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 351720796 INDIANA UNIVERSITY HEALTH BLOOMINGTON INC % CRAIG J JONES INDI 3179634842 950 N MERIDIAN STREET Suite 300 INDIANAPOLIS IN 46204 MICHAEL L CRAIG VP & CFO 3179634842 2019-11-14 JENNIFER D RHODERICK P00395735 3176817000 162.1.129.128 35198520193185000007 2019-11-14 P E86E71EDF6F7DFE9336F32ED7F8459C58967F52A B94C62B5C6A0955190C280FDFCA25CEB3EEAF170 2018 2020-03-31 21:24:44Z BRIAN T SHOCKNEY 950 N MERIDIAN ST STE 300 INDIANAPOLIS IN 46204 510461341 false X SEE SCHEDULE O X 1988 IN Improve the health of our patients and community through innovation and excellence in care, education, research and service. 13 7 2735 238 0 61581 2426000 3697447 435751697 473015183 5283975 8355418 3015202 2234114 446476874 487302162 873688 81427 0 0 135893901 137511534 0 0 0 220433837 228483342 357201426 366076303 89275448 121225859 578845857 644933798 67772712 52028374 511073145 592905424 X IMPROVE THE HEALTH OF OUR PATIENTS AND COMMUNITY THROUGH INNOVATION AND EXCELLENCE IN CARE, EDUCATION, RESEARCH AND SERVICE. false false 284136357 81427 464745577 Indiana University Health Bloomington, Inc. ("IU Health Bloomington") is a 293-bed full service hospital that offers a broad range of services to care for its patients without regard to their ability to pay. Based upon the values of trust, excellence, accountability, and mutual respect, IU Health Bloomington enhances the health of its patients and community in south-central Indiana by advancing the art and science of medicine through the use of new technologies, procedures, and care. 4374197 0 7154623 IU HEALTH BLOOMINGTON PROVIDES SERVICES TO RELATED TAX-EXEMPT ORGANIZATIONS. 649562 0 1062451 IU Health Bloomington receives revenue from the following pass-through entities: Brown County Medical Cooperative, LLC, SIHO Network, LLC, SIRA Imaging Center, LLC, Southern Indiana Surgery Center, LLC and PIMCO Bravo Fund. 29148 0 4856 RENTAL INCOME FROM RELATED TAX-EXEMPT ENTITIES 2967 0 47676 Clinical Research 32115 0 52532 289192231 true true false true false false false false false true true false false false true true false true false false false false false false false false true true true false true false false false false false false false false false false false false true true true true false false true 264 0 true 2735 true true true false false false false false false false false false false false X 13 7 true false true false true true true true true false false true true true true true true true true true true IN X CRAIG J JONES 3179634842 950 N MERIDIAN STREET SUITE 300 INDIANAPOLIS IN 46204 X LYNN H COYNE (SCR) DIRECTOR/BOARD CHAIR 2.0 5.0 X X 0 0 0 JOYCE B POLING (SCR) DIRECTOR/Secretary 2.0 5.0 X X 0 0 0 JAMES J LAUGHLIN MD (SCR) DIRECTOR 2.0 53.0 X 0 456043 13700 MATTHEW D BAILEY PRESIDENT (SCR) (Part Year) 25.0 30.0 X X 0 1493222 329267 BRIAN T SHOCKNEY President (SCR) (Part Year) 25.0 30.0 X X 274723 222658 80275 Daniel J Peterson Chairman (SCR) 2.0 5.0 X X 0 0 0 Jack A Kenworthy Vice Chairman (SCR) 2.0 5.0 X X 0 0 0 Danny L Moore Treasurer (SCR) (Part Year) 2.0 5.0 X X 0 0 0 Richard G Hendrickson Dir/Treasur (SCR) (Part Year) 2.0 5.0 X X 0 3600 0 David L Beachy DO (SCR) Director 2.0 53.0 X 0 287229 37429 Alfonso W Gatmaitan (SCR) Director 2.0 53.0 X 0 3058805 1037833 Julie Minton (SCR) Director (Part Year) 2.0 5.0 X 0 0 0 Janet Farlow Perry (SCR) Director 2.0 5.0 X 0 0 0 Hojjat M Shamloo MD (SCR) Director 2.0 53.0 X 0 484042 44168 John S Strobel MD (SCR) Director 2.0 53.0 X 0 721056 38285 MICHAEL L CRAIG VP & CFO (SCR) 25.0 30.0 X 0 279207 29312 KENNETH E MARSHALL MD VP & CMO (SCR) (PARTIAL YEAR) 25.0 30.0 X 180306 150755 33144 LARRY BAILEY PRESIDENT IUH PAOLI/IUH MORGAN 10.0 45.0 X 489304 0 34909 WENDY HERNANDEZ VP, PROF & SUPPORT SERVICES 50.0 5.0 X 196574 0 28731 Daniel A Handel MD VP & CMO (SCR)(PARTIAL YEAR) 55.0 0.0 X 327587 49480 28382 Cynthia Herrington VP & CNO (SCR) (Part Year) 50.0 5.0 X 179318 0 18897 Derek Fields Dir-Pharmacy 55.0 0.0 X 188836 0 27600 CAREY C MAYER MD PSYCHIATRIST 55.0 0.0 X 283132 0 35442 CHAD W SCHULTHEIS MD PSYCHIATRIST 55.0 0.0 X 281833 0 36843 Nida JSyed MD Psychiatrist 55.0 0.0 X 293948 0 20561 Greg SSidell MD Psychiatrist 55.0 0.0 X 292463 0 41458 Douglas M Frye Physicist-Radiation Medicine 55.0 0.0 X 241615 0 40853 LINDA LEWIS VP & CNO 0.0 0.0 X 124205 0 0 3353844 7206097 1957089 105 true true false ARAMARK 27310 NETWORK PLACE CHICAGO IL 60673 FACILITIES 5052887 FA WILHELM CONSTRUCTION CO INC 3914 Prospect Street INDIANAPOLIS IN 46203 Construction 9738917 HELLMUTH OBATA KASSABAUM INC 10 S BROADWAY SUITE 200 ST LOUIS MO 63102 DESIGN/ENGINEERING 4280814 MEDEFIS PO Box 5068 NEW YORK NY 100875068 Staffing 3278909 CSO ARCHITECTS INC PO BOX 6069 DEPT 94 INDIANAPOLIS IN 462066069 Architectural/Design 2032225 35 0 3055939 641508 3697447 NET PATIENT SERVICE REVENUE 622110 464745577 464745577 SHARED SERVICES 541900 7154623 7154623 RENT FROM RELATED 501(C)(3) ORGS. 532000 4856 4856 CLINICAL RESEARCH 541700 47676 47676 INCOME (LOSS) FROM PASS-THROUGH ENTITIES 900099 1062451 1062451 473015183 8011393 0 0 8011393 0 0 611982 1045328 -433346 0 -433346 0 0 -433346 22453176 4700 22045620 68231 407556 -63531 344025 0 0 344025 0 0 0 0 0 0 0 0 0 CAFETERIA/FOOD SERVICE 721110 1422621 1422621 VENDING 900099 43549 43549 EDUCATION 900099 142845 142845 1058445 1058445 2667460 487302162 473015183 0 10589532 X 81427 81427 0 0 0 2033833 1809114 224719 0 0 107090920 95258401 11832519 0 5402126 4805243 596883 0 15375894 13677005 1698889 0 7608761 6768066 840695 0 0 556300 70 556230 0 4342 4342 0 12959 12959 0 0 317168 317168 0 88600376 32612862 55987514 102162 4454 97708 0 1387093 1237611 149482 0 1612691 1557214 55477 0 0 6272962 6018458 254504 0 233119 173584 59535 0 0 60527 41937 18590 0 1159393 1159393 0 0 13840395 12454836 1385559 0 2342667 575239 1767428 0 DRUGS AND MEDICAL SUPPLIES 64152396 64152396 BAD DEBT 25764281 25764281 HOSPITAL ASSESSMENT FEE 17935751 17935751 NONCAPITALIZED EQUIPMENT 1046507 525174 521333 3082253 2579715 502538 366076303 289192231 76884072 0 13827 1637134 236390720 286220442 0 0 60009757 60897331 0 0 0 0 403541 193452 5212018 5515391 2065400 3960418 357966593 257454418 81689161 100512175 172677658 166745390 0 0 3438376 2306666 3610563 3610563 13334836 13334836 578845857 644933798 25033065 28954953 0 0 31166 1114136 0 0 0 0 0 0 216497 216497 0 0 42491984 21742788 67772712 52028374 X 497738309 579570588 7774144 7774144 5560692 5560692 511073145 592905424 578845857 644933798 X 121225859 -9059217 -30334363 X false true X true true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 12959 12959 false false Schedule C, Part II-B, Line 1i - Other Activities IU Health Bloomington paid institutional membership dues to the American Hospital Association ("AHA"), Indiana Hospital Association ("IHA") and The Greater Bloomington Chamber of Commerce during 2018 in the amount of $42,811, $34,425 and $13,400, respectively. Each membership organization notified IU Health Bloomington that a portion of the dues it paid were used for lobbying purposes. The AHA used 22.98%, or $9,838 of the 2018 membership dues paid by IU Health Bloomington, for lobbying expenditures. The IHA used 7.12%, or $2,451 of the 2018 membership dues paid by IU Health Bloomington, for lobbying expenditures. The Greater Bloomington Chamber of Commerce use $5.00%, or $670 of the 2018 membership dues paid by IU Health Bloomington, for lobbying expenditures. The total membership dues paid to these organizations by IU Health Bloomington during 2018 that were attributable to lobbying expenditures was $12,959. 13334836 13334836 4906654 8468719 16073 49762 4513 2335 13334836 4906654 4906654 4906654 4906654 4817324 89330 4906654 0.41700 0.58300 false false 19741447 19741447 154956495 136107857 18848638 7487767 5800732 1687035 132219258 110879927 21339331 43561626 4665902 38895724 100512175 0 INTERCOMPANY PAYABLES (NET) 18346906 DUE TO THIRD-PARTY PAYERS 2718662 SELF-INSURANCE LIABILITIES 311422 ENVIRONMENTAL OBLIGATIONS 412602 ACCRUED LOAN GUARANTEES -46804 21742788 X Schedule D, Part V, Line 4 - Intended Uses of Org.'s Endowment Funds Temporarily and permanently restricted net assets are generally restricted for indigent and other patient care services, medical education and research programs, and medical supplies and equipment. Schedule D, Part X, Line 2 - FIN 48 (ASC 740) Footnote IU Health Bloomington 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 Indiana University 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 5430 5493696 5493696 0.01610 7061 70860670 54072427 16788243 0.04930 12491 76354366 54072427 22281939 0.06540 18 42607 3746620 186625 3559995 0.01050 4 3146 704598 205937 498661 0.00150 3 982 21627060 13991297 7635763 0.02240 1 8165 8165 3 483 680081 598486 81595 0.00020 29 47218 26766524 14982345 11784179 0.03460 29 59709 103120890 69054772 34066118 0.10000 2 244 3062 3062 1 5075 42053 42053 0.00010 1 12 5139 5139 4 5331 50254 50254 0.00010 false 5493696 94251135 103427287 -9176152 X true true SEE PART VI AMBULATORY SURGERY CENTER 0.5 0.5 SEE PART VI DIAG. AND OTHER OUTPATIENT 0.5 0.5 SEE PART VI AMBULATORY SURGERY CENTER 0.5 0.5 1 1 IU HEALTH BLOOMINGTON HOSPITAL 601 WEST SECOND STREET BLOOMINGTON IN 47403 SEE PART V, SECTION C 18-005047-1 X X X IU HEALTH BLOOMINGTON HOSPITAL 1 false false true X X X X X X X X X 18 true false false true X SEE PART V, SECTION C X true 19 true SEE PART V, SECTION C false true X 200. 0. X X X X X X true true X X X true X SEE PART V, SECTION C X SEE PART V, SECTION C X SEE PART V, SECTION C X X X X X X X true X false X X X X true X false false Schedule H, Part V, Section B, Line 5 - Input from Community In conducting its most recent CHNA, IU Health Bloomington's approach to gathering qualitative data consisted of a multi-component approach to identify and verify community health needs for the IU Health Bloomington service area. This included the following components: 1. Community Meetings 2. Key Stakeholders Interviews 3. Community Survey Community Meetings (Monroe & Owen Counties) To obtain a more complete picture of the factors that play into the Monroe and Owen County community health, input from local leaders with a stake in the community's health were invited to attend a community health sub-committee meeting on May 8, 2018 held at IU Health Bloomington. Organizations who participated in the focus groups are as follows: - Bloomington Economic Development Center - Bloomington Health Foundation - Bloomington North High School - Monroe County Health Department - Local Council of Women - United Way of Monroe County - Slotegraff and Niehoff The meeting began with a presentation that discussed the goals and status of the CHNA process and the purpose of the community meeting. Then, secondary data were presented, along with a summary of the most unfavorable community health indicators. For the community served by IU Health Bloomington Hospital, those indicators were (in alphabetical order): - Cardiovascular diseases and related mortality - Drug and substance abuse - Motor vehicle accidents and drunk driving - Physically and mentally unhealthy days - Poverty and un-employment - Severe housing problems - Smoking, including during pregnancy - Supply of primary care physicians and mental health providers Meeting participants then were asked to discuss whether the identified, unfavorable indicators accurately identified the most significant community health issues and were encouraged to add issues that they believed were significant.Several issues were added, such as: childhood poverty, transportation needs, infant mortality, sexually transmitted diseases, obesity, patient compliance, and chronic disease. In addition, the group decided it would be best to split poverty and un-employment into two distinct needs. After discussing the needs identified through secondary data and adding others to the list, each participant was asked through a voting process to identify three to five needs they consider to be the most significant. From this process, the group identified these five needs as being the most significant in the community served by IU Health Bloomington Hospital: - Drug and substance abuse - Chronic disease - Smoking, including during pregnancy - Obesity - Physically and mentally unhealthy days In addition to the sub-committee meeting, two open focus groups were conducted at local schools in Monroe County and a third open focus group was conducted at the Owen County YMCA. A member of the Owen County Health Board attended the Owen County YMCA focus group. In total, 18 individuals participated in these focus groups. Individual interviews were conducted with people experiencing or recently experiencing homelessness and the Bloomington Commission on Aging. The top health issues identified were: - Homelessness - Lack of mental healthcare providers - Transportation to healthcare appointments for those without vehicles - Food Insecurities - Substance Abuse - Children and infants in need - Housing - Healthcare During the meetings, a range of other topics were discussed including: - Resource access - Substance use - Food insecurity - Importance of side-walks for community building, - transportation, and recreation - Healthcare - Basic needs - Homelessness - Childhood conditions - Understanding self - sense of belonging to community - Transportation - Social connections - Insurance - High cost of housing - Care of older adults in the community - Mental health After comparing, the data gathered from the meetings and interviews, the following five needs were noted as the most significant for the community served by IU Health Bloomington Hospital: - Drug and substance abuse - Chronic disease - Smoking, including during pregnancy - Obesity - Mental health Community Meeting (Lawrence County) To obtain a more complete picture of the factors that play into the Lawrence community health, input from local leaders with a stake in the community's health were invited to attend a community health sub-committee meeting on April 10, 2018 held at IU Health Bedford. Organizations who participated in the focus groups are as follows: - Bedford Public Library - Bedford Chamber of Commerce - City of Bedford - City of Bedford Parks and Recreation - Purdue Extension - Stone City Products The meeting began with a presentation that discussed the goals and status of the CHNA process and the purpose of the community meeting. Then, secondary data were presented, along with a summary of the most unfavorable community health indicators. For the community served by IU Health Bloomington Hospital, those indicators were (in alphabetical order): - Chronic Disease management and mortality - Low birthweight and teen birth rates - Mental illness and supply of mental health providers - Mortality from motor vehicle accidents and other injuries - Obesity and physical inactivity - Smoking and smoking during pregnancy - Unemployment and economic factors Meeting participants then were asked to discuss whether the identified, unfavorable indicators accurately identified the most significant community health issues and were encouraged to add issues that they believed were significant. Several issues were added, such as: substance abuse and treatment, access to and pricing of healthcare, collaboration in the community on health needs, and healthy food access and knowledge. During the meetings, a range of other topics were discussed including: - Hospital admission that are preventable - Skills gap in local area compared to job opportunities - Mental health stigma - Smoking policies - Limited resources in the community - Lack of awareness of existing programs/resources - Population patterns in the world and in rural communities After discussing the needs identified through secondary data and adding others to the list, each participant was asked through a voting process to identify three to five needs they consider the most significant. From this process, the group identified five needs as being the most significant in the Lawrence County community: - Substance abuse and treatment - Obesity and physical inactivity - Access to and pricing of healthcare - Unemployment and economic factors/workforce training and education - Mental illness and supply of mental health providers Key Stakeholder Interviews (Monroe and Lawrence Counties) IU Health Bloomington also conducted key stakeholder interviews with representatives of the Monroe and Lawrence County Health Departments. An interview was not conducted with the Owen County Health Department; however, a member of the Owen County Health Board attended the Owen county YMCA focus group. The interviews were conducted to assure that appropriate and additional input was received from the governmental public health officials. Accordingly, the results of the community meetings were discussed and insights were sought regarding significant community health needs, why such needs are present, and how they can be addressed. The interviews were guided by a structural protocol that focused on opinions regarding significant community health needs, describing why such needs are present, and seeking ideas for how to address them. Monroe County The interviewee confirmed that the needs identified through the community meetings were all issues, including: - Drug and substance abuse - Chronic disease - Smoking, including pregnancy - Obesity - Physical Inactivity Overall, services for mental health and substance abuse treatment were considered some of the most significant needs. Substance abuse continues to be a major issue and seems to have increased in recent years despite many efforts to curb the epidemic. While obesity has improved in recent times in Monroe County, it is still an issue and leading to chronic diseases such as heart disease and diabetes. Early childhood trauma and early adult trauma were identified as contributing factors for many of these issues as it was thought that many who experience traumatic events do not learn coping skills to carry on later into life. Access to health care and health services is a need. Although Monroe County has an abundance of resources, it is often difficult to get economically disadvantaged populations to affordable providers. Basic needs insecurity is an issue for certain residents, and affects many aspects of health. Encouraging vaccinations in the community is an important need, as conditions like mumps, measles and others seem to have been revitalized. Public health funding is a major need, as funding opportunities are typically for new programs while previously established programs have difficulty maintaining their Schedule H, Part V, Section B, Line 7a - CHNA Website A copy of IU Health Bloomington's CHNA is available on its website at the following URL: https://iuhealth.org/in-the-community Schedule H, Part V, Section B, Line 10a - Implementation Strategy Website A copy of IU Health Bloomington'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 Bloomington's Board adopted an implementation strategy in April 2019 relating to the 2018 CHNA. IU Health Bloomington prioritized and determined which of the community health needs identified in its most recently conducted CHNA was most critical for it to address. IU Health Bloomington will address the following community health needs between 2019 and 2021: -Access to Healthcare Services -Chronic Disease and Chronic Disease Management -Drug and Substance Abuse (including Opioids and Alcohol) -Obesity, Diabetes and Physical Inactivity -Mental Health -Senior Health -Social Determinants of Health IU Health uses the term Behavioral Health to refer to Mental Health and Drug and Substance Abuse (including Opioids and Alcohol). Access to Healthcare IU Health Bloomington's implementation strategy to address the identified need of Access to Healthcare includes the following: -Implement a medical neighborhood approach to increase delivery of coordinated healthcare to patients. -Community organizations and members will have access to information about services to support health and wellness. -Support development of a community portal with referral to services. -Develop congregational support through a community collaboration. -Conduct prediabetes screenings in the community to identify people at-risk for diabetes and chronic disease. -Support evidence-based obesity prevention programs: GOAL (Get Onboard Active Living); Moving Forward, and Goal University Chronic Disease and Chronic Disease Management -Implement a medical neighborhood approach to increase delivery of coordinated healthcare to patients. -Community organizations and members will have access to information about services to support health and wellness. -Support development of a community portal with referral to services. -Develop congregational support through a community collaboration. -Develop an integrated pathway for diabetes, hypertension, hyperlipidemia prevention and comprehensive education and care. -Conduct prediabetes screenings in the community to identify people at-risk for diabetes and chronic disease. -Support evidence-based obesity prevention programs: GOAL (Get Onboard Active Living); Moving Forward, and Goal University -Identify at-risk populations, such as pregnant moms, youth, and adults using tobacco products and refer to services. Obesity, Diabetes and Physical Inactivity IU Health Bloomington's implementation strategy to address the identified need of Obesity, Diabetes and Physical Inactivity includes the following: -Develop an integrated pathway for diabetes, hypertension, hyperlipidemia prevention and comprehensive education and care. -Conduct prediabetes screenings in the community to identify people at-risk for diabetes and chronic disease. -Support evidence-based obesity prevention programs: GOAL (Get Onboard Active Living); Moving Forward, and Goal University Behavioral Health (includes Drug & Substance Abuse and Mental Health) IU Health Bloomington's implementation strategy to address the identified need of Behavioral Health includes the following: -Women with children and pregnant women who have behavioral health and/or substance use issues will be identified early and receive care through IU Health Bloomington Women's Clinics. -Provide and promote drug take-back program in the hospital. -Develop behavioral health access and appointment system of support for Positive Link client's onsite. -Provide services and upgrade area for confidential support in collaboration with Volunteers of America. -Support caregivers caring for family or dependents with dementia. -Provide staff from Alzheimer's Resource Services to support the Memory Clinic. Senior Health IU Health Bloomington's implementation strategy to address the identified need of Senior Health includes the following: -Support caregivers caring for family or dependents with dementia. -Provide staff from Alzheimer's Resource Services to support the Memory Clinic. Also, IU Health Bloomington will address all 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 Bloomington 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 Bloomington takes into consideration several other factors in determining patient eligibility for financial assistance. These factors include the following: 1. IU Health'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'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 Bloomington'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 Bloomington'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 Bloomington. Eligible patients who receive medical care from IU Health Bloomington 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 Bloomington is entitled. In the event a Financial Assistance Award has already been granted in such circumstances, IU Health Bloomington reserves the right to reverse the award in an amount equal to the amount IU Health Bloomington would be entitled to receive had no Financial Assistance been awarded. 3. Alternate Methods of Eligibility Determination IU Health Bloomington will conduct a quarterly review of all accounts placed with a collection agency partner for a period of no less than one hundred and twenty (120) days after the account is eligible for an Extraordinary Collection Action ("ECA"). Said accounts may be eligible for assistance under the FAP based on the patient's individual scoring criteria. To ensure all patients potentially eligible for Financial Assistance under the FAP may receive Financial Assistance, IU Health Bloomington 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 Bloomington will deny or revoke Financial Assistance for any patient or guarantor who falsifies any portion of a Financial Assistance application. 5. Non-Emergent Services Down Payment Uninsured Patients presenting for scheduled or other non-emergent services will not be charged more than the Amounts Generally Billed ("AGB") AGB for their services. Patients will receive an estimated AGB cost of their care prior to IU Health Bloomington rendering the services and will be asked to pay a down-payment percentage of the AGB adjusted cost prior to receiving services. In the event a patient is unable to fulfill the down-payment, their service may be rescheduled for a later date as medically prudent and in accordance with all applicable federal and state laws and/or regulations. 6. Emergency Services Non-Refundable Deposit This section will be implemented with a strict adherence to EMTALA and IU Health Policy ADM 1.32, Screening and Transfer of Emergency or Unstable Patients. Amount of Non-Refundable Deposit All Uninsured Patients presenting for services at IU Health Bloomington'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 Bloomington 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 Bloomington's FAP is available on the following website: https://iuhealth.org/pay-a-bill/financial-assistance Schedule H, Part V, Section B, Line 16b - FAP Application Website A copy of IU Health Bloomington's FAP Application is available on the following website: https://iuhealth.org/pay-a-bill/financial-assistance Schedule H, Part V, Section B, Line 16c - FAP PlS Website A plain language summary of the FAP, including translated copies, is available on the following website: https://iuhealth.org/pay-a-bill/financial-assistance Schedule H, Part V, Section B, Line 16j - Other Measures to Publicize IU Health Bloomington takes several other measures to publicize its FAP within the community. These measures include the following: 1. Conspicuous public displays will be posted in appropriate acute care settings such as the emergency department and registration areas describing the available assistance and directing eligible patients to the Financial Assistance Application. 2. IU Health Bloomington 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 Bloomington 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 Bloomington will broadly communicate this Policy as part of its general outreach efforts. 5. IU Health Bloomington 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 Bloomington's 2018 Community Health Needs Assessment (CHNA) Report includes a prioritized description of significant health needs in the community. The CHNA report identified the following seven needs as priorities for IU Health Bloomington: -Access to Healthcare Services -Chronic Disease and Chronic Disease Management -Drug and Substance Abuse (including Opioids and Alcohol) -Mental Health -Obesity, Diabetes, and Physical Inactivity -Senior Health -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). Schedule H, Part V, Section A, Line 1 Primary Website Address https://iuhealth.org/find-locations/iu-health-bloomington-hospital 25 BLOOMINGTON ENDOSCOPY CENTER 550 LANDMARK AVE BLOOMINGTON IN 47402 AMBULATORY SURGERY SOUTHERN INDIANA SURGERY CENTER 2800 REX GROSSMAN BLVD BLOOMINGTON IN 47403 AMBULATORY SURGERY GREEN COUNTY WIC 200 E MAIN ST STE 1 BLOOMFIELD IN 47424 DIAGNOSTIC AND OTHER OUTPATIENT IU HEALTH ADVANCED HEART CARE CENTER 714 S ROGERS ST BLOOMINGTON IN 47403 DIAGNOSTIC AND OTHER OUTPATIENT IU HEALTH ANTICOAGULATOIN CLINIC 451 LANDMARK AVE BLOOMINGTON IN 47403 DIAGNOSTIC AND OTHER OUTPATIENT IU HEALTH BEHAVIORAL HEALTH 445 LANDMARK AVE BLOOMINGTON IN 47404 DIAGNOSTIC AND OTHER OUTPATIENT IU HEALTH BLOOMINGTON OCCUP SERVICES 326 S WOODCREST DR BLOOMINGTON IN 47401 DIAGNOSTIC AND OTHER OUTPATIENT IU HEALTH BLOOMINGTON URGENT CARE EAST 326 S WOODCREST BLOOMINGTON IN 47401 DIAGNOSTIC AND OTHER OUTPATIENT IU HEALTH CANCER RADIATION CENTER 2620 COTA DR BLOOMINGTON IN 47404 DIAGNOSTIC AND OTHER OUTPATIENT IU HEALTH CANCER RADIATION CENTER 9149 SR 37 RR 11 BEDFORD IN 47421 DIAGNOSTIC AND OTHER OUTPATIENT IU HEALTH CHILDREN'S THERAPY CENTER 4935 W ARLINGTON RD STE B C BLOOMINGTON IN 47404 DIAGNOSTIC AND OTHER OUTPATIENT IU HEALTH COMMUNITY HEALTH 333 E MILLER DR BLOOMINGTON IN 47401 DIAGNOSTIC AND OTHER OUTPATIENT IU HEALTH COMMUNITY HEALTH EDUC CENTER 431 S COLLEGE BLOOMINGTON IN 47403 DIAGNOSTIC AND OTHER OUTPATIENT IU HEALTH DIABETES CENTER 727 W 2ND ST BLOOMINGTON IN 47403 DIAGNOSTIC AND OTHER OUTPATIENT IU HEALTH EMERGENCY MEDICAL TRANSPORT 601 W 1ST ST BLOOMINGTON IN 47403 DIAGNOSTIC AND OTHER OUTPATIENT IU HEALTH OCCUPATIONAL HEALTH 3443 W 3RD ST BLOOMINGTON IN 47403 DIAGNOSTIC AND OTHER OUTPATIENT IU HEALTH PAIN CENTER 888 AUTO MALL RD BLOOMINGTON IN 47401 DIAGNOSTIC AND OTHER OUTPATIENT IU HEALTH REHAB AND SPORTS MDEDICINE 5 CRANE AVE SPENCER IN 47460 DIAGNOSTIC AND OTHER OUTPATIENT IU HEALTH REHAB AND SPORTS MEDICINE 326 S WOODCREST DR BLOOMINGTON IN 47401 DIAGNOSTIC AND OTHER OUTPATIENT IU HEALTH REHAB AND SPORTS MEDICINE 2499 W COTA DR BLOOMINGTON IN 47403 DIAGNOSTIC AND OTHER OUTPATIENT IU HEALTH WOUND CENTER 2920 MCINTIRE DR BLOOMINGTON IN 47404 DIAGNOSTIC AND OTHER OUTPATIENT IU HEALTH BLOOMINGTON HOSP HOME HEALTH 333 E MILLER DR BLOOMINGTON IN 47402 HOME HEALTH IU HEALTH HOSPICE 619 W 1ST ST BLOOMINGTON IN 47403 HOSPICE SIRA IMAGING CENTER 500 S LANDMARK AVE BLOOMINGTON IN 47403 DIAGNOSTIC AND OTHER OUTPATIENT IU HEALTH CANCER CENTER INFUSION THERAPY 508 W 2ND ST BLOOMINGTON IN 47403 DIAGNOSTIC AND OTHER OUTPATIENT Schedule H, Part IV, Line 1(a) - Name of Entity SIRA Imaging Center, LLC Schedule H, Part IV, Line 2(a) - Name of Entity Southern Indiana Surgery Center, LLC Schedule H, Part IV, Line 3(a) - Name of Entity Brown County Medical Cooperative, LLC Schedule H, Part I, Line 3c - Other Factors Used in Determining Elig. IU Health Bloomington uses several factors other than Federal Poverty Guidelines ("FPGs") in determining eligibility for free care under its FAP. These factors include the following: 1. Indiana Residency Requirement Financial Assistance will only be made available to residents of the State of Indiana and those eligible for assistance under 42 U.S.C.A. 1396b(v). IU Health Bloomington 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 guardians' federal income tax return. 2. IU Health'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'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 Bloomington 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 Bloomington'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 Bloomington'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 Bloomington. Eligible patients who receive medical care from IU Health Bloomington 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 Bloomington is entitled. In the event a Financial Assistance Award has already been granted in such circumstances, IU Health Bloomington reserves the right to reverse the award in an amount equal to the amount IU Health Bloomington would be entitled to receive had no Financial Assistance been awarded. 6. Alternate Methods of Eligibility Determination IU Health Bloomington 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 Bloomington 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 Bloomington 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 Bloomington 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 Bloomington 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 Bloomington rendering the services and will be asked to pay a down-payment percentage of the AGB adjusted cost prior to receiving services. In the event a patient is unable to fulfill the down-payment, their service may be rescheduled for a later date as medically prudent and in accordance with all applicable federal and state laws and/or regulations. 10. Emergency Services Non-Refundable Deposit This section will be implemented with a strict adherence to EMTALA and IU Health Policy ADM 1.32, Screening and Transfer of Emergency or Unstable Patients. Amount of Non-Refundable Deposit All Uninsured Patients presenting for services at IU Health Bloomington'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 Bloomington processing said application. Uninsured Patients making payments toward their outstanding non-refundable deposit balance will have said payments applied to their oldest application on file, if applicable. Schedule H, Part I, Line 6a - C.B. Report Prepared by a Related Org. IU Health Bloomington's community benefit and other investments, encompassing its total community investment, are included in the IU Health Community Benefit Report which is prepared on behalf of and includes IU Health and its related hospital entities in the State of Indiana. The IU Health Community Benefit Report is made available to the public on IU Health's website at https://iuhealth.org/in-the-community. The IU Health Community Benefit Report is also distributed to numerous key organizations throughout the State of Indiana in order to broadly share the IU Health Statewide 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 7, Column (c) - 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 excludes direct offsetting revenue, is 30.30%. Schedule H, Part I, Line 7, Column (f) - Percent of Total Expense The amount of bad debt expense subtracted for purposes of calculating the percentage of total expense on Line 7, column (f) is $25,764,281. 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 7g - Subsidized Health Services IU Health Bloomington does not include any costs associated with physician clinics as subsidized health services. Schedule H, Part II - Promotion of Health in Communities Served IU Health Bloomington is part of the IU Health Statewide System. The IU Health Statewide System participates in a variety of community-building activities that address the social determinants of health in the communities it serves through investments in economic development efforts across the state, collaboration with like-minded organizations through coalitions that address key issues, and advocacy 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: -Monroe County Public Health Clinic -Monroe County Community School System -Monroe County Opioid Commission -Early Learning Indiana -United Way 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 - Bad Debt Expense Methodology The amount reported on line 2 as bad debt is reported at cost, as calculated using the cost to charge ratio methodology. Schedule H, Part III, Line 4 - Bad Debt Expense IU Health Bloomington 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 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 Bloomington Medicare Cost Report. "Allowable costs" for Medicare Cost Report purposes, however, are not reflective of all costs associated with IU Health Bloomington'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 Bloomington's participation in Medicare programs would significantly increase the Medicare shortfall reported on Schedule H, Part III, Line 7. IU Health Bloomington's Medicare shortfall is attributable to reimbursements that are less than the cost of providing patient care and services to Medicare beneficiaries and does not include any amounts that result from inefficiencies or poor management. IU Health Bloomington accepts all Medicare patients knowing that there may be shortfalls; therefore it has taken the position that any shortfall should be counted as part of its community benefit. Additionally, it is implied in Internal Revenue Service Revenue Ruling 69-545 that treating Medicare patients is a community benefit. Revenue Ruling 69-545, which established the community benefit standard for nonprofit hospitals, states that if a hospital serves patients with governmental health benefits, including Medicare, then this is an indication that the hospital operates to promote the health of the community. Schedule H, Part III, Line 9b - Written Debt Collection Policy IU Health Bloomington'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, 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. The application will be pended for a period of forty-five (45) days from the date the notification is mailed. IU Health will suspend any ECA until the application is complete, or the patient fails to cure any deficiencies in their application in the allotted period. Patients with limited English proficiency may request to have a copy of the FAP, a FAP Application, and FAP Plain Language Summary in one of the below languages: -Arabic -Burmese -Burmese-Falam -Burmese-Hakha Chin -Mandarin/Chinese -Spanish The patient, and/or their representative, such as the 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 Bloomington 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 return, the patient may submit a notarized affidavit attesting to the foregoing; -Most recent W-2 statement; -For patients or members of the Household who are currently unemployed, Wage Inquiry from WorkOne; and -If applicable, divorce/dissolution decrees and child custody order 2. Eligibility Determination IU Health Bloomington will inform patients or guarantors of the results of their application by providing the patient or guarantor with a Financial Assistance Determination within ninety (90) days of receiving a completed Application and all requested documentation. If a patient or guarantor is granted less than full charity assistance and the patient or guarantor provides additional information for reconsideration, IU Health Revenue Cycle Services may amend a prior Financial Assistance Determination. If a patient or guarantor seeks to appeal the Financial Assistance Determination further, a written request must be submitted, along with the supporting documentation, to the Financial Assistance Committee for additional review/reconsideration. All decisions of the Financial Assistance Committee are final. A 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 Bloomington 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 Bloomington 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 Bloomington 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 Bloomington. IU Health Bloomington 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 Bloomington 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 Bloomington 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 Bloomington assesses the health care needs of the communities it serves by conducting a CHNA. This assessment includes collaboration with other community organizations such as: -Bloomington Economic Development Center -Bloomington Health Foundation -Bloomington North High School -Local Council of Women -Monroe County Health Department -Slodagraff and Niehoff -United Way of Monroe County -Bedford Public Library -Bedford Chamber of Commerce -City of Bedford -City of Bedford Parks and Recreation -Purdue Extension -Stone City Products After completion of the CHNA, IU Health Bloomington reviewed the information gathered from community leader focus groups, community input surveys and statistical data. The needs identified were analyzed and ranked to determine the prevalence and severity of community health needs and which ones were most critical. Additionally, the effectiveness of an intervention for each need and IU Health Bloomington's ability to impact positive change was evaluated. Schedule H, Part VI, Line 3 - Patient Education of Eligibility for Assist. IU Health Bloomington 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 Bloomington has established a FAP to provide Financial Assistance to Uninsured Patients. IU Health Bloomington is committed to ensuring its patients are compliant with all provisions of the Patient Protection & Affordable Care Act. To that end, IU Health Bloomington 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 Bloomington 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 Bloomington will include a conspicuous written notice on all patient billing statements that notifies the patient about the availability of this Policy, and the telephone number of its Customer Service Department which can assist patients with any questions they may have regarding this Policy. 3. IU Health Customer Service representatives will be available via telephone Monday through Friday, excluding major holidays, from 8:00 a.m. to 7:00 p.m. Eastern Time to address questions related to this Policy. 4. IU Health Bloomington will broadly communicate this Policy as part of its general outreach efforts. 5. IU Health Bloomington 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 Bloomington Hospital is located in Monroe County, a county located in south central Indiana. Monroe County includes ZIP codes within the towns of Bloomington, Ellettsville and Unionville. Based on the most recent Census Bureau (2018) statistics, Monroe County's population is 146,917 and approximately 50.3% were female and 49.7% male. The county's population estimates by race are 86.4% White, 3.6% Black, 7.0% Asian, 0.3% American Indian or Alaska Native and 2.6% persons reporting two or more races. In the county, in addition to the above categorizations, 3.5% reported Hispanic or Latino heritage. Monroe County has relatively high levels of educational attainment, as compared to other Indiana counties. Almost half (45.8%) of the population has a bachelor's degree or graduate/professional degree, while 91.9% of the population has obtained a high school degree. Schedule H, Part VI, Line 5 - Promotion of Community Health IU Health Bloomington 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 Bloomington Community Health offers a wide variety of programs and services to the community. From work with the local school systems, to programs that help those living with HIV/AIDS and Alzheimer's disease, our goal is to help our community live healthier. Schedule H, Part VI, Line 6 - Affiliated Health Care System IU Health Bloomington 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 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 cutting-edge and comprehensive treatment options. In 2012, IU Health and the IU School of Medicine announced that they would invest $150 million in the Strategic Research Initiative, for a five year period ended December 31, 2016 for certain basic, clinical and translational research programs. The total commitment aggregated $75,000,000. In 2017, a new five-year term of $55,000,000 was agreed upon effective July 1, 2017 through June 30, 2022. The initial focus is on projects in the fields of neuroscience, cancer and cardiovascular disease with the goal to fund transformative proposals that will fundamentally change our understanding of these diseases and lead to important new therapies for patients. 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. In 2018, IU Health provided more than $711 million in total community benefit and served more than 1 million individuals. Some ways we address our community health priorities as a system include: IU Health Day of Service The annual IU Health Days of Service is a high-impact event aimed at engaging IU Health team members in activities that address an identified community priority. In 2018, more than 2,848 IU Health team members dedicated more than 9,694 volunteer hours in their communities 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 in the South Central Region: Family Vitality Initiative development and implementation, IU Health South Central Region, $230,000 over two years. By bringing together existing healthcare providers, social workers and researchers, this integrated program will take a holistic approach to addressing substance-related healthcare issues, especially among the most vulnerable populations of women and children. The South Central Region has seen alarming increases in the numbers of infants who test positive for opiates at birth, opioid-related encounters in each emergency department, and mothers struggling with addiction including smoking. 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 Monroe County. -Monroe County Public Health Clinic -Monroe County Community School System -Monroe County Opioid Commission -Early Learning Indiana -United Way 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 Schedule H, Part III, Line 3 - Bad Debt Att to Patients Eligible 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 Bloomington Hospital Foundation Inc PO Box 1149 Bloomington IN 47402 351720795 501(c)(3) 81427 General Support 1 Sch. I, Part I, Line 2 - Org.'s Proced. for Monit. the Use of Grant Funds Although IU Health Bloomington does not monitor the use of grant funds once distributed, through due diligence the organization has reasonably confirmed that the entities to which the contributions are made are highly reputable in the community and use the funds for the purposes intended. X X true X X X X true true false false false false false true false JAMES J LAUGHLIN MD (SCR) DIRECTOR 0 408397 0 40788 0 6858 0 13700 0 0 0 469743 0 0 MATTHEW D BAILEY PRESIDENT (SCR) (Part Year) 0 287416 0 158544 0 1047262 0 322129 0 7138 0 1822489 0 343365 MICHAEL L CRAIG VP & CFO (SCR) 0 234635 0 42348 0 2224 0 12590 0 16722 0 308519 0 0 KENNETH E MARSHALL MD VP & CMO (SCR) (PARTIAL YEAR) 78417 65565 0 0 101889 85190 3341 2794 14710 12299 198357 165848 0 0 BRIAN T SHOCKNEY President (SCR) (Part Year) 203036 164557 40359 32710 31328 25391 29937 24264 14402 11672 319062 258594 0 0 LARRY BAILEY PRESIDENT IUH PAOLI/IUH MORGAN 257796 0 95359 0 136149 0 13700 0 21209 0 524213 0 115340 0 LINDA LEWIS VP & CNO 0 0 0 0 124205 0 0 0 0 0 124205 0 0 0 WENDY HERNANDEZ VP, PROF & SUPPORT SERVICES 169480 0 26267 0 827 0 10555 0 18176 0 225305 0 0 0 CAREY C MAYER MD PSYCHIATRIST 281608 0 0 0 1524 0 13512 0 21930 0 318574 0 0 0 CHAD W SCHULTHEIS MD PSYCHIATRIST 265957 0 0 0 15876 0 13642 0 23201 0 318676 0 0 0 David L Beachy DO (SCR) Director 0 254890 0 25481 0 6858 0 13700 0 23729 0 324658 0 0 Alfonso W Gatmaitan (SCR) Director 0 853829 0 504450 0 1700526 0 1012983 0 24850 0 4096638 0 703392 Hojjat M Shamloo MD (SCR) Director 0 330464 0 151256 0 2322 0 13700 0 30468 0 528210 0 0 John S Strobel MD (SCR) Director 0 601964 0 58845 0 60247 0 13700 0 24585 0 759341 0 0 Daniel A Handel MD VP & CMO (SCR)(PARTIAL YEAR) 262321 39622 47195 7129 18071 2729 9557 1443 15101 2281 352245 53204 0 0 Cynthia Herrington VP & CNO (SCR) (Part Year) 143899 0 34774 0 645 0 8457 0 10440 0 198215 0 0 0 Nida JSyed MD Psychiatrist 261410 0 0 0 32538 0 11000 0 9561 0 314509 0 0 0 Greg SSidell MD Psychiatrist 260388 0 0 0 32075 0 11000 0 30458 0 333921 0 0 0 Douglas M Frye Physicist-Radiation Medicine 234717 0 6183 0 715 0 10621 0 30232 0 282468 0 0 0 Derek Fields Dir-Pharmacy 166067 0 17205 0 5564 0 9497 0 18103 0 216436 0 0 0 Schedule J, Part I, Line 4a - Severance Matthew D. Bailey entered into a severance agreement with IU Health during 2018. Severance of $198,986 that was received during 2018 is included in column B(III), other reportable compensation. Deferred severance of $308,429 is included in column c, retirement and other deferred compensation. Alfonso W. Gatmaitan entered into a severance agreement with IU Health during 2018. Severance of $17,530 that was received during 2018 is included in column B(III), other reportable compensation. Deferred severance of $999,283 is included in column c, retirement and other deferred compensation. Kenneth E. Marshall entered into a severance agreement with IU Health during 2018. Severance of $185,350 that was received during 2018 is included in column B(III), other reportable compensation. Linda Lewis entered into a severance agreement with IU Health during 2018. Severance of $124,205 that was received during 2018 is included in column B(III), other reportable compensation. Schedule J, Part I, Line 4b - Supplemental Nonqualified Retirement Plan Matthew D. Bailey, Larry R. Bailey, Brian T. Shockney and Alfonso W. Gatmaitan participate in a supplemental executive retirement plan, provisions of which are designed to retain these critical employees. The plan provides for an additional retirement benefit for service through normal retirement or other key dates. If the executive leaves prior to retirement or other key dates, the benefit may be forfeited or reduced. Brian T. Shockney has an amount included in column c, deferred compensation, representing the current year unvested contributions made under the supplemental retirement plan. No amounts were actually paid to this executive during the year. Matthew D. Bailey, Larry R. Bailey and Alfonso W. Gatmaitan have amounts included in column B (iii), other reportable compensation, representing the vested amount paid out under IU Health's supplemental executive retirement plan. The amounts received are as follows: -Matthew D. Bailey ($ 789,115) -Larry R. Bailey ($132,573) -Alfonso W. Gatmaitan ($1,654,573) Schedule J, Part I, Line 7 - Non-Fixed Payments Amounts disclosed in Column B(ii) include incentives for certain executives. As part of IU Health Bloomington's executive compensation plan, annual goals are set for each member of the senior leadership group with each members' annual incentive determined upon the degree of successful completion of his or her set goals. Any incentive payouts are made in the form of a lump sum payment and do not affect the executive's base pay. Alternatively, the executive may elect to defer any or all of the incentive compensation through IU Health Bloomington's 457(f) plan, subject to any plan restrictions. Any incentive amounts for the President must receive approval from the Compensation Committee. All other incentive amounts must receive approval from the President and the Compensation Committee. Schedule J, Part I, Line 1a - Listed Benefits Temporary housing allowance was provided to two key employees listed in IU Health Bloomington's Form 990, Part VII, Section A. The cost of the arrangement was treated as taxable compensation and was grossed-up for taxes. Part VI, Section A, Line 2 - Family or Business Relationships Certain officers, directors or key employees of Indiana University Health, Inc. (IU Health) may also serve on the boards or as officers of other related or unrelated organizations. As noted below, no additional compensation was provided to these individuals for their service to related organizations. Related for-profit organization: Indiana University Southern Indiana Physicians, Inc. Type of Relationship: Business Director or Officer: Brian T. Shockney, Joyce B. Poling and Michael L. Craig Part VI, Section A, Lines 6, 7a and 7b - Members or Stockholders Line 6: The sole member of IU Health Bloomington is IU Health, a 501(c)(3) tax-exempt organization. Line 7A: The Board of Directors shall consist of thirteen (13) members. To be eligible for Board membership, a Director candidate shall satisfy the selection criteria and personal characteristics as may be established by IU Health from time to time. It is preferred that at least three (3) of the Directors are physician members, but it is not required. The composition of the Board of Directors shall be consistent with the following criteria: I. Two (2) members shall be representatives of Indiana University Health Bedford, Inc.; ii. Two (2) members shall be representatives of Indiana University Health Paoli, Inc.; iii. Two (2) members shall be representatives of Indiana University Health Morgan, Inc.; iv. Five (5) members shall be representatives of Indiana University Health Bloomington, Inc.; and v. Two (2) members shall be the President of the IU Health South Central Region and an IU Health executive leadership representative. Line 7B: The following matters require the approval of IU Health, as the Member, before becoming effective: (a) Authorize the establishment or acquisition of any subsidiaries, affiliates or joint venture arrangements or acquisitions of all or substantially all of the assets of any other business or entity; (b) Recommend and ratify or amend and operating and capital budgets of the Corporation; (c) Authorize any unbudgeted operating or capital budget items or deviations, including any issuance or guarantee of any unbudgeted debt, greater than the budgeted amount of $100,000 for any individual item or $300,000 per fiscal year in the aggregate; (d) Authorize the incurrence of debt by the Corporation in accordance with policies and procedures issued by IU Health, including to serve as a guarantor, surety or co-obligor; (e) Authorize any merger, consolidation, reorganization, sale or transfer of all or substantially all of the Corporation's assets or a subsidiary organization of the Corporation; (f) Authorize any voluntary declaration of bankruptcy, plan of dissolution, any liquidating distribution of assets or other action related to the dissolution or liquidation of the Corporation or a subsidiary organization of the Corporation; (g) Approve any management agreement for the management of all or a substantial part of the Corporation's operations; (h) Approve, upon recommendation of the Nominating Committee, the members of the Board of Directors of the Corporation; (i) Recommend and ratify any strategic plans and amendments thereto, which will be aligned with IU Health; (j) Approve any action to terminate acute care services or close the hospital operated by the Corporation (the "Hospital"); and (k) Approve any amendments to the Articles of Incorporation and Bylaws of the Corporation or a subsidiary organization of the Corporation. Part VI, Section B, Line 11b - Review of Form 990 The VP & CFO reviewed and approved the Form 990. Following the VP & 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, 14, and 16b - Policies IU Health Bloomington is part of the IU Health system. As the sole member and controlling parent of IU Health Bloomington, IU Health and its Board of Directors have mandated that certain policies be followed to ensure greater standardization throughout the system. Thus, IU Health Bloomington'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 Bloomington 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 Bloomington has the following process for determining the compensation of its officers and key employees: IU Health Bloomington has a formal written policy governing the compensation for its President, VP & CFO, and all other members of its senior leadership group ("SLG"). The policy provides that the compensation and/or benefits for the SLG are to be reviewed on an annual basis, with any changes approved, by the Compensation Committee. The Compensation Committee is comprised of independent members and members of IU Health Bloomington's administrative staff shall not be present while discussions are being held. Any proposed changes in compensation and/or benefits for the SLG that come before the Compensation Committee are required to be reasonable and market competitive based upon market comparability data supplied by an independent compensation consulting firm directly hired by the Compensation Committee. Written minutes of the Compensation Committee's meetings shall be kept, containing a list of the members involved in the decision-making process, documentation of the independence of such members, and what decisions were made. Following approval by the Compensation Committee, any changes are then disclosed to the Board of Directors at its next regularly scheduled meeting. Part VI, Section C, Line 19 - Public Disclosure IU Health Bloomington's Articles of Incorporation are available for public inspection through the Indiana Secretary of State's website. IU Health Bloomington's conflict of interest procedures are described on Form 990, Schedule O. IU Health Bloomington 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 Bloomington's Form 990. Part XI, Line 9 - Other Changes in Net Assets or Fund Balances During 2018, IU Health Bloomington recorded the following other changes in net assets or fund balances: Net Asset Transfer - $ (53,964,481) Change in Pension Obligation - $ 23,630,118 Total: $ (30,334,363) Page 1, Line J Web Site: https://iuhealth.org/find-locations/iu-health-bloomington-hospital Part VI, Section A, Line 4 - Sig. Changes to Gov. Documents During 2018, IU Health Bloomington amended and restated its Bylaws to change the composition, terms, and powers of its board of directors. FORM 990 PART IX LINE 11G DESCRIPTION:SHARED SERVICES/PROF FEES TOTAL FEES:88600376 Bloomington Endoscopy Center LLC 950 N Meridian St Ste 800 Indianapolis IN 46204 352117943 Healthcare IN 4126933 4317546 IUHB 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 Inc 950 N Meridian St Ste 300 Indianapolis IN 46204 263162145 Healthcare IN 501(c)(3) 3 IUH true IU Health Ball Memorial Hospital Inc 950 N Meridian St Ste 300 Indianapolis IN 46204 350867958 Healthcare IN 501(c)(3) 3 IUH true IU Health Ball Memorial Physicians Inc 950 N Meridian St Ste 300 Indianapolis IN 46204 351925641 Healthcare IN 501(c)(3) 10 IUHBMH true IU Health Bedford Inc 950 N Meridian St Ste 300 Indianapolis IN 46204 237042323 Healthcare IN 501(c)(3) 3 IUH true IU Health Blackford Hospital Inc 950 N Meridian St Ste 300 Indianapolis IN 46204 010646166 Healthcare IN 501(c)(3) 3 IUHBMH true IU Health BMH Foundation Inc 950 N Meridian St Ste 800 Indianapolis IN 46204 311111784 Fundraising IN 501(c)(3) 12 I IUHBMH true IU Health Care Associates Inc 950 N Meridian St Ste 300 Indianapolis IN 46204 351747218 Healthcare IN 501(c)(3) 10 IUH true IU Health Frankfort Inc 950 N Meridian St Ste 300 Indianapolis IN 46204 815174295 Healthcare IN 501(c)(3) 3 IUH true IU Health Jay Foundation Inc 950 N Meridian St Ste 800 Indianapolis IN 46204 351809127 FUNDRAISING IN 501(c)(3) 12 I IUH true IU Health Jay Inc 950 N Meridian St Ste 300 Indianapolis IN 46204 822736786 Healthcare IN 501(c)(3) 3 IUH true IU Health Morgan Inc 950 N Meridian St Ste 800 Indianapolis IN 46204 273533027 Healthcare IN 501(c)(3) 10 IUH true IU Health North Hospital Inc 950 N Meridian St Ste 300 Indianapolis IN 46204 351932442 Healthcare IN 501(c)(3) 3 IUH true IU Health Paoli Inc 950 N Meridian St Ste 300 Indianapolis IN 46204 352090919 Healthcare IN 501(c)(3) 3 IUHB true IU Health Plans NFP Inc 950 N Meridian St Ste 800 Indianapolis IN 46204 463803873 Insurance IN 501(c)(4) N/A IUH true IU Health Tipton Hospital Inc 950 N Meridian St Ste 300 Indianapolis IN 46204 262772226 Healthcare IN 501(c)(3) 3 IUH true IU Health West Hospital Inc 950 N Meridian St Ste 300 Indianapolis IN 46204 351814660 Healthcare IN 501(c)(3) 3 IUH true IU Health White Memorial Hospital Inc 950 N Meridian St Ste 300 Indianapolis IN 46204 273532963 Healthcare IN 501(c)(3) 3 IUH true IU Medical Group Foundation Inc 340 W 10th St No FS5100 Indianapolis IN 46202 201093251 Fundraising IN 501(c)(3) 12 II NA false IUHLP Liquidation Inc 950 N Meridian St Ste 800 Indianapolis IN 46204 351125434 Healthcare IN 501(c)(3) 10 IUH true IUHLP-P Liquidation Inc 950 N Meridian St Ste 800 Indianapolis IN 46204 311070868 Healthcare IN 501(c)(3) 10 IUHLP true LaPorte Hospital Foundation Inc PO Box 250 LaPorte IN 46352 310952775 Fundraising IN 501(c)(3) 12 I NA false MDwise Marketplace Inc 1200 Madison Ave Indianapolis IN 46225 465270582 Insurance IN 501(c)(4) N/A IUH true MDwise Network Inc 1200 Madison Ave Indianapolis IN 46225 472619552 Insurance IN 501(c)(4) N/A IUH true Indiana University Health Foundation Inc 1800 N Capitol Ave Indianapolis IN 46202 356043086 Fundraising IN 501(c)(3) 12 I IUH true Methodist Health Group Inc 950 N Meridian St Ste 800 Indianapolis IN 46204 350876390 Healthcare IN 501(c)(3) 12 III-FI NA false Methodist Occup Health Centers Inc 950 N Meridian St Ste 300 Indianapolis IN 46204 351844176 Healthcare IN 501(c)(3) 3 IUH true Rehabilitation Hospital of Indiana Inc 4141 Shore Dr Indianapolis IN 46254 351786005 Healthcare IN 501(c)(3) 3 MHH true RHI Foundation Inc 4141 Shore Dr Indianapolis IN 46254 351932349 Fundraising IN 501(c)(3) 12 I RHI true The Cheer Guild of Riley Hos for Child 705 Riley Hospital Dr Indianapolis IN 46202 356018517 Fundraising IN 501(c)(3) 12 III-FI NA false University Family Physicians Inc 950 N Meridian St Ste 800 Indianapolis IN 46204 237427350 Healthcare IN 501(c)(3) 10 IUHCA true Ball Outpatient Sur Ctr LLC 569 Brookwood Village Ste 901 Birmingham AL 35244 270275794 Healthcare IN NA 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 CHV Fund I LLC 950 N Meridian St Ste 800 Indianapolis IN 46204 262523206 Venture Capital IN NA CHV Fund II Management LLC 950 N Meridian St Ste 800 Indianapolis IN 46204 371717823 Venture Capital IN NA CHV Fund II LLC 950 N Meridian St Ste 800 Indianapolis IN 46204 800902337 Venture Capital IN NA CHV Fund Management LLC 950 N Meridian St Ste 800 Indianapolis IN 46204 262523151 Venture Capital 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 N/A HEALTH VENTURE MANAGEMENT LLC 950 N MERIDIAN ST STE 800 Indianapolis IN 46204 205740218 Management IN NA BMH Medical Pavilion Association Inc 2525 W University Ave Muncie IN 47303 351858408 Condo Mgmt IN NA C true Cardinal Health Ventures Inc 950 N Meridian St Ste 800 Indianapolis IN 46204 351611424 Management IN NA C true CHV Capital Inc 950 N Meridian St Ste 800 Indianapolis IN 46204 260752507 Venture Capital IN NA C true IU Health 457(B) Plan 1100 N Market St Wilmington DE 19890 476948347 Investments IN NA T true IU Health ACO Inc 950 N Meridian St Ste 800 Indianapolis IN 46204 454421020 Healthcare IN NA C true IU Health Board Designated Trust 400 Howard St San Francisco CA 94105 306309021 Investments IN NA T true IU Health NTGI S&P500 Fund CF PO Box 804358 Chicago IL 60680 306298263 Investments IN NA T true IU Health Plans Holding Company Inc 950 N Meridian St Ste 800 Indianapolis IN 46204 463794815 Insurance IN NA C true IU Health Plans Inc 950 N Meridian St Ste 800 Indianapolis IN 46204 262127080 HMO IN NA C true IU Health Risk Purchasing Group Inc 151 Meeting St Ste 301 Charleston SC 29401 260202446 Insurance IN NA C true IU Health Risk Retention Group Inc 151 Meeting St Ste 301 Charleston SC 29401 201107674 Insurance SC NA C true IU Health Southern IN Physicians Inc 950 N Meridian St Ste 300 Indianapolis IN 46204 351913875 Healthcare IN IUHB C 107163516 26505882 0.76920 true IUH Assurance SPC Ltd PO BOX 69 94 SOLARIS AVE CAMANA BAY GRAND CAYMAN CJ 980395429 Insurance CJ NA C true Proteuo Fund LP PO BOX 31106 89 NEXUS WAY CAMANA BAY GRAND CAYMAN CJ 981075227 Investments CJ NA C true SCANS Inc 950 N Meridian St Ste 800 Indianapolis IN 46204 453080392 Healthcare IN NA C true IU Health Plans Insurance Company 950 N Meridian St Ste 800 Indianapolis IN 46204 811097215 Insurance IN NA C true false false true false true false false false false true true true true false true false false true true IU HEALTH SOUTHERN INDIANA PHYSICIANS INC J 533380 FMV IU HEALTH BEDFORD INC K 118907 FMV IU HEALTH BEDFORD INC L 4147969 FMV IU HEALTH PAOLI INC L 1984854 FMV IU HEALTH SOUTHERN INDIANA PHYSICIANS INC L 344046 FMV IU HEALTH CARE ASSOCIATES INC M 66686 FMV IU HEALTH SOUTHERN INDIANA PHYSICIANS INC M 12143337 FMV IU HEALTH PAOLI INC O 198799 FMV IU HEALTH SOUTHERN INDIANA PHYSICIANS INC O 169234 FMV IU HEATLH RISK RETENTION GROUP INC R 966740 FMV IUH ASSURANCE SPC LTD R 823306 FMV