150 23209 448380 8552 CHARLES SCOTT VORE MD DIRECTOR 227500 227500 DAVID C WILLIAMS DO PRES - WEST REGION 403328 147600 19995 159706 23209 753838 47600 DOUG PENLEY COO - WEST REGION 174521 17280 1157 64820 35387 293165 17280 JEFFERY KIRKHAM FORMER OFFICER 293422 39600 1477 55500 34753 424752 39600 ELIZABETH HALL FORMER FINANCE DIR 93940 10082 496 17482 22585 144585 10082 SCHEDULE J, PAGE 1, PART I, LINE 4 BRYAN A. MILLS 0 118,000 0 LYNN NICKOL 35,187 0 0 SCHEDULE J, PART III PART I, LINE 3 - RELATED ORG METHODS USED FOR COMPENSATION EXPLANATION INDIANAPOLIS OSTEOPATHIC HOSPITAL, INC. ("IOH") CEO/EXECUTIVE DIRECTOR IS PAID BY COMMUNITY HEALTH NETWORK, INC. ("CHNW"), A RELATED 501(C)(3) ORGANIZATION. CHNW USES THE FOLLOWING IN DETERMINING THE CEO'S COMPENSATION: 1) COMPENSATION COMMITTEE, 2) INDEPENDENT COMPENSATION CONSULTANT, 3) COMPENSATION SURVEY OR STUDY, AND 4) APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. PART I, LINE 4A - SEVERANCE LYNN NICKOL RECEIVED PAYMENTS FOR TERMINATION OF EMPLOYMENT EFFECTIVE 08/01/16. THE PAYMENTS WERE BASED ON HER ANNUAL BASE COMPENSATION AS OF AUGUST 1, 2016 AND WERE PAYABLE FOR THE DURATION OF THE SEVERANCE PERIOD ENDING JANUARY 1, 2017 PER AGREEMENT. PART I, LINE 4B - SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN BRYAN A. MILLS PARTICIPATED IN A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN THROUGH HIS EMPLOYER, CHNW WHICH WAS PAYABLE IN 2016. PART I, LINE 7 - NON-FIXED PAYMENTS PROVIDED INDIANAPOLIS OSTEOPATHIC HOSPITAL INC., PARTICIPATES IN THE NETWORK'S SENIOR LEADERSHIP INCENTIVE PROGRAM. CERTAIN INDIVIDUALS OF THE LEADERSHIP TEAM PARTICIPATE IN THIS PROGRAM. THE PROGRAM WAS ADOPTED BY THE EXECUTIVE COMPENSATION COMMITTEE, AND IS INTENDED TO INFLUENCE OUTSTANDING PERFORMANCE BY THE SENIOR LEADERS, AS MEASURED AGAINST BOTH ORGANIZATIONAL AND INDIVIDUAL PERFORMANCE. THE PROGRAM IS REVIEWED ANNUALLY BY THE EXECUTIVE COMPENSATION COMMITTEE, WHICH IS COMPOSED ENTIRELY OF INDEPENDENT COMMUNITY MEMBERS. THE INCENTIVE COMPENSATION THAT IS AWARDED IS INCLUDED IN TOTAL COMPENSATION TO THE EXECUTIVE. THE TOTAL COMPENSATION (INCLUDING ANY PAYMENTS UNDER THE PROGRAM) IS SUBJECT TO THE REVIEW AND APPROVAL OF THE EXECUTIVE COMPENSATION COMMITTEE AND INDEPENDENT COMPENSATION CONSULTANT, IN CONSIDERATION OF CODE SECTION 4958 (AND THE CORRESPONDING TREASURY REGULATIONS) TO ENSURE THAT IT REFLECTS ARMS LENGTH, FAIR MARKET TERMS. FORM 990 - ORGANIZATION'S MISSION TO PROVIDE QUALITY HEALTHCARE TO THE CENTRAL INDIANA COMMUNITY - REGARDLESS OF THEIR ABILITY TO PAY - WITH FACILITIES, SUPPORT AND GROWTH FOR THE OSTEOPATHIC PROFESSION THROUGH OUR INTERN/RESIDENT EDUCATION PROGRAMS, INCREASED PHYSICIAN PRACTICES, PRESENCE AND EXPERTISE. FORM 990 FORM 990, PART I, LINE 4 - INDEPENDENT VOTING MEMBERS INDIANAPOLIS OSTEOPATHIC HOSPITAL, INC. ("IOH") IS AN AFFILIATE OF COMMUNITY HEALTH NETWORK ("THE NETWORK"), AN INTEGRATED HEALTH DELIVERY SYSTEM. IOH IS CONTROLLED BY ITS PARENT, COMMUNITY HEALTH NETWORK, INC. ("CHNW"), THE TAX-EXEMPT PARENT OF THE INTEGRATED HEALTH DELIVERY SYSTEM. IOH'S ARTICLES OF INCORPORATION AND BYLAWS DESIGNATE THE MEMBERS OF THE BOARD OF DIRECTORS OF CHNW TO BE THE DIRECTORS OF IOH. CHNW EXERCISES CONTROL OVER IOH THROUGH A SERIES OF GOVERNANCE RIGHTS: A) CHNW IS THE SOLE MEMBER OF IOH; B) IOH HAS DELEGATED EXCLUSIVE AUTHORITY TO CHNW, ACTING THROUGH CHNW'S BOARD OF DIRECTORS, IN THE FOLLOWING SUBSTANTIVE AREAS: STRATEGIC PLANNING; CAPITAL ACCESS, BUDGETING AND ALLOCATION; AUDIT AND COMPLIANCE; EXECUTIVE COMPENSATION; AND DISPUTE RESOLUTION; C) CHNW MUST APPROVE ANY MODIFICATION, REPEAL, AMENDMENT, OR RESTATEMENT OF IOH'S ARTICLES OF INCORPORATION; AND D) CHNW MUST APPROVE ANY SALE OR DISPOSITION OF SUBSTANTIALLY ALL OF THE ASSETS OF IOH. WITH REGARD TO EXECUTIVE COMPENSATION, CHNW HAS DELEGATED AUTHORITY TO REVIEW AND APPROVE EXECUTIVE COMPENSATION, INCLUDING IOH'S EXECUTIVES, TO A NETWORK EXECUTIVE COMPENSATION COMMITTEE COMPOSED OF INDEPENDENT OUTSIDE DIRECTORS. IN SUM, IOH HAS REMOVED ANY RISK OF INAPPROPRIATE RELATED PARTY TRANSACTIONS BY DELEGATING (THROUGH CHNW) ITS EXECUTIVE COMPENSATION DECISIONS TO A NETWORK EXECUTIVE COMPENSATION COMMITTEE AND ITS CONFLICT OF INTEREST DECISIONS TO A NETWORK AUDIT COMMITTEE, WITH EACH COMMITTEE COMPOSED OF INDEPENDENT OUTSIDE DIRECTORS. FORM 990, PAGE 2, PART III, LINE 3 FOR A NUMBER OF YEARS, A DECLINING ECONOMIC AND SOCIAL STRUCTURE IN THE GEOGRAPHIC AREA, COUPLED WITH AN INABILITY TO NEGOTIATE FAVORABLE PRICING AND REIMBURSEMENT LEVELS DUE TO THE SMALL MARKET SIZE PUT A STRAIN ON THE ECONOMIC FEASIBILITY OF IOH. ON DECEMBER 2, 2016 THE SURGERY DEPARTMENT CLOSED. THE EMERGENCY DEPARTMENT AND ALL OTHER HOSPITAL SERVICES IN THE MAIN BUILDING CLOSED ON DECEMBER 16, 2016. FORM 990, PAGE 2, PART III, LINE 4A INCLUDED 10,230 EMERGENCY VISITS. THE IOH SURGERY DEPARTMENT PERFORMED 1,844 SURGERIES IN 2016. FORM 990, PART V FORM 990, PART V, LINE 1A - BOX 3 OF FORM 1096 FORM 1096 WAS PROCESSED UNDER THE NAME AND FEDERAL IDENTIFICATION NUMBER OF COMMUNITY HEALTH NETWORK, INC. FORM 990, PART VI FORM 990, PART VI, LINE 2 - RELATED PARTY INFORMATION AMONG OFFICERS THE BOARD OF DIRECTORS FOR IOH IS ALSO THE BOARD OF DIRECTORS FOR COMMUNITY HEALTH NETWORK, INC. ("CHNW") AND BRYAN MILLS AND DAVID WILLIAMS, D.O. RECEIVED COMPENSATION FROM CHNW. THE FOLLOWING DIRECTORS ALSO SERVED AS A DIRECTOR OF COMMUNITY PHYSICIANS OF INDIANA, INC. ("CPI"): JASON BECKER BRYAN A. MILLS ANNETTE M. MOORE, M.D. STEVEN R. PLUMP AND HANY HADDAD, M.D., ANNETTE M. MOORE, M.D., AND KENNETH SHAVER, M.D. RECEIVED COMPENSATION FROM CPI. THE FOLLOWING DIRECTORS SERVED AS DIRECTORS OF VISIONARY ENTERPRISES, INC., A TAXABLE AFFILIATE OF CHNW: BRUCE F. KING BRYAN A. MILLS FORM 990, PART VI, LINE 16B - JOINT VENTURE POLICY EVEN THOUGH A WRITTEN POLICY DOES NOT CURRENTLY EXIST, THE MATTER IS UNDER REVIEW. FORM 990, PAGE 6, PART VI, LINE 3 EFFECTIVE JANUARY 30, 2014, IOH DELEGATED EXCLUSIVE AUTHORITY TO CHNW (THE SOLE MEMBER), ACTING THROUGH CHNW'S BOARD OF DIRECTORS, IN THE FOLLOWING SUBSTANTIVE AREAS: STRATEGIC PLANNING, CAPITAL ACCESS, BUDGETING AND ALLOCATION; AUDIT AND COMPLIANCE; NETWORK COMPENSATION; AND DISPUTE RESOLUTION. IN ADDITION, CHNW MUST APPROVE ANY MODIFICATION, REPEAL, AMENDMENT, OR RESTATEMENT OF IOH'S ARTICLES OF INCORPORATION. FINALLY, CHNW MUST APPROVE ANY MATERIAL SALE OR DISPOSITION OF THE ASSETS OF IOH. FORM 990, PAGE 6, PART VI, LINE 6 CHNW IS THE SOLE MEMBER OF IOH. CHNW IS AN EXEMPT ORGANIZATION PURSUANT TO SECTION 501(C)(3). FORM 990, PAGE 6, PART VI, LINE 7B EFFECTIVE JANUARY 30, 2014, IOH DELEGATED EXCLUSIVE AUTHORITY TO CHNW (THE SOLE MEMBER), ACTING THROUGH CHNW'S BOARD OF DIRECTORS, IN THE FOLLOWING SUBSTANTIVE AREAS: STRATEGIC PLANNING, CAPITAL ACCESS, BUDGETING AND ALLOCATION; AUDIT AND COMPLIANCE; NETWORK COMPENSATION; AND DISPUTE RESOLUTION. IN ADDITION, CHNW MUST APPROVE ANY MODIFICATION, REPEAL, AMENDMENT, OR RESTATEMENT OF IOH'S ARTICLES OF INCORPORATION. FINALLY, CHNW MUST APPROVE ANY MATERIAL SALE OR DISPOSITION OF THE ASSETS OF IOH. FORM 990, PAGE 6, PART VI, LINE 11B IOH IS AN AFFILIATE OF COMMUNITY HEALTH NETWORK ("THE NETWORK"), AN INTEGRATED HEALTH DELIVERY SYSTEM. IOH HAS DELEGATED AUTHORITY FOR THE REVIEW OF THE FORM 990 TO TWO COMMITTEES COMPOSED OF INDEPENDENT OUTSIDE DIRECTORS: A) THE NETWORK EXECUTIVE COMPENSATION COMMITTEE REVIEWED THE COMPENSATION ASPECTS OF IOH'S FORM 990, AND B) THE NETWORK FINANCE COMMITTEE REVIEWED THE REMAINDER OF THE FORM 990. IN ADDITION, IOH'S BOARD OF DIRECTORS AND THE NETWORK'S OUTSIDE ACCOUNTING FIRM AND LAW FIRM REVIEWED THE FORM 990 PRIOR TO FILING. IOH UTILIZED THIS PROCESS TO ENSURE THAT IOH'S FORM 990 RECEIVED SUBSTANTIVE REVIEW BY DIRECTORS AND PROFESSIONALS WITH SPECIFIC KNOWLEDGE OF IOH'S ACTIVITIES AND EXTENSIVE FINANCIAL, ACCOUNTING, AND TAX EXPERTISE. FORM 990, PAGE 6, PART VI, LINE 12C CHNW HAS ASSUMED RESPONSIBILITY FOR IOH'S AUDIT AND COMPLIANCE MATTERS. CHNW HAS ADOPTED A CONFLICT OF INTEREST POLICY THAT APPLIES TO IOH. THE CONFLICT OF INTEREST POLICY REQUIRES DIRECTORS, OFFICERS, AND KEY EMPLOYEES TO SUBMIT AN ANNUAL CONFLICT OF INTEREST DISCLOSURE. THE ANNUAL DISCLOSURE REQUIRES DIRECTORS, OFFICERS, AND KEY EMPLOYEES TO DISCLOSE, IN WRITING, ANY KNOWN FINANCIAL INTEREST THAT THE INDIVIDUAL (TOGETHER WITH FAMILY MEMBERS) HAS IN ANY BUSINESS ENTITY THAT TRANSACTS BUSINESS WITH IOH. IN ADDITION, DIRECTORS, OFFICERS, AND KEY EMPLOYEES ARE REQUIRED TO IMMEDIATELY DISCLOSE ANY POSSIBLE CONFLICT OF INTEREST THAT ARISES MID-YEAR IN RELATION TO A PROPOSED TRANSACTION. THE CONFLICT OF INTEREST POLICY REQUIRES THAT ANY INDIVIDUAL WITH A CONFLICT BE RECUSED FROM THE DECISION MAKING PROCESS, THAT INDEPENDENT DIRECTORS OR COMMITTEE MEMBERS DETERMINE THAT THE PROPOSED TRANSACTION IS IN THE BEST INTEREST OF IOH, AND THE TRANSACTION MUST BE APPROVED BY A VOTE OF INDEPENDENT DIRECTORS OR COMMITTEE MEMBERS WITHOUT THE PARTICIPATION OF ANY INTERESTED INDIVIDUAL. THE ANNUAL CONFLICT DISCLOSURE STATEMENTS ARE SUBMITTED TO, AND REVIEWED BY, CHNW'S AUDIT COMMITTEE, COMPOSED OF INDEPENDENT DIRECTORS. IN ADDITION, THE EXECUTIVE STAFF AND GENERAL COUNSEL OF THE NETWORK ARE RESPONSIBLE FOR MONITORING ANY POSSIBLE CONFLICT TRANSACTIONS THAT ARISE AND MANAGING THEM TO ENSURE THAT ALL TRANSACTIONS REPRESENT ARMS LENGTH, FAIR MARKET VALUE TERMS FOR THE BENEFIT OF IOH. FORM 990, PAGE 6, PART VI, LINE 15A CHNW ASSUMED RESPONSIBILITY FOR IOH'S EXECUTIVE COMPENSATION MATTERS. CHNW HAS ADOPTED AN EXECUTIVE COMPENSATION AND INTERMEDIATE SANCTIONS POLICY. THE PURPOSE OF THE POLICY IS TO ENSURE THAT CHNW'S COMPENSATION ARRANGEMENTS WITH RELATED PARTIES ARE EVALUATED AND ENTERED AT ARMS LENGTH AND THAT ANY COMPENSATION THAT IS PAID TO A RELATED PARTY IS REASONABLE AND REFLECTS FAIR MARKET VALUE. THIS POLICY ENCOURAGES THE APPLICATION OF THE REBUTTABLE PRESUMPTION STANDARD OF CODE SECTION 4958 AND THE RELATED TREASURY REGULATIONS BY: A) EXCLUDING ANY INTERESTED PARTY FROM THE DECISION MAKING PROCESS, B) REQUIRING DISINTERESTED BOARD OR COMMITTEE MEMBERS TO OBTAIN AND RELY UPON COMPARABILITY DATA WHEN SETTING THE PROPOSED COMPENSATION TERMS, C) REQUIRING APPROVAL OF THE TRANSACTION IN ADVANCE BY DISINTERESTED DIRECTORS OR COMMITTEE MEMBERS, AND D) REQUIRING CONTEMPORANEOUS DOCUMENTATION (I.E. MINUTES) REFLECTING THE DECISION AND THE PROCESS BY WHICH IT WAS MADE. CHNW ALSO DELEGATED AUTHORITY REGARDING IOH'S EXECUTIVE COMPENSATION TO A) THE NETWORK EXECUTIVE COMPENSATION COMMITTEE, COMPOSED OF INDEPENDENT OUTSIDE DIRECTORS, WHICH IS RESPONSIBLE FOR APPLYING THE TERMS AND PROCESS OF THE EXECUTIVE COMPENSATION AND INTERMEDIATE SANCTIONS POLICY AS OUTLINED ABOVE, AND B) THE NETWORK VICE PRESIDENT OF HUMAN RESOURCES WHO IS RESPONSIBLE FOR OBTAINING COMPARATIVE SALARY MARKET DATA FOR THE CHIEF EXECUTIVE OFFICER, OFFICERS, AND KEY EMPLOYEES, PERIODICALLY ENGAGING AN INDEPENDENT COMPENSATION CONSULTANT TO ESTABLISH REASONABLE COMPENSATION, AND PROVIDING STAFF SUPPORT TO THE NETWORK EXECUTIVE COMPENSATION COMMITTEE. DURING 2016, THE NETWORK EXECUTIVE COMPENSATION COMMITTEE FOLLOWED THIS PROCESS FOR ALL SENIOR EXECUTIVE LEADERS. FORM 990, PAGE 6, PART VI, LINE 15B SEE LINE 15A ABOVE FORM 990, PAGE 6, PART VI, LINE 19 A) THE ARTICLES OF INCORPORATION AND CERTIFICATE OF EXISTENCE ARE ON FILE WITH THE INDIANA SECRETARY OF STATE AND ARE AVAILABLE TO THE PUBLIC UPON REQUEST TO THE INDIANA SECRETARY OF STATE OR FREE OF CHARGE ON THE SECRETARY OF STATE'S WEBSITE. B) IOH DOES NOT MAKE ITS CONFLICT OF INTEREST POLICY AVAILABLE TO THE PUBLIC. C) IOH DOES NOT HAVE INDIVIDUALLY AUDITED FINANCIAL STATEMENTS. ITS FINANCIAL RESULTS ARE INCLUDED IN THE CONSOLIDATED FINANCIAL STATEMENTS OF CHNW AND AFFILIATES. AS SUCH, THERE ARE NO INDIVIDUAL FINANCIAL STATEMENTS TO POST. IOH DOES FILE THE 990 TAX RETURN ON AN ANNUAL BASIS WHICH IS AVAILABLE UPON REQUEST AND/OR AVAILABLE ON A DELAYED BASIS ON GUIDESTAR.ORG. D) COMMUNITY HEALTH NETWORK, INC. AND AFFILIATES PROVIDE ANY DOCUMENT OPEN TO PUBLIC INSPECTION UPON REQUEST. FORM 990, PART IX, LINE 11G PROFESSIONAL FEES 128,457 50,265 0 SERVICE EXPENSE 5,341,397 7,430,248 0 TOTAL 5,469,854 7,480,513 0 FORM 990, PART X AN APPRAISAL OF THE HOSPITAL WAS COMPLETED AND THE VALUE WAS SIGNIFICANTLY LESS THAN THE BOOK VALUE DUE TO THE LOCATION, CONDITION AND AGE OF THE BUILDING. AS A RESULT, AN ADJUSTMENT WAS MADE TO LOWER THE BOOK VALUE OF THE HOSPITAL. 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