2019-11-14T15:57:51-06:00 2018-12-31 ERNST & YOUNG US LLP 111 MONUMENT CIRCLE SUITE 4000 INDIANAPOLIS IN 46204 990 2018-01-01 262772226 INDIANA UNIVERSITY HEALTH TIPTON HOSPITAL INC % CRAIG J JONES INDI 3179634842 950 N MERIDIAN STREET Suite 300 INDIANAPOLIS IN 46204 CARA BREIDSTER CFO 3179634842 2019-11-12 JENNIFER D RHODERICK P00395735 3176817000 162.1.129.128 35198520193185000002 2019-11-14 P E9BB99990D559D2579C16A2912A9ECE87B6779B9 B94C62B5C6A0955190C280FDFCA25CEB3EEAF170 2018 2020-04-17 16:48:07Z Kenneth Puckett 950 N MERIDIAN ST STE 300 INDIANAPOLIS IN 46204 42079315 false X SEE SCHEDULE O X 2008 IN Improve the health of our patients and community through innovation and excellence in care, education, research and service. 7 6 281 34 0 93063 50567 221529 39452291 40438903 180074 573846 148482 215366 39831414 41449644 0 0 0 0 12356387 12506037 0 0 0 26070722 25303420 38427109 37809457 1404305 3640187 57241156 60114064 24470487 23265360 32770669 36848704 X IMPROVE THE HEALTH OF OUR PATIENTS AND COMMUNITY THROUGH INNOVATION AND EXCELLENCE IN CARE, EDUCATION, RESEARCH AND SERVICE. false false 29646316 39833358 Indiana University Health Tipton Hospital, Inc. ("IU Health Tipton Hospital"), located in Tipton, Indiana, is a 25-bed acute-care and critical access hospital that offers a broad range of services to care for its patients without regard to their ability to pay. IU Health Tipton Hospital provides leading-edge, patient-centered care, as well as personalized nursing care, in a wide range of medical specialties to residents of Tipton County and its surrounding communities. IU Health Tipton Hospital receives "Shared Services" revenue by sharing/providing services with Methodist Occupational Health Centers, Inc. ("Methodist Occupational Health Centers"), Indiana University Health Care Associates, Inc. ("IU Health Physicians"), Indiana University Health North Hospital, Inc. ("IU Health North Hospital"), and Indiana University Health, Inc. ("IU Health"). 411308 552641 IU Health Tipton Hospital receives revenue through pharmacy services as well as their retail pharmacy. 38879 52238 IU Health Tipton Hospital receives revenue from a related exempt organization, IU Health Physicians for various offices and clinics. 495 0 666 Electronic Health Records Incentive 495 0 666 30096998 true true false true false false false false false true true false false true true true false true false false false false false false false false true true false false true false false false false false false false false false false false false false true true true false false true 37 0 true 281 true true true false false false false false false false false false false false X 7 6 false false false false true true true true true false false true true true true true true false true false IN X CRAIG J JONES 3179634842 950 N MERIDIAN STREET SUITE 300 INDIANAPOLIS IN 46204 X STEVEN A WERTZ CHAIRMAN 1.0 0.0 X X 3600 0 0 LINDA G JOINES DIRECTOR/SECRETARY 1.0 0.0 X X 3600 0 0 TAMERA N BROWN RN DIRECTOR 1.0 0.0 X 3600 0 0 JONATHAN R GOBLE DIR/PRESIDENT (ISR)(PART YEAR) 5.0 50.0 X 0 1707608 255962 BEN B HOBBS DIRECTOR 1.0 0.0 X 3600 0 0 DESTRY W LAMBERT MD DIRECTOR 1.0 0.0 X 3600 0 0 DAVID L VORIS DIRECTOR 1.0 0.0 X 3600 0 0 Jennifer M Alvey Director (Part Year) 1.0 54.0 X 0 872512 146707 MICHAEL L HARLOWE PRESIDENT-TIPTON & SAXONY HOSP 25.0 30.0 X 0 267138 31996 RANDALL C YUST COO/CFO (ISR) (Partial Year) 5.0 50.0 X 0 336981 33695 Cara L Breidster CFO - ISR (Partial Year) 5.0 50.0 X 0 313895 36365 GUARAV ARORA MD CMO 5.0 50.0 X 0 530423 30133 RUTH A KAIN RN VP & CNO (ISR) 5.0 50.0 X 0 240428 38356 JEFFERY W MOORE RN Anesthetist 40.0 0.0 X 179526 0 8946 ANGELA K MORGAN MANAGER, PHARMACY DEPT. 40.0 0.0 X 121886 0 37085 PATRICIA A HARRIS MANAGER, CLINICAL OPERATIONS 40.0 0.0 X 108336 0 7348 CATHERINE L WHITE PHARMACIST 40.0 0.0 X 111651 0 24487 EMILY A SNELL PHARMACIST 40.0 0.0 X 110569 0 37030 653568 4268985 688110 6 false true false ARAMARK 10510 TWIN LAKES PARKWAY CHARLOTTE NC 28269 FACILITIES MGMT. 615082 ANESTHESIA CONSULTANTS OF INDIANAPO 3815 RIVER CROSSING PKWY INDIANAPOLIS IN 46240 MEDICAL 400000 KEVIN W CONDICT MD 4865 S 800 W TIPTON IN 46072 MEDICAL 210000 MESSER CONSTRUCTION 2445 N Meridian Street INDIANAPOLIS IN 46206 Construction 983715 HENRY C SMITHER ROOFING 6850 East 32nd Street INDIANAPOLIS IN 46226 Facilities Mgmt 226750 9 221529 221529 NET PATIENT SERVICE REVENUE 622100 39766678 39766678 SHARED SERVICES 541900 66680 66680 PHARMACY 446110 552641 552641 RENT FROM RELATED 501(C)(3) ORGS. 532000 52238 52238 ELECTRONIC HEALTH RECORDS INCENTIVE 900099 666 666 40438903 503747 0 0 503747 0 0 3800 3800 0 0 0 632054 63916 625871 0 6183 63916 70099 70099 0 0 0 0 0 0 0 0 0 CAFETERIA/FOOD SERVICE 722320 143060 143060 MISCELLANEOUS REVENUE 900099 72306 72306 215366 41449644 40438903 0 789212 X 0 0 0 0 0 0 9884736 9648572 236164 0 373150 364235 8915 0 1531273 1494688 36585 0 716878 699751 17127 0 0 0 3668 0 3668 0 2759 0 2759 0 0 8973 0 8973 0 10807641 5247784 5559857 24736 778 23958 0 130719 93756 36963 0 31332 31332 0 0 0 2739716 2739716 0 0 15452 11348 4104 0 0 5463 5463 0 0 742787 0 742787 0 0 1695316 940856 754460 0 273541 273541 0 DRUGS AND MEDICAL SUPPLIES 5929873 5929873 0 0 BAD DEBT 1622627 1622627 0 0 INSTITUTIONAL DUES/LICENSES 31353 31353 0 0 HOSPITAL ASSESSMENT FEE 1043581 1043581 0 0 193883 191285 2598 37809457 30096998 7712459 0 61308 83456 23182347 25313182 0 0 5066586 5357852 0 0 0 0 0 0 692457 617266 188845 178412 15502399 10455264 4646244 5047135 4823251 4630023 0 0 0 0 10261289 9866624 8318829 9020114 57241156 60114064 3539438 2544627 0 0 0 0 0 0 0 0 0 0 0 0 0 0 20931049 20720733 24470487 23265360 X 24451840 27829130 2256797 2943615 6062032 6075959 32770669 36848704 57241156 60114064 X 3640187 -249391 687239 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 2759 2759 false Schedule C, Part II-B, Line 1i - Other Activities IU Health Tipton Hospital paid institutional membership dues to the American Hospital Association ("AHA") and Indiana Hospital Association ("IHA") during 2018 in the amount of $10,916 and $3,522, respectively. Each membership organization notified IU Health Tipton Hospital that a portion of the dues it paid were used for lobbying purposes. The AHA used 22.98%, or $2,508 of 2018 membership dues paid by IU Health Tipton Hospital, for lobbying expenditures. The IHA used 7.12%, or $251 of the 2018 membership dues paid by IU Health Tipton Hospital, for lobbying expenditures. The total membership dues paid to these organizations by IU Health Tipton Hospital during 2018 that were attributable to lobbying expenditures was $2,759. 8318829 14939 808027 37773 967 83481 9019574 8384234 28793 289716 220452 79078 84384 8318829 8669107 134061 -114159 218496 86279 8384234 8752980 25533 196490 220413 85483 8669107 8463912 25739 583156 235348 84479 8752980 0.67360 0.32640 true false 0 2872457 1115535 1756922 12518097 9333174 3184923 111845 6555 105290 5047135 INT. IN NET ASSETS OF FNDTN. 9019574 ALL OTHER ASSETS 540 9020114 0 INTERCOMPANY PAYABLES (NET) 17659924 DUE TO THIRD-PARTY PAYERS 3010773 SELF INSURANCE LIABILITIES 50036 20720733 X Schedule D, Part V, Line 4 - Intended Uses of Org.'s Endowment Funds Temporarily and permanently restricted net assets represent endowments held by Tipton County Foundation, Inc., an unrelated 501(c)(3) tax-exempt organization, of which Indiana University Health Tipton Hospital, Inc. is the beneficiary. The uses of the funds are in accordance with the donor-restrictions of each endowment. Schedule D, Part X, Line 2 - FIN 48 (ASC 740) Footnote IU Health Tipton Hospital is a subsidiary in IU Health's Consolidated Audited Financial Statements. The Internal Revenue Service (IRS) has determined that IU Health and certain of its affiliated entities are tax-exempt organizations as defined in Section 501(c)(3) of the Internal Revenue Code (IRC). IU Health and its tax-exempt affiliates are, however, subject to federal and state income taxes on unrelated business income under the provision of IRC Section 511. The Tax Cuts and Jobs Act (TCJA) was enacted on December 22, 2017. For tax-exempt entities, TCJA requires organizations to categorize certain fringe benefit expenses as a source of unrelated business income subject to tax, pay an excise tax on compensation above certain thresholds, and record income or losses for tax determination purposes from unrelated business activities on an activity-by-activity basis, among other provisions. Regulations necessary to implement certain aspects of TCJA are expected to be promulgated by the IRS in 2019. As of and for the year ended December 31, 2018, Indiana University Health has made reasonable estimates of the provision for income taxes, the compensation excise tax, and the effects, if any, on existing deferred tax balances based on accounting guidance included in Accounting Standards Codification (ASC) 740, Income Taxes. Indiana University Health will continue to refine its calculations in future periods, as additional regulations and guidance are issued by the IRS. Deferred income taxes which, as of December 31, 2018 and 2017, have no net carrying value, reflect the net tax effect of temporary differences between the carrying amounts of assets and liabilities for financial reporting and the amounts used for income tax purposes. As of December 31, 2018 and 2017, the Indiana University Health System had gross deferred tax assets of $119,965 and $93,794, respectively, primarily relating to net operating loss carryovers. Management determined that a full valuation allowance at December 31, 2018 and 2017 was necessary to reduce the deferred tax assets to the amount that would more likely than not be realized. ASC Topic 740-10-50-3, Income Taxes: Disclosure, requires a valuation allowance to reduce the deferred tax assets reported if, based on the weight of the evidence, it is more likely than not that some portion or all of the deferred tax assets will not be realized. The change in the valuation allowance for the current year is $26,171. At December 31, 2018, the Indiana University Health System has available net operating loss carryforwards of $482,349. Net operating losses generated from 1999 through 2017 will expire between 2019 and 2037. Net operating losses generated during 2018 do not expire. Certain subsidiaries of IU Health are taxable entities. The tax expense and liabilities of these subsidiaries are not material to the consolidated financial statements. true true X true X false true true false true true 526 581010 581010 0.01610 784 4455263 1956690 2498573 0.06900 1310 5036273 1956690 3079583 0.08510 7 1920 201964 201964 0.00560 1 95 78882 78882 0.00220 2 6660 153805 9500 144305 0.00400 10 8675 434651 9500 425151 0.01180 10 9985 5470924 1966190 3504734 0.09690 1 115 500 500 0.00000 1 124 124 0.00000 2 115 624 624 0.00000 false 547925 13588316 13467321 120995 X true true 1 1 IU HEALTH TIPTON HOSPITAL 1000 S MAIN ST TIPTON IN 46072 SEE PART V, SECTION C 17-005049-1 X X X X IU HEALTH TIPTON HOSPITAL 1 false false true X X X X X X X X X 18 true false false true X SEE PART V, SECTION C X true 18 true SEE PART V, SECTION C false true X 200. 0. X X X X X X true true X X X true X SEE PART V, SECTION C X SEE PART V, SECTION C X SEE PART V, SECTION C X X X X X X X true X false X X X X true X false false Schedule H, Part V, Section B, Line 5 - Input from Community IU Health Tipton Hospital's approach to gathering qualitative data for its 2018 CHNA consisted of a multi-component approach to identify and verify community health needs for the IU Health Tipton Hospital service area. This included the following components: 1. Community Meetings 2. Key Stakeholder Interviews 3. Community Survey Community Meetings To obtain a more complete understanding of the community health needs it serves, IU Health Tipton held two community meetings with public health officials and community leaders. The community meetings were held on April 17, 2018 at the Hamilton County 4H fairgrounds in Noblesville and on May 2, 2018 at the IU Health Tipton Hospital in Tipton. The goal of soliciting these leaders' feedback was to gather insights into the quantitative data that may not be easily identified from the secondary statistical data alone. Organizations who participated in the focus groups in Tipton County included: -Tipton County Fire Department -Alternatives, Inc. -Tipton Schools -Tipton Emergency Department -Tipton County Foundation -Tipton County School Nurse -Four County Counseling Center -Purdue Extension -Tipton Chamber of Commerce -Tipton County Health Department -Aspire Indiana -Central Indiana Council on Aging (CICOA) -Chaucie's Place -Department of Child Services -Fishers City Council -Good Samaritan Network -HAND, Inc. -HOPE Family Care Center -Hamilton County Council on Alcohol and other Drugs -Hamilton County Health Department -Hamilton County Harvest Food Bank -Noblesville Chamber of Commerce -Noblesville Schools -Partnership for a Healthy Hamilton County -Prevail, Inc. -PrimeLife Enrichment, Inc. -Shepard's Center of Hamilton County -Stones 3 Resources -Trinity Free Clinic -Westfield Washington Schools At each of the community meetings, IU Health facilitators presented the goals and requirements of the CHNA, reviewed secondary health data including demographics, insurance information, poverty rates and county health rankings, causes of death, physical activity, chronic conditions and past needs identified during the previous CHNA cycle. At the Tipton County meeting, each participant was asked to select the top five health needs. After the results were tallied, a discussion to gain consensus of the top five health needs of the community was conducted, along with current resources and gaps for each need was discussed. This was intended to inspire candid discussions and give leaders another chance to vote for their top five needs from the list. The focus group concluded by sharing a timeline of next steps and accomplishments since the last CHNA. Due to the size of the group at the Hamilton County meeting, participants were split into three groups. The same list was provided to each group of potential unmet health needs for the individuals to discuss and vote on to indicate what they considered to be the most significant health needs for Hamilton county. Key Stakeholder Interviews IU Health Tipton also conducted an interview with a representative of the Hamilton County Public Health Department who also attended the Noblesville community meeting. The interview was conducted to assure that appropriate and additional input was received from a government public health official. Accordingly, the results of the community meetings were discussed and insights were sought out regarding significant community health needs, why such needs are present, and how these needs can be addressed. Community Survey IU Health Tipton also solicited responses from the general public regarding the health of the IU Health Tipton community through a community survey conducted by the Indiana Hospital Collaborative. A questionnaire was developed, with input provided by the Indiana hospital systems, and included a number of questions about the general health status, access and utilization of services, personal behaviors, social determinants of health, and also respondent demographic information. The surveys were mailed to approximately 82,000 households between April 2, 2018 and June 29, 2018 across the State of Indiana. Overall, 9,161 completed the questionnaires were received by all of the participating hospitals, for an overall response rate of 11.6%, 5,030 questionnaires were received from the 17 Indiana counties served by one or more of the IU Health Hospitals. A dataset was then created from the IU Health survey responses, and the responses were adjusted for two factors; the number of adults in each household and a post-stratification adjustment designed to make the results more representative of the population in each community. For IU Health Tipton Hospital, surveys were received from 620 community households. Below is the assessment of secondary data regarding the health needs of the community, which IU Health Tipton Hospital serves. The hospital's community is comprised of Tipton and Hamilton counties in Indiana. The survey sample was 92.1% Caucasian (White) and 50.7% were female. The educational attainment of the community was very high as 92.6% reported completing high school or GED, 39.4% reported completing a Bachelor's degree or higher. Survey respondents also were asked to report their insurance status. A majority of respondents had commercial/private insurance (93.8%), followed by a small percentage reporting to be Uninsured/self-pay (6.2%). Subsequent to the ACA's passage, a June 2012 Supreme Court ruling provided states with the discretion regarding whether or not to expand Medicaid eligibility.Indiana was one of those states that expanded Medicaid. Across the United States, uninsured rates have fallen most in states that decided to expand Medicaid. Schedule H, Part V, Section B, Line 7a - CHNA Website A copy of IU Health Tipton Hospitals CHNA is available on its website at the following URL: https://iuhealth.org/in-the-community/ Schedule H, Part V, Section B, Line 10a - Implementation Strategy Website A copy of IU Health Tipton Hospital's CHNA implementation strategy is available on its website at the following URL: https://iuhealth.org/in-the-community/ Schedule H, Part V, Section B, Line 11 - Addressing Identified Needs In conjunction with the CHNA, IU Health Tipton adopted an implementation strategy in 2018. IU Health Tipton prioritized and determined which of the community health need identified in its most recently conducted CHNA were most critical for it to address. IU Health Tipton will address the following community health needs between 2019 and 2021: -Behavioral Health (includes Mental Health/Substance Abuse) -Access to Healthcare -Chronic Disease -Aging Population and Needs of Seniors -Transportation IU Health uses the term Behavioral Health to refer to Mental Health and Drug Substance Abuse (including Opioids and Alcohol). Behavioral Health (includes Mental Health/Substance Abuse) IU Health Tipton Hospital's implementation strategy to address the identified need of behavioral health includes the following: -Partner with local subject matter experts to provide programs in schools (all ages) and clubs to help educate youth on the risks of drug and alcohol use and abuse. -Provide access to meeting space for the local smoking cessation program. -Provide supplies for the local smoking cessation program. -Provide 24/7 peer counseling via telemedicine for patients who present in the emergency department (ED) with substance abuse issues. -Trained behavioral health clinicians provide telemedicine visits to patients who present in the emergency department (ED) with behavioral health needs. Access to Healthcare IU Health Tipton Hospital's implementation strategy to address the identified need of access to healthcare includes the following: -Provide free diabetic screenings and education on proper disease management. -Work with the Tipton County Foundation (Women's Fund) to establish a program for underserved community members. -Provide annual or recommended mammography screenings. Chronic Disease IU Health Tipton Hospital's implementation strategy to address the identified need of chronic disease includes the following: -Provide free diabetic screenings and education on proper disease management. -Work with the Tipton County Foundation (Women's Fund) to establish a program for underserved community members. -Provide annual or recommended mammography screenings. -Promote health, wellness, good nutrition and active living through annual Days of Service by making improvements to local parks, thus encouraging greater physical activity in the parks by residents and visitors. -Partner with community organizations to implement the Fresh & Fit program in Tipton. Aging Population and Needs of Seniors IU Health Tipton Hospital's implementation strategy to address the identified need of the aging population and needs of seniors includes the following: -Promote health, wellness, good nutrition and active living through annual Days of Service by making improvements to local parks, thus encouraging greater physical activity in the parks by residents and visitors. -Provide access to free screenings, general health education and activities to promote active and healthy lifestyles for seniors. -Provide transportation to seniors utilizing community organizations' buses. -Partner with community organizations to implement the Fresh & Fit program in Tipton. -Modify Fresh & Fit program to serve the senior population in the community. Transportation IU Health Tipton Hospital's implementation strategy to address the identified need of transportation includes the following: -Provide transportation to seniors utilizing community organizations' buses. Also, IU Health Tipton Hospital will address all the community health needs based on their 2018 Community Health Needs Assessment. Schedule H, Part V, Section B, Line 13b - Income Level Other than FPG In addition to FPG, IU Health Tipton Hospital may take into consideration a patient's income and/or ability to pay in calculation of a financial assistance award. Schedule H, Part V, Section B, Line 13h - Other FAP Factors IU Health Tipton Hospital takes into consideration several other factors in determining patient eligibility for financial assistance. These factors include the following: 1. IU Health Tipton Hospital's Individual Solutions Department Prior to seeking Financial Assistance under the FAP, all patients or their guarantors must consult with a member of IU Health Tipton Hospital's Individual Solutions department to determine if healthcare coverage may be obtained from a government insurance/assistance product or from the Health Insurance Exchange Marketplace. 2. Alternate Sources of Assistance When technically feasible, a patient will exhaust all other state and federal assistance programs prior to receiving an award from IU Health Tipton Hospital's Financial Assistance Program. Patients who may be eligible for coverage under an applicable insurance policy, including, but not limited to, health, automobile, and homeowner's, must exhaust all insurance benefits prior to receiving an award from IU Health Tipton Hospital's Financial Assistance Program. This includes patients covered under their own policy and those who may be entitled to benefits from a third-party policy. Patients may be asked to show proof that such a claim was properly submitted to the proper insurance provider at the request of IU Health Tipton Hospital. Eligible patients who receive medical care from IU Health Tipton Hospital as a result of an injury proximately caused by a third party, and later receive a monetary settlement or award from said third party, may receive Financial Assistance for any outstanding balance not covered by the settlement or award to which IU Health Tipton Hospital is entitled. In the event a Financial Assistance Award has already been granted in such circumstances, IU Health Tipton Hospital reserves the right to reverse the award in an amount equal to the amount IU Health Tipton Hospital would be entitled to receive had no Financial Assistance been awarded. 3. Alternate Methods of Eligibility Determination IU Health Tipton Hospital will conduct a quarterly review of all accounts placed with a collection agency partner for a period of no less than one hundred and twenty (120) days after the account is eligible for an ECA. Said accounts may be eligible for assistance under the FAP based on the patient's individual scoring criteria. To ensure all patients potentially eligible for Financial Assistance under the FAP may receive Financial Assistance, IU Health Tipton Hospital will deem patients/guarantors to be presumptively eligible for Financial Assistance if they are found to be eligible for one of the following programs, received emergency or direct admit care, and satisfied his/her required co-pay/deductible: -Indiana Children's Special Health Care Services -Medicaid -Healthy Indiana Plan -Patients who are awarded Hospital Presumptive Eligibility (HPE) -Enrolled in a state and/or federal program that verifies the patient's gross household income is less than or equal to 200% of the Federal Poverty Level 4. Additional Considerations Financial Assistance may be granted to a deceased patient's account if said patient is found to have no estate. Additionally, IU Health Tipton Hospital will deny or revoke Financial Assistance for any patient or guarantor who falsifies any portion of a Financial Assistance application. 5. Non-Emergent Services Down Payment Uninsured Patients presenting for scheduled or other non-emergent services will not be charged more than the Amounts Generally Billed ("AGB") for their services. Patients will receive an estimated AGB cost of their care prior to IU Health Tipton Hospital rendering the services and will be asked to pay a down-payment percentage of the AGB adjusted cost prior to receiving services. In the event a patient is unable to fulfill the down-payment, their service may be rescheduled for a later date as medically prudent and in accordance with all applicable federal and state laws and/or regulations. 6. Emergency Services Non-Refundable Deposit This section will be implemented with a strict adherence to EMTALA and IU Health Policy ADM 1.32, Screening and Transfer of Emergency or Unstable Patients. Amount of Non-Refundable Deposit All Uninsured Patients presenting for services at one of IU Health Tipton Hospital's Emergency Departments, via transfer from another hospital facility, or direct admission, will be responsible for a one-hundred dollar ($100.00) non-refundable deposit for services rendered. Patients/guarantors will be responsible for any copays and/or deductibles required by their plan prior to full Financial Assistance being applied. Uninsured Patients wishing to make an application for Financial Assistance greater than the AGB must fulfill their non-refundable deposit prior to IU Health Tipton Hospital processing said application. Uninsured Patients making payments toward their outstanding non-refundable deposit balance will have said payments applied to their oldest application on file, if applicable. Schedule H, Part V, Section B, Line 16a - FAP Website A copy of IU Health Tipton Hospital's FAP is available at the following URL: https://iuhealth.org/pay-a-bill/financial-assistance/ Schedule H, Part V, Section B, Line 16b - FAP Application Website A copy of IU Health Tipton Hospital's FAP Application is available at the following URL: https://iuhealth.org/pay-a-bill/financial-assistance/ Schedule H, Part V, Section B, Line 16c - FAP PLS Website A copy of IU Health's FAP Plain Language Summary is available on its website at the following URL: https://iuhealth.org/pay-a-bill/financial-assistance/ Schedule H, Part V, Section B, Line 16j - Ohter Measures to Publicize IU Health Tipton Hospital takes several other measures to broadly publicize its FAP within the community. These measures include the following: 1. Conspicuous public displays will be posted in appropriate acute care settings such as the emergency department and registration areas describing the available assistance and directing eligible patients to the Financial Assistance Application. 2. IU Health Tipton Hospital will include a conspicuous written notice on all patient billing statements that notifies the patient about the availability of this Policy, and the telephone number of its Customer Service Department which can assist patients with any questions they may have regarding this Policy. 3. IU Health Tipton Hospital Customer Service representatives will be available via telephone Monday through Friday, excluding major holidays, from 8:00 a.m. to 7:00 p.m. Eastern Time to address questions related to this Policy. 4. IU Health Tipton Hospital will broadly communicate this Policy as part of its general outreach efforts. 5. IU Health Tipton Hospital will educate its patient facing team members of the FAP and the process for referring patients to the Program. Schedule H, Part V, Section B, Line 3e Prioritized Health Needs IU Health Tipton Hospital's 2018 Community Health Needs Assessment (CHNA) Report includes a prioritized description of significant health needs in the community. The CHNA report identified the following needs as priorities for IU Health Tipton Hospital: -Access to Healthcare Services -Aging Population and Needs of Seniors -Chronic Disease Management -Drug and Substance Abuse (including Opioids and Alcohol) -Mental Health -Transportation IU Health uses the term behavioral health to refer mental health and drug and substance abuse (including opioids and alcohol). Schedule H, Part V, Section A, Line 1 Primary Website Address https://iuhealth.org/find-locations/iu-health-tipton-hospital Schedule H, Part I, Line 3c - Other Factors Used in Determining Elig. IU Health Tipton Hospital uses several factors other than Federal Poverty Guidelines ("FPG") in determining eligibility for free care under its FAP. These factors include the following: 1. Indiana Residency Requirement Financial Assistance will only be made available to residents of the State of Indiana and those eligible for assistance under 42 U.S.C.A. 1396b(v). IU Health Tipton Hospital will employ the same residency test as set forth in Indiana Code 6-3-1-12 to define an Indiana resident. The term Resident includes any individual who was domiciled in Indiana during the taxable year, or any individual who maintains a permanent place of residence in Indiana and spends more than one hundred eight-three (183) days of the taxable year in Indiana. Patients residing in the state of Indiana while attending an institution of higher education may be eligible for assistance under the FAP if they meet the aforementioned residency test and are not claimed as a dependent on a parent's or guardian's federal income tax statement. 2. IU Health Tipton Hospital's Individual Solutions Department Prior to seeking Financial Assistance under the FAP, all patients or their guarantors must consult with a member of IU Health Tipton Hospital's Individual Solutions department to determine if healthcare coverage may be obtained from a government insurance/assistance product or from the Health Insurance Exchange Marketplace. 3. Uninsured Patients All Uninsured Patients presenting for services at IU Health Tipton Hospital eligible under the FAP will not be charged more than the AGB as described in the FAP. 4. Services Rendered by Individual Providers The FAP does not cover services rendered by individual providers. A full listing of providers and services not covered by the FAP is available at https://iuhealth.org/pay-a-bill/financial-assistance and is updated on a quarterly basis. 5. Alternate Sources of Assistance When technically feasible, a patient will exhaust all other state and federal assistance programs prior to receiving an award from IU Health Tipton Hospital's Financial Assistance Program. Patients who may be eligible for coverage under an applicable insurance policy, including, but not limited to, health, automobile, and homeowner's, must exhaust all insurance benefits prior to receiving an award from IU Health Tipton Hospital's Financial Assistance Program. This includes patients covered under their own policy and those who may be entitled to benefits from a third-party policy. Patients may be asked to show proof that such a claim was properly submitted to the proper insurance provider at the request of IU Health Tipton Hospital. Eligible patients who receive medical care from IU Health Tipton Hospital as a result of an injury proximately caused by a third party, and later receive a monetary settlement or award from said third party, may receive Financial Assistance for any outstanding balance not covered by the settlement or award to which IU Health Tipton Hospital is entitled. In the event a Financial Assistance Award has already been granted in such circumstances, IU Health Tipton Hospital reserves the right to reverse the award in an amount equal to the amount IU Health Tipton Hospital would be entitled to receive had no Financial Assistance been awarded. 6. Alternate Methods of Eligibility Determination IU Health Tipton Hospital will conduct a quarterly review of all accounts placed with a collection agency partner for a period of no less than one hundred and twenty (120) days after the account is eligible for an ECA. Said accounts may be eligible for assistance under the FAP based on the patient's individual scoring criteria. To ensure all patients potentially eligible for Financial Assistance under the FAP may receive Financial Assistance, IU Health Tipton Hospital will deem patients/guarantors to be presumptively eligible for Financial Assistance if they are found to be eligible for one of the following programs, received emergency or direct admit care, and satisfied his/her required co-pay/deductible: -Indiana Children's Special Health Care Services -Medicaid -Healthy Indiana Plan -Patients who are awarded Hospital Presumptive Eligibility (HPE) -Enrolled in a state and/or federal program that verifies the patient's gross household income is less than or equal to 200% of the Federal Poverty Level 7. Additional Considerations Financial Assistance may be granted to a deceased patient's account if said patient is found to have no estate. Additionally, IU Health Tipton Hospital will deny or revoke Financial Assistance for any patient or guarantor who falsifies any portion of a Financial Assistance application. 8. Patient Assets IU Health Tipton Hospital may consider patient/guarantor Assets in the calculation of a patient's true financial burden. A patient's/guarantor's primary residence and one (1) motor vehicle will be exempted from consideration in most cases. A patient's primary residence is defined as the patient's principal place of residence and will be excluded from a patient's extraordinary asset calculation so long as the patient's equity is less than five-hundred thousand dollars ($500,000) and the home is occupied by the patient/guarantor, patient's/guarantor's spouse or child under twenty-one (21) years of age. One (1) motor vehicle may be excluded as long as the patient's equity in the vehicle is less than fifty-thousand dollars ($50,000). IU Health Tipton Hospital reserves the right to request a list of all property owned by the patient/guarantor and adjust a patient's award of Financial Assistance if the patient demonstrates a claim or clear title to any extraordinary Asset not excluded from consideration under the above guidance. 9. Non-Emergent Services Down Payment Uninsured Patients presenting for scheduled or other non-emergent services will not be charged more than the AGB for their services. Patients will receive an estimated AGB cost of their care prior to IU Health Tipton Hospital rendering the services and will be asked to pay a down-payment percentage of the AGB adjusted cost prior to receiving services. In the event a patient is unable to fulfill the down-payment, their service may be rescheduled for a later date as medically prudent and in accordance with all applicable federal and state laws and/or regulations. 10. Emergency Services Non-Refundable Deposit This section will be implemented with a strict adherence to EMTALA and IU Health Tipton Hospital Policy ADM 1.32, Screening and Transfer of Emergency or Unstable Patients. Amount of Non-Refundable Deposit All Uninsured Patients presenting for services at IU Health Tipton Hospital's Emergency Department, via transfer from another hospital facility, or direct admission, will be responsible for a one-hundred dollar ($100.00) non-refundable deposit for services rendered. Patients/guarantors will be responsible for any copays and/or deductibles required by their plan prior to full Financial Assistance being applied. Uninsured Patients wishing to make an application for Financial Assistance greater than the AGB must fulfill their non-refundable deposit prior to IU Health Tipton Hospital processing said application. Uninsured Patients making payments toward their outstanding non-refundable deposit balance will have said payments applied to their oldest application on file, if applicable. Schedule H, Part I, Line 7, Column (f) - Bad Debt Expense The amount of bad debt expense included on Form 990, Part IX, Line 25, column (A), but subtracted for purposes of calculating the percentage of total expense on Line 7, column (f) is $1,622,627. Bad debt expense is reported on a 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 15.12%. Schedule H, Part II - Promotion of Health in Communities Served IU Health Tipton Hospital participates in a variety of community-building activities that address the social determinants of health in the communities it serves. IU Health Tipton Hospital is a subsidiary of IU Health. IU Health and its related hospital entities across the State of Indiana ("IU Health Statewide System") invest in economic development efforts across the state, collaborate with like-minded organizations through coalitions that address key issues, and advocate for improvements in the health status of vulnerable populations. This includes making contributions to community-building activities by providing investments and resources to local community initiatives that addressed economic development, community support and workforce development. Several examples include IU Health's support of the following organizations and initiatives that focus on some of the root causes of health issues, such as lack of education, employment and poverty: -Encore Lifestyle and Enrichment Center -Boys and Girls Club of Tipton County -Tipton Community School Corporation -Tri-Central School Corporation -Tipton City Park Additionally, through the IU Health Statewide System's team member community benefit service program, "Strength That Cares", team members across the state make a difference in the lives of thousands of Hoosiers every year. Schedule H, Part III, Line 2 - Methodology Used to Est. Bad Debt Exp. The bad debt expense of $547,925 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 4 - Bad Debt Expense IU Health Tipton Hospital is a subsidiary in the consolidated financial statements of IU Health. IU Health's consolidated financial statements, Footnote 4, addresses bad debt expense as follows: The Indiana University Health System does not require collateral or other security from its patients, substantially all of whom are residents of the State, for the delivery of health care services. However, consistent with industry practice, the Indiana University Health System routinely obtains assignment of (or is otherwise entitled to receive) patients' benefits payable under their health insurance programs, plans or policies (e.g., Medicare, Medicaid, managed care payers, and commercial insurance policies. The Indiana University Health System uses a portfolio approach to account for categories of patient contracts as a collective group, rather than recognizing revenue on an individual contract basis. The portfolios consist of major payer classes for inpatient revenue and outpatient revenue. Based on the historical collection trends and other analysis, the Indiana University Health System believes that revenue recognized by utilizing the portfolio approach approximates the revenue that would have been recognized if an individual contract approach were used. In support of its mission, the Indiana University Health System provides care to uninsured and underinsured patients. The Indiana University Health System provides charity care to patients who lack financial resources and are deemed to be medically indigent. Under its financial assistance policy, the Indiana University Health System provides medically necessary care to uninsured patients with inadequate financial resources at charitable discounts equivalent to the amounts generally billed, and it provides eligibility for full charity for emergent encounters for uninsured patients who earn less than 200% of the federal poverty level and who meet application criteria. Patients whose liability is deemed catastrophic relative to their annual household income are also eligible for reduced charges. Since the Indiana University Health System does not pursue collection of these amounts, the discounted amounts are not reported as patient service revenue. The Indiana University Health System uses presumptive eligibility screening procedures for free care and recognizes net patient service revenue on services provided to self-pay patients at the discounted rate at the time services are rendered. The estimated cost of charity care, using the consolidated cost to charge ratio, was $94,886,000 and $85,295,000 in 2018 and 2017, respectively. Schedule H, Part III, Line 8 - Medicare Shortfall IU Health Tipton 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 Tipton 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 - Written Debt Collection Policy IU Health Tipton 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 Patients or their guarantors wishing to apply for Financial Assistance are encouraged to submit a Financial Assistance Application within ninety (90) days of their discharge. Patients or their guarantors may submit an application up to two-hundred and forty (240) days from the date of their first billing statement from IU Health Tipton Hospital, however, accounts may be subject to ECA as soon as one hundred and twenty (120) days after having received their first billing statement. Patients or their guarantors submitting an incomplete application will receive written notification of the application's deficiency upon discovery by IU Health Tipton Hospital. The application will be pended for a period of forty-five (45) days from the date the notification is mailed. IU Health Tipton Hospital will suspend any ECA until the application is complete, or the patient fails to cure any deficiencies in their application in the allotted period. Patients will limited English proficiency may request to have a copy of the FAP, a FAP Application, and FAP Plain Language Summary in one of the below languages: -Arabic -Burmese -Burmese-Falam -Burmese-Hakha Chin -Mandarin/Chinese -Spanish The patient, and/or their representative, such as the patient's physician, family members, legal counsel, community or religious groups, social services or hospital personnel may request a FAP Application to be mailed to a patient's primary mailing address free of charge. IU Health Tipton Hospital keeps all applications and supporting documentation confidential. Patients applying for assistance under the FAP will be required to complete a Financial Assistance Application. Patients must include the following documentation with their Financial Assistance Application: -All sources of Income for the last three (3) months; -Most recent three (3) months of pay stubs or Supplemental Security Income via Social Security; -Most recent three (3) statements from checking and savings accounts, certificates of deposit, stocks, bonds and money market accounts; -Most recent state and Federal Income Tax forms including schedules C, D, E, and F. In the event a patient's and/or guarantor's income does not warrant the filing of a federal tax statement, the patient may submit a notarized affidavit attesting to the foregoing; -Most recent W-2 statement; -For patients or members of the Household who are currently unemployed, Wage Inquiry from WorkOne; and -If applicable, divorce/dissolution decrees and child custody order 2. Eligibility Determination IU Health Tipton Hospital will inform patients or guarantors of the results of their application by providing the patient or guarantor with a Financial Assistance Determination within ninety (90) days of receiving a completed Application and all requested documentation. If a patient or guarantor is granted less than full charity assistance and the patient or guarantor provides additional information for reconsideration, IU Health Tipton Hospital Revenue Cycle Services may amend a prior Financial Assistance Determination. If a patient or guarantor seeks to appeal the Financial Assistance Determination further, a written request must be submitted, along with the supporting documentation, to the Financial Assistance Committee for additional review/reconsideration. All decisions of the Financial Assistance Committee are final. A patient's Financial Assistance Application and eligibility determination are specific to each individual date(s) of service and related encounters. 3. Extraordinary Collection Actions IU Health Tipton Hospital may refer delinquent patient accounts to a third-party collection agency after utilizing reasonable efforts to determine a patient's eligibility for assistance under the FAP. IU Health Tipton Hospital and its third-party collection agencies may initiate ECA against a patient or their guarantor in accordance with this Policy and 26 C.F.R. 1.501(r). Said ECA may include the following: -Selling a patient's or their guarantor's outstanding financial responsibility to a third party. -Reporting adverse information about the patient or their guarantor to consumer credit reporting agencies or credit bureaus. -Deferring or denying, or requiring a payment before providing, medically necessary care because of a patient's or their guarantor's nonpayment of one or more bills for previously provided care covered under the FAP. -Actions requiring a legal or judicial process, including but not limited to placing a lien on patient's or their guarantor's property, foreclosing on a patient's or their guarantor's real property attaching or seizing a patient's or their guarantor's bank account or other personal property, commencing a civil action against a patient or their guarantor, causing a patient or guarantor's arrest, causing a patient and/or guarantor to be subject to a writ of body attachment, and garnishing a patient or guarantor's wages. When it is necessary to engage in such action, IU Health Tipton Hospital and its third party collection agencies, will engage in fair, respectful and transparent collections activities. Patients or guarantors currently subject to an ECA who have not previously applied for Financial Assistance may apply for assistance up to two-hundred and forty (240) days of the date of their first billing statement from IU Health Tipton Hospital. IU Health Tipton Hospital and their third-party collection agencies will suspend any ECA engaged on a patient or their guarantor while an Application is being processed and considered. 4. Refunds Patients eligible for assistance under the FAP who remitted payment to IU Health Tipton Hospital in excess of their patient responsibility will be alerted to the overpayment as promptly after discovery as is reasonable given the nature of the overpayment. Patients with an outstanding account balance on a separate account not eligible for assistance under the FAP will have their refund applied to the outstanding balance. Patients without an outstanding account balance described above will be issued a refund check for their overpayment as soon as technically feasible. Schedule H, Part VI, Line 2 - Needs Assessment Communities are multifaceted and so are their health needs. IU Health Tipton Hospital understands that the health of individuals and communities are shaped by various social and environmental factors, along with health behaviors and additional influences. IU Health assessed the health care needs of the communities it serves by conducting a Community Health Needs Assessment (CHNA) for each of its hospital locations. For the 2018 CHNAs, Indiana University Health conducted the community survey data collection in collaboration with Indiana University, University of Evansville and an Indiana Hospital Collaborative, including Community Health Network, Franciscan Alliance, St. Vincent Health and other hospital partners. After completion of the CHNA, IU Health reviewed secondary data, findings from other community health assessments of areas served by the hospital, input obtained from individuals who participated in community meetings, input obtained from key stakeholders, and a community survey to identify and analyze the needs identified by each source. The top health needs of the IU Health 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. Schedule H, Part VI, Line 3 - Patient Education of Eligibility for Assist. IU Health Tipton 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 Tipton Hospital has established a FAP to provide Financial Assistance to Uninsured Patients. IU Health Tipton Hospital is committed to ensuring its patients are compliant with all provisions of the Patient Protection & Affordable Care Act. To that end, IU Health Tipton 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 Tipton Hospital takes several measures to inform its patients of the FAP and FAP-eligibility. These measures include the following: 1. Conspicuous public displays will be posted in appropriate acute care settings such as the emergency department and registration areas describing the available assistance and directing eligible patients to the Financial Assistance Application. 2. IU Health Tipton Hospital will include a conspicuous written notice on all patient billing statements that notifies the patient about the availability of this Policy, and the telephone number of its Customer Service Department which can assist patients with any questions they may have regarding this Policy. 3. IU Health Tipton Hospital Customer Service representatives will be available via telephone Monday through Friday, excluding major holidays, from 8:00 a.m. to 7:00 p.m. Eastern Time to address questions related to this Policy. 4. IU Health Tipton Hospital will broadly communicate this Policy as part of its general outreach efforts. 5. IU Health Tipton Hospital will educate its patient facing team members of the FAP and the process for referring patients to the Program. Schedule H, Part VI, Line 4 - Community Information IU Health Tipton Hospital is located in Tipton County, Indiana, a county located in central Indiana. Tipton County includes ZIP codes within the towns of Tipton, Elwood, Windfall City, Kempton, and Sharpsville. Based on the most recent Census Bureau (2018) statistics, Tipton County's population is 15,128, with approximately 50% being female and 50% male. The county's population estimates by race are 97.1% white, 2.9% Hispanic, 0.7% Black, 0.6% Asian, 0.4% American Indian or Alaska Native, and 1.2% persons reporting two or more races. Tipton County has relatively low levels of educational attainment. In the county, 11.0% did not complete high school, 46.4% did not continue their education after high school or a GED; Just 21.3% have a bachelor's degree or higher, which is far below the national level of more than 29% and below the state level of nearly 25.3%. Schedule H, Part VI, Line 5 - Promotion of Community Health IU Health Tipton Hospital is committed to improving the future of our community members by offering programs that lead to improved health. Community benefit highlights are described below. In 2018, IU Health Tipton Hospital hosted an annual health fair that offered a variety of free and low-cost screenings, blood draws, including glucose, A1C and cholesterol; blood pressure checks, foot screenings, echocardiogram screenings, sleep disorder screenings, and bone density screenings. These evaluations were offered at no cost to about 160 community members. Participants also had the opportunity to bring any unwanted medications to our collection site so they could be disposed of properly. IU Health Tipton Hospital is a subsidiary of IU Health. IU Health extends medical privileges to all physicians who meet the credentialing qualifications necessary for appointment to its medical staff. IU Health does not deny appointment on the basis of gender, race, creed, or national origin. IU Health, in conjunction with the IU School of Medicine, trains the next generation of physicians in an exceptional environment, blending breakthrough research and treatments with the highest quality of patient care. IU Health's five year strategic planning process was renewed during 2014 resulting in mission-critical focusing and re-focusing of investments, both people and financial resources, to fund improvements in patient care, medical education, and research. One of the most crucial elements in that process was the statement of IU Health's Value Proposition: IU Health will be a leader in: -Managing the health of populations it serves, leveraging all aspects of its tripartite mission; -Providing care for patients with complex illnesses, while serving as a destination referral center in select areas. -IU Health will compete on excellence and innovation to drive outcomes and value. This proposition advances IU Health's Mission Statement and recognizes core values that are crucial to its historic and current identity. IU Health is already seeing new and sustained initiatives based upon this statement. Schedule H, Part VI, Line 6 - Affiliated Health Care System IU Health Tipton Hospital is part of the IU Health Statewide System. The IU Health Statewide system 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. IU Health is comprised of hospitals, physicians and allied services dedicated to providing preeminent care throughout Indiana and beyond. National Recognition -Eight hospitals designated as Magnet by the American Nurses Credentialing Center recognizing excellence in nursing care. -Indiana University Health Medical Center is honored to be nationally ranked by U.S. News & World Report for the 21st year in a row. That means IU Health continues to be ranked among the best healthcare systems in the nation and the top healthcare system in Indiana. This ranking recognizes the exceptional care, unmatched expertise and continued excellence of our entire team of caregivers, while giving you confidence that you made the right choice in trusting IU Health with your care. -One adult and ten pediatric specialty programs ranked among the top 50 national programs in U.S. News & World Report's 2018-2019 edition of America's Best Hospitals. -Nine out of ten specialty programs at Riley Hospital for Children at IU Health ranked among the top 50 children's hospitals in the nation. Education and Research As an academic health center, IU Health works in partnership with the IU School of Medicine to train physicians, blending breakthrough research and treatments with the highest quality of patient care. Each year, more than 1,000 residents and fellows receive training in IU Health hospitals. Research conducted by IU School of Medicine faculty gives IU Health physicians and patients access to the most leading-edge and comprehensive treatment options. The three target research areas represent research strengths at IU School of Medicine, key strategic service lines for IU Health, and important medical needs in a time of an aging population and rising healthcare costs: -Cancer: One of the initiative's primary goals is to enable the IU Health Melvin and Bren Simon Cancer Center to attain the National Cancer Institute's top status of "comprehensive," which would recognize it as one of the top-tier cancer centers in the nation. -Neuroscience: The neurosciences research program will tackle a broad range of brain injuries, neurodegenerative disorders and neurodevelopmental disorders. -Cardiovascular: The cardiovascular research initiative will develop a comprehensive program for the study and treatment of heart failure, from newborns to older adults. A top priority is developing a cardiovascular genetics program. The Strategic Research Initiative will provide patients with access to internationally renowned physicians and to new therapies developed through translational research and clinical trials, and will make use of the latest genetic tools to develop personalized therapies that are more effective for individuals and efficient for healthcare providers. IU Health Statewide System IU Health is a part of the IU Health Statewide System which continues to broaden its reach and positive impact throughout the state of Indiana. IU Health is Indiana's most comprehensive academic health center and consists of IU Health Methodist Hospital, IU Health University Hospital, Riley Hospital for Children at IU Health, and IU Health Saxony Hospital. Other hospitals in the IU Health Statewide System include the following: -IU Health Arnett Hospital -IU Health Ball Memorial Hospital -IU Health Bedford Hospital -IU Health Blackford Hospital -IU Health Bloomington Hospital -IU Health Frankfort Hospital -IU Health Jay Hospital -IU Health North Hospital -IU Health Paoli Hospital -IU Health Tipton Hospital -IU Health West Hospital -IU Health White Memorial Hospital Although each hospital in the IU Health Statewide System prepares and submits its own community benefits plan relative to the local community, the IU Health Statewide System considers its community benefit plan as part of an overall vision for strengthening Indiana's overall health. A comprehensive community outreach strategy and community benefit plan is in place that encompasses the academic medical center downtown Indianapolis, suburban Indianapolis and statewide entities around priority areas that focus on health improvement efforts statewide. IU Health is keenly aware of the positive impact it can have on the communities of need in the state of Indiana by focusing on the most pressing needs in a systematic and strategic way. Some ways we address our community health priorities as a system include: IU Health Day of Service The annual IU Health Days of Service is a high-impact event aimed at engaging IU Health team members in activities that address an identified community priority. In 2018, more than 2,848 IU Health team members dedicated more than 9,694 volunteer hours in their communities during the Days of Service. Community Health Initiatives With investments in high-quality and impactful initiatives to address community health needs statewide, IU Health is helping Indiana residents improve their health and their quality of life. In 2018, IU Health impacted many people statewide through presentations, health risk screenings, health education programs, and additional health educational opportunities made available to the community, especially to our community members in the greatest need of such services. The Indiana University Health Board of Directors also approved Community Health Improvement Grants. With these grants, nearly $750,000 will fund projects that address IU Health priorities-behavioral health/substance abuse, obesity, tobacco use, and infant mortality-as well as community-specific needs. The grants, administered by the Indiana University Health Foundation, were awarded to the following hospitals in the Indianapolis Suburban Region: -Hope Healthcare Services Program, IU Health West, $203,000 over two years. Hope Healthcare Services in Avon is the only entity in Hendricks County that provides primary medical and dental care to uninsured patients. It is staffed entirely by volunteer clinicians, many of them IU Health team members, and helps more than 900 patients a year out of nearly 15,000 uninsured adults in Hendricks County. This grant will fund the clinic's first-ever employee, a nurse practitioner, allowing for consistent operating hours, and behavioral health services on-site and via tele-health. With this staffed clinic, they anticipate seeing more than 4,000 patients per year. -Fishers Fire Department, Paramedicine Behavioral Response Program, $43,680 for one year. This pilot project expands the city's existing paramedicine program to provide direct follow-up and support services for mental health patients. Paramedics specially trained in crisis intervention will act as patient advocates and navigators. The program will also introduce new protocols that decrease patient stress and anxiety during emergency responses, and will divert patients to behavioral services instead of emergency departments when appropriate. The IU Health Community Health Grants seek to improve community health by supporting collaboration among IU Health Regional Hospital Boards and Community Health Committees, and local resources and programs. The Community Health Grants are awarded to programs most likely to improve access to health services, enhance the health of the community, advance medical or healthcare knowledge, and relieve or reduce the burden of government or other community efforts. Grantees must also build capacity for addressing these community health issues going forward. Community Partnerships IU Health believes in the power of investing in community partnerships and what that means for the health of our residents and their communities. IU Health seeks to partner with local non-profits on initiatives that specifically aim to serve an identified community need, particularly in the areas of IU Health's five community outreach priorities: reducing health disparities or improving the quality of life for individuals living within IU Health communities, reaching largely underserved communities and supporting the strategic business goals for IU Health. Below are a few of the partners we worked with in 2018 to address priority health needs in Tipton County. -Encore Lifestyle and Enrichment Center -Boys and Girls Club of Tipton County -Tipton Community School Corporation -Tri-Central School Corporation -Tipton City Park Access to Healthcare IU Health is committed to providing quality and complete healthcare for Hoosiers. Access to healthcare was a leading community health need identified in all communities served by IU Health across the state. IU Health is focusing on the needs of the underserved to create initiatives and support efforts that: -Increase access to primary Schedule H, Part III, Line 3 - Est. Bad Debt Attr. to Patients Under FAP An uninsured patient and/or guarantor who was admitted through an eligible facility's emergency department via a direct admission from a physician's office, or transfer from another hospital facility, and whose household income is less than or equal to 200% of the Federal Poverty Level may be eligible for full charity assistance after the successful completion of the Financial Assistance Application and satisfaction of his/her non-refundable deposit. To capture all patients who are potentially eligible for Financial Assistance under the IU Health Financial Assistance Policy, IU Health will deem patients/guarantors to be presumptively eligible for financial assistance if they are found to be eligible for one of the following programs, received emergency or direct admit care, and satisfied the required co-pay/deductible: 1. Indiana Children's Special Health Care Services 2. Medicaid 3. Healthy Indiana Plan 4. Patients who are awarded Hospital Presumptive Eligibility 5. Enrolled in a state and/or federal program that verifies the patient's gross household income is less than or equal to 200% of the Federal Poverty Level (FPL). IU Health also conducts a quarterly review of all accounts placed with a collection agency partner for a period of no less than one hundred and twenty (120) days after the account is eligible for an extraordinary collection actions. Said accounts may be eligible for assistance under the financial assistance policy based on the patient's individual scoring criteria and are not included in bad debt. Due to this comprehensive methodology, IU Health does not believe any amount of bad debt is attributable to patients who may be eligible under the Financial Assistance Policy and no portion of bad debt is included as community benefit. true true false false false false false true false JONATHAN R GOBLE DIR/PRESIDENT (ISR)(PART YEAR) 0 202192 0 123785 0 1381631 0 244995 0 10967 0 1963570 0 0 MICHAEL L HARLOWE PRESIDENT-TIPTON & SAXONY HOSP 0 252976 0 12920 0 1242 0 8447 0 23549 0 299134 0 0 RANDALL C YUST COO/CFO (ISR) (Partial Year) 0 269336 0 42287 0 25358 0 13700 0 19995 0 370676 0 0 GUARAV ARORA MD CMO 0 491864 0 19519 0 19040 0 17625 0 12508 0 560556 0 0 RUTH A KAIN RN VP & CNO (ISR) 0 226055 0 13233 0 1140 0 12344 0 26012 0 278784 0 0 JEFFERY W MOORE RN Anesthetist 178734 0 0 0 792 0 8946 0 0 0 188472 0 0 0 ANGELA K MORGAN MANAGER, PHARMACY DEPT. 117787 0 3823 0 276 0 6587 0 30498 0 158971 0 0 0 Jennifer M Alvey Director (Part Year) 0 582446 0 287162 0 2904 0 118123 0 28584 0 1019219 0 0 Cara L Breidster CFO - ISR (Partial Year) 0 272747 0 37215 0 3933 0 13532 0 22833 0 350260 0 0 Schedule J, Part I, Line 3 - Comp. of the Org.'s CEO/Executive Director IU Health Tipton Hospital's President is employed by Indiana University Health North, Inc. ("IU Health North Hospital"). IU Health North Hospital utilizes IU Health's process for determining compensation, which includes the use of a compensation survey/study conducted by an independent compensation consultant with review and approval by the Committee on Personnel and Compensation and the Board of Directors. Please see Schedule O for additional details. Schedule J, Part I, Line 4b - Supplemental Nonqualified Retirement Plan Jonathan R. Goble and Jennifer M. Alvey participated in an IU Health supplemental executive retirement plan, provisions of which are designed to retain its critical employees. The plan provides for an additional retirement benefit for service through normal retirement or other key dates. If the executive leaves prior to retirement or other key dates, the benefit may be forfeited or reduced. Jennifer M. Alvey has an amount included in column c, deferred compensation, representing the current year unvested contributions made under the supplemental retirement plan. No amount was actually paid to this executive during the year. Jonathan R. Goble received, $1,009,768.65, included in column B (iii), other reportable compensation, representing the vested amount paid out under IU Health's supplemental executive retirement plan. Schedule J, Part I, Line 7 - Non-Fixed Payments Amounts disclosed in Column B (ii) include a long-term and short-term incentive for certain executives and short-term incentive for other employees. Although these plans are based on a fixed formula that has been approved by the Board of Directors based upon certain qualitative and quantitative factors and goals, all discretionary incentive plans must be approved by the Board of Directors prior to any incentive payout. Schedule J, Part I, Line 4a - Severance Payments Johnathan R. Goble entered into a severance agreement with IU Health during 2018. Severance of $308,158 that was received during 2018 is included in column B(III), other reportable compensation. Deferred severance of $231,295 included in column C, retirement and other deferred compensation. Part VI, Section A, Lines 6, 7a and 7b - Members or Stockholders Line 6: The sole member of IU Health Tipton Hospital is IU Health, a 501(c)(3) tax-exempt organization. Line 7A: The Board of Directors of the IU Health Tipton Hospital shall range from three (3) to seven (7), with IU Health having the right to appoint one (1) more than one-half (1/2) of the directors. Line 7B: The following actions require IU Health's prior approval: -The appointment or removal of any director; -The amendment of the Articles of Incorporation; -The amendment of the Bylaws; -The approval of IU Health Tipton Hospital's annual capital and operating budgets; -The incurrence of expenses for any unbudgeted operating or capital budget items or deviations, including any issuance or guarantee of debt not included in IU Health Tipton Hospital's approved budget for the current fiscal year, but only to the extent that such expenses exceed budgeted amounts by (a) $100,000 per fiscal year per budget line item or (b) $500,000 per fiscal year in the aggregate; -The adoption of any strategic plan for IU Health Tipton Hospital, including any amendments thereto; -The encumbrance, sale, lease, transfer or other alienation of more than 5% of the net book value of IU Health Tipton Hospital's assets, measured on a consolidated basis during any fiscal year; -The addition of any members of IU Health Tipton Hospital; -The creation of any new affiliates of IU Health Tipton Hospital; -The approval of any merger, consolidation, joint venture or affiliation involving IU Health Tipton Hospital or any of its affiliates; and -The dissolution of IU Health Tipton Hospital or any of its affiliates. Part VI, Section B, Line 11b - Review of Form 990 The following process was used by IU Health Tipton Hospital to review the Form 990 prior to its filing: The Indianapolis Regional Chief Financial Officer (CFO) reviewed and approved the Form 990. Following the CFO's review and approval, a complete copy of the Form 990 was made available to each board member prior to its filing. Each member was also informed of the availability of IU Health's Tax Department to answer any questions. Part VI, Section B, Lines 12, 13, and 14 - Policies IU Health Tipton Hospital is part of the IU Health system. As the sole member and controlling parent of IU Health Tipton Hospital, IU Health and its board of directors have mandated that certain policies be followed to ensure greater standardization throughout the system. Thus, IU Health Tipton 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. Part VI, Section B, Line 12c - Conflict of Interest Policy IU Health Tipton 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. Part VI, Section B, Line 15 - Process for Determining Compensation IU Health North Hospital utilizes IU Health's process for determining compensation, which is as follows: (1) The Board of Directors has established a Committee on Personnel and Compensation. The individuals on this Committee are made up of individuals who are on the Board and who do not have a conflict of interest with IU Health. There are no physicians or employees on this Committee. This Committee develops and reviews annually the executive compensation philosophy, market analysis as to comparability and reasonableness. One of the purposes of this Committee is to review, approve and make recommendations regarding executive compensation and benefits to the IU Health Board. As deemed appropriate, this Committee also reviews the same detail with the Committee on Finance. The Committee on Finance is represented by certain members of the Board as well. (2) Each year the Committee on Personnel and Compensation engages an outside compensation consulting firm to conduct a compensation and benefits study for all senior vice presidents and above. The current compensation advisor is the Sullivan Center. Sullivan Center performs an independent compensation survey. The relevant comparability data includes: compensation and benefit levels paid by similarly situated organizations (both governmental and tax exempt) for functionally comparable positions as well as the availability of similar services in the geographic area.The Committee reviews the entire compensation package including: base compensation, short term and long term incentive plans, basic health and welfare benefits, qualified and nonqualified plans as well as any additional fringe benefits. Further, Sullivan Center will provide recommendations based upon the reasonable compensation information as it relates to salary increases, bonuses and benefits that are consistent with the compensation philosophy of the Committee. A separate analysis using the same methodology is done for the Chief Executive Officer. (3) The Committee reviews the salary survey and, if appropriate, makes recommendations on increases in salary and any changes in bonuses or benefits. The Committee's goal is to ensure that the total compensation and benefits package is reasonable based upon the independent data provided by Sullivan Center. The Committee votes on any changes in compensation or benefits. This review, discussion and vote are documented in the minutes for the meeting. There are no executives present during the final discussion and approval of compensation. (4) The Board reviews the report prepared by the Sullivan Center as well as the recommendations of the Committee on Personnel and Compensation as to changes in compensation approved by the Committee. As requested, the Committee on Finance also provides its review of recommendations on changes in executive compensation and benefits. This review, discussion and vote are documented in the minutes. (5) The Board then reviews the recommendations provided by the Committee on Personnel and Compensation and votes on the changes as well. No additional compensation or benefits are paid to the executives until the changes have been approved by the Committee and the Board.The discussion and approval are documented in the minutes of the meeting. There are no executives present during the final discussion and approval of compensation. The General Counsel prepares a formal written opinion reviewing the compensation and benefits approval process, comparing that process to the Intermediate Sanctions Test of IRC Section 4958 and, if the facts warrant, provides comments regarding the compensation and benefits approval process as this relates to meeting the requirements for a rebuttable presumption of reasonableness as provided in the Intermediate Sanctions Test. (6) After the end of each year, the Committee and Board also reviews the achievements of the executive group as it relates to the long-term and short-term shared and individual goals developed by the executive and the Board. These achievements may also be reviewed with the Committee on Finance. The Board, at its discretion, may approve bonus payments based upon the achievement of the goals and the compensation survey. The discussion and vote of the Committee and Board is documented in the minutes for each such meeting. The bonuses are not paid until approval is made by the Board. (7) The Committee on Personnel and Compensation and Audit Committee also review the required Form 990 disclosures related to executive compensation and benefits as well as compensation practices and approval processes prior to the filing of the Form 990 return with the Internal Revenue Service. IU Health Tipton Hospital has a process in place to determine the compensation for the other officers and key employees. IU Health Tipton Hospital uses an independent compensation consultant who utilizes a variety of methods and procedures to obtain compensation ranges for comparable officer and employee positions. The independent compensation consultant provides IU Health Tipton Hospital with recommended compensation ranges for its officers and other employees, which are then used as a guide for setting reasonable compensation by management. Management decisions with regard to determining compensation are subject to the review and approval of the Compensation Committee and Board of Directors. Part VI, Section C, Line 19 - Public Disclosure IU Health Tipton Hospital's Articles of Incorporation are available for public inspection through the Indiana Secretary of State's website. IU Health Tipton Hospital's conflict of interest procedures described on Form 990, Schedule O. IU Health Tipton 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 as well as IU Health Tipton Hospital's Form 990. Part XI, Line 9 - Other Changes in Net Assets or Fund Balances During 2018, IU Health Tipton Hospital recorded the following other changes in net assets or fund balances: Change in Interest in Restricted Net Assets of Foundations: $700,745 Equity Transfer (Settlement of Debt): $(13,506) Total Other Changes: $687,239 Page 1, Line J Web Site: https://iuhealth.org/find-locations/iu-health-tipton-hospital FORM 990 PART IX LINE 11G DESCRIPTION:SHARED SERVICE/PROFESSIONAL FE TOTAL FEES:10807641 Clarian Transplant Institute Inc 950 N Meridian St Ste 800 Indianapolis IN 46204 134350599 Healthcare IN 501(c)(3) 10 IUH true HealthLINC Incorporated 950 N Meridian St Ste 800 Indianapolis IN 46204 263571507 Healthcare IN 501(c)(3) 10 IUHB true Indiana Health Info Exchange Inc 846 N Senate Ave Indianapolis IN 46202 364550324 Healthcare IN 501(c)(3) 12 I NA false Indiana University Health Inc 950 N Meridian St Ste 300 Indianapolis IN 46204 351955872 Healthcare IN 501(c)(3) 3 NA false IU Health Arnett 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