INDIANA UNIVERSITY HEALTH BLACKFORD HOSPITAL INC: Form 990, tax year 2021

View the entire original 990 at ProPublica ↗

Organization: INDIANA UNIVERSITY HEALTH BLACKFORD HOSPITAL INC (EIN 01-0646166)
Tax period: 2021-01-01 to 2021-12-31
Filed: 2022-11-14
IRS object ID: 202213189349308121
Schema version: 2021v4.2
Note: A later return for the same period supersedes this one.
Source: Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header
Form 990
Schedule A
Schedule C
Schedule D
Schedule H
Schedule J
Schedule L
Schedule O
Schedule R

Return header ReturnHeader

Field	Value	IRS element (for citing)
Return	2022-11-14T12:36:04-06:00	ReturnTs
Tax Period End	2021-12-31	TaxPeriodEndDt
Return Type	990	ReturnTypeCd
Tax Period Begin	2021-01-01	TaxPeriodBeginDt

Filer Filer

Field	Value	IRS element (for citing)
EIN	010646166	EIN

Business Name BusinessName

Field	Value	IRS element (for citing)
Business Name Line1	Indiana University Health Blackford Hospital Inc	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Business Name Control	INDI	BusinessNameControlTxt
Phone	3179634842	PhoneNum

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	950 N MERIDIAN STREET 1200	AddressLine1Txt
City	INDIANAPOLIS	CityNm
State Abbreviation	IN	StateAbbreviationCd
ZIP	46204	ZIPCd

Business Officer BusinessOfficerGrp

Field	Value	IRS element (for citing)
Person	JONATHAN W VANATOR	PersonNm
Person Title	CFO	PersonTitleTxt
Signature	2022-11-14	SignatureDt

Signing Officer SigningOfficerGrp

Person Full Name PersonFullName

Field	Value	IRS element (for citing)
Person First	JONATHAN W	PersonFirstNm
Person Last	VANATOR	PersonLastNm

Field	Value	IRS element (for citing)
SSN	999009999	SSN

Field	Value	IRS element (for citing)
Tax	2021	TaxYr
Build TS	2022-09-23 18:48:47Z	BuildTS

Form 990 IRS990

Principal Ofcr Business Name PrincipalOfcrBusinessName

Field	Value	IRS element (for citing)
Business Name Line1	DAVID HYATT	BusinessNameLine1Txt

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	950 N MERIDIAN STREET 1200	AddressLine1Txt
City	INDIANAPOLIS	CityNm
State Abbreviation	IN	StateAbbreviationCd
ZIP	46204	ZIPCd

Field	Value	IRS element (for citing)
Gross Receipts	$29,029,033	GrossReceiptsAmt
Group Return For Affiliates	false	GroupReturnForAffiliatesInd
Organization501c3	Yes (X)	Organization501c3Ind
Website Address	SEE SCHEDULE O	WebsiteAddressTxt
Type Of Organization Corp	Yes (X)	TypeOfOrganizationCorpInd
Formation	2002	FormationYr
Legal Domicile State	IN	LegalDomicileStateCd
Activity Or Mission	Lead the transformation of healthcare through quality, innovation & education, and make Indiana one of the nation's healthiest states.	ActivityOrMissionDesc
Voting Members Governing Body	18	VotingMembersGoverningBodyCnt
Voting Members Independent	13	VotingMembersIndependentCnt
Total Employee	168	TotalEmployeeCnt
Total Volunteers	60	TotalVolunteersCnt
Total Gross UBI	$0	TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm	$0	NetUnrelatedBusTxblIncmAmt
PY Contributions Grants	$13,831	PYContributionsGrantsAmt
CY Contributions Grants	$15,035	CYContributionsGrantsAmt
PY Program Service Revenue	$19,738,983	PYProgramServiceRevenueAmt
CY Program Service Revenue	$28,971,282	CYProgramServiceRevenueAmt
PY Investment Income	$68,498	PYInvestmentIncomeAmt
CY Investment Income	-$139	CYInvestmentIncomeAmt
PY Other Revenue	$53,632	PYOtherRevenueAmt
CY Other Revenue	$42,855	CYOtherRevenueAmt
PY Total Revenue	$19,874,944	PYTotalRevenueAmt
CY Total Revenue	$29,029,033	CYTotalRevenueAmt
CY Grants And Similar Paid	$0	CYGrantsAndSimilarPaidAmt
CY Benefits Paid To Members	$0	CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid	$6,203,076	PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid	$9,940,480	CYSalariesCompEmpBnftPaidAmt
CY Total Prof Fndrsng Expns	$0	CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense	$0	CYTotalFundraisingExpenseAmt
PY Other Expenses	$15,079,161	PYOtherExpensesAmt
CY Other Expenses	$15,640,997	CYOtherExpensesAmt
PY Total Expenses	$21,282,237	PYTotalExpensesAmt
CY Total Expenses	$25,581,477	CYTotalExpensesAmt
PY Revenues Less Expenses	-$1,407,293	PYRevenuesLessExpensesAmt
CY Revenues Less Expenses	$3,447,556	CYRevenuesLessExpensesAmt
Total Assets BOY	$16,345,493	TotalAssetsBOYAmt
Total Assets EOY	$16,872,469	TotalAssetsEOYAmt
Total Liabilities BOY	$8,296,484	TotalLiabilitiesBOYAmt
Total Liabilities EOY	$5,379,736	TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY	$8,049,009	NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY	$11,492,733	NetAssetsOrFundBalancesEOYAmt
Mission	Lead the transformation of healthcare through quality, innovation & education, and make Indiana one of the nation's healthiest states.	MissionDesc
Significant New Program Srvc	false	SignificantNewProgramSrvcInd
Significant Change	false	SignificantChangeInd
Expense	$24,131,114	ExpenseAmt
Grant	$0	GrantAmt
Revenue	$24,566,152	RevenueAmt
Desc	IU HEALTH BLACKFORD HOSPITAL IS A 15-BED CRITICAL ACCESS HOSPITAL THAT OFFERS A BROAD RANGE OF SERVICES TO CARE FOR ITS PATIENTS WITHOUT REGARD TO THEIR ABILITY TO PAY. IU HEALTH BLACKFORD HOSPITAL FEATURES ALL PRIVATE ROOMS, A SPECIALTY CLINIC, CARDIAC AND PULMONARY REHABILITATION, OUTPATIENT SURGICAL SERVICES AND DIAGNOSTIC IMAGING. IN ADDITION TO PROVIDING 24 HOUR EMERGENCY SERVICES, THE HOSPITAL HOSTS A PARAMEDIC-LEVEL AMBULANCE SERVICE.	Desc

Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp

Field	Value	IRS element (for citing)
Expense	$0	ExpenseAmt
Grant	$0	GrantAmt
Revenue	$4,280,702	RevenueAmt
Desc	As of December 31, 2021, Indiana University Health Blackford Hospital, Inc. received stimulus funds from the Provider Relief Fund under the provisions of the Coronavirus Aid, Relief, and Economic Security Act (CARES Act) and Paycheck Protection Program and Health Care Enhancement Act. Indiana University Health Blackford Hospital recognized $4,280,702 as other program service revenue. Indiana University Health Blackford Hospital, Inc. will continue to monitor compliance with the terms and conditions of the Provider Relief Fund.	Desc

Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp

Field	Value	IRS element (for citing)
Expense	$122,225	ExpenseAmt
Grant	$0	GrantAmt
Revenue	$124,428	RevenueAmt
Desc	INDIANA UNIVERSITY HEALTH BLACKFORD HOSPITAL, INC. LEASES PHYSICIAN AND CLINIC SPACE TO RELATED TAX-EXEMPT ORGANIZATIONS. IU HEALTH BLACKFORD RECEIVES REVENUE FROM A RELATED 501(C)(3) ENTITY FOR SHARED SERVICES.	Desc

Field	Value	IRS element (for citing)
Total Program Service Expenses	$24,253,339	TotalProgramServiceExpensesAmt
Described In Section501c3	Yes (true)	DescribedInSection501c3Ind
Schedule B Required	false	ScheduleBRequiredInd
Political Campaign Acty	false	PoliticalCampaignActyInd
Lobbying Activities	Yes (true)	LobbyingActivitiesInd
Donor Advised Fund	false	DonorAdvisedFundInd
Conservation Easements	false	ConservationEasementsInd
Collections Of Art	false	CollectionsOfArtInd
Credit Counseling	false	CreditCounselingInd
Donor Rstr Or Quasi Endowments	false	DonorRstrOrQuasiEndowmentsInd
Report Land Building Equipment	Yes (true)	ReportLandBuildingEquipmentInd
Report Investments Other Sec	false	ReportInvestmentsOtherSecInd
Report Program Related Invst	false	ReportProgramRelatedInvstInd
Report Other Assets	false	ReportOtherAssetsInd
Report Other Liabilities	Yes (true)	ReportOtherLiabilitiesInd
Include FIN48 Footnote	Yes (true)	IncludeFIN48FootnoteInd
Independent Audit Fincl Stmt	false	IndependentAuditFinclStmtInd
Consolidated Audit Fincl Stmt	Yes (true)	ConsolidatedAuditFinclStmtInd
School Operating	false	SchoolOperatingInd
Foreign Office	false	ForeignOfficeInd
Foreign Activities	false	ForeignActivitiesInd
More Than5000 K To Org	false	MoreThan5000KToOrgInd
More Than5000 K To Individuals	false	MoreThan5000KToIndividualsInd
Professional Fundraising	false	ProfessionalFundraisingInd
Fundraising Activities	false	FundraisingActivitiesInd
Gaming Activities	false	GamingActivitiesInd
Operate Hospital	Yes (true)	OperateHospitalInd
Audited Financial Stmt Att	Yes (true)	AuditedFinancialStmtAttInd
Grants To Organizations	false	GrantsToOrganizationsInd
Grants To Individuals	false	GrantsToIndividualsInd
Schedule J Required	Yes (true)	ScheduleJRequiredInd
Tax Exempt Bonds	false	TaxExemptBondsInd
Engaged In Excess Benefit Trans	false	EngagedInExcessBenefitTransInd
PY Excess Benefit Trans	false	PYExcessBenefitTransInd
Loan Outstanding	false	LoanOutstandingInd
Grant To Related Person	false	GrantToRelatedPersonInd
Business Rln With Org Mem	false	BusinessRlnWithOrgMemInd
Business Rln With Fam Mem	Yes (true)	BusinessRlnWithFamMemInd
Business Rln With35 Ctrl Ent	false	BusinessRlnWith35CtrlEntInd
Deductible Non Cash Contri	false	DeductibleNonCashContriInd
Deductible Art Contribution	false	DeductibleArtContributionInd
Terminate Operations	false	TerminateOperationsInd
Partial Liquidation	false	PartialLiquidationInd
Disregarded Entity	false	DisregardedEntityInd
Related Entity	Yes (true)	RelatedEntityInd
Related Organization Ctrl Ent	Yes (true)	RelatedOrganizationCtrlEntInd
Transaction With Control Ent	Yes (true)	TransactionWithControlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org	false	TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp	false	ActivitiesConductedPrtshpInd
Schedule O Required	Yes (true)	ScheduleORequiredInd
IRP Document	0	IRPDocumentCnt
IRP Document W2 G	0	IRPDocumentW2GCnt
Employee	168	EmployeeCnt
Employment Tax Returns Filed	Yes (true)	EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over Limit	false	UnrelatedBusIncmOverLimitInd
Foreign Financial Account	false	ForeignFinancialAccountInd
Prohibited Tax Shelter Trans	false	ProhibitedTaxShelterTransInd
Taxable Party Notification	false	TaxablePartyNotificationInd
Nondeductible Contributions	false	NondeductibleContributionsInd
Quid Pro Quo Contributions	false	QuidProQuoContributionsInd
Form8282 Property Disposed Of	false	Form8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft Cntrct	false	RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct	false	PayPremiumsPrsnlBnftCntrctInd
Indoor Tanning Services	false	IndoorTanningServicesInd
Subj To Tax Rmnrtn Ex Prcht Pymt	false	SubjToTaxRmnrtnExPrchtPymtInd
Subject To Excs Tax Net Invst Inc	false	SubjectToExcsTaxNetInvstIncInd
Info In Schedule O Part VI	Yes (X)	InfoInScheduleOPartVIInd
Governing Body Voting Members	18	GoverningBodyVotingMembersCnt
Independent Voting Member	13	IndependentVotingMemberCnt
Family Or Business Rln	false	FamilyOrBusinessRlnInd
Delegation Of Mgmt Duties	false	DelegationOfMgmtDutiesInd
Change To Org Documents	false	ChangeToOrgDocumentsInd
Material Diversion Or Misuse	false	MaterialDiversionOrMisuseInd
Members Or Stockholders	Yes (true)	MembersOrStockholdersInd
Election Of Board Members	Yes (true)	ElectionOfBoardMembersInd
Decisions Subject To Approva	Yes (true)	DecisionsSubjectToApprovaInd
Minutes Of Governing Body	Yes (true)	MinutesOfGoverningBodyInd
Minutes Of Committees	Yes (true)	MinutesOfCommitteesInd
Officer Mailing Address	false	OfficerMailingAddressInd
Local Chapters	false	LocalChaptersInd
Form990 Provided To Gvrn Body	Yes (true)	Form990ProvidedToGvrnBodyInd
Conflict Of Interest Policy	Yes (true)	ConflictOfInterestPolicyInd
Annual Disclosure Covered Prsn	Yes (true)	AnnualDisclosureCoveredPrsnInd
Regular Monitoring Enfrc	Yes (true)	RegularMonitoringEnfrcInd
Whistleblower Policy	Yes (true)	WhistleblowerPolicyInd
Document Retention Policy	Yes (true)	DocumentRetentionPolicyInd
Compensation Process CEO	false	CompensationProcessCEOInd
Compensation Process Other	false	CompensationProcessOtherInd
Investment In Joint Venture	false	InvestmentInJointVentureInd
States Where Copy Of Return Is Fld	IN	StatesWhereCopyOfReturnIsFldCd
Upon Request	Yes (X)	UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

Field	Value	IRS element (for citing)
Business Name Line1	CRAIG J JONES	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Phone	3179634842	PhoneNum

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	950 N MERIDIAN STREET SUITE 800	AddressLine1Txt
City	INDIANAPOLIS	CityNm
State Abbreviation	IN	StateAbbreviationCd
ZIP	46204	ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (29 entries)

TitleTitleTxt	Average Hours Per WeekAverageHoursPerWeekRt	Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt	Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd	OfficerOfficerInd	Reportable Comp From OrgReportableCompFromOrgAmt	Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt	Other CompensationOtherCompensationAmt	Key EmployeeKeyEmployeeInd	Highest Compensated EmployeeHighestCompensatedEmployeeInd	Former Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd
DAVID W HYATT
DIRECTOR / PRESIDENT	51.0	4.0	Yes (X)	Yes (X)	$0	$293,884	$50,346
JEFFREY C BIRD MD
DIRECTOR/REGIONAL PRESIDENT (ECR)	10.0	45.0	Yes (X)	Yes (X)	$0	$1,348,455	$50,692
JOHN D LITTLER
DIRECTOR/CHAIR (PART YEAR)	1.0	3.0	Yes (X)	Yes (X)	$0	$0	$0
CHANTILLE ALLEN
DIRECTOR (PART YEAR)	1.0	3.0	Yes (X)		$0	$0	$0
CHARLES R ROUTH MD
DIRECTOR (PART YEAR)	1.0	54.0	Yes (X)		$0	$287,062	$50,547
DANIEL E BORGENHEIMER
DIRECTOR	1.0	3.0	Yes (X)		$0	$0	$0
DAVID A LITTLER
Director/ Chair (Part Year)	1.0	3.0	Yes (X)		$0	$0	$0
DERRON L BISHOP PHD
DIRECTOR (PART YEAR)	1.0	3.0	Yes (X)		$0	$0	$0
JOAN V CASTOR
DIRECTOR (PART YEAR)	1.0	54.0	Yes (X)		$0	$1,168,100	$169,979
PATRICK A CLEARY MD
DIRECTOR (PART YEAR)	1.0	3.0	Yes (X)		$0	$0	$0
SAMUEL C KIM MD
DIRECTOR (PART YEAR)	1.0	21.0	Yes (X)		$0	$53,840	$0
TERRY W BAILEY
DIRECTOR (PART YEAR)	1.0	3.0	Yes (X)		$0	$0	$0
WILLIAM W HINKLE
DIRECTOR (PART YEAR)	1.0	3.0	Yes (X)		$0	$0	$0
BETTIE A CALDWELL
TREASURER (PART YEAR)	10.0	45.0		Yes (X)	$0	$152,294	$19,621
JONATHAN W VANATOR
CFO (ECR)	10.0	45.0		Yes (X)	$0	$394,728	$44,214
MICHELLE R ALTOBELLA
SECRETARY (PART YEAR)	10.0	45.0		Yes (X)	$0	$280,297	$49,704
ANN M MCGUIRE
VP-HUMAN RESOURCES REGIONAL (ECR)-PART YEAR	1.0	3.0			$0	$252,844	$11,848	Yes (X)
CARLA C COX RN
VP & CNO (ECR)	10.0	45.0			$0	$319,533	$44,150	Yes (X)
LORI A LUTHER
COO (ECR)	10.0	45.0			$0	$427,171	$49,584	Yes (X)
MEGAN HAYMAKER
VP-HUMAN RESOURCES (ECR) (Part Year)	10.0	45.0			$0	$249,496	$20,638	Yes (X)
PETER M VOSS MD
CMO (ECR)	10.0	45.0			$0	$504,425	$48,556	Yes (X)
HELEN A BORGENHEIMER MD
PHYSICIAN	40.0	10.0			$224,038	$35,417	$42,406		Yes (X)
JAN BLAKE
VP - CNO - BLACKFORD HOSP	50.0	0			$158,171	$0	$30,245		Yes (X)
MONICA R GAITHER
ADMIN-ASSOC-NURSING	50.0	0			$150,032	$0	$29,387		Yes (X)
THOMAS D STEWART MD
PHYSICIAN	40.0	10.0			$359,391	$47,554	$51,815		Yes (X)
THOMAS M LEE MD
PHYSICIAN	40.0	10.0			$326,872	$119,841	$53,214		Yes (X)
CHARLES L CARROLL DO
FORMER HIGHEST COMPENSATED EMPLOYEE	0.0	50.0			$0	$264,034	$9,022			Yes (X)
JUDITH L COLEMAN
FORMER OFFICER	0.0	55.0			$0	$361,715	$48,281			Yes (X)
KEVIN W SCHREIBER MD
FORMER HIGHEST COMPENSATED EMPLOYEE	0.0	50.0			$0	$413,897	$55,537			Yes (X)

Field	Value	IRS element (for citing)
Total Reportable Comp From Org	$1,218,503	TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org	$6,974,587	TotReportableCompRltdOrgAmt
Total Other Compensation	$929,784	TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K	14	IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed	Yes (true)	FormerOfcrEmployeesListedInd
Total Comp Greater Than150 K	Yes (true)	TotalCompGreaterThan150KInd
Compensation From Other Srcs	false	CompensationFromOtherSrcsInd
Cntrct Rcvd Greater Than100 K	0	CntrctRcvdGreaterThan100KCnt
Government Grants	$15,035	GovernmentGrantsAmt
Total Contributions	$15,035	TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (4 entries)

DescDesc	BusinessBusinessCd	Total Revenue ColumnTotalRevenueColumnAmt	Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
NET PATIENT SERVICE REVENUE	622110	$24,566,152	$24,566,152
FEDERAL RECOVERY REVENUE	900099	$4,280,702	$4,280,702
SHARED SERVICES	541900
RENT FROM RELATED 501(C)(3) ORGS	532000	$124,428	$124,428

Total Oth Program Service Rev TotalOthProgramServiceRevGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$0	TotalRevenueColumnAmt
Related Or Exempt Func Income	$0	RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue	$0	UnrelatedBusinessRevenueAmt
Exclusion	$0	ExclusionAmt

Field	Value	IRS element (for citing)
Total Program Service Revenue	$28,971,282	TotalProgramServiceRevenueAmt

Gross Rents GrossRentsGrp

Field	Value	IRS element (for citing)
Real	$100	RealAmt

Rental Income Or Loss RentalIncomeOrLossGrp

Field	Value	IRS element (for citing)
Real	$100	RealAmt
Personal	$0	PersonalAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$100	TotalRevenueColumnAmt
Exclusion	$100	ExclusionAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

Field	Value	IRS element (for citing)
Other	-$139	OtherAmt

Gain Or Loss GainOrLossGrp

Field	Value	IRS element (for citing)
Securities	$0	SecuritiesAmt
Other	-$139	OtherAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

Field	Value	IRS element (for citing)
Total Revenue Column	-$139	TotalRevenueColumnAmt
Exclusion	-$139	ExclusionAmt

Other Revenue Misc OtherRevenueMiscGrp

Field	Value	IRS element (for citing)
Desc	CAFETERIA/FOOD SERVICES	Desc
Business	721110	BusinessCd
Total Revenue Column	$32,144	TotalRevenueColumnAmt
Exclusion	$32,144	ExclusionAmt

Miscellaneous Revenue MiscellaneousRevenueGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$10,611	TotalRevenueColumnAmt
Related Or Exempt Func Income	$0	RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue	$0	UnrelatedBusinessRevenueAmt
Exclusion	$10,611	ExclusionAmt

Field	Value	IRS element (for citing)
Other Revenue Total	$42,755	OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$29,029,033	TotalRevenueColumnAmt
Related Or Exempt Func Income	$28,971,282	RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue	$0	UnrelatedBusinessRevenueAmt
Exclusion	$42,716	ExclusionAmt

Field	Value	IRS element (for citing)
Info In Schedule O Part IX	Yes (X)	InfoInScheduleOPartIXInd

Other Salaries And Wages OtherSalariesAndWagesGrp

Field	Value	IRS element (for citing)
Total	$7,865,373	TotalAmt
Program Services	$7,609,884	ProgramServicesAmt
Management And General	$255,489	ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

Field	Value	IRS element (for citing)
Total	$274,099	TotalAmt
Program Services	$265,196	ProgramServicesAmt
Management And General	$8,903	ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

Field	Value	IRS element (for citing)
Total	$1,260,832	TotalAmt
Program Services	$1,219,877	ProgramServicesAmt
Management And General	$40,955	ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

Field	Value	IRS element (for citing)
Total	$540,176	TotalAmt
Program Services	$522,630	ProgramServicesAmt
Management And General	$17,546	ManagementAndGeneralAmt

Fees For Services Lobbying FeesForServicesLobbyingGrp

Field	Value	IRS element (for citing)
Total	$1,953	TotalAmt
Management And General	$1,953	ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

Field	Value	IRS element (for citing)
Total	$9,684,553	TotalAmt
Program Services	$8,902,302	ProgramServicesAmt
Management And General	$782,251	ManagementAndGeneralAmt
Fundraising	$0	FundraisingAmt

Information Technology InformationTechnologyGrp

Field	Value	IRS element (for citing)
Total	$15,078	TotalAmt
Program Services	$7,539	ProgramServicesAmt
Management And General	$7,539	ManagementAndGeneralAmt

Occupancy OccupancyGrp

Field	Value	IRS element (for citing)
Total	$591,995	TotalAmt
Program Services	$591,995	ProgramServicesAmt

Travel TravelGrp

Field	Value	IRS element (for citing)
Total	$2,616	TotalAmt
Program Services	$2,405	ProgramServicesAmt
Management And General	$211	ManagementAndGeneralAmt

Conferences Meetings ConferencesMeetingsGrp

Field	Value	IRS element (for citing)
Total	$14,493	TotalAmt
Program Services	$13,322	ProgramServicesAmt
Management And General	$1,171	ManagementAndGeneralAmt

Depreciation Depletion DepreciationDepletionGrp

Field	Value	IRS element (for citing)
Total	$800,602	TotalAmt
Program Services	$765,857	ProgramServicesAmt
Management And General	$34,745	ManagementAndGeneralAmt

Insurance InsuranceGrp

Field	Value	IRS element (for citing)
Total	$136,385	TotalAmt
Management And General	$136,385	ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (3 entries)

DescDesc	TotalTotalAmt	Program ServicesProgramServicesAmt
BAD DEBT	$1,447,547	$1,447,547
DRUGS AND MEDICAL SUPPLIES	$1,638,333	$1,638,333
HOSPITAL ASSESSMENT FEE	$799,966	$799,966

All Other Expenses AllOtherExpensesGrp

Field	Value	IRS element (for citing)
Total	$507,476	TotalAmt
Program Services	$466,486	ProgramServicesAmt
Management And General	$40,990	ManagementAndGeneralAmt
Fundraising	$0	FundraisingAmt

Total Functional Expenses TotalFunctionalExpensesGrp

Field	Value	IRS element (for citing)
Total	$25,581,477	TotalAmt
Program Services	$24,253,339	ProgramServicesAmt
Management And General	$1,328,138	ManagementAndGeneralAmt
Fundraising	$0	FundraisingAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

Field	Value	IRS element (for citing)
BOY	$8,617,454	BOYAmt
EOY	$6,160,169	EOYAmt

Pledges And Grants Receivable PledgesAndGrantsReceivableGrp

Field	Value	IRS element (for citing)
EOY	$15,035	EOYAmt

Accounts Receivable AccountsReceivableGrp

Field	Value	IRS element (for citing)
BOY	$2,243,451	BOYAmt
EOY	$3,606,379	EOYAmt

Receivables From Officers Etc ReceivablesFromOfficersEtcGrp

Field	Value	IRS element (for citing)
BOY	$0	BOYAmt
EOY	$0	EOYAmt

Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp

Field	Value	IRS element (for citing)
BOY	$0	BOYAmt
EOY	$0	EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

Field	Value	IRS element (for citing)
BOY	$307,281	BOYAmt
EOY	$355,339	EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

Field	Value	IRS element (for citing)
BOY	$50,102	BOYAmt
EOY	$70,933	EOYAmt

Field	Value	IRS element (for citing)
Land Bldg Equip Cost Or Other Bss	$20,483,136	LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec	$13,962,848	LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

Field	Value	IRS element (for citing)
BOY	$6,602,634	BOYAmt
EOY	$6,520,288	EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

Field	Value	IRS element (for citing)
BOY	$0	BOYAmt

Investments Program Related InvestmentsProgramRelatedGrp

Field	Value	IRS element (for citing)
BOY	$0	BOYAmt

Other Assets Total OtherAssetsTotalGrp

Field	Value	IRS element (for citing)
BOY	-$1,475,429	BOYAmt
EOY	$144,326	EOYAmt

Total Assets TotalAssetsGrp

Field	Value	IRS element (for citing)
BOY	$16,345,493	BOYAmt
EOY	$16,872,469	EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

Field	Value	IRS element (for citing)
BOY	$5,714,550	BOYAmt
EOY	$2,618,301	EOYAmt

Loans From Officers Directors LoansFromOfficersDirectorsGrp

Field	Value	IRS element (for citing)
BOY	$0	BOYAmt
EOY	$0	EOYAmt

Other Liabilities OtherLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$2,581,934	BOYAmt
EOY	$2,761,435	EOYAmt

Total Liabilities TotalLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$8,296,484	BOYAmt
EOY	$5,379,736	EOYAmt

Field	Value	IRS element (for citing)
Organization Follows FASB117	Yes (X)	OrganizationFollowsFASB117Ind

No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$8,049,009	BOYAmt
EOY	$11,492,733	EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$8,049,009	BOYAmt
EOY	$11,492,733	EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$16,345,493	BOYAmt
EOY	$16,872,469	EOYAmt

Field	Value	IRS element (for citing)
Reconcilation Revenue Expnss	$3,447,556	ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst	-$3,832	NetUnrlzdGainsLossesInvstAmt
Other Changes In Net Assets	$0	OtherChangesInNetAssetsAmt
Method Of Accounting Accrual	Yes (X)	MethodOfAccountingAccrualInd
Accountant Compile Or Review	false	AccountantCompileOrReviewInd
FS Audited	Yes (true)	FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

Field	Value	IRS element (for citing)
Consolidated Basis Fincl Stmt	Yes (X)	ConsolidatedBasisFinclStmtInd

Field	Value	IRS element (for citing)
Audit Committee	Yes (true)	AuditCommitteeInd
Federal Grant Audit Required	false	FederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

Field	Value	IRS element (for citing)
Hospital	Yes (X)	HospitalInd

Schedule C IRS990ScheduleC

Field	Value	IRS element (for citing)
Volunteers	false	VolunteersInd
Paid Staff Or Management	false	PaidStaffOrManagementInd
Media Advertisements	false	MediaAdvertisementsInd
Mailings Members	false	MailingsMembersInd
Publications Or Broadcast	false	PublicationsOrBroadcastInd
Grants Other Organizations	false	GrantsOtherOrganizationsInd
Direct Contact Legislators	false	DirectContactLegislatorsInd
Rallies Demonstrations	false	RalliesDemonstrationsInd
Other Activities	Yes (true)	OtherActivitiesInd
Other Activities	$1,953	OtherActivitiesAmt
Total Lobbying Expenditures	$1,953	TotalLobbyingExpendituresAmt
Not Described Section501c3	false	NotDescribedSection501c3Ind

Supplemental Information Detail SupplementalInformationDetail

Field	Value	IRS element (for citing)
Form And Line Reference	Schedule C, Part II-B, Line 1 DETAILED DESCRIPTION OF THE LOBBYING ACTIVITY	FormAndLineReferenceDesc
Explanation	IU Health Blackford Hospital paid institutional membership dues to the American Hospital Association ("AHA") and Indiana Hospital Association ("IHA") during 2021 in the amount of $7,136 and $3,532 respectively. Each membership organization notified IU Health Blackford Hospital that a portion of the dues it paid were used for lobbying purposes. The AHA used 23.32%, or $1,664 of the 2021 membership dues paid by IU Health Blackford Hospital, for lobbying expenditures. The IHA used 8.19%, or $289 of the 2021 membership dues paid by IU Health Blackford Hospital, for lobbying expenditures.	ExplanationTxt

Schedule D IRS990ScheduleD

Land LandGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$190,324	OtherCostOrOtherBasisAmt
Book Value	$190,324	BookValueAmt

Buildings BuildingsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$15,007,745	OtherCostOrOtherBasisAmt
Depreciation	$10,203,086	DepreciationAmt
Book Value	$4,804,659	BookValueAmt

Leasehold Improvements LeaseholdImprovementsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$0	OtherCostOrOtherBasisAmt
Depreciation	$0	DepreciationAmt
Book Value	$0	BookValueAmt

Equipment EquipmentGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$4,640,320	OtherCostOrOtherBasisAmt
Depreciation	$3,349,040	DepreciationAmt
Book Value	$1,291,280	BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$644,747	OtherCostOrOtherBasisAmt
Depreciation	$410,722	DepreciationAmt
Book Value	$234,025	BookValueAmt

Field	Value	IRS element (for citing)
Total Book Value Land Buildings	$6,520,288	TotalBookValueLandBuildingsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (3 entries)

DescDesc	AmtAmt
SELF-INSURANCE LIABILITIES	$15,277
DUE TO THIRD-PARTY PAYERS	$2,746,158
Intercompany Payables	$0

Field	Value	IRS element (for citing)
Total Liability	$2,761,435	TotalLiabilityAmt
Footnote Text	Yes (X)	FootnoteTextInd

Supplemental Information Detail SupplementalInformationDetail

Field	Value	IRS element (for citing)
Form And Line Reference	Schedule D, Part X, Line 2 FIN 48 (ASC 740) footnote	FormAndLineReferenceDesc
Explanation	IU Health Blackford is a subsidiary in Indiana University Health, Inc.'s ("IU Health") Consolidated Audited Financial Statements. The Internal Revenue Service (IRS) has determined that Indiana University Health and certain of its affiliated entities are tax-exempt organizations as defined in Section 501(c)(3) of the Internal Revenue Code (IRC). Indiana University Health and its tax-exempt affiliates are, however, subject to federal and state income taxes on unrelated business income under the provisions of IRC Section 511. Deferred income taxes that, as of December 31, 2021 and 2020, have no net carrying value reflect the net tax effect of temporary differences between the carrying amounts of assets and liabilities for financial reporting and the amounts used for income tax purposes. As of December 31, 2021 and 2020, the Indiana University Health System had gross deferred tax assets of $146,281,000 and $135,889,000 respectively, primarily relating to net operating loss carryovers. Management determined that a full valuation allowance at December 31, 2021 and 2020, was necessary to reduce the deferred tax assets to the amount that would more likely than not be realized. Based on the weight of the evidence, if it is more likely than not that some portion or all of the deferred tax assets will not be realized, a valuation allowance to reduce the deferred tax assets is recorded. The increase in the valuation allowance for the current year is $10,392,000. At December 31, 2021, Indiana University Health System has available net operating loss carryforwards of $588,158,000. Net operating losses generated from 2001 through 2017 will expire between 2022 and 2037. Net operating losses generated after 2017 do not expire.	ExplanationTxt

Schedule H IRS990ScheduleH

Field	Value	IRS element (for citing)
Financial Assistance Policy	Yes (true)	FinancialAssistancePolicyInd
Written Policy	Yes (true)	WrittenPolicyInd
All Hospitals Policy	Yes (X)	AllHospitalsPolicyInd
FPG Reference Free Care	Yes (true)	FPGReferenceFreeCareInd

Free Care Oth Percentage FreeCareOthPercentageGrp

Field	Value	IRS element (for citing)
Other	Yes (X)	OtherInd
Free Care Other	300	FreeCareOtherPct

Field	Value	IRS element (for citing)
FPG Reference Discounted Care	false	FPGReferenceDiscountedCareInd
Free Care Medically Indigent	Yes (true)	FreeCareMedicallyIndigentInd
Financial Assistance Budget	Yes (true)	FinancialAssistanceBudgetInd
Expenses Exceed Budget	Yes (true)	ExpensesExceedBudgetInd
Unable To Provide Care	false	UnableToProvideCareInd
Annual Community Bnft Report	Yes (true)	AnnualCommunityBnftReportInd
Report Publically Available	Yes (true)	ReportPublicallyAvailableInd

Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp

Field	Value	IRS element (for citing)
Persons Served	1134	PersonsServedCnt
Total Community Benefit Expns	$597,064	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$0	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$597,064	NetCommunityBenefitExpnsAmt
Total Expense	0.0247	TotalExpensePct

Unreimbursed Medicaid UnreimbursedMedicaidGrp

Field	Value	IRS element (for citing)
Persons Served	3168	PersonsServedCnt
Total Community Benefit Expns	$5,486,701	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$2,925,984	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$2,560,717	NetCommunityBenefitExpnsAmt
Total Expense	0.1061	TotalExpensePct

Unreimbursed Costs UnreimbursedCostsGrp

Field	Value	IRS element (for citing)
Net Community Benefit Expns	$0	NetCommunityBenefitExpnsAmt
Total Expense	0.0	TotalExpensePct

Total Financial Assistance Typ TotalFinancialAssistanceTyp

Field	Value	IRS element (for citing)
Activities Or Programs	0	ActivitiesOrProgramsCnt
Persons Served	4302	PersonsServedCnt
Total Community Benefit Expns	$6,083,765	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$2,925,984	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$3,157,781	NetCommunityBenefitExpnsAmt
Total Expense	0.1308	TotalExpensePct

Community Health Services CommunityHealthServicesGrp

Field	Value	IRS element (for citing)
Activities Or Programs	6	ActivitiesOrProgramsCnt
Persons Served	2719	PersonsServedCnt
Total Community Benefit Expns	$139,567	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$67,635	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$71,932	NetCommunityBenefitExpnsAmt
Total Expense	0.0030	TotalExpensePct

Health Professions Education HealthProfessionsEducationGrp

Field	Value	IRS element (for citing)
Activities Or Programs	2	ActivitiesOrProgramsCnt
Persons Served	7	PersonsServedCnt
Total Community Benefit Expns	$5,989	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$0	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$5,989	NetCommunityBenefitExpnsAmt
Total Expense	0.0002	TotalExpensePct

Subsidized Health Services SubsidizedHealthServicesGrp

Field	Value	IRS element (for citing)
Activities Or Programs	0	ActivitiesOrProgramsCnt
Persons Served	0	PersonsServedCnt
Total Community Benefit Expns	$0	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$0	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$0	NetCommunityBenefitExpnsAmt
Total Expense	0.0	TotalExpensePct

Research ResearchGrp

Field	Value	IRS element (for citing)
Activities Or Programs	0	ActivitiesOrProgramsCnt
Persons Served	0	PersonsServedCnt
Total Community Benefit Expns	$0	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$0	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$0	NetCommunityBenefitExpnsAmt
Total Expense	0.0	TotalExpensePct

Cash And In Kind Contributions CashAndInKindContributionsGrp

Field	Value	IRS element (for citing)
Activities Or Programs	1	ActivitiesOrProgramsCnt
Persons Served	20	PersonsServedCnt
Total Community Benefit Expns	$730	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$0	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$730	NetCommunityBenefitExpnsAmt
Total Expense	0.0000	TotalExpensePct

Total Other Benefits TotalOtherBenefitsGrp

Field	Value	IRS element (for citing)
Activities Or Programs	9	ActivitiesOrProgramsCnt
Persons Served	2746	PersonsServedCnt
Total Community Benefit Expns	$146,286	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$67,635	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$78,651	NetCommunityBenefitExpnsAmt
Total Expense	0.0033	TotalExpensePct

Total Community Benefits TotalCommunityBenefitsGrp

Field	Value	IRS element (for citing)
Activities Or Programs	9	ActivitiesOrProgramsCnt
Persons Served	7048	PersonsServedCnt
Total Community Benefit Expns	$6,230,051	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$2,993,619	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$3,236,432	NetCommunityBenefitExpnsAmt
Total Expense	0.1341	TotalExpensePct

Physical Imprv And Housing PhysicalImprvAndHousingGrp

Field	Value	IRS element (for citing)
Net Community Benefit Expns	$0	NetCommunityBenefitExpnsAmt
Total Expense	0.0	TotalExpensePct

Economic Development EconomicDevelopmentGrp

Field	Value	IRS element (for citing)
Net Community Benefit Expns	$0	NetCommunityBenefitExpnsAmt
Total Expense	0.0	TotalExpensePct

Community Support CommunitySupportGrp

Field	Value	IRS element (for citing)
Net Community Benefit Expns	$0	NetCommunityBenefitExpnsAmt
Total Expense	0.0	TotalExpensePct

Environmental Improvements EnvironmentalImprovementsGrp

Field	Value	IRS element (for citing)
Net Community Benefit Expns	$0	NetCommunityBenefitExpnsAmt
Total Expense	0.0	TotalExpensePct

Leadership Development LeadershipDevelopmentGrp

Field	Value	IRS element (for citing)
Net Community Benefit Expns	$0	NetCommunityBenefitExpnsAmt
Total Expense	0.0	TotalExpensePct

Coalition Building CoalitionBuildingGrp

Field	Value	IRS element (for citing)
Activities Or Programs	1	ActivitiesOrProgramsCnt
Persons Served	20	PersonsServedCnt
Total Community Benefit Expns	$7,214	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$0	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$7,214	NetCommunityBenefitExpnsAmt
Total Expense	0.0003	TotalExpensePct

Health Improvement Advocacy HealthImprovementAdvocacyGrp

Field	Value	IRS element (for citing)
Net Community Benefit Expns	$0	NetCommunityBenefitExpnsAmt
Total Expense	0.0	TotalExpensePct

Workforce Development WorkforceDevelopmentGrp

Field	Value	IRS element (for citing)
Net Community Benefit Expns	$0	NetCommunityBenefitExpnsAmt
Total Expense	0.0	TotalExpensePct

Other Communtity Building Acty OtherCommuntityBuildingActyGrp

Field	Value	IRS element (for citing)
Net Community Benefit Expns	$0	NetCommunityBenefitExpnsAmt
Total Expense	0.0	TotalExpensePct

Total Communtity Building Acty TotalCommuntityBuildingActyGrp

Field	Value	IRS element (for citing)
Activities Or Programs	1	ActivitiesOrProgramsCnt
Persons Served	20	PersonsServedCnt
Total Community Benefit Expns	$7,214	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$0	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$7,214	NetCommunityBenefitExpnsAmt
Total Expense	0.0003	TotalExpensePct

Field	Value	IRS element (for citing)
Bad Debt Expense Reported	Yes (true)	BadDebtExpenseReportedInd
Bad Debt Expense	$546,210	BadDebtExpenseAmt
Reimbursed By Medicare	$9,057,764	ReimbursedByMedicareAmt
Cost Of Care Reimbursed By Medcr	$8,573,360	CostOfCareReimbursedByMedcrAmt
Medicare Surplus Or Shortfall	$484,404	MedicareSurplusOrShortfallAmt

Costing Methodology Used CostingMethodologyUsedGrp

Field	Value	IRS element (for citing)
Cost To Charge Ratio	Yes (X)	CostToChargeRatioInd

Field	Value	IRS element (for citing)
Written Debt Collection Policy	Yes (true)	WrittenDebtCollectionPolicyInd
Financial Assistance Prvsn	Yes (true)	FinancialAssistancePrvsnInd
Hospital Facilities	1	HospitalFacilitiesCnt

Hospital Facilities HospitalFacilitiesGrp

Field	Value	IRS element (for citing)
Facility	1	FacilityNum

Business Name BusinessName

Field	Value	IRS element (for citing)
Business Name Line1	IU HEALTH BLACKFORD HOSPITAL	BusinessNameLine1Txt

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	410 PILGRIM BLVD	AddressLine1Txt
City	HARTFORD CITY	CityNm
State Abbreviation	IN	StateAbbreviationCd
ZIP	47348	ZIPCd

Field	Value	IRS element (for citing)
Website Address	https://iuhealth.org/FIND-LOCATIONS/IU-HEALTH-BLACKFORD-HOSPITAL	WebsiteAddressTxt
State License	22-005101-1	StateLicenseNum
Licensed Hospital	Yes (X)	LicensedHospitalInd
General Medical And Surgical	Yes (X)	GeneralMedicalAndSurgicalInd
Critical Access Hospital	Yes (X)	CriticalAccessHospitalInd
Emergency Room24 Hrs	Yes (X)	EmergencyRoom24HrsInd

Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp

Hospital Facility Name HospitalFacilityName

Field	Value	IRS element (for citing)
Business Name Line1	IU HEALTH BLACKFORD HOSPITAL	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Facility	1	FacilityNum
First Licensed CY Or PY	false	FirstLicensedCYOrPYInd
Tax Exempt Hospital CY Or PY	false	TaxExemptHospitalCYOrPYInd
CHNA Conducted	Yes (true)	CHNAConductedInd
Community Definition	Yes (X)	CommunityDefinitionInd
Community Demographics	Yes (X)	CommunityDemographicsInd
Existing Resources	Yes (X)	ExistingResourcesInd
How Data Obtained	Yes (X)	HowDataObtainedInd
Community Health Needs	Yes (X)	CommunityHealthNeedsInd
Other Health Issues	Yes (X)	OtherHealthIssuesInd
Community Hlth Needs Id Process	Yes (X)	CommunityHlthNeedsIdProcessInd
Consulting Process	Yes (X)	ConsultingProcessInd
Prior CHNA Impact	Yes (X)	PriorCHNAImpactInd
CHNA Conducted	21	CHNAConductedYr
Take Into Account Others Input	Yes (true)	TakeIntoAccountOthersInputInd
CHNA Conducted With Other Fclts	false	CHNAConductedWithOtherFcltsInd
CHNA Conducted With Non Fclts	false	CHNAConductedWithNonFcltsInd
CHNA Report Widely Available	Yes (true)	CHNAReportWidelyAvailableInd
Rpt Available On Own Website	Yes (X)	RptAvailableOnOwnWebsiteInd
Own Website URL	https://iuhealth.org/in-the-community/community-benefit	OwnWebsiteURLTxt
Implementation Strategy Adopt	Yes (true)	ImplementationStrategyAdoptInd
Implementation Strategy Adpt	22	ImplementationStrategyAdptYr
Strategy Posted Website	Yes (true)	StrategyPostedWebsiteInd
Strategy Website URL	https://iuhealth.org/in-the-community/community-benefit	StrategyWebsiteURLTxt
Organization Incur Excise Tax	false	OrganizationIncurExciseTaxInd
Elig Criteria Explained	Yes (true)	EligCriteriaExplainedInd
FPG Family Incm Lmt Free Dscnt	Yes (X)	FPGFamilyIncmLmtFreeDscntInd
FPG Family Incm Lmt Free Care	300.0	FPGFamilyIncmLmtFreeCarePct
Income Level Criteria	Yes (X)	IncomeLevelCriteriaInd
Asset Level Criteria	Yes (X)	AssetLevelCriteriaInd
Medical Indigency Criteria	Yes (X)	MedicalIndigencyCriteriaInd
Insurance Status Criteria	Yes (X)	InsuranceStatusCriteriaInd
Underinsurance Stat Criteria	Yes (X)	UnderinsuranceStatCriteriaInd
Residency Criteria	Yes (X)	ResidencyCriteriaInd
Other Criteria	Yes (X)	OtherCriteriaInd
Explained Basis	Yes (true)	ExplainedBasisInd
App Financial Asst Expln	Yes (true)	AppFinancialAsstExplnInd
Described Info	Yes (X)	DescribedInfoInd
Described Suprt Doc	Yes (X)	DescribedSuprtDocInd
Provided Hospital Contact	Yes (X)	ProvidedHospitalContactInd
Includes Publicity Measures	Yes (true)	IncludesPublicityMeasuresInd
FAP Available On Website	Yes (X)	FAPAvailableOnWebsiteInd
FAP Available On Website URL	https://iuhealth.org/pay-a-bill/financial-assistance	FAPAvailableOnWebsiteURLTxt
FAP App Available On Website	Yes (X)	FAPAppAvailableOnWebsiteInd
FAP App Available On Website URL	https://iuhealth.org/pay-a-bill/financial-assistance	FAPAppAvailableOnWebsiteURLTxt
FAP Summary On Website	Yes (X)	FAPSummaryOnWebsiteInd
FAP Summary On Website URL	https://iuhealth.org/pay-a-bill/financial-assistance	FAPSummaryOnWebsiteURLTxt
FAP Avlbl On Request No Charge	Yes (X)	FAPAvlblOnRequestNoChargeInd
FAP App Avlbl On Request No Chrg	Yes (X)	FAPAppAvlblOnRequestNoChrgInd
FAP Sum Avlbl On Request No Chrg	Yes (X)	FAPSumAvlblOnRequestNoChrgInd
Notified FAP Copy Bill Display	Yes (X)	NotifiedFAPCopyBillDisplayInd
Communtity Notified FAP	Yes (X)	CommuntityNotifiedFAPInd
FAP Translated	Yes (X)	FAPTranslatedInd
Other Publicity	Yes (X)	OtherPublicityInd
FAP Actions On Nonpayment	Yes (true)	FAPActionsOnNonpaymentInd
Permit No Actions	Yes (X)	PermitNoActionsInd
Collection Activities	false	CollectionActivitiesInd
Provided Written Notice	Yes (X)	ProvidedWrittenNoticeInd
Made Effort Orally Notify	Yes (X)	MadeEffortOrallyNotifyInd
Processed FAP Application	Yes (X)	ProcessedFAPApplicationInd
Made Presumptive Elig Determ	Yes (X)	MadePresumptiveEligDetermInd
Nondis Emergency Care Policy	Yes (true)	NondisEmergencyCarePolicyInd
Look Back Medicare Private	Yes (X)	LookBackMedicarePrivateInd
Amounts Generally Billed	false	AmountsGenerallyBilledInd
Gross Charges	false	GrossChargesInd

Supplemental Information SupplementalInformationGrp (7 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
Schedule H, Part V, Section B, Line 3E	IU Health Blackford Hospital's 2021 Community Health Needs Assessment (CHNA) report includes a prioritized description of significant health needs in the community. The CHNA report identified the following needs as priorities for IU Blackford Hospital: 1. Access to Healthcare Services 2. Aging Population and Needs of Seniors 3. Behavioral Health 4. Chronic Disease and Chronic Disease Management 5. Smoking, Tobacco Use and Exposure to Secondhand Smoke 6. Social Determinants of Health
Schedule H, Part V, Section B, Line 5 Facility , 1	Facility , 1 - IU HEALTH BLACKFORD HOSPITAL. In conducting each its most recent CHNA, IU Health Blackford took into account input from persons who represent the broad interests of the communities it serves by hosting two community focus groups and an interview. These events engaged public health officials and community-based organizations that provide services and/or reflect community members who are medically underserved, low-income, or of a minority subpopulation to discuss the health needs of the service area and what role IU Health could play in addressing the identified needs. IU Health Blackford The defined community per the most recent CHNA is Blackford County, Indiana, where the hospital resides. Blackford County - Community Meetings and Interview Two community meetings were held in 2021 to receive input from stakeholders regarding the health needs in Blackford County - one on April 23 and another on May 13. Secondary data and a preliminary list of community health need priorities was presented at both meetings. Each group was then asked questions about the preliminary list, including their reactions, additions to the proposed needs, thoughts regarding the causes, impacts of the COVID-19 pandemic and others. After these discussions, participants were given the opportunity to make additional comments before being asked to vote on the significant needs in the county. Participants were asked to choose three to five significant health needs in a poll during the meeting. Participants focused discussion on access to mental health services, health insurance barriers, substance abuse and addiction, tobacco use (including during pregnancy and among youth with vaping), a lack of health education, maternal and infant health, childcare, the disconnect between good education rates but lack of jobs, transportation barriers, a lack of knowledge of available resources and others. From this process, participants from the April 23 community meeting identified the following needs as most significant for Blackford County: * Access to mental health providers * Health literacy and education * Substance abuse (including opioids, alcohol and methamphetamines) * Obesity and associated conditions (diabetes, cardiovascular issues) Participants from the May 13 community meeting identified the following needs as most significant for Blackford County: * Substance abuse and addiction (including tobacco usage) * Access to healthcare services * Access to mental health services * Maternal, infant and child health and wellbeing In discussing the impacts of the COVID-19 pandemic on health, participants focused on isolation and its impacts on mental health, increase in substance abuse, impacts on child learning, increase in domestic violence and abuse, increasing physical inactivity and growing community conflict and negative attitudes (including towards frontline workers). An additional community survey was issued to stakeholders unable to attend community meetings, asking them to identify priority needs. Among two responses, the following issues were identified as the most significant by both respondents: * Substance abuse and addiction * Mental health and suicide * Poverty and lack of resources for low-income population * Lack of providers (specialists and mental health) The survey also asked about the impacts of the COVID-19 pandemic. Issues selected as significant impacts by both respondents include: * Social isolation and loneliness * Learning and development impacts among children An additional interview was conducted with a representative of a local public health department to obtain subject-matter expertise into the health needs in Blackford County. The following issues were discussed as significant: * Substance abuse and addiction is a significant issue * Mental health and access to mental health care are significant issues, amplified by the COVID-19 pandemic * Maternal and infant health issues exist, particularly around teen births and smoking during pregnancy * Smoking and obesity are two issues that have long been identified as issues in Blackford and continue to persist despite local work * Transportation is a large barrier to accessing services, particularly a lack of public transportation options * More community focus on health lifestyle is needed, including nutrition, physical activity, tobacco-free residents and accessible areas to exercise (health education plays a role here) Community meeting and survey participants Individuals from a wide variety of organizations and communities participated in the interview process, community meetings and surveys. Participants included representatives from the following organizations: * Blackford County Community Corrections * Blackford County Community Foundation * Blackford County Economic Development Corporation * Blackford County Health Department * Blackford County Schools * Blackford County Sheriff's Office * Citizens State Bank * Indy Container Board * IU Health * IU Health Ball * IU Health Blackford * LifeStream Services * Purdue Extension * Second Harvest Food Bank * Smith Insurance Services
Schedule H, Part V, Section B, Line 11 Facility , 1	Facility , 1 - IU HEALTH BLACKFORD HOSPITAL. In conjunction with the CHNA, IU Health Blackford Hospital's Board adopted an implementation strategy in April 2022 related to the 2021 CHNA. IU Health Blackford 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 Blackford Hospital will address the following community health needs between 2022 and 2024: - Access to Healthcare Services - Aging Population and Needs of Seniors - Behavioral Health* - Chronic Disease and Chronic Disease Management* - Smoking, Tobacco Use and Exposure to Secondhand Smoke - 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) Chronic Disease and Chronic Disease Management includes needs such as obesity, diabetes, and physical inactivity *Social Determinants of Health includes needs such as food insecurity and healthy eating IU Health Blackford Hospital will address all community health needs based on their 2021 Community Health Needs Assessment. There were no identified needs that will not be addressed. In addition, during 2021 IU Health Blackford Hospital continued to address the needs identified in the 2018 CHNA, through the implementation strategy adopted in April 2019 related to the 2018 CHNA. IU Health Blackford will address the following community health needs in between 2019 and 2021: - Access to Healthcare Services - Aging Population and Needs of Seniors - Drug and Substance Abuse (including Opioids and Alcohol) - Maternal and Infant Health and Child Wellbeing - 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 Services IU Health Blackford's implementation strategy to address the identified need of Access to Healthcare includes the following: Five-Year Physician Plan - Recruit new primary care, obstetric and mental health medical doctors to practice in East Central Region. In 2021, a new two-physician primary care clinic was established in Upland and also includes a FNP-BC to provide additional primary care support. A partnership with Taylor University began providing a student health center at this practice starting in the fall. The IU Health Blackford clinic received a Rural Health Clinic (RHC) certification in November of 2020 and began practicing as a RHC on 1/1/2021. A new Nurse Practitioner joined the Blackford practice in May of 2021. Jay Family First Health added a new physician in the fall of 2021. A new clinic was opened in Muncie in the second half of 2021 with a newly recruited Family Medicine/OB physician. Another newly recruited Family Medicine Physician started in Portland in September. Three new APPs for Family Medicine have been recruited to join clinic opening in Albany late 2021. The capability for any primary care clinic to do acute behavioral health consults virtually was added in 2021. Aging Population and Needs of Seniors IU Health Blackford's implementation strategy to address the identified need of Aging Population and Needs of Seniors include the following: East Central Indiana Food Council The East Central Indiana Food Council is a volunteer-run organization led by local activists interested in addressing community issues around new food policy, food waste reduction, healthy eating and food access. It receives support from the IU Health-driven Healthy Community Alliance initiative. The group has strategically grown from a Delaware County focus to include participants from Blackford and Jay Counties. The Council is composed of multiple community collaborators representing Ball State University, The Muncie Food Hub, IU Health, Purdue Extension, Second Harvest Food Bank, Grace Baptist Church, the Soup Kitchen of Muncie, Blood-n-Fire Ministries, Community and Family Services Food Pantries in Hartford City, Montpelier and Portland and the Children's Bureau; as well as local farmers and farmers market organizers. The Healthy Community Alliance Nutrition Workgroup was combined into the Food Council in June 2021 and this has brought additional partners into the collaborative discussions as well as integrating a more defined focus on healthy eating. The group organized educational activities and field trip in July 2021 to tour an aquaculture facility which has long term potential to bring fresh produce to underserved areas. Families at the Farmers Market The Families at the Farmers Market in Muncie and Hartford City are offered in IU Health's East Central Region each year. In 2021, the program's in-person sessions were eliminated due to COVID-19 precautions. 68 families in Muncie and 29 families in Hartford City received a healthy lifestyle packet with coupons redeemable at local farmers markets and farm stands. Tobacco cessation information was also included. Head Start joined the collaboration and facilitated connections with families in Blackford County. 67% of survey participants stated they utilize fresh fruits/vegetables at "most meals" after completing the program; 100% of respondents stated they "Learned a Lot"; and reported they used the Farmers Market "2 or more times." Coupon redemption rates were slightly more than 50%. Several new farmers market locations were added to extend the footprint of the program. In 2021, area markets processed more than $2,800 worth of produce from area families primarily from underserved areas of the community. Collaborators - Minnetrista, Whitely Comm. Council, Ross Center, Minority Health Coalition, Ivy Tech, Boys/Girls Club, Buley Center, Open Door Health Services, Salvation Army, YWCA of ECI, YMCA/Appletree, Youth Opportunity Center, Hillcroft, Spangler Farms, Northern Tropics Greenhouse and IU Health Blackford Hospital Hospital. Blackford County: Children and Family Services of Blackford County /WIC, Grace United Methodist Church, Growers and Makers Market, Common Grounds Coffee Shop, Blackford County Public Library, Purdue Extension, and IU Health Blackford. Healthy Community Alliance of East Central Indiana (HCA) The Healthy Community Alliance of East Central Indiana (HCA) engaged 149 collaborating organizations in 3 ECR counties- Delaware, Blackford and Jay during 2021. HCA makes multiple resources available to collaborators, including facilitated workgroup sessions in each county, materials such as Tobacco Cessation Toolkits and Healthy Lifestyle toolkits; and online resources such a e-newsletter, media messaging and access to community health data for each of the three counties. These resources are provided to all collaborating organizations free of charge. A majority of HCA Partner organizations are currently utilizing at least one of these provided resources to influence change amongst their audiences. To adapt to COVID-19 restrictions, in 2021 the HCA retooled its virtual workgroup process to focus on specific partner initiatives for obesity prevention and tobacco cessation and ways other partners can become engaged. One new partner was added in 2021.
Schedule H, Part V, Section B, Line 11 Facility , 2	Facility , 2 - IU HEALTH BLACKFORD HOSPITAL (CONTINUED). Blackford Community Partnership Plan IU Health Blackford established a hospital advisory council to engage community partners in discussions around community healthcare topics such as the Community Heath Needs Assessment, EMS and County 911 operations, Hospital Quality Outcomes, COVID-19 Response, IU Health Foundation, Medical Staff business, Physician recruitment, Team Member Engagement, and Hospital Finances. Participating organizations include Blackford County Council, 3M, New Indy, Purdue Extension Office, Smith Insurance Agency, Blackford Community Foundation, and the Blackford County Health Department. The group meets for discussion on a bi-monthly basis. In 2021, the group participated in the IU Health Community Health Needs Assessment focus group process. Behavioral Health (includes Drug & Substance Abuse and Mental Health) IU Health Blackford's implementation strategy to address the identified need of Behavioral Health includes the following: IU Health Blackford Hospital Hospital Addiction Treatment and Recovery Center-Adult Intensive Outpatient Program (IOP) - Provide structured therapeutic recovery program. The IU Health Blackford Hospital Addiction Treatment and Recovery Center opened in 2019 and now offers an Intensive Outpatient Program (IOP) - which includes Group therapy Recreation therapy and individual and family counseling services and peer recovery coaching. Medication Assisted Treatment (MAT) is also offered as well as an Individual outpatient Program and IOP Aftercare Program. During 2021, the Center assessed nearly 150 patients, and enrolled more than 150 in the IOP or individual track. Patients who have completed the IOP demonstrate a 35% increase in sobriety and pregnant women have demonstrated a 100% sobriety rate. IU Health Blackford Virtual Care Behavioral Health Hub In 2021, approximately 70 patients were admitted into the IU Health Blackford and Jay Emergency Rooms with an SUD diagnosis. Patients are identified by administering an UNCOPE screening; or the patient reports previous Substance use/treatment; or bedside staff identifies substance misuse is the cause for ED visit. In 2021, approximately 75 episodes of treatment were provided for 60 patients. The Hub employees a total of seven coaches. There is always a coach available 24/7. Average response time, once a consult is requested is approx. 5 mins. The Hub receives a call from ECR every 8-10 days. Collaborators include SCS/Virtual Care, BHC, ED management and staff. Funding is through FSSA and ISDH. New in 2021- PRC support for IU Health Blackford Hospital when in person coaches are not available, approximately seven patients seen in 2021. Drug Take Back Program - Provide prescription medication disposal kiosks at IU Health East Central Region facilities. Drug take-back kiosks have been installed at four East Central Indiana locations: Pavilion Pharmacy at IU Health Blackford Hospital Memorial Hospital in Muncie; IU Health Yorktown Pharmacy, Yorktown; IU Health Blackford Pharmacy, Hartford City; and IU Health Jay Hospital, Portland. The kiosks are open to the public and available during business hours. IU Health has installed drug take-back kiosks at four east central Indiana pharmacy locations: the kiosks are open to the public and available during business hours. In 2021, over 1,400 pounds of prescription medications were recovered. Blackford Community Partnership Plan See Initiative Update under Aging Population and Needs of Seniors. Maternal and Infant Health and Child Well-being IU Health Blackford's implementation strategy to address the identified need of Maternal and Infant Health and Child Wellbeing include the following: Obstetric Clinic - Provide two family medicine directors and a resident rotation at a subsidized rate to local federally qualified health center. IU Health Blackford Hospital provided two family Medicine Directors plus a resident rotation at a subsidized rate to Open Door health Services (which services several counties including Blackford County). This has allowed Open Door to expand its obstetric capability to service low-income residents of East Central Indiana. The two physicians provided more than 9,000 patient encounters in 2021. Other OB Services are offered at IU Health Blackford Hospital Memorial Hospital through its Family Medicine Program, Perinatal Center and physician practice facilities. Several other private practices offer OB Services to the community as well. Obesity and Diabetes IU Health Blackford's implementation strategy to address the identified need of Obesity and Diabetes include the following: East Central Indiana Food Council See Initiative Update under Aging Population and Needs of Seniors. Healthy Community Alliance of East Central Indiana (HCA) See Initiative Update under Aging Population and Needs of Seniors. Families of the Farmers Market See Initiative Update under Aging Population and Needs of Seniors. Smoking and Tobacco Usage IU Health Blackford's implementation strategy to address the identified need of Smoking and Tobacco Usage include the following: 1-800-QUIT-NOW: Indiana Tobacco Quitline - Educate staff regarding "Ask, Advise, Refer" process to refer patients and family members to the Indiana Tobacco Quitline. In 2021, after declining during the COVID-19 pandemic, the Indiana Tobacco Quit Line received a total of 114 referrals from the East Central Region; 76 from Delaware County, 20 from Blackford County and 18 from Jay County. IU Health East Central Region Perinatal Coordinator - Enhance efforts to decrease infant mortality in the IU Health East Central Region. In 2021 the IU Health ECR Perinatal Coordinator implemented a Tobacco Treatment Pilot Program in 5 ECR physician office settings designed to provide client consultations and referrals to 1-800 Quit Now, Baby and Me Tobacco Free program, and pharmacotherapy options. In 2021, the Indiana Department of Health (IDOH) awarded two years of funding for the implementation of a HIPAA compliant text messaging and remote monitoring virtual platform to all obstetrical practices in the ECR providing prenatal care and offering delivery services at IU Health Blackford Hospital. Healthy Community Alliance of East Central Indiana (HCA) See Initiative Update under Aging Population and Needs of Seniors. Families of the Farmers Market See Initiative Update under Aging Population and Needs of Seniors. Social Determinants of Health IU Health Blackford's implementation strategy to address the identified need of Social Determinants of Health include the following: Blackford Community Partnership See Initiative Update under Behavioral Health. IU Health East Central Regional Perinatal Coordinator See Initiative Update under Smoking and Tobacco. IU Health Blackford addressed 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 13 Facility , 1	Facility , 1 - IU HEALTH BLACKFORD HOSPITAL. IN ADDITION TO FPG, IU HEALTH BLACKFORD 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 13 Facility , 1	Facility , 1 - IU HEALTH BLACKFORD HOSPITAL. IU Health Blackford Hospital takes into consideration several other factors in determining patient eligibility for financial assistance. These factors include the following: 1. Eligibility for Financial Assistance due to Financial or Personal Hardship In order to be eligible for Financial Assistance due to Financial or Personal Hardship under this Policy, a patient or guarantor must: - Submit a completed Financial Assistance Application with all supporting documentation and be approved in accordance with this Policy; - Be an Indiana Resident as defined in this Policy; and - If Uninsured, consult with a member of IU Health's Individual Solutions department to determine if health care coverage may be obtained from a government insurance or assistance product, the Health Insurance Marketplace, or from any other source of coverage. Financial Assistance due to Financial Hardship is only available for encounters where care was initiated via an eligible facility's emergency department, direct admission from a physician's office, or transfer from another hospital facility. 2. Financial Assistance due to Financial Hardship The FPL income threshold under this section is as follows: - If one or more adults and zero dependents are in the household, the FPL Income Threshold is 200%. - If two or more adults and one or more dependents are in the household, the FPL Income Threshold is 250%. - If one adult and one or more dependents are in the household, the FPL Income Threshold is 300%. In some instances, an adult will also qualify as a dependent. When this occurs, IU Health will treat the adult as a dependent for purposes of the FPL calculation. IU Health will utilize the most recent FPL data available and will apply the FPL data to a patient or guarantor's account balance based upon the calendar date a completed Financial Assistance Application was received, not a patient's date of service. An Uninsured Patient or their guarantor whose household income is less than or equal to the FPL income threshold may be eligible for full Financial Assistance up to 100% of Gross Charges if approved. An Underinsured Patient or their guarantor whose household income is less than or equal to the FPL income threshold may be eligible for full Financial Assistance up to 100% of Patient Responsibility if approved. 3. Financial Assistance due to Personal Hardship An Uninsured or Underinsured patient or their guarantor whose household income is above the FPL income threshold may be eligible for Financial Assistance if the patient's outstanding Patient Responsibility exceeds 20% of the patient's or their guarantor's annual household income. - If approved, the patient's balance will be reduced to 20% of the patient or guarantor's annual household income or the Amounts Generally Billed, whichever is less. - IU Health will work with the patient or guarantor to identify a reasonable payment plan on the remainder of the balance. 4. Eligibility Period If approved for financial assistance by IU Health, the patient will be guaranteed financial assistance for treatment related to the underlying condition, for which the patient was originally screened and approved, through the remainder of the calendar year. As a condition of extending the on-going Financial Assistance, the patient must comply with requests from IU Health to verify that the patient continues to meet the conditions for qualification. 5. Appeals and Assistance Granted By the Financial Assistance Committee The Financial Assistance Committee will review and make determinations on all requests for appeals related to Financial Assistance. If a patient or guarantor seeks to appeal a Financial Assistance Determination, a written request must be submitted, along with the supporting documentation. The Financial Assistance Committee will review requests for and may grant additional Financial Assistance, including but not limited to, the following: - Assistance to patients who are seeking treatment that can only be provided in Indiana by IU Health or who would benefit from continued medical services from IU Health for continuity of care; - Care approved by the IU Health Chief Medical Officer (CMO) or the Chief Executive Officer (CEO) or CMO of an IU Health facility or region, including medically necessary non-elective services for which no payment source can be identified; - Care provided when it is known no payment source exists; - International humanitarian aid; and - Other care identified by the Financial Assistance Committee that fulfills the IU Health Mission. All decisions of the Financial Assistance Committee are final. 6. Presumptive Eligibility No Financial Assistance Application is required to receive Financial Assistance under this Presumptive Eligibility section. IU Health will deem patients or their guarantors presumptively eligible for Financial Assistance if they are found to be eligible for one of the following programs and care was initiated via an eligible facility's emergency department, direct admission from a physician's office, or transfer from another hospital facility: - Medicaid (any state) - Indiana Children's Special Health Care Services - Healthy Indiana Plan - Patients who are awarded Hospital Presumptive Eligibility (HPE) - A state and/or federal program that verifies the patient or guarantor's gross household income meets the FPL income threshold. IU Health will conduct a quarterly review of all accounts placed with a collection agency partner for at least one hundred and twenty (120) days after the account is eligible for an ECA as set forth in this Policy. If the patient or guarantor's individual scoring criteria demonstrates the patient has a low likelihood and/or propensity to pay or no credit, the patient or guarantor may be deemed presumptively eligible for Financial Assistance. Financial Assistance may additionally be granted in the following circumstances: - If the patient or their guarantor is found to have filed a petition for bankruptcy. - If the patient is deceased and found to have no estate. - If the patient is deceased and was under 21 years of age at the time of death. 7. Exhaustion of Alternate Sources of Assistance Patients must exhaust all other state and federal assistance programs prior to receiving Financial Assistance due to Financial or Personal Hardship under this Policy including, but not limited to, Medicaid. Patients who may be eligible for coverage under an applicable health insurance policy must exhaust all insurance benefits. - This includes patients covered under their own policy and those who may be entitled to benefits from a third-party policy. - IU Health may request patients show proof that such a claim was properly submitted to the appropriate insurance provider before awarding Financial Assistance. Eligible patients who receive medical care from an IU Health facility as a result of an injury proximately caused by a third party, and later receive a monetary settlement or award from said third party, may receive Financial Assistance for any outstanding balance not covered by the settlement or award. In the event Financial Assistance has already been granted in the above circumstances, IU Health reserves the right to reverse the Financial Assistance Determination in an amount equal to the amount IU Health would be entitled to receive had no Financial Assistance been awarded. 8. Patient Assets There are situations where a patient or their guarantor may have significant income or assets available to pay for healthcare services such as a legal settlement. The Financial Assistance Committee may evaluate the income or assets in determining Financial Hardship. IU Health may require a list of all property owned by the patient or guarantor and adjust a Financial Assistance Determination as a result.
Schedule H, Part V, Section B, Line 16 Facility , 1	Facility , 1 - IU HEALTH BLACKFORD HOSPITAL. IU Health Blackford Hospital takes several other measures to publicize its FAP within the community. These measures include the following: 1. Post this Policy, a Plain Language Summary of this Policy, and the Financial Assistance Application on its website. 2. Provide patients with a Plain Language Summary of this Policy during registration and/or discharge. 3. Post conspicuous displays in appropriate acute care settings such as emergency departments and registration areas describing the available assistance and directing eligible patients to the Financial Assistance Application. 4. Include a conspicuous written notice on all patient post-discharge billing statements notifying the patient about this Policy and the telephone number of the Customer Service Department which can assist patients with questions regarding this Policy. 5. Make available Customer Service representatives via telephone during normal business hours. 6. Mail copies of this Policy, a Plain Language Summary of this Policy, and a Financial Assistance Application to patients or their guarantor free of charge upon request. 7. Broadly communicate this Policy as a part of its general outreach efforts. 8. Educate patient-facing team members on this Policy and the process for referring patients to the program.

Field	Value	IRS element (for citing)
Facility	3	FacilityNum

Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp

Oth Hlth Care Fclts OthHlthCareFcltsGrp (3 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	FacilityFacilityTxt
IU HEALTH BLACKFORD HOSPITAL RADIOLOGY
410 PILGRIM BLVD	HARTFORD CITY	IN	47348	DIAGNOSTIC AND OTHER OUTPATIENT
IUH BLACKFORD PHYSICAL THERAPY AND REHAB
410 PILGRIM BLVD	HARTFORD CITY	IN	47350	DIAGNOSTIC AND OTHER OUTPATIENT
IU HEALTH BLACKFORD PHARMACY
400 PILGRIM BLVD	HARTFORD CITY	IN	47349	PHARMACY

Supplemental Information Detail SupplementalInformationDetail (20 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
Schedule H, Part I, Line 6a C.B. REPORT PREPARED BY A RELATED ORG.	IU HEALTH BLACKFORD 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 ("IU HEALTH STATEWIDE SYSTEM"). THE IU HEALTH COMMUNITY BENEFIT REPORT IS MADE AVAILABLE TO THE PUBLIC ON IU HEALTH'S WEBSITE AT HTTPS://IUHEALTH.ORG/IN-THE-COMMUNITY/COMMUNITY BENEFIT THE IU HEALTH COMMUNITY BENEFIT REPORT IS ALSO DISTRIBUTED TO NUMEROUS KEY ORGANIZATIONS THROUGHOUT THE STATE OF INDIANA IN ORDER TO BROADLY SHARE THE IU HEALTH STATEWIDE SYSTEM'S COMMUNITY BENEFIT EFFORTS. IT IS ALSO AVAILABLE BY REQUEST THROUGH THE INDIANA STATE DEPARTMENT OF HEALTH OR IU HEALTH.
Schedule H, Part I, Line 7f 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 IS $1,447,547. 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 25.81%.
Schedule H, Part II PROMOTION OF HEALTH IN COMMUNITIES SERVED	IU Health Blackford is a subsidiary of IU Health. 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") investments include 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 numerous organizations and initiatives that focus on some of the root causes of the health issues, such as lack of education, employment and poverty. IU Health Blackford is a supporting member of a three-county health coalition focused on obesity prevention and tobacco cessation as a means to reduce the impact of chronic disease including cancer and heart disease. More than 150 organizations are partners in the "Healthy Community Alliance of East Central Indiana" coalition and each pledge to influence audiences to make positive choices regarding improved nutrition, increased physical activity or tobacco cessation. Coalition partners report a collective total audience size of more than 50,000 people. In 2019 IU Health Blackford Hospital established a hospital advisory council to engage community partners in discussions around community healthcare topics such as the Community Heath Needs Assessment, EMS and County 911 operations, Hospital Quality Outcomes, COVID-19 Response, IU Health Foundation, Medical Staff business, Physician recruitment, Team Member Engagement, and Hospital Finances. Participating organizations include Blackford County Council, 3M, New Indy, Purdue Extension Office, Smith Insurance Agency, Blackford Community Foundation, and the Blackford County Health Department. The group meets for discussion on a bi-monthly basis. IU Health Blackford is part of the Consortium for Opioids Response Engagement which was created to build sustainable consortium of stakeholders to combat the opioid crisis. Early intervention of children, adolescents and families with a focus on the individual, interpersonal, community, and societal influences that produce health disparities, stigma and bias, and cultural insensitivities. Embed evidence-based prevention, treatment and recovery services into a seamless community-based system of care for both counties through process design and improvement. Increase access to medication-assisted treatment (MAT) for opioid addiction. Participating organizations include: Purdue University, Jay County Drug Prevention Coalition, Blackford County Community Corrections, Hester Hollis Concern Center, A Better Life Brianna's Hope.
Schedule H, Part I, Line 6a Community benefit report prepared by related organization	Indiana University Health, Inc.
Schedule H, Part I, Line 7 Bad Debt Expense excluded from financial assistance calculation	1447547
Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount	THE BAD DEBT EXPENSE OF $546,210 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 Bad Debt Expense Methodology	IU Health will deem patients or their guarantors presumptively eligible for Financial Assistance if they are found to be eligible for one of the following programs and care was initiated via an eligible facility's emergency department, direct admission from a physician's office, or transfer from another hospital facility: 1. Medicaid (any state) 2. Indiana Children's Special Health Care Services 3. Healthy Indiana Plan 4. Patients who are awarded Hospital Presumptive Eligibility (HPE) 5. A state and/or federal program that verifies the patient or guarantor's gross household income meets the FPL income threshold. No Financial Assistance Application is required to receive Financial Assistance under this Presumptive Eligibility section. IU Health will conduct a quarterly review of all accounts placed with a collection agency partner for at least one hundred and twenty (120) days after the account is eligible for an ECA as set forth in this Policy. If the patient or guarantor's individual scoring criteria demonstrates the patient has a low likelihood and/or propensity to pay or no credit, the patient or guarantor may be deemed presumptively eligible for Financial Assistance. Financial Assistance may additionally be granted in the following circumstances: a) If the patient or their guarantor is found to have filed a petition for bankruptcy. b) If the patient is deceased and found to have no estate. c) If the patient is deceased and was under 21 years of age at the time of death. Due to this comprehensive methodology, IU Health does not believe any amount of bad debt is attributable to patients who may be eligible under the financial assistance policy and no portion of bad debt is included as community benefit.
Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote	IU Health's consolidated financial statements, Footnote 5, 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. Financial assistance is available to qualifying uninsured and underinsured patients receiving care at an Indiana University Health System hospital location. Under its financial assistance policy, the Indiana University Health System provides medically necessary care to uninsured patients. Financial assistance up to the full amount of patient financial responsibility is available for uninsured and underinsured patients receiving care via the emergency department, direct admission from a physician's office, or transfer from another hospital. The federal poverty level (FPL) thresholds for this type of financial assistance are based on household makeup. Households without dependents are eligible for assistance if household income is less than or equal to 200% FPL, two adults and at least one dependent are eligible if household income is less than or equal to 250% FPL, and households with one adult and at least one dependent are eligible if household income is less than or equal to 300% FPL. Individuals with medical bills totaling more than 20% of annual household income, regardless of FPL, qualify for catastrophic assistance and are eligible for a reduction in patient financial responsibility to 20% of annual household income. Since the Indiana University Health System does not pursue collection of these amounts, the discounted amounts are not reported as patient service revenue. The Indiana University Health System uses presumptive eligibility screening procedures for some forms of financial assistance and recognizes net patient service revenue on services provided to self-pay patients at the discounted rate at the time services are rendered. The estimated cost of charity care, using the consolidated cost to charge ratio, was $133,584,000 and $90,358,000 in 2021 and 2020, respectively.
Schedule H, Part III, Line 8 Community benefit & methodology for determining medicare costs	IU Health Blackford Hospital did not have a Medicare shortfall for 2021. IU Health Blackford Hospital's Medicare reimbursements, however, are normally less than the cost of providing patient care and services to Medicare beneficiaries and do not include any amounts that result from inefficiencies or poor management. IU Health Blackford 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. 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 Medicare Cost Report. "Allowable costs" for Medicare Cost Report purposes, however, are not reflective of all costs associated with IU Health's participation in Medicare programs. For example, the Medicare Cost Report excludes certain costs such as billed physician services, the costs of Medicare Parts C and D, fee schedule reimbursed services, and durable medical equipment services. Inclusion of all costs associated with IU Health Blackford Hospital's participation in Medicare programs would significantly reduce the Medicare surplus reported on Schedule H, Part III, Line 7.
Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance	IU Health Blackford Hospital's FAP and Written Debt Collection Policy describe the collection practices applicable to patients, including those who may qualify for financial assistance. 1. Financial Assistance Application Financial Assistance Applications must include the following documentation: - All sources of Income for the last three (3) months. - Most recent three (3) months of pay stubs or Supplemental Security Income via Social Security. - Most recent three (3) statements from checking and savings accounts, certificates of deposit, stocks, bonds and money market accounts. - Most recent state and Federal Income Tax forms including Schedules C, D, E, and F. In the event the patient or guarantor's income does not warrant the filing of a federal tax statement, the individual may submit a notarized affidavit attesting to the foregoing. - Most recent W-2 statement. - For patients or members of the Household who are currently unemployed, Wage Inquiry from WorkOne. - If applicable, divorce/dissolution decrees and child custody order. Patients or their guarantors wishing to apply for Financial Assistance due to Financial Hardship are encouraged to submit an Application within ninety (90) days of discharge. Patients or their guarantors may submit an Application up to two-hundred and forty (240) days from the date of their initial post-discharge billing statement from IU Health, however, accounts may be subject to Extraordinary Collection Actions (ECA) as soon as one-hundred and twenty (120) days after receipt of the initial post-discharge billing statement. Patients or their guarantors submitting an incomplete Financial Assistance Application will receive written notification of the Application's deficiency upon discovery by IU Health. 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 expiration of the forty-five (45) day period. Patients with limited English proficiency may request a copy of this Policy, a Financial Assistance Application, and a Plain Language Summary in one of the below languages: - Arabic; - Burmese; - Burmese - Falam; - Burmese - Hakha Chin; - Mandarin/Chinese; or - Spanish The patient, and/or their representative, such as the patient's physician, family members, legal counsel, community or religious groups, social services or hospital personnel may request a Financial Assistance Application be mailed to a patient's primary mailing address free of charge. IU Health maintains the confidentiality of all Financial Assistance Applications and supporting documentation. IU Health will deny or revoke Financial Assistance for any patient or guarantor who falsifies any portion of a Financial Assistance Application. 2. Financial Assistance Determinations IU Health will inform patients or guarantors of the results of their Application by providing the patient or guarantor with a Financial Assistance Determination within ninety (90) days of receiving a completed Application and all requested documentation. A patient's Financial Assistance Application and Financial Assistance Determination are specific to each date(s) of service and approved related encounters. If a patient or guarantor is granted less than full charity assistance and the patient or guarantor provides additional information for reconsideration, Revenue Cycle Services may amend a prior Financial Assistance Determination. 3. Extraordinary Collection Actions IU Health may refer delinquent patient accounts to a third-party collection agency after utilizing reasonable efforts to determine a patient's eligibility for assistance under this Policy. Reasonable efforts include the following: - IU Health will notify the patient of this Policy at least thirty (30) days prior to initiating an ECA. - IU Health will not initiate an ECA for at least one-hundred and twenty (120) days after the patient's initial post-discharge billing statement. - IU Health will review all Financial Assistance Applications received up to and including two-hundred and forty (240) days after the patient's initial post-discharge billing statement. IU Health will cease any ECAs it has initiated upon receipt of a Financial Assistance Application until a Financial Assistance Determination is made under this policy. - If an Application is Approved, IU Health will issue a revised statement, issue refunds, and make reasonable efforts to reverse ECAs as necessary. IU Health and its third-party collection agencies may initiate an ECA against a patient or their guarantor in accordance with this Policy and 26 C.F.R. § 1.501(r). ECAs may include the following: - Selling a patient or their guarantor's outstanding financial responsibility to a third party. - Reporting adverse information about the patient or their guarantor to consumer credit reporting agencies or credit bureaus. - Deferring or denying, or requiring a payment before providing, medically necessary care because of a patient or their guarantor's nonpayment of one or more bills for previously provided care covered under this Policy. - Actions requiring a legal or judicial process, including but not limited to placing a lien on a patient's or their guarantor's property, foreclosing on a patient's or their guarantor's real property, attaching or seizing a patient's or their guarantor's bank account or other personal property, commencing a civil action against a patient or their guarantor, causing a patient or guarantor's arrest, causing a patient and/or guarantor to be subject to a writ of body attachment, and garnishing a patient or guarantor's wages When it is necessary to engage in such action, IU Health and its third party collection agencies, will engage in fair, respectful and transparent collections activities. 4. Refunds Patients eligible for Financial Assistance under this Policy who remitted payment to IU Health in excess of their Patient Responsibility will be alerted to the overpayment as promptly after discovery as is reasonable given the nature of the overpayment. Patients with an outstanding account balance due on a separate account will have their refund applied to the outstanding balance. Patients without an outstanding account balance described above will be issued a refund check for their overpayment as soon as technically feasible.
Schedule H, Part V, Section B, Line 16a FAP website	- IU HEALTH BLACKFORD HOSPITAL: Line 16a URL: https://iuhealth.org/pay-a-bill/financial-assistance;
Schedule H, Part V, Section B, Line 16b FAP Application website	- IU HEALTH BLACKFORD HOSPITAL: Line 16b URL: https://iuhealth.org/pay-a-bill/financial-assistance;
Schedule H, Part V, Section B, Line 16c FAP plain language summary website	- IU HEALTH BLACKFORD HOSPITAL: Line 16c URL: https://iuhealth.org/pay-a-bill/financial-assistance;
Schedule H, Part VI, Line 2 Needs assessment	Each IU Health hospital is dedicated to the community it serves. Each hospital conducts a CHNA to understand current community health needs and to inform strategies designed to improve community health, including initiatives designed to address social determinants of health. The CHNAs are conducted using widely accepted methodologies to identify the significant needs of a specific community. The assessments also are conducted to comply with federal laws and regulatory requirements that apply to tax-exempt hospitals. IU Health Blackford Hospital assesses the health care needs of the communities it serves by conducting a Community Health Needs Assessment (CHNA) for its hospital location. For the 2021 CHNA, IU Health Blackford Hospital obtained community input through focus groups of community stakeholders, additional surveys issued to stakeholders who were unable to attend community meetings, a survey issued to internal providers from IU Health Blackford Hospital and key informant interviews with those possessing public health expertise. After completion of the CHNA, IU Health Blackford 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, and input obtained from key stakeholders. The top health needs of the IU Health communities are those that are supported by multiple data sources. Additionally, the effectiveness of an intervention for each need and IU Health's ability to impact positive change was evaluated. IU Health believes its CHNA process is comprehensive and additional assessments are not required.
Schedule H, Part VI, Line 3 Patient education of eligibility for assistance	IU Health Blackford 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 Blackford Hospital has established a FAP to provide Financial Assistance to Uninsured Patients. IU Health Blackford Hospital is committed to ensuring its patients are compliant with all provisions of the Patient Protection & Affordable Care Act. To that end, IU Health Blackford 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 Blackford Hospital takes several measures to inform its patients of the FAP and FAP-eligibility. These measures include the following: 1. Post this Policy, a Plain Language Summary of this Policy, and the Financial Assistance Application on its website. 2. Provide patients with a Plain Language Summary of this Policy during registration and/or discharge. 3. Post conspicuous displays in appropriate acute care settings such as emergency departments and registration areas describing the available assistance and directing eligible patients to the Financial Assistance Application. 4. Include a conspicuous written notice on all patient post-discharge billing statements notifying the patient about this Policy and the telephone number of the Customer Service Department which can assist patients with questions regarding this Policy. 5. Make available Customer Service representatives via telephone during normal business hours. 6. Mail copies of this Policy, a Plain Language Summary of this Policy, and a Financial Assistance Application to patients or their guarantor free of charge upon request. 7. Broadly communicate this Policy as a part of its general outreach efforts. 8. Educate patient-facing team members on this Policy and the process for referring patients to the program.
Schedule H, Part VI, Line 4 Community information	IU Health Blackford Hospital is located in Blackford County, Indiana, a county located in east-central Indiana. Its service areas include Blackford, Grant, Delaware, Jay, and Wells counties. Blackford County includes ZIP codes within the towns of Hartford City and Montpelier. Based on the most recent Census Bureau (2021) statistics, Blackford County's population is 12,091 persons with approximately 50.6% being female and 49.4% male. The county's population estimates by race are 94.8% White, 1.9% Hispanic or Latino, 0.9% Black, 0.6% Asian, 0.3% American Indian or Alaska Native, and 1.7% persons reporting two or more races. Blackford County has relatively low levels of educational attainment. The level of education most of the population has achieved is a high school degree (91.1%). As of 2021, 13.7% of the population had a bachelor's degree or higher.
Schedule H, Part VI, Line 5 Promotion of community health	IU Health Blackford is a subsidiary of Indiana University Health, Inc., a tax-exempt healthcare organization, whose Board of Directors is composed of members of which substantially all are independent community members. IU Health Blackford extends medical staff privileges to all qualified physicians in its community for some or all its departments and specialties. IU Health does not deny appointments based on gender, race, creed or national origin. IU Health, in conjunction with the IU School of Medicine, trains the next generation of physicians in an exceptional environment. Blending breakthrough research and treatments with the highest quality of patient care. IU Health Blackford participates in other initiatives and collaborations throughout the year to promote health and wellness in the community. Some of these include: - IU Health Blackford team member annual campaign to raise donations for the local United Way. - Nutrition counseling available to diabetics in the community. - Education for students in the healthcare field such as nursing, pharmacy and radiology. Students job shadowed nurses at IU Health Blackford to learn and experience the healthcare field. - In 2021, IU Health Blackford held COVID-19 vaccine clinics at the hospital which were open to the community. Clinics were also held at the local high school for students over the age of 16. More than 2,500 vaccines were administered. - Additionally, team members at IU Health Blackford Hospital participated in 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 VI, Line 6 Affiliated health care system	Indiana University Health Blackford is part of Indiana University Health ("IU Health" or "the healthcare system"), which is Indiana's most comprehensive healthcare system. A unique partnership with the Indiana University School of Medicine ("IU School of Medicine"), one of the nation's leading medical schools, gives patients access to innovative treatments and therapies. The healthcare system is comprised of hospitals, physicians and allied services dedicated to providing preeminent care throughout Indiana and beyond. IU Health's affiliate hospitals are divided into five regions that serve communities in Northwest, Northeast, Central and Southern Indiana. The 16 hospitals in the healthcare system include IU Health Inc. (i.e., the IU Health Academic Health Center consists of IU Health Methodist Hospital, IU Health University Hospital, Riley Hospital for Children at IU Health and IU Health Saxony Hospital); IU Health Arnett; IU Health Ball; IU Health Bedford Hospital; IU Health Blackford Hospital; IU Health Bloomington Hospital; IU Health Frankfort; IU Health Jay; IU Health North Hospital; IU Health Paoli Hospital; IU Health Tipton Hospital; IU Health West Hospital; and IU Health White Memorial Hospital. Each affiliate hospital in the healthcare system conducts and adopts its own community health needs assessment (CHNA) and implementation strategy. IU Health considers the sum of these CHNAs and the implementation strategies part of a system wide goal of making Indiana one of the healthiest states in the nation. The affiliate hospitals are guided by a system wide mission to improve the health of our patients and community through innovation, and excellence in care, education, research, and service. The healthcare system is keenly aware of the positive impact it can have on improving the health of communities throughout the state of Indiana by aligning resources in a system-level and strategic way. The healthcare system includes an Academic Health Center (i.e., IU Health Inc.), a regional academic health center (i.e., IU Health Bloomington Hospital) and several affiliate hospitals that work in partnership with the IU School of Medicine to train physicians, blending breakthrough research and treatments with the highest quality of patient care throughout IU Health. Each year, more than 1,000 residents and fellows receive training in affiliate 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. To further promote the health of the communities served by IU Health, the system-level Community Health Division team partners with state and local community-based organizations, community coalitions and governmental agencies to focus on clinical care, community investment and advocacy strategy that seeks to improve the health of communities. All affiliate hospitals in the healthcare system identifies and addresses significant health needs unique to the community they serve. Some of these health needs are common in communities served by multiple affiliate hospitals in the healthcare system and align with system priority areas, warranting a system level strategy. The Community Health Division plans and provides technical assistance for system-level strategies that address these common health needs including health inequities, tobacco, behavioral health access, infant and maternal health and social needs. Each affiliate hospital works collaboratively with the Community Health Division team to operationalize system-level strategies through the implementation of specific activities that align and activate local resources too. This benefits the community each affiliate hospital serves and works towards a statewide impact (system-level) on health outcomes. As part of the Community Health Division, IU Health Serves, a system-level team member volunteer program, seeks to positively impact the health of communities IU Health affiliate hospitals serve and foster a culture of engagement and social responsibility. IU Health Blackford coordinates the different initiatives of the program, including Days of Service. This is the largest volunteer event of the year, consisting of projects designed to engage IU Health Blackford team members in activities that address local, identified community health priorities. The Community Impact and Investment (CII) Fund is a $100 million board designated fund that is managed by the IU Health Foundation to financially support high impact community investing designed to address social determinants of health in communities IU Health serves. Each affiliate hospital has a significant impact on and is deeply invested in their local communities. Through the grants provided by this CII Fund, IU Health can strategically and intentionally address the social, economic, and environmental factors that impact the health of their surrounding communities. Each IU Health affiliate hospital and its team members are eligible to pursue this grant opportunity with a community organization or agency.
Schedule H, Part VI, Line 7 State filing of community benefit report	IN

Schedule J IRS990ScheduleJ

Field	Value	IRS element (for citing)
Severance Payment	Yes (true)	SeverancePaymentInd
Supplemental Nonqual Rtr Plan	Yes (true)	SupplementalNonqualRtrPlanInd
Equity Based Comp Arrngm	false	EquityBasedCompArrngmInd
Comp Based On Revenue Of Flng Org	false	CompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related Orgs	false	CompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng Org	false	CompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd Orgs	false	CompBsdNetEarnsRltdOrgsInd
Any Non Fixed Payments	Yes (true)	AnyNonFixedPaymentsInd
Initial Contract Exception	false	InitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (20 entries)

TitleTitleTxt	Base Compensation Filing OrgBaseCompensationFilingOrgAmt	Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt	Bonus Filing OrganizationBonusFilingOrganizationAmount	Bonus Related OrganizationsBonusRelatedOrganizationsAmt	Other Compensation Filing OrgOtherCompensationFilingOrgAmt	Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt	Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt	Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt	Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt	Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt	Total Compensation Filing OrgTotalCompensationFilingOrgAmt	Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt	Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt	Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
JEFFREY C BIRD MD
DIRECTOR/REGIONAL PRESIDENT (ECR)	$0	$539,835	$0	$383,684	$0	$424,936	$0	$18,725	$0	$31,967	$0	$1,399,147	$0	$248,972
DAVID W HYATT
DIRECTOR / PRESIDENT	$0	$233,473	$0	$58,329	$0	$2,081	$0	$17,278	$0	$33,068	$0	$344,229	$0	$0
CHARLES R ROUTH MD
DIRECTOR (PART YEAR)	$0	$211,621	$0	$55,441	$0	$20,000	$0	$18,505	$0	$32,042	$0	$337,609	$0	$0
JOAN V CASTOR
DIRECTOR (PART YEAR)	$0	$674,502	$0	$486,396	$0	$7,202	$0	$89,727	$0	$80,252	$0	$1,338,080	$0	$0
JUDITH L COLEMAN
FORMER OFFICER	$0	$259,703	$0	$72,456	$0	$29,556	$0	$18,725	$0	$29,556	$0	$409,996	$0	$0
JONATHAN W VANATOR
CFO (ECR)	$0	$316,645	$0	$77,273	$0	$810	$0	$17,223	$0	$26,991	$0	$438,942	$0	$0
MICHELLE R ALTOBELLA
SECRETARY (PART YEAR)	$0	$222,227	$0	$56,927	$0	$1,143	$0	$18,116	$0	$31,588	$0	$330,000	$0	$0
BETTIE A CALDWELL
TREASURER (PART YEAR)	$0	$111,215	$0	$21,423	$0	$19,657	$0	$8,028	$0	$11,593	$0	$171,915	$0	$0
CARLA C COX RN
VP & CNO (ECR)	$0	$250,515	$0	$62,414	$0	$6,604	$0	$18,145	$0	$26,005	$0	$363,683	$0	$0
LORI A LUTHER
COO (ECR)	$0	$320,772	$0	$83,335	$0	$23,064	$0	$15,810	$0	$33,774	$0	$476,755	$0	$0
ANN M MCGUIRE
VP-HUMAN RESOURCES REGIONAL (ECR)-PART YEAR	$0	$7,136	$0	$0	$0	$245,708	$0	$10,678	$0	$1,170	$0	$264,692	$0	$205,618
PETER M VOSS MD
CMO (ECR)	$0	$371,142	$0	$107,040	$0	$26,242	$0	$18,725	$0	$29,831	$0	$552,980	$0	$0
MEGAN HAYMAKER
VP-HUMAN RESOURCES (ECR) (Part Year)	$0	$154,045	$0	$56,037	$0	$39,414	$0	$10,467	$0	$10,171	$0	$270,134	$0	$0
KEVIN W SCHREIBER MD
FORMER HIGHEST COMPENSATED EMPLOYEE	$0	$350,362	$0	$41,165	$0	$22,369	$0	$18,946	$0	$36,591	$0	$469,434	$0	$0
CHARLES L CARROLL DO
FORMER HIGHEST COMPENSATED EMPLOYEE	$0	$236,540	$0	$25,705	$0	$1,789	$0	$9,022	$0	$0	$0	$273,056	$0	$0
THOMAS M LEE MD
PHYSICIAN	$182,657	$119,841	$137,357	$0	$6,858	$0	$18,725	$0	$34,489	$0	$380,086	$119,841	$0	$0
JAN BLAKE
VP - CNO - BLACKFORD HOSP	$126,607	$0	$30,474	$0	$1,090	$0	$10,096	$0	$20,149	$0	$188,416	$0	$0	$0
MONICA R GAITHER
ADMIN-ASSOC-NURSING	$122,318	$0	$23,990	$0	$3,724	$0	$9,372	$0	$20,014	$0	$179,419	$0	$0	$0
THOMAS D STEWART MD
PHYSICIAN	$221,568	$47,554	$134,259	$0	$3,564	$0	$18,566	$0	$33,249	$0	$411,206	$47,554	$0	$0
HELEN A BORGENHEIMER MD
PHYSICIAN	$150,524	$10,912	$61,082	$20,361	$12,432	$4,144	$11,925	$3,975	$19,879	$6,626	$255,842	$46,018	$0	$0

Supplemental Information Detail SupplementalInformationDetail (4 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
Schedule J, Part I, Line 3 Arrangement used to establish the top management official's compensation	IU HEALTH BLACKFORD'S REGIONAL PRESIDENT IS EMPLOYED BY IU HEALTH, INC. IU HEALTH BLACKFORD'S PRESIDENT IS EMPLOYED BY IU HEALTH BALL MEMORIAL HOSPITAL. IU HEALTH, IU HEALTH BALL AND OTHER RELATED ORGANIZATIONS HAVE A PROCESS IN PLACE FOR DETERMINING THE COMPENSATION FOR THE OFFICERS AND KEY EMPLOYEES. IU HEALTH HUMAN RESOURCES USES MARKET DATA FROM MULTIPLE COMPENSATION EXPERTS/VENDORS WHO UTILIZE A VARIETY OF METHODS AND PROCEDURES TO OBTAIN COMPENSATION RANGES FOR COMPARABLE OFFICERS AND EMPLOYEE POSITONS. THIS MARKET DATA AND MULTIPLE OTHER FACTORS (INCLUDE MARKET PAY BENCHMARKS, INTERNAL EQUITY, CANDIDATE/EMPLOYEE QUALIFICATIONS AND PERFORMANCE, AND OTHER BUSINESS NEEDS) ARE USED TO RECOMMEND COMPENSATION RANGES FOR ITS OFFICERS AND OTHER EMPLOYEES, WHICH ARE THEN USED AS A GUIDE FOR SETTING REASONABLE COMPENSATION BY MANAGEMENT. PLEASE SEE SCHEDULE O FOR ADDITIONAL DETAILS.
Schedule J, Part I, Line 4a Severance or change-of-control payment	ANN MCGUIRE ENTERED INTO A SEVERANCE AGREEMENT WITH IU HEALTH INC. DURING 2020. NO SEVERANCE OF $245,708 WAS RECEIVED DURING 2021. DURING 2020, DEFERRED SEVERANCE OF $205,618 WAS INCLUDED IN COLUMN C, RETIREMENT AND OTHER DEFERRED COMPENSATION.
Schedule J, Part I, Line 4b Supplemental nonqualified retirement plan	JEFFREY C. BIRD M.D. AND JOAN (TORY) CASTOR 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 SERVICES 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 THE EXECUTIVES LISTED ABOVE, WITH THE EXCEPTION OF JEFFREY C. BIRD, M.D., HAVE AN AMOUNT INCLUDED IN COLUMN C, DEFERRED COMPENSATION, REPRESENTING THE CURRENT YEAR UNVESTED CONTRIBUTIONS MADE UNDER THE SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN. THESE AMOUNTS WERE NOT PAID TO THE EXECUTIVES DURING THE YEAR. THE FOLLOWING EXECUTIVE HAS AN AMOUNT INCLUDED IN COLUMN B (III), OTHER REPORTABLE COMPENSATION, REPRESENTING THE CURRENT YEAR VESTED AMOUNTS RECEIVED UNDER THE SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN: - JEFFREY C. BIRD ($398,625)
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 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.

Schedule L IRS990ScheduleL

Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp

Name Of Interested NameOfInterested

Business Name BusinessName

Field	Value	IRS element (for citing)
Business Name Line1	DANIEL BORGENHEIMER	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Relationship Description	FAMILY	RelationshipDescriptionTxt
Transaction	$301,861	TransactionAmt
Transaction	HELEN BORGENHEIMER - COMPENSATION FOR SERVICES AS A PHYSICIAN - IU HEALTH BLACKFORD & IU HEALTH BALL MEMORIAL PHYSICIANS	TransactionDesc
Sharing Of Revenues	false	SharingOfRevenuesInd

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (11 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
Form 990, Part VI, Line 13 SECTION B, LINES 12, 13, 14, AND 16B - POLICIES	IU HEALTH BLACKFORD HOSPITAL IS PART OF THE IU HEALTH SYSTEM. IU HEALTH BLACKFORD HOSPITAL'S SOLE MEMBER IS IU HEALTH BALL MEMORIAL HOSPITAL. IU HEALTH BALL MEMORIAL HOSPITAL'S SOLE MEMBER IS IU HEALTH, INC. IU HEALTH, INC. AND ITS BOARD OF DIRECTORS HAVE MANDATED THAT CERTAIN POLICIES BE FOLLOWED TO ENSURE GREATER STANDARDIZATION THROUGHOUT THE SYSTEM. THUS, IU HEALTH BLACKFORD HOSPITAL'S BOARD OF DIRECTORS WAS NOT REQUIRED TO SEPARATELY ADOPT A CONFLICT OF INTEREST, WHISTLEBLOWER, DOCUMENT RETENTION AND DESTRUCTION AND JOINT VENTURE POLICIES BECAUSE IU HEALTH'S BOARD OF DIRECTORS HAD ALREADY ADOPTED AND REQUIRED THESE POLICIES TO BE FOLLOWED BY ITS SUBSIDIARIES.
Form 990, Part VI, Line 1b INDEPENDENT VOTING MEMBERS	IU HEALTH BLACKFORD HOSPITAL IS PART OF A MULTI-ENTITY HOSPITAL SYSTEM, ULTIMATELY CONTROLLED BY IU HEALTH, INC., A 501(C)(3) TAX-EXEMPT ORGANIZATION WHOSE BOARD IS COMPRISED OF VOTING MEMBERS, OF WHICH SUBSTANTIALLY ALL ARE INDEPENDENT COMMUNITY MEMBERS.
Form 990, Part VI, Line 15 PROCESS FOR DETERMINING COMPENSATION	The Regional President is employed by IU Health. IU Health's process for determining compensation is as follows: (1) The Board of Directors ("Board") has established a Talent Management and Executive Compensation Committee ("TMECC"), the purpose of which includes reviewing and making recommendations regarding executive (Senior Vice Presidents and above) pay and benefits (collectively referred to as "compensation") on an annual basis in April. The TMECC is made up of members of the Board that are neither physicians nor employees and do not otherwise have a conflict of interest regarding any of IU Health's compensation arrangements. The TMECC reviews an executive's entire compensation package including base salary, short-term and long-term incentives, health and welfare benefits, qualified and nonqualified retirement plans, as well as any additional fringe benefits. As deemed appropriate, the Committee on Finance, which is also made up of members of the Board, may also review executive compensation and benefits. (2) The TMECC engages an independent compensation consulting firm on an annual basis to conduct a compensation analysis for its executive group, which consists of employees at the level of senior vice president and above. The current compensation advisor is SullivanCotter. SullivanCotter performs its analysis in the form of a compensation survey ("survey") that includes relevant comparability data for compensation levels paid by similarly situated organizations (both governmental and tax exempt) for functionally comparable positions as well as the availability of similar services in the geographic area. SullivanCotter then prepares a survey report and provides recommendations to the TMECC, if deemed appropriate, on changes in executive compensation. A separate analysis using the same methodology is done for the President and Chief Executive Officer. (3) The TMECC then reviews SullivanCotter's report and recommendations and, if appropriate, votes on whether to recommend any changes in executive compensation to the Board. The TMECC will only recommend changes to the Board if they are consistent with the Board's philosophy on compensation matters and are deemed reasonable based upon the independent analysis provided by SullivanCotter. The TMECC's review, discussion and vote are documented in the minutes for the meeting. There are no executives present during the final discussion and approval. (4) The Board then reviews the report prepared by SullivanCotter as well as the recommendations of the TMECC as to any changes in executive compensation. As deemed appropriate, the Committee on Finance may also provide its review of the TMECC's recommendations on any changes in executive compensation. This review and discussion are documented in the minutes (5) The Board then votes on whether to accept the TMECC's recommendations on any changes in executive compensation. Changes in executive compensation are made if approved by the TMECC and Board on an annual basis, or as necessary throughout the year. The discussion and approval are documented in the minutes of the meeting. There are no executives present during the final discussion and approval. IU Health's General Counsel also prepares a formal written opinion reviewing the executive compensation approval process, comparing it to the Intermediate Sanctions Test of IRC Section 4958. If warranted, IU Health's General Counsel may also provide comments regarding the executive compensation approval process as it relates to meeting the requirements for a rebuttable presumption of reasonableness as provided in the Intermediate Sanctions Test. (6) After the end of each year, the TMECC and Board also review the achievements of the executive group as it relates to the long-term and short-term shared and individual goals developed by the executives and the Board. These achievements may also be reviewed with the Committee on Finance. The Board, at its discretion, may approve bonus payments based upon the achievement of the goals. The discussion and vote of the TMECC and Board is documented in the minutes for each such meeting. The bonuses are not paid until approval is made by the Board. (7) The TMECC and Audit Committee also review Form 990 disclosures related to executive compensation as well as the organization's practices and approval processes prior to the filing of the Form 990 return with the Internal Revenue Service. IU Health Blackford Hospital's President is an employee of IU Health Ball Memorial Hospital. IU Health, Inc. and IU Health Ball Memorial Hospital, and other related entities have a process in place to determine the compensation for its officers and key employees. IU Health Human Resources uses market data from multiple compensation experts/vendors who utilize a variety of methods and procedures to obtain compensation ranges for comparable officer and employee positions. This market data and multiple other factors (including market pay benchmarks, internal equity, candidate/employee qualifications & performance, and business needs) are used to recommend compensation ranges for its officers and other employees, which are then used as a guide for setting reasonable compensation by management.
Form 990, Part VI, Line 6 Classes of members or stockholders	IU HEALTH BLACKFORD HOSPITAL HAS ONE CLASS OF MEMBERSHIP AND THE SOLE MEMBER IS IU HEALTH BALL MEMORIAL HOSPITAL, A WHOLLY OWNED SUBSIDIARY OF IU HEALTH.
Form 990, Part VI, Line 7a Members or stockholders electing members of governing body	THE BOARD OF DIRECTORS SHALL CONSIST OF SUCH NUMBER OF MEMBERS NOT FEWER THAN THREE (3) NOR MORE THAN FIVE (5) IN NUMBER. COMPOSITION OF THE BOARD OF DIRECTORS SHALL BE CONSISTENT WITH THE FOLLOWING CRITERIA: TWO (2) MEMBERS APPOINTED BY IU HEALTH BALL MEMORIAL HOSPITAL SHALL BE REPRESENTATIVES OF THE LOCAL COMMUNITY AND ONE (1) TO THREE (3) MEMBERS APPOINTED BY IU HEALTH BALL MEMORIAL HOSPITAL SHALL BE AT-LARGE REPRESENTATIVES.
Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders	Notwithstanding any other provisions of the Articles of Incorporation, the following matters require the approval of IU Health Ball Memorial Hospital prior to implementation: - Approve the Governing Documents of the Hospital. - Appoint, upon the recommendation of the Board of the Hospital, or remove, with or without cause, the members of the Board of Directors of the Hospital. Removal does not require a recommendation of the Hospital's Board. - Approve the incurrence of debt of the Hospital within limits delegated to the Board of Directors from time to time by IU Health Ball Memorial Hospital - Approve and recommend the formation of legal entities, the sale, transfer or substantial change in use of all or substantially all of the assets of the Hospital or the divestiture, dissolution, closure, merger, consolidation or change in the Corporate Member of the Hospital. - Approve the transfer or encumbrance of the assets of the Hospital, except in the ordinary course of business. - Subject to approval by IU Health, approve the capital and operating budgets for Hospital. - Approve the mission and vision statements for the Hospital.
Form 990, Part VI, Line 11b Review of form 990 by governing body	THE CFO REVIEWED AND APPROVED THE FORM 990. A COMPLETE COPY OF THE FORM 990 WAS MADE AVAILABLE TO EACH BOARD MEMBER PRIOR TO ITS FILING. EACH MEMBER WAS ALSO INFORMED OF THE AVAILABILITY OF IU HEALTH'S TAX DEPARTMENT TO ANSWER ANY QUESTIONS.
Form 990, Part VI, Line 12c Conflict of interest policy	IU Health Blackford Hospital follows IU Health's Conflict of Interest Policy. IU Health's Conflict of Interest Policy includes the following provisions: All IU Health employees, associates, colleagues and contracted personnel, including employed physicians and paid medical directors ("IU Health Representatives") are covered by and subject to its Conflict of Interest Policy. IU Health regularly and consistently monitors and enforces compliance with the policy through the following procedures: (a) On an annual basis, each IU Health Representative at the level of Manager or above, together with every other person designated by the Corporate Compliance Department ("Department"), must complete, sign and submit a Conflict of Interest Questionnaire ("Questionnaire") to the Department. Governing board members, committee members, corporate officers, medical staff and researchers must comply with the administrative requirements noted in the respective policies and procedures relative to those areas. (b) An IU Health Representative must supplement a Questionnaire in writing, if after completion of the original Questionnaire, a situation arises, or may reasonably be expected to arise, that would change any answer or information on the original Questionnaire if the situation had existed or been anticipated at the time of completion of the original Questionnaire. (c) If a fully and properly completed Questionnaire reveals facts or other information that might reasonably indicate a Conflict of Interest or violation of the policy, the IU Health Representative completing the questionnaire must secure approval by his/her supervisor, evidenced in writing. (d) The Department will review each Questionnaire and determine whether a Conflict of Interest exists and, if so, whether and how it should or may be eliminated, avoided or managed in order to comply with the spirit of the policy and with the best interests of IU Health and its patients. In making the determination, the Corporate Compliance Department may consult with the IU Health Representative's supervisor and other appropriate individuals and groups. (e) The scope of the policy is not limited to those who are required to complete Questionnaires. If an IU Health Representative is involved in a situation or relationship that would constitute a violation of the policy in the absence of disclosure and approval as described above, then the IU Health Representative must disclose the matter to his/her supervisor, secure his/her supervisor's approval in writing, and disclose the matter to the Department. Otherwise, the IU Health Representative is in violation of the policy and subject to corrective action, up to and including termination. (f) The Chief Compliance Officer, in consultation with onsite Compliance personnel, may from time to time appoint standing or ad hoc committees to assist in resolving issues that arise under provisions of the policy.
Form 990, Part VI, Line 19 Required documents available to the public	IU Health Blackford Hospital's Articles of Incorporation are available for public inspection through the Indiana Secretary of State's web-site. IU Health Blackford Hospital's conflict of interest procedures are disclosed on the Form 990, Schedule O. IU Health Blackford Hospital is a subsidiary in IU Health's Consolidated Audited Financial Statements. IU Health's Consolidated Audited Financial Statements are available for public inspection through its bond filings and as an attachment to IU Health's Form 990.
Form 990, Part VIII, Line 11d Other Miscellaneous Revenue	OTHER - Total Revenue: 10611, Related or Exempt Function Revenue: , Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: 10611;
Form 990, Part IX, Line 11g Other Fees	PROF. FEES/SHARED SERVICES - Total Expense: 9684553, Program Service Expense: 8902302, Management and General Expenses: 782251, Fundraising Expenses: ;

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (26 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	EINEIN	Primary ActivitiesPrimaryActivitiesTxt	Legal Domicile StateLegalDomicileStateCd	Exempt Code SectionExemptCodeSectionTxt	Public Charity StatusPublicCharityStatusTxt	Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt	Controlled OrganizationControlledOrganizationInd	Address Line2USAddress/AddressLine2Txt
INDIANA HEALTH INFO EXCHANGE INC
846 N SENATE AVE	INDIANAPOLIS	IN	46202	364550324	HEALTHCARE	IN	501(c)(3)	Type I	NA	false
INDIANA UNIVERSITY HEALTH INC
950 N MERIDIAN STREET	INDIANAPOLIS	IN	46204	351955872	HEALTHCARE	IN	501(c)(3)	3	NA	false	Suite 300
IU HEALTH ARNETT INC
950 N MERIDIAN STREET	INDIANAPOLIS	IN	46204	263162145	HEALTHCARE	IN	501(c)(3)	3	IUH	Yes (true)	Suite 300
IU HEALTH BALL MEMORIAL HOSPITAL INC
950 N MERIDIAN STREET	INDIANAPOLIS	IN	46204	350867958	HEALTHCARE	IN	501(c)(3)	3	IUH	Yes (true)	Suite 300
IU HEALTH JAY INC
950 N MERIDIAN STREET	INDIANAPOLIS	IN	46204	822736786	HEALTHCARE	IN	501(c)(3)	3	IUH	Yes (true)	Suite 300
IU HEALTH BEDFORD INC
950 N MERIDIAN STREET	INDIANAPOLIS	IN	46204	237042323	HEALTHCARE	IN	501(c)(3)	3	IUH	Yes (true)	Suite 300
IU HEALTH BLOOMINGTON INC
950 N MERIDIAN STREET	INDIANAPOLIS	IN	46204	351720796	HEALTHCARE	IN	501(c)(3)	3	IUH	Yes (true)	Suite 300
IU HEALTH CARE ASSOCIATES INC
950 N MERIDIAN STREET	INDIANAPOLIS	IN	46204	351747218	HEALTHCARE	IN	501(c)(3)	10	IUH	Yes (true)	Suite 300
INDIANA UNIVERSITY HEALTH FOUNDATION INC
1633 N CAPITOL AVE	INDIANAPOLIS	IN	46202	356043086	FUNDRAISING	IN	501(c)(3)	Type I	IUH	Yes (true)	SUITE 1200
IU HEALTH FRANKFORT INC
950 N MERIDIAN STREET	INDIANAPOLIS	IN	46204	815174295	HEALTHCARE	IN	501(c)(3)	3	IUH	Yes (true)	Suite 300
METHODIST HEALTH GROUP INC
950 N MERIDIAN STREET	INDIANAPOLIS	IN	46204	350876390	HEALTHCARE	IN	501(c)(3)	Type III-FI	NA	false	Suite 800
IU HEALTH MORGAN INC
950 N MERIDIAN STREET	INDIANAPOLIS	IN	46204	273533027	HEALTHCARE	IN	501(c)(3)	10	IUH	Yes (true)	Suite 800
IU HEALTH NORTH HOSPITAL INC
950 N MERIDIAN STREET	INDIANAPOLIS	IN	46204	351932442	HEALTHCARE	IN	501(c)(3)	3	IUH	Yes (true)	Suite 300
IU HEALTH PAOLI INC
950 N MERIDIAN STREET	INDIANAPOLIS	IN	46204	352090919	HEALTHCARE	IN	501(c)(3)	3	IUH	Yes (true)	Suite 300
IU HEALTH PLANS NFP INC
950 N MERIDIAN STREET	INDIANAPOLIS	IN	46204	463803873	INSURANCE	IN	501(c)(4)		IUH	Yes (true)	Suite 800
IU HEALTH TIPTON HOSPITAL INC
950 N MERIDIAN STREET	INDIANAPOLIS	IN	46204	262772226	HEALTHCARE	IN	501(c)(3)	3	IUH	Yes (true)	Suite 300
IU HEALTH WEST HOSPITAL INC
950 N MERIDIAN STREET	INDIANAPOLIS	IN	46204	351814660	HEALTHCARE	IN	501(c)(3)	3	IUH	Yes (true)	Suite 300
IU HEALTH WHITE MEMORIAL HOSPITAL INC
950 N MERIDIAN STREET	INDIANAPOLIS	IN	46204	273532963	HEALTHCARE	IN	501(c)(3)	3	IUH	Yes (true)	Suite 300
IU MEDICAL GROUP FOUNDATION INC
340 W 10TH ST NO FS5100	INDIANAPOLIS	IN	46202	201093251	FUNDRAISING	IN	501(c)(3)	Type I	NA	false
IUHLP LIQUIDATION INC
950 N MERIDIAN STREET	INDIANAPOLIS	IN	46204	351125434	HEALTHCARE	IN	501(c)(3)	10	IUH	Yes (true)	Suite 800
MDWISE MARKETPLACE INC
950 N MERIDIAN STREET	INDIANAPOLIS	IN	46204	465270582	INSURANCE	IN	501(c)(4)		IUH	Yes (true)	Suite 800
METHODIST OCCUP HEALTH CENTERS INC
950 N MERIDIAN STREET	INDIANAPOLIS	IN	46204	351844176	HEALTHCARE	IN	501(c)(3)	3	IUH	Yes (true)	Suite 300
RILEY CHEER GUILD INC
705 RILEY HOSPITAL DR	INDIANAPOLIS	IN	46202	356018517	FUNDRAISING	IN	501(c)(3)	Type III-FI	NA	false
UNIVERSITY FAMILY PHYSICIANS INC
950 N MERIDIAN STREET	INDIANAPOLIS	IN	46204	237427350	HEALTHCARE	IN	501(c)(3)	10	IUHCA	Yes (true)	Suite 800
16 Tech Community Corporation
1220 Waterway Blvd	Indianapolis	IN	46202	810853467	Economic Development	IN	501(c)(3)	Type I	NA	Yes (true)
IU Health Ball Memorial Physicians Inc
950 N Meridian St Ste 300	Indianapolis	IN	46204	351925641	Healthcare	IN	501(c)(3)	3	IUHBMH	Yes (true)

Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (13 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	EINEIN	Primary ActivitiesPrimaryActivitiesTxt	Legal Domicile StateLegalDomicileStateCd	Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt
BELTWAY SURGERY CENTERS LLC
569 Brookwood Village Ste 901	BIRMINGHAM	AL	35244	352072586	HEALTHCARE	IN	NA
BOSC HOLDINGS LLC
950 N Meridian St Ste 800	INDIANAPOLIS	IN	46204	454147343	HEALTHCARE	IN	NA
BSC HOLDINGS LLC
950 N Meridian St Ste 800	INDIANAPOLIS	IN	46204	452314634	HEALTHCARE	IN	NA
HEALTH VENTURE MANAGEMENT LLC
950 N Meridian St Ste 800	INDIANAPOLIS	IN	46204	205740218	MANAGEMENT	IN	NA
IEC HOLDINGS LLC
950 N Meridian St Ste 800	INDIANAPOLIS	IN	46204	454148032	HEALTHCARE	IN	NA
INDIANA ENDOSCOPY CENTERS LLC
569 Brookwood Village Ste 901	BIRMINGHAM	AL	35244	208398421	HEALTHCARE	IN	NA
ROC SURGERY LLC
569 Brookwood Village Ste 901	BIRMINGHAM	AL	35244	271497960	HEALTHCARE	IN	NA
ROCS HOLDINGS LLC
950 N Meridian St Ste 800	INDIANAPOLIS	IN	46204	454148369	HEALTHCARE	IN	NA
SENATE ST SURGERY CENTER LLC
569 Brookwood Village Ste 901	BIRMINGHAM	AL	35244	421709357	HEALTHCARE	IN	NA
SSSC HOLDINGS LLC
950 N Meridian St Ste 800	INDIANAPOLIS	IN	46204	454148167	HEALTHCARE	IN	NA
IU HEALTH FORT WAYNE LLC
950 N Meridian St Ste 800	INDIANAPOLIS	IN	46204	831224627	HEALTHCARE	IN	NA
BALL OUTPATIENT SUR CTR LLC
569 Brookwood Village Ste 901	BIRMINGHAM	AL	35244	270275794	HEALTHCARE	IN	NA
IU Health Southwest Fort Wayne Ambulatory Surgery Center LLC
569 Brookwood Village Ste 901	Birmingham	AL	35244	842206388	Healthcare	IN	na

Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (16 entries)

Address Line1ForeignAddress/AddressLine1Txt	CityForeignAddress/CityNm	Province Or StateForeignAddress/ProvinceOrStateNm	CountryForeignAddress/CountryCd	Primary ActivitiesPrimaryActivitiesTxt	Legal Domicile Foreign CountryLegalDomicileForeignCountryCd	Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt	Entity TypeEntityTypeTxt	Controlled OrganizationControlledOrganizationInd	Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	EINEIN	Legal Domicile StateLegalDomicileStateCd	Address Line2USAddress/AddressLine2Txt	Address Line2ForeignAddress/AddressLine2Txt
CERBERUS RESIDENTIAL OPPORT INST LTD
190 ELGIN AVENUE	GEORGE TOWN	GRAND CAYMAN	CJ	INVESTMENTS	CJ	NA	C Corporation	Yes (true)
IU HEALTH 457(B) PLAN
				INVESTMENTS		NA	Trust	Yes (true)	1100 N MARKET ST	WILMINGTON	DE	19890	476948347	IN
IU HEALTH ACO INC
				HEALTHCARE		NA	C Corporation	Yes (true)	950 N MERIDIAN ST	INDIANAPOLIS	IN	46204	454421020	IN	SUITE 800
IU HEALTH BOARD DESIGNATED TRUST
				INVESTMENTS		NA	Trust	Yes (true)	400 HOWARD ST	SAN FRANCISCO	CA	94105	306309021	IN
IU HEALTH PLANS HOLDING COMPANY INC
				INSURANCE		NA	C Corporation	Yes (true)	950 N MERIDIAN ST	INDIANAPOLIS	IN	46204	463794815	IN	SUITE 800
IU HEALTH PLANS INSURANCE COMPANY
				INSURANCE		NA	C Corporation	Yes (true)	950 N MERIDIAN ST	INDIANAPOLIS	IN	46204	811097215	IN	SUITE 800
IU HEALTH PLANS INC
				HMO		NA	C Corporation	Yes (true)	950 N MERIDIAN ST	INDIANAPOLIS	IN	46204	262127080	IN	SUITE 800
IU HEALTH RISK PURCHASING GROUP INC
				INSURANCE		NA	C Corporation	Yes (true)	151 MEETING ST	CHARLESTON	SC	29401	260202446	IN	SUITE 301
IU HEALTH RISK RETENTION GROUP INC
				INSURANCE		NA	C Corporation	Yes (true)	151 MEETING ST	CHARLESTON	SC	29401	201107674	SC	SUITE 301
IUH ASSURANCE SPC LTD
PO BOX 69 94 SOLARIS AVE		GRAND CAYMAN	CJ	INSURANCE	CJ	NA	C Corporation	Yes (true)					980395429			CAMANA BAY
PROTEUO FUND LP
PO BOX 69 94 SOLARIS AVE		GRAND CAYMAN	CJ	INVESTMENTS	CJ	NA	C Corporation	Yes (true)					981075227			CAMANA BAY
BMH MEDICAL PAVILION ASSOCIATION INC
				CONDO MANAGEMENT		NA	C Corporation	Yes (true)	2525 W UNIVERSITY AVE	MUNCIE	IN	47303	351858408	IN
University Surgeons Inc
				Physician Services		NA	C Corporation	Yes (true)	950 N Meridian St Ste 800	Indianapolis	IN	46204	202981280	IN
Pediatric Surgical Associates Inc
				Physician Services		NA	C Corporation	Yes (true)	950 N Meridian St Ste 800	Indianapolis	IN	46204	352122922	IN
Cardiothoracic Surgeons Inc
				Physician Services		NA	C Corporation	Yes (true)	950 N Meridian St Ste 800	Indianapolis	IN	46204	351416173	IN
University Vascular Surgery Inc
				Physician Services		NA	C Corporation	Yes (true)	950 N Meridian St Ste 800	Indianapolis	IN	46204	351832370	IN

Field	Value	IRS element (for citing)
Receipt Of Int Annts Rnts Rylts	false	ReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth Org	false	GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth Org	Yes (true)	GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other Org	false	LoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth Org	false	LoansOrGuaranteesFromOthOrgInd
Div Related Organization	false	DivRelatedOrganizationInd
Asset Sale To Other Org	false	AssetSaleToOtherOrgInd
Asset Purchase From Other Org	false	AssetPurchaseFromOtherOrgInd
Asset Exchange	false	AssetExchangeInd
Rental Of Facilities To Oth Org	Yes (true)	RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth Org	Yes (true)	RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth Org	false	PerformOfServicesForOthOrgInd
Perform Of Services By Other Org	Yes (true)	PerformOfServicesByOtherOrgInd
Sharing Of Facilities	false	SharingOfFacilitiesInd
Paid Employees Sharing	Yes (true)	PaidEmployeesSharingInd
Reimbursement Paid To Other Org	Yes (true)	ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other Org	false	ReimbursementPaidByOtherOrgInd
Transfer To Other Org	Yes (true)	TransferToOtherOrgInd
Transfer From Other Org	false	TransferFromOtherOrgInd

Transactions Related Org TransactionsRelatedOrgGrp (7 entries)

Transaction TypeTransactionTypeTxt	InvolvedInvolvedAmt	Method Of Amount DeterminationMethodOfAmountDeterminationTxt
IU HEALTH RISK RETENTION GROUP INC
R	$88,973	FMV
IUH BALL MEMORIAL HOSPITAL INC
O	$152,249	FMV
IU HEALTH CARE ASSOCIATES INC
M	$1,414,901	FMV
IUH BALL MEMORIAL HOSPITAL INC
M	$2,938,235	FMV
IU HEALTH BALL MEMORIAL HOSPITAL INC
K	$182,329	FMV
IU HEALTH CARE ASSOCIATES INC
O	$130,991	FMV
IU HEALTH BALL MEMORIAL PHYSICIANS INC
M	$121,130	FMV