2018-11-15T17:44:33-06:00 2017-12-31 ERNST & YOUNG US LLP 111 MONUMENT CIR STE 4000 INDIANAPOLIS IN 46204 990 2017-01-01 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 2018-11-14 JENNIFER D RHODERICK P00395735 3176817000 162.1.129.9 35198520183195000015 2018-11-15 P 842B4015AA74789D8DE0DB2AD372C72C472CE315 B5629F424D143381A8D4CEB53CEB5536823EBB68 2017 2019-02-21 02:37:17Z BRIAN T SHOCKNEY 950 N MERIDIAN ST STE 300 INDIANAPOLIS IN 46204 471735889 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. 18 13 2720 170 0 0 2339133 2426000 395368539 435751697 4006689 5283975 2787479 3015202 404501840 446476874 946874 873688 0 0 132555820 135893901 0 0 0 205037096 220433837 338539790 357201426 65962050 89275448 549149854 578845857 88904934 67772712 460244920 511073145 X IMPROVE THE HEALTH OF OUR PATIENTS AND COMMUNITY THROUGH INNOVATION AND EXCELLENCE IN CARE, EDUCATION, RESEARCH AND SERVICE. false false 265456179 873688 427235609 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. 4204385 0 6766703 IU HEALTH BLOOMINGTON PROVIDES SERVICES TO RELATED TAX-EXEMPT ORGANIZATIONS. 1066983 0 1717245 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. 3220 0 5183 RENTAL INCOME FROM RELATED TAX-EXEMPT ENTITIES 16749 0 26957 CLINICAL RESEARCH 19969 0 32140 270747516 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 301 0 true 2720 true false false false false false false false false false false X 18 13 true false false 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 DIRECTOR/BOARD CHAIR 2.0 5.0 X X 0 0 0 JOYCE B POLING DIRECTOR/VICE CHAIR 2.0 5.0 X X 0 0 0 SUSAN D WIER DIRECTOR/SECRETARY 2.0 5.0 X X 0 0 0 KENT N RODGERS DIRECTOR/TREASURER 2.0 5.0 X X 0 0 0 JONATHAN W GOTTLIEB MD DIRECTOR 2.0 53.0 X 0 1327372 18864 MICHELLE A JANNEY DIRECTOR 2.0 53.0 X 0 710593 120894 ROBERT T ADAMS MD DIRECTOR 2.0 53.0 X 0 445547 39568 ALLEN W DUNN DIRECTOR 2.0 5.0 X 0 0 0 JAMES GARDNER MD DIRECTOR 2.0 5.0 X 0 0 0 MICHAEL L GENTILE MD DIRECTOR 2.0 5.0 X 0 0 0 JAMES J LAUGHLIN MD DIRECTOR 2.0 53.0 X 0 563247 10800 ELEANOR H ROGERS RN DIRECTOR 2.0 5.0 X 0 0 0 VI SIMPSON DIRECTOR 2.0 5.0 X 0 0 0 JONATHAN W SURDAM MD DIRECTOR 2.0 53.0 X 0 806061 35857 MOHAMMAD R TORABI DIRECTOR 2.0 5.0 X 0 0 0 JENNIFER A VAUGHAN DIRECTOR 2.0 5.0 X 0 0 0 MARCUS DEBRO DIRECTOR 2.0 5.0 X 0 0 0 BRADLEY C WHEELER DIRECTOR 2.0 5.0 X 0 0 0 MATTHEW D BAILEY PRESIDENT (SCR) 25.0 20.0 X 0 559020 113289 MICHAEL L CRAIG VP & CFO (SCR) 25.0 20.0 X 0 240876 26228 MARK MOORE PRESIDENT (PARTIAL YEAR) 55.0 0.0 X 1053098 0 25530 KENNETH E MARSHALL MD VP & CMO (PARTIAL YEAR) 25.0 20.0 X 402878 0 226685 BRIAN T SHOCKNEY COO (SCR) 25.0 20.0 X 347761 587 36616 LARRY BAILEY PRESIDENT IUH PAOLI/IUH MORGAN 10.0 45.0 X 288017 0 56914 LINDA LEWIS VP & CNO 45.0 5.0 X 171889 2000 24681 WENDY HERNANDEZ VP, PROF & SUPPORT SERVICES 45.0 5.0 X 171889 2000 14681 CAREY C MAYER MD PSYCHIATRIST 50.0 0.0 X 301499 0 32736 CHAD W SCHULTHEIS MD PSYCHIATRIST 50.0 0.0 X 290376 0 29576 JEFFREY A MUMPER RADIATION PHYSICIST 50.0 0.0 X 208772 0 16781 3236179 4657303 829700 92 false true false HELLMUTH OBATA KASSABAUM INC 10 S BROADWAY SUITE 200 ST LOUIS MO 63102 DESIGN/ENGINEERING 5919414 COGENT 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false false false true 20112 20112 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 2017 in the amount of $81,649, $36,034 and $7,650, respectively. Each membership organization notified IU Health Bloomington that a portion of the dues it paid were used for lobbying purposes. The AHA used 21.78%, or $17,783 of the 2017 membership dues paid by IU Health Bloomington, for lobbying expenditures. The IHA used 5.40%, or $1,946 of the 2017 membership dues paid by IU Health Bloomington, for lobbying expenditures. The Greater Bloomington Chamber of Commerce use $5.00%, or $383 of the 2017 membership dues paid by IU Health Bloomington, for lobbying expenditures. The total membership dues paid to these organizations by IU Health Bloomington during 2017 that were attributable to lobbying expenditures was $20,112. 4906654 8468719 16073 49762 4513 2335 13334836 4906654 4906654 4906654 4906654 4817324 89330 4906654 4104847 712477 4817324 0.00000 0.41700 0.58300 true false 19741447 19741447 154923712 128727516 26196196 7531019 5416770 2114249 172639179 151341313 21297866 16757402 4417999 12339403 81689161 0 INTERCOMPANY PAYABLES (NET) 39053045 DUE TO THIRD-PARTY PAYERS 2627021 SELF-INSURANCE LIABILITIES 399316 ENVIRONMENTAL OBLIGATIONS 412602 42491984 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. Deferred income taxes, which as of December 31, 2017 and 2016, 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 amount used for income tax purposes. As of December 31, 2017 and 2016, the Indiana University Health System had gross deferred tax assets of $93,794,000 and $116,490,000, respectively, primarily relating to net operating loss carryovers. Management determined that a full valuation allowance at both December 31, 2017 and 2016 was necessary to reduce the deferred tax assets to the amount that would more likely than not be realized. Accounting Standards Codification (ASC) 740, Income Taxes, 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 valuation allowance for the current year is $22,696,000, which reflects a change in the federal corporate tax rate to 21% effective for years beginning after December 31, 2017, pursuant to the Tax Cuts and Jobs Act enacted December 22, 2017. At December 31, 2017, the Indiana University Health System has available net operating loss carryforwards of $377,123,000. These net operating losses will expire between 2018 and 2037. Certain subsidiaries of IU Health are taxable entities. The tax expense and liabilities of these subsidiaries are not material to the consolidated financial statements. true true X true X false true true false true true 5438 4398480 4398480 0.01310 16449 70368568 60850078 9518490 0.02830 21887 74767048 60850078 13916970 0.04140 19 35719 4486626 367214 4119412 0.01230 4 1972 844958 207471 637487 0.00190 3 29653 24858421 17659398 7199023 0.02140 1 18332 18332 0.00010 4 1063 679510 605667 73843 0.00020 31 68407 30887847 18839750 12048097 0.03590 31 90294 105654895 79689828 25965067 0.07730 1 563 25 538 0.00000 3 196 22833 13400 9433 0.00000 3 743 209946 209946 0.00060 1 82 958 958 0.00000 8 1021 234300 13425 220875 0.00060 false 4629762 88477474 100320296 -11842822 X true true SEE PART VI AMBULATORY SURGERY CENTER 0.51 0.49 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 17-005047-1 X X X IU HEALTH BLOOMINGTON HOSPITAL 1 false false true X X X X X X X X X 15 true false false true X SEE PART V, SECTION C X true 15 true SEE PART V, SECTION C false true X 200. 0. X X X X X X true true X X X true X SEE PART V, SECTION C X SEE PART V, SECTION C X SEE PART V, SECTION C X X X X X X X true X false X X X X true X false false Schedule H, Part V, Section B, Line 5 - Input from Community IU Health Bloomington's approach to gathering qualitative data for its CHNA 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. Hosting multiple focus groups with public health officials and community leaders in attendance to discuss the healthcare needs of the service area and what role IU Health Bloomington could play in addressing the identified needs. 2. Surveying the community at large through survey mailed to 2,000 randomly sampled addresses. Local leaders with a stake in the communitys health were invited to attend a focus group session held at IU Health Bloomington. Attendees from organizations such as, Indiana University, Meadows Hospital, Monroe County Health Department, Richland-Bean Blossom School Corporation, Volunteers in Medicine, and the United Way, among others participated in the focus group. To obtain a more complete picture of the factors that play into the Monroe County communitys health, input from local health leaders was gathered through five separate focus group sessions. Four were held in our area middle schools allowing for convenient access to participate. A Focus Group was held for the Spanish speaking population and one was offered at the Shalom Center to reach the homeless population. The goal of soliciting these leaders and community members' feedback was to gather insights into the quantitative data that may not be easily identified from the secondary statistical data alone. Upon arrival to the focus group, participants were asked to list their believed five prioritized health needs for the IU Health Bloomington community. These responses were collected and aggregated into a comprehensive list of identified needs to be further discussed later in the session and ranked for severity of need within the community. IU Health facilitators then provided participants with a presentation featuring IU Healths mission, current outreach priorities and local health data, including demographics, insurance information, poverty rates, county health rankings, causes of death, physical activity, chronic conditions, preventive behaviors and community needs index. Upon completion of the data presentation, IU Health facilitated a discussion on the comprehensive list of identified needs from earlier in the session. The objective of this method was intended to inspire candid discussions prior to a second identification of five prioritized health needs by each participant. The votes on the five prioritized health needs were tallied and final input from the group was encouraged during this process in order to validate the previously identified needs. Following additional discussion, participants were also asked to address what they thought the role of IU Health Bloomington could be in meeting the local health needs. IU Health Bloomington also solicited responses from the general public regarding the health of the IU Health Bloomington community through an online survey. The survey consisted of approximately 26 close- and open-ended questions that assessed the community members feedback regarding healthcare issues and barriers to access. 2,000 random sampled addresses were mailed a survey. 1,000 of these mailings contained a hard copy survey to complete and return via mail. The other 1,000 received a link to the survey online and were asked to complete and submit. In total 624 completed surveys were received for a response rate of 31% (before adjusting for undeliverable mail). In addition to the survey community input was received through four separate focus groups held in convenient locations across the community. 624 respondents participated in the randomly sampled survey of 2,000. All of the respondents were from the PSA (Monroe County). The survey sample was 93.6% Caucasian (White) and 64.7% were female. Analysis by age range shows the largest share of respondents was 60-69 (19.8%), followed by those 50-59 (19.2%), then 70-79 (15.3%). Smaller shares of respondents were 30-39 (12.5%) or 40-49 (11.6%) years of age. The educational attainment of the sample was very high as 15.4% reported completing high school or GED, 23.9% reported completing a Bachelors degree and 32.6% completed a graduate or professional degree or higher. Reported household income of the sample was relatively high, with 54.2% of respondents reporting an income of $50,000 or higher, which is higher than the median household income of $40,052 for all of Monroe County. 19% of the respondents reported a household income lower than $24,900. Survey respondents also were asked to report their insurance status. A majority of respondents had commercial/private insurance (75%), followed by a small percentage reported having Medicaid (6.5%) and Uninsured/self-pay (3%). While the survey sample was a random selection of addresses, older adults were disproportionately among the respondents (60 and over were 35% of the survey replies, compared with less than 20% of the adult population that is 60 or older). This means that some of the survey results might not be generalizable to the entire Monroe County population. Schedule H, Part V, Section B, Line 7a - CHNA Website A copy of IU Health Bloomingtons 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 Bloomingtons 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 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 by using the Hanlon Method of prioritization. This method prioritizes identified needs based upon the prevalence and severity of the need and the effectiveness of interventions available to address the needs. Based upon the Hanlon Method of prioritization, IU health Bloomington selected the following five needs to be addressed: - Substance Abuse - Health Equity or Basic Needs - Obesity and Chronic Disease - Mental Health - Senior Health Substance Abuse IU Health Bloomingtons implementation strategy to address the identified need of Substance Abuse includes the following: - Collaborate with nonprofits providing behavioral health and substance abuse programs and services - Develop and execute communication plan to inform community of programs and services - Research training of care providers in early identification of behavioral health issues and substance abuse and referral process - Collaborate with community agencies to support Needle Access Program approved by State - Discuss potential policy changes of pain medication prescription Health Equity or Basic Needs IU Health Bloomingtons implementation strategy to address the identified need of Health Equity or Basic Needs: - Support onsite preventative screening, access eligibility and provide health care onsite in shelters - Collaborate with service providers on screenings, vaccinations, health insurance outreach and health literacy at community events Obesity and Chronic Disease IU Health Bloomingtons implementation strategy to address the identified need of Obesity and Chronic Disease includes the following: - Provide educational materials and promote healthy needs - Invest in food access initiatives including summer food programs, food pantries and community garden - Increase access to physical assets and community spaces that encourage physical activity and wellness - Support physical activity and healthy foods in schools and after school care Mental Health IU Health Bloomingtons implementation strategy to address the identified need of Mental Health includes the following: - Mental Health Task Force will continue to collaborate with community partners to increase awareness of need and decrease stigma - Support and continue to seek funding for housing programs for those living with mental health issues - Community health staff will serve on the housing network 10 year plan specifically the Healthcare Committee - Add screening tool and resource list to monthly screenings for large populations - Support new mental health providers in community - Work with IU School of Social Work and other departments to offer practical experiences for students Senior Health IU Health Bloomingtons implementation strategy to address the identified need of Senior Health includes the following: - Support community efforts to empower seniors to prevent disease and disability through Senior Expo, Creating Aging Festival - Promote physical activity and healthy diet to population - Develop dementia capable community - Support palliative care services provided. Also, based on the Hanlon Method of prioritization, the following identified community health needs were not amongst the needs chosen to be addressed: - Lack of Exercise - Child Safety/Abuse - Violence - Infectious Diseases After completing a gap analysis, IU Health Bloomington determined that the severity and lack of resources available to address the five needs chosen to be addressed outweighed the severity of and resources available to address the four needs not chosen. 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 Healths Individual Solutions Department Prior to seeking Financial Assistance under the FAP, all patients or their guarantors must consult with a member of IU Healths 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 Bloomingtons Financial Assistance Program. Patients who may be eligible for coverage under an applicable insurance policy, including, but not limited to, health, automobile, and homeowners, must exhaust all insurance benefits prior to receiving an award from IU Health Bloomingtons 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 patients 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 Childrens 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 patients 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 Bloomingtons 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 Bloomingtons 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 Bloomingtons 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 2015 Community Health Needs Assessment (CHNA) Report includes a prioritized description of significant health needs in the community. The CHNA report identified the following four needs as priorities for IU Health Bloomington: - Substance abuse - Health equity or basic needs - Obesity and chronic disease - Mental health - Senior health 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 Bloomington Endoscopy Center, LLC Schedule H, Part IV, Line 2(a) - Name of Entity SIRA Imaging Center, LLC Schedule H, Part IV, Line 3(a) - Name of Entity Southern Indiana Surgery Center, 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 parents or guardians federal income tax return. 2. IU Healths Individual Solutions Department Prior to seeking Financial Assistance under the FAP, all patients or their guarantors must consult with a member of IU Healths 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 Bloomingtons Financial Assistance Program. Patients who may be eligible for coverage under an applicable insurance policy, including, but not limited to, health, automobile, and homeowners, must exhaust all insurance benefits prior to receiving an award from IU Health Bloomingtons 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 patients 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 Childrens 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 patients 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 Bloomingtons 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 Bloomingtons 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 Healths 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 Systems 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 31.43%. 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 $21,092,311. 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 Healths 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 - Starfish Initiative - Early Learning Indiana - United Way Additionally, through the IU Health Statewide Systems 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 Healths bad debt expense footnote is as follows: The Indiana University Health System does not require collateral or other security for the delivery of health care services from its patients, substantially all of whom are residents of the state of Indiana. However, assignment of benefit payments payable under patients health insurance programs and plans (e.g., Medicare, Medicaid, health maintenance organizations, and commercial insurance policies) is routinely obtained, consistent with industry practice. The provision for uncollectible accounts, for all payers, is recognized when services are provided based upon managements assessment of historical and expected net collections, taking into consideration business and economic conditions, changes and trends in health care coverage, and other collection indicators. Periodically, management assesses the adequacy of the allowance for uncollectible accounts based upon accounts receivable payer composition and aging, the significance of individual payers to outstanding accounts receivable balances, and historical write-off experience by payer category, as adjusted for collection indicators. The results of this review are then used to make any modifications to the provision for uncollectible accounts and the allowance for uncollectible accounts. In addition, the Indiana University Health System follows established guidelines for placing certain past-due patient balances with collection agencies. Patient accounts that are uncollected, including those placed with collection agencies, are initially charged against the allowance for uncollectible accounts in accordance with collection policies of the Indiana University Health System and, in certain cases, are reclassified to charity care if deemed to otherwise meet financial assistance policies of the Indiana University Health System. 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 Bloomingtons 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 Bloomingtons 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 Bloomingtons 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 applications 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 patients physician, family members, legal counsel, community or religious groups, social services or hospital personnel may request a FAP Application to be mailed to a patients 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 patients and/or guarantors 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 patients 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 patients 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 patients or their guarantors 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 patients or their guarantors 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 patients or their guarantors property, foreclosing on a patients or their guarantors real property attaching or seizing a patients or their guarantors bank account or other personal property, commencing a civil action against a patient or their guarantor, causing a patient or guarantors arrest, causing a patient and/or guarantor to be subject to a writ of body attachment, and garnishing a patient or guarantors 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 the Bloomington County Health Department, the Indiana State Department of Health, the Centers for Disease Control and Prevention and the United Way of Central Indiana. 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 using the Hanlon method of prioritization 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 Bloomingtons 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 (2017) statistics, Monroe Countys population is 146,986 and approximately 50.2% were female and 49.8% male. The countys population estimates by race are 86.3% White, 2.9% Black, 5.4% Asian, 0.1% American Indian or Alaska Native and 2.0% persons reporting two or more races. In the county, in addition to the above categorizations, 3.3% reported Hispanic or Latino heritage. Monroe County has relatively high levels of educational attainment, as compared to other Indiana counties. Almost half (45.0%) of the population has a bachelors degree or graduate/professional degree, while 92.4% 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 Alzheimers 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 Indianas most comprehensive healthcare system. A unique partnership with the IU School of Medicine, one of the nations 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 - Six hospitals designated as Magnet by the American Nurses Credentialing Center recognizing excellence in nursing care - Seven clinical programs ranked among the top 50 national programs in U.S. News & World Reports 2017-18 edition of Americas Best Hospitals - Ten out of ten specialty programs at Riley Hospital for Children at IU Health ranked among the top 50 childrens hospitals in the nation Education and Research As an academic health center, IU Health works in partnership with the IU School of Medicine to train physicians, blending breakthrough research and treatments with the highest quality of patient care. Each year, more than 1,000 residents and fellows receive training in IU Health hospitals. Research conducted by IU School of Medicine faculty gives IU Health physicians and patients access to the most leading-edge and comprehensive treatment options. In 2012, IU Health and the IU School of Medicine announced that they would invest $150 million over five years in the Strategic Research Initiative, a new research collaboration that has enhanced the institutions joint capabilities in fundamental scientific investigation, translational research and clinical trials. 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 Indianas 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 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 Indianas overall health. A comprehensive community outreach strategy and community benefit plan is in place that encompasses the academic medical center downtown Indianapolis, suburban Indianapolis and statewide entities around priority areas that focus on health improvement efforts statewide. IU Health is keenly aware of the positive impact it can have on the communities of need in the state of Indiana by focusing on the most pressing needs in a systematic and strategic way. Some ways we address our community health priorities as a system include: IU Health Day of Service The annual IU Health Days of Service is a high-impact event aimed at engaging IU Health team members in activities that address an identified community priority. Each year, more than 2,000 IU Health team members volunteer 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 2017, 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. Examples of the types of programming and investment we make in community outreach areas include: Access to Healthcare IU Health is committed to providing quality and complete healthcare for Hoosiers. Access to healthcare was a leading community health need identified in all communities served by IU Health across the state. IU Health is focusing on the needs of the underserved to create initiatives and support efforts that: - Educate community members to understand and navigate the healthcare system - Increase the availability of low-cost services and provide financial assistance IU Health provides free or reduced-cost care and supports a number of clinics to provide free or reduced-cost care to individuals without access to insurance or the ability to pay the full cost of their healthcare. These clinics include: - IU Student Outreach Clinic - Hope Healthcare Services - Gennesaret Free Clinics - Trinity Free Clinic Healthy Weight & Nutrition Like most of the nation, Hoosiers see the alarming rise of obesity in their communities as a leading concern. Nationally, Indiana has the 15th highest adult obesity rate in the nation (The State of Obesity: Better Policies for a Healthier America, 2016). Obesity prevention was a critical community health need identified in IU Health communities across the state. IU Health is committed to launching innovative efforts aimed at preventing and reversing obesity in our communities to help community members get active, get healthy and get strong. IU Health is working to create initiatives and support efforts to: - Improve access to healthy foods - Create healthier school environments - Increase access to safe places for community members to be physically active IU Health initiatives aimed at preventing and reversing obesity in our communities include: - Strong Schools - Change the Play - Youth Diabetes Prevention Clinic Healthy Food Access Grant The Healthy Food Access Grant is an extension of the work started in 2011 with the Garden on the Go program to address obesity in the Indianapolis community. According to the USDA, between 25 and 30 million (9%) Americans are currently living in communities that do not provide adequate access to healthy food within a mile of their home. In Indianapolis, it is estimated that over 300,000 (36%) residents live in food deserts and have limited access to healthy and affordable food options. Indianapolis is reported as having the highest incidence of food deserts in the country (USDA, 2014). The lack of consumption and lack of access to healthy affordable food, particularly fresh produce, contributes to a poor diet and often can lead to higher rates of obesity and other diet-related diseases, such as diabetes and heart disease. Approximately 31% of Marion County residents are considered obese, up nearly 7% from 2010. When controlling for obesity, weight-related health problems, and health of environment, the Indianapolis area ranks among the worst metropolitan areas in the United States in terms of health. In sum, obesity is on the rise while increasingly more Indianapolis residents have less access to healthy and affordable food, which can contribute to lower consumption rates of fresh fruits and vegetables and higher rates of diet-related diseases. To address this important community and population health issue, IU Health Community Outreach and Engagement launched a new Healthy Food Access Grant Initiative specifically aimed at addressing the food des true BLOOMINGTON HOSPITAL FOUNDATION INC PO BOX 1149 BLOOMINGTON IN 47402 351720795 501(C)(3) 873688 N/A N/A GENERAL SUPPORT 1 0 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 X X true true false false false false false true false JONATHAN W GOTTLIEB MD DIRECTOR 0 701723 0 120332 0 505317 0 10800 0 8064 0 1346236 0 316949 MICHELLE A JANNEY DIRECTOR 0 486404 0 103318 0 120871 0 115039 0 5855 0 831487 0 81278 ROBERT T ADAMS MD DIRECTOR 0 413810 0 30927 0 810 0 10377 0 29191 0 485115 0 0 JAMES J LAUGHLIN MD DIRECTOR 0 511893 0 44496 0 6858 0 10800 0 0 0 574047 0 0 JONATHAN W SURDAM MD DIRECTOR 0 740875 0 64376 0 810 0 10800 0 25057 0 841918 0 0 MATTHEW D BAILEY PRESIDENT (SCR) 0 467926 0 51435 0 39659 0 95400 0 17889 0 672309 0 0 MICHAEL L CRAIG VP & CFO (SCR) 0 229282 0 9423 0 2171 0 9444 0 16784 0 267104 0 0 KENNETH E MARSHALL MD VP & CMO (PARTIAL YEAR) 263867 0 12777 0 126234 0 196150 0 30535 0 629563 0 0 0 BRIAN T SHOCKNEY COO (SCR) 301107 508 30836 52 15818 27 10782 18 25773 43 384316 648 0 0 LARRY BAILEY PRESIDENT IUH PAOLI/IUH MORGAN 252921 0 31771 0 3325 0 35432 0 21482 0 344931 0 0 0 LINDA LEWIS VP & CNO 162241 1888 7161 83 2487 29 6329 74 18068 210 196286 2284 0 0 WENDY HERNANDEZ VP, PROF & SUPPORT SERVICES 162241 1888 7161 83 2487 29 6329 74 8068 210 186286 2284 0 CAREY C MAYER MD PSYCHIATRIST 273975 0 26000 0 1524 0 10417 0 22319 0 334235 0 0 0 CHAD W SCHULTHEIS MD PSYCHIATRIST 273850 0 16250 0 276 0 6650 0 22926 0 319952 0 0 0 JEFFREY A MUMPER RADIATION PHYSICIST 208256 0 0 0 516 0 9353 0 7428 0 225553 0 0 0 MICHAEL J MELBY DIRECTOR, PHARMACY 175612 0 19667 0 7711 0 9071 0 22075 0 234136 0 0 0 MARK MOORE PRESIDENT (PARTIAL YEAR) 259610 0 51424 0 742064 0 9724 0 15806 0 1078628 0 0 0 Schedule J, Part I, Line 4a - Severance Kenneth E. Marshall, M.D. entered into a severance agreement with IU Health during 2017. Severance of $82,128 that was received in 2017 is included in column b(iii), other reportable compensation. Deferred severance of $185,350 is included in column c, retirement and other deferred compensation. Linda C. Lewis entered into a severance agreement with IU Health during 2017. Severance of $21,522 that was received in 2017 is included in column b(iii), other reportable compensation. Deferred severance of $124,205 is included in column c, retirement and other deferred compensation. Schedule J, Part I, Line 4b - Supplemental Nonqualified Retirement Plan Mark E. Moore, Jonathan E. Gottlieb, Michelle A. Janney and Matthew D. Bailey 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. Each of the executives listed above, with the exeption of Jonathan E. Gottlieb and Mark E. Moore, has an amount have included in column c, deferred compensation, representing the current year unvested contributions made under the supplemental retirement plan. No amounts were actually paid to these executives during the year. The following executives have an amount included in column b(iii), other reportable compensation, representing the current year vested amounts received under the supplemental executive retirement plan: - Mark E. Moore ($639,532) - Michelle A. Janney, R.N. ($89,959) - Jonathan E. Gottlieb, M.D. ($471,531) 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 Bloomingtons 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 executives base pay. Alternatively, the executive may elect to defer any or all of the incentive compensation through IU Health Bloomingtons 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. Part VI, Section A, Line 2 - Family or Business Relationships Lynn H. Coyne, Michael L. Craig, Kenneth E. Marshall, M.D., and Larry R. Bailey served on the board of directors of Indiana University Health Southern Indiana Physicians, Inc. 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 of the IU Health Bloomington shall consist of nineteen (19) directors. IU Health shall appoint and may remove ten (10) members of the Board. At all times (a) at least two (2) IU Health appointed directors shall be members of the hospitals active Medical Staff, (b) at least one (1) IU Health appointed director shall be a member of the IU Health Board of Directors and (c) at least one (1) IU Health appointed director shall be a senior IU Health executive. Line 7B: IU Health Bloomington shall not, without the prior approval of IU Health, do the following: - Authorize the establishment or acquisition of any subsidiaries, affiliates or joint venture arrangements or acquisition of all or substantially all of the assets of any other business entity; - Approve or amend any operating or capital budget; - Authorize any unbudgeted operating or capital budget item or deviations, including any issuance or guarantee of any unbudgeted debt, greater than the budgeted amount by $1 million for any individual item or $3 million per fiscal year in the aggregate; - Authorize any agreement to act as primary obligor, or to serve as a guarantor, surety or co-obligor with respect to the indebtedness of any other person or entity, to borrow amounts from third-party lenders or to loan money to any person or entity; - Approve any strategic plans and amendments thereto, which will be integrated with IU Healths strategic plan; - Subject to a supermajority vote of the Board and any approvals required, amend or repeal its Articles of Incorporation or By-Laws in any manner, including without limitation any change relating to the nonprofit purposes of the hospital; - Subject to a supermajority vote of the Board, authorize any merger, consolidation, reorganization, sale or transfer of all or substantially all of its assets; - Subject to a supermajority vote of the Board, authorize any voluntary declaration of bankruptcy, plan of dissolution, liquidating distribution of assets or other action related to its dissolution or liquidation; - Subject to a supermajority vote of the Board, authorize any pledge of, or grant any security interest or mortgage in, or otherwise encumber, any tangible assets in excess of $1 million for any individual pledge, grant or encumbrance or $3 million per fiscal year in the aggregate, other than in the ordinary course of business or pursuant to an approved budget; or - Subject to a supermajority vote of the Board, approve any management agreement for the management of all or a substantial part of the hospitals or any of its affiliates operations. 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 Healths Conflict of Interest Policy. IU Healths 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 Representatives 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 supervisors 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 Bloomingtons 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 Committees 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 Bloomingtons Articles of Incorporation are available to the public through the Indiana Secretary of State's web-site. IU Health Bloomingtons conflict of interest policy is 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. Part XI, Line 9 - Other Changes in Net Assets or Fund Balances During 2017, IU Health Bloomington recorded the following other changes in net assets or fund balances: Net Asset Transfer - $-62,773,257 Change in Pension Obligation - $ 463,564 Change in Temporary Restricted Assets - $ 3,502,121 Change in Restricted Assets - $ 4,926,061 Equity Transfer Bloomington Endoscopy Center, LLC $ 1,055,109 HealthLINC Net Asset Transfer - $ -788,751 Premier Acquisition Net Asset Transfer - $ 527,068 Total: $-53,088,085 Page 1, Line J Web Site: https://iuhealth.org/find-locations/iu-health-bloomington-hospital FORM 990 PART IX LINE 11G DESCRIPTION:SHARED SERVICES/PROF. 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