INDIANA UNIVERSITY HEALTH BLACKFORD HOSPITAL INC: Form 990, tax year 2016
View the entire original 990 at ProPublica ↗
- Organization
- INDIANA UNIVERSITY HEALTH BLACKFORD HOSPITAL INC (EIN 01-0646166)
- Tax period
- 2016-01-01 to 2016-12-31
- Filed
- 2017-11-15
- IRS object ID
- 201703199349302785
- Schema version
- 2016v3.1
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule H
- Schedule I
- Schedule J
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2017-11-15T09:10:10-06:00 | ReturnTs |
| Tax Period End | 2016-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ERNST & YOUNG US LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 111 MONUMENT CIRCLE SUITE 4000 | AddressLine1Txt |
| City | INDIANAPOLIS | CityNm |
| State Abbreviation | IN | StateAbbreviationCd |
| ZIP | 46204 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2016-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 010646166 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | INDIANA UNIVERSITY HEALTH BLACKFORD | BusinessNameLine1Txt |
| Business Name Line2 | HOSPITAL INC | BusinessNameLine2Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| In Care Of | % SEAN M BARR | InCareOfNm |
| Business Name Control | INDI | BusinessNameControlTxt |
| Phone | 3179624112 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 950 N MERIDIAN STREET SUITE 300 | AddressLine1Txt |
| City | INDIANAPOLIS | CityNm |
| State Abbreviation | IN | StateAbbreviationCd |
| ZIP | 46204 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | JONATHAN W VANATOR | PersonNm |
| Person Title | CFO | PersonTitleTxt |
| Phone | 3179624112 | PhoneNum |
| Signature | 2017-11-15 | SignatureDt |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | JENNIFER D RHODERICK | PreparerPersonNm |
| PTIN | P00395735 | PTIN |
| Phone | 3176817000 | PhoneNum |
Filing Security Information FilingSecurityInformation
IP Address IPAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| I Pv4 Address | 162.1.129.128 | IPv4AddressTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Federal Original Submission Id | 35668520173195000020 | FederalOriginalSubmissionId |
| Federal Original Submission Id | 2017-11-15 | FederalOriginalSubmissionIdDt |
| Filing License Type | P | FilingLicenseTypeCd |
| At Submission Creation Device Id | 842B4015AA74789D8DE0DB2AD372C72C472CE315 | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | 49A42BAE7DB19B68098C55D96BB751E89F2C86F0 | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2016 | TaxYr |
| Build TS | 2021-01-29 14:40:06Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Change | Yes (X) | AddressChangeInd |
| Principal Officer | STEVEN J WEST | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 950 N MERIDIAN ST STE 300 | AddressLine1Txt |
| City | INDIANAPOLIS | CityNm |
| State Abbreviation | IN | StateAbbreviationCd |
| ZIP | 46204 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $17,170,223 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | HTTP://IUHEALTH.ORG/BLACKFORD/ | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 2002 | FormationYr |
| Legal Domicile State | IN | LegalDomicileStateCd |
| Activity Or Mission | Promote wellness and improve the health status of the people of East Central Indiana and surrounding areas through patient care, health education and medical research. | ActivityOrMissionDesc |
| Voting Members Governing Body | 3 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 1 | VotingMembersIndependentCnt |
| Total Employee | 141 | TotalEmployeeCnt |
| Total Volunteers | 50 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| PY Contributions Grants | $21,889 | PYContributionsGrantsAmt |
| CY Contributions Grants | $11,032 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $18,302,889 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $17,078,348 | CYProgramServiceRevenueAmt |
| PY Investment Income | $7,474 | PYInvestmentIncomeAmt |
| CY Investment Income | $13,163 | CYInvestmentIncomeAmt |
| PY Other Revenue | $100,281 | PYOtherRevenueAmt |
| CY Other Revenue | $67,041 | CYOtherRevenueAmt |
| PY Total Revenue | $18,432,533 | PYTotalRevenueAmt |
| CY Total Revenue | $17,169,584 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $42,000 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $44,050 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $6,345,037 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $7,028,412 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $9,299,036 | PYOtherExpensesAmt |
| CY Other Expenses | $9,353,234 | CYOtherExpensesAmt |
| PY Total Expenses | $15,686,073 | PYTotalExpensesAmt |
| CY Total Expenses | $16,425,696 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $2,746,460 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $743,888 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $18,689,669 | TotalAssetsBOYAmt |
| Total Assets EOY | $18,802,756 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $3,180,399 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $2,549,598 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $15,509,270 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $16,253,158 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | PROMOTE WELLNESS AND IMPROVE THE HEALTH STATUS OF THE PEOPLE OF EAST CENTRAL INDIANA AND SURROUNDING AREAS THROUGH PATIENT CARE, HEALTH EDUCATION AND MEDICAL RESEARCH. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $13,230,230 | ExpenseAmt |
| Grant | $44,050 | GrantAmt |
| Revenue | $17,078,348 | RevenueAmt |
| Desc | Indiana University Health Blackford Hospital, Inc. ("IU Health Blackford Hospital"), located in Hartford City, Indiana, is a 15-bed acute-care and critical access hospital that offers a broad range of services to care for its patients without regard to their ability to pay. IU Health Blackford Hospital features all private rooms, a specialty clinic, cardiac and pulmonary rehabilitation, outpatient surgical services and diagnostic imaging. In addition to providing 24-hour emergency services, the hospital hosts a paramedic-level ambulance service. IU Health Blackford Hospital also serves the community with an annual health fair which includes free and low-cost screenings. The hospital promotes wellness initiatives such as diabetes education, tobacco cessation, childrens safety, after-school health lifestyle initiatives, seniors programming and outreach to local employers with screenings and health information. | Desc |
| Total Program Service Expenses | $13,230,230 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (true) | ScheduleBRequiredInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (true) | LobbyingActivitiesInd |
| Subject To Proxy Tax | false | SubjectToProxyTaxInd |
| Donor Advised Fund | false | DonorAdvisedFundInd |
| Conservation Easements | false | ConservationEasementsInd |
| Collections Of Art | false | CollectionsOfArtInd |
| Credit Counseling | false | CreditCounselingInd |
| Temp Or Permanent Endowments | false | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (true) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | false | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | false | ReportProgramRelatedInvstInd |
| Report Other Assets | false | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (true) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (true) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | false | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (true) | ConsolidatedAuditFinclStmtInd |
| School Operating | false | SchoolOperatingInd |
| Foreign Office | false | ForeignOfficeInd |
| Foreign Activities | false | ForeignActivitiesInd |
| More Than5000 K To Org | false | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividualsInd |
| Professional Fundraising | false | ProfessionalFundraisingInd |
| Fundraising Activities | false | FundraisingActivitiesInd |
| Gaming Activities | false | GamingActivitiesInd |
| Operate Hospital | Yes (true) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (true) | AuditedFinancialStmtAttInd |
| Grants To Organizations | Yes (true) | GrantsToOrganizationsInd |
| Grants To Individuals | false | GrantsToIndividualsInd |
| Schedule J Required | Yes (true) | ScheduleJRequiredInd |
| Tax Exempt Bonds | false | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | false | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | false | PYExcessBenefitTransInd |
| Loan Outstanding | false | LoanOutstandingInd |
| Grant To Related Person | false | GrantToRelatedPersonInd |
| Business Rln With Org Mem | false | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | false | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | false | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | false | DeductibleNonCashContriInd |
| Deductible Art Contribution | false | DeductibleArtContributionInd |
| Terminate Operations | false | TerminateOperationsInd |
| Partial Liquidation | false | PartialLiquidationInd |
| Disregarded Entity | false | DisregardedEntityInd |
| Related Entity | Yes (true) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (true) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | Yes (true) | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | false | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| IRP Document | 17 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (true) | BackupWthldComplianceInd |
| Employee | 141 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (true) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | false | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | false | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | false | TaxablePartyNotificationInd |
| Nondeductible Contributions | false | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | false | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | false | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | false | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 3 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 1 | IndependentVotingMemberCnt |
| Family Or Business Rln | Yes (true) | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | false | DelegationOfMgmtDutiesInd |
| Change To Org Documents | false | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (true) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (true) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (true) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (true) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (true) | MinutesOfCommitteesInd |
| Officer Mailing Address | false | OfficerMailingAddressInd |
| Local Chapters | false | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (true) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (true) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (true) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (true) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (true) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (true) | DocumentRetentionPolicyInd |
| Compensation Process CEO | false | CompensationProcessCEOInd |
| Compensation Process Other | false | CompensationProcessOtherInd |
| Investment In Joint Venture | false | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | IN | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | SEAN M BARR | PersonNm |
| Phone | 3179624112 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 950 N MERIDIAN ST STE 800 | AddressLine1Txt |
| City | INDIANAPOLIS | CityNm |
| State Abbreviation | IN | StateAbbreviationCd |
| ZIP | 46204 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | Yes (X) | InfoInScheduleOPartVIIInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (12 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Key EmployeeKeyEmployeeInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|---|
| JOHN K JACKSON | |||||||||
| CHAIR | 5.0 | 0.0 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| STEVEN J WEST | |||||||||
| DIRECTOR/PRESIDENT | 5.0 | 55.0 | Yes (X) | Yes (X) | $0 | $175,660 | $19,741 | ||
| MICHAEL E HALEY | |||||||||
| DIRECTOR | 5.0 | 55.0 | Yes (X) | $0 | $728,340 | $132,781 | |||
| JUDITH L COLEMAN | |||||||||
| CFO (PARTIAL YEAR) | 0.0 | 55.0 | Yes (X) | $0 | $238,175 | $39,104 | |||
| LORI A LUTHER | |||||||||
| CFO | 0.0 | 55.0 | Yes (X) | $0 | $342,103 | $24,561 | |||
| JEFFREY C BIRD MD | |||||||||
| CMO | 0.0 | 55.0 | $0 | $385,671 | $35,143 | Yes (X) | |||
| CARLA C COX RN | |||||||||
| VP & CNO | 0.0 | 55.0 | $0 | $202,906 | $22,486 | Yes (X) | |||
| ELIZABETH A DROEGE MD | |||||||||
| PHYSICIAN | 55.0 | 0.0 | $299,153 | $0 | $34,145 | Yes (X) | |||
| CHARLES L CARROLL DO | |||||||||
| PHYSICIAN | 55.0 | 0.0 | $159,565 | $0 | $6,383 | Yes (X) | |||
| KEVIN W SCHREIBER MD | |||||||||
| PHYSICIAN | 55.0 | 0.0 | $123,267 | $0 | $5,296 | Yes (X) | |||
| THOMAS M LEE MD | |||||||||
| PHYSICIAN | 55.0 | 0.0 | $121,814 | $272,663 | $40,237 | Yes (X) | |||
| JOHN C CROSBIE | |||||||||
| DIRECTOR, SUPPORT SERVICES | 55.0 | 0.0 | $108,176 | $0 | $24,679 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $811,975 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $2,345,518 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $384,556 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 6 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | false | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (true) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp
Contractor Name ContractorName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | ELMER TOLIVER PSC | PersonNm |
Contractor Address ContractorAddress
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1412 SMUGGLERS NOTCH | AddressLine1Txt |
| City | FORT WAYNE | CityNm |
| State Abbreviation | IN | StateAbbreviationCd |
| ZIP | 46814 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Services | MEDICAL | ServicesDesc |
| Compensation | $371,840 | CompensationAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 1 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $11,032 | GovernmentGrantsAmt |
| Total Contributions | $11,032 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| NET PATIENT SERVICE REVENUE | 621110 | $17,037,478 | $17,037,478 |
| RENT FROM RELATED 501(C)(3) ORGS. | 532000 | $40,870 | $40,870 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $17,078,348 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $13,802 | TotalRevenueColumnAmt |
| Exclusion | $13,802 | ExclusionAmt |
Incm From Invest Bond Proceeds IncmFromInvestBondProceedsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Royalties Revenue RoyaltiesRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $4,600 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $4,600 | RealAmt |
| Personal | $0 | PersonalAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $4,600 | TotalRevenueColumnAmt |
| Exclusion | $4,600 | ExclusionAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $639 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | -$639 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$639 | TotalRevenueColumnAmt |
| Exclusion | -$639 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fundraising Gross Income | $0 | FundraisingGrossIncomeAmt |
| Fundraising Direct Expenses | $0 | FundraisingDirectExpensesAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gaming Gross Income | $0 | GamingGrossIncomeAmt |
| Gaming Direct Expenses | $0 | GamingDirectExpensesAmt |
Net Income From Gaming NetIncomeFromGamingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Sales Of Inventory | $0 | GrossSalesOfInventoryAmt |
| Cost Of Goods Sold | $0 | CostOfGoodsSoldAmt |
Net Income Or Loss NetIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Other Revenue Misc OtherRevenueMiscGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | ExclusionExclusionAmt |
|---|---|---|---|
| CAFETERIA/FOOD SERVICE | 721110 | $54,494 | $54,494 |
| VENDING | 900099 | $1,215 | $1,215 |
| ALL OTHER REVENUE | 900099 | $6,732 | $6,732 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $62,441 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $17,169,584 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $17,078,348 | RelatedOrExemptFuncIncomeAmt |
| Exclusion | $80,204 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $44,050 | TotalAmt |
| Program Services | $44,050 | ProgramServicesAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Foreign Grants ForeignGrantsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Benefits To Members BenefitsToMembersGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Comp Disqual Persons CompDisqualPersonsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,716,470 | TotalAmt |
| Program Services | $5,341,072 | ProgramServicesAmt |
| Management And General | $375,398 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $204,213 | TotalAmt |
| Program Services | $190,802 | ProgramServicesAmt |
| Management And General | $13,411 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $712,614 | TotalAmt |
| Program Services | $665,817 | ProgramServicesAmt |
| Management And General | $46,797 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $395,115 | TotalAmt |
| Program Services | $369,168 | ProgramServicesAmt |
| Management And General | $25,947 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Lobbying FeesForServicesLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,888 | TotalAmt |
| Management And General | $1,888 | ManagementAndGeneralAmt |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,930,018 | TotalAmt |
| Program Services | $3,453,627 | ProgramServicesAmt |
| Management And General | $2,476,391 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,519 | TotalAmt |
| Program Services | $1,692 | ProgramServicesAmt |
| Management And General | $4,827 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $53,610 | TotalAmt |
| Program Services | $27,739 | ProgramServicesAmt |
| Management And General | $25,871 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $12,070 | TotalAmt |
| Program Services | $10,937 | ProgramServicesAmt |
| Management And General | $1,133 | ManagementAndGeneralAmt |
Royalties RoyaltiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $471,152 | TotalAmt |
| Program Services | $471,138 | ProgramServicesAmt |
| Management And General | $14 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,860 | TotalAmt |
| Program Services | $4,915 | ProgramServicesAmt |
| Management And General | $1,945 | ManagementAndGeneralAmt |
Pymt Travel Entrtnmnt Pub Ofcl PymtTravelEntrtnmntPubOfclGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $165 | TotalAmt |
| Program Services | $165 | ProgramServicesAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Payments To Affiliates PaymentsToAffiliatesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $824,125 | TotalAmt |
| Program Services | $789,571 | ProgramServicesAmt |
| Management And General | $34,554 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $167,474 | TotalAmt |
| Program Services | $60,040 | ProgramServicesAmt |
| Management And General | $107,434 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| BAD DEBT | $907,537 | $907,537 | |
| DRUGS AND MEDICAL SUPPLIES | $805,665 | $805,665 | |
| INSTITUTIONAL DUES/LICENSES | $11,135 | $11,135 | |
| ALL OTHER EXPENSES | $155,016 | $75,160 | $79,856 |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $16,425,696 | TotalAmt |
| Program Services | $13,230,230 | ProgramServicesAmt |
| Management And General | $3,195,466 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $600 | BOYAmt |
| EOY | $600 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,434,084 | BOYAmt |
| EOY | $8,416,333 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,031,924 | BOYAmt |
| EOY | $1,528,896 | EOYAmt |
Receivables From Officers Etc ReceivablesFromOfficersEtcGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $202,216 | BOYAmt |
| EOY | $253,038 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $53,183 | BOYAmt |
| EOY | $89,464 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $20,978,094 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $12,463,669 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,967,662 | BOYAmt |
| EOY | $8,514,425 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $18,689,669 | BOYAmt |
| EOY | $18,802,756 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $784,818 | BOYAmt |
| EOY | $858,648 | EOYAmt |
Grants Payable GrantsPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,037 | BOYAmt |
| EOY | $12,866 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Escrow Account Liability EscrowAccountLiabilityGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Loans From Officers Directors LoansFromOfficersDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,384,544 | BOYAmt |
| EOY | $1,678,084 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,180,399 | BOYAmt |
| EOY | $2,549,598 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $15,509,270 | BOYAmt |
| EOY | $16,253,158 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $15,509,270 | BOYAmt |
| EOY | $16,253,158 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $18,689,669 | BOYAmt |
| EOY | $18,802,756 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $743,888 | ReconcilationRevenueExpnssAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | false | AccountantCompileOrReviewInd |
| FS Audited | Yes (true) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (true) | AuditCommitteeInd |
| Federal Grant Audit Required | false | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Grassroots Lobbying | TotalGrassrootsLobbyingGrp | |
| Total Direct Lobbying | TotalDirectLobbyingGrp | |
| Total Lobbying Expend | TotalLobbyingExpendGrp | |
| Other Exempt Purpose Expend | OtherExemptPurposeExpendGrp | |
| Total Exempt Purpose Expend | TotalExemptPurposeExpendGrp | |
| Lobbying Nontaxable Amount | LobbyingNontaxableAmountGrp | |
| Grassroots Nontaxable | GrassrootsNontaxableGrp | |
| Tot Lbbyng Grassroot Mns Non Tx | TotLbbyngGrassrootMnsNonTxGrp | |
| Tot Lbby Expend Mns Lbbyng Non Tx | TotLbbyExpendMnsLbbyngNonTxGrp | |
| Volunteers | false | VolunteersInd |
| Paid Staff Or Management | false | PaidStaffOrManagementInd |
| Media Advertisements | false | MediaAdvertisementsInd |
| Mailings Members | false | MailingsMembersInd |
| Publications Or Broadcast | false | PublicationsOrBroadcastInd |
| Grants Other Organizations | false | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | false | DirectContactLegislatorsInd |
| Rallies Demonstrations | false | RalliesDemonstrationsInd |
| Other Activities | Yes (true) | OtherActivitiesInd |
| Other Activities | $1,888 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $1,888 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | false | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Schedule C, Part II-B, Line 1i - Other Activities | FormAndLineReferenceDesc |
| Explanation | IU Health Blackford Hospital paid institutional membership dues to the American Hospital Association ("AHA") and Indiana Hospital Association ("IHA") during 2016 in the amount of $7,282 and $2,860, respectively. Each membership organization notified IU Health Blackford Hospital that a portion of the dues it paid were used for lobbying purposes. The AHA used 23.65%, or $1,722 of the 2016 membership dues paid by IU Health Blackford Hospital, for lobbying expenditures. The IHA used 5.80%, or $166 of the 2016 membership dues paid by IU Health Blackford Hospital, for lobbying expenditures. The total membership dues paid to these organizations by IU Health Blackford Hospital during 2016 that were attributable to lobbying expenditures was $1,888. | ExplanationTxt |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Art Public Exhibition Amounts | ArtPublicExhibitionAmountsGrp | |
| Held Works Art | HeldWorksArtGrp | |
| CY Minus3 Yr Endwmt Fund | CYMinus3YrEndwmtFundGrp | |
| CY Minus4 Yr Endwmt Fund | CYMinus4YrEndwmtFundGrp |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $190,324 | OtherCostOrOtherBasisAmt |
| Book Value | $190,324 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $15,007,746 | OtherCostOrOtherBasisAmt |
| Depreciation | $7,893,774 | DepreciationAmt |
| Book Value | $7,113,972 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Leasehold Improvements | LeaseholdImprovementsGrp |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $5,243,194 | OtherCostOrOtherBasisAmt |
| Depreciation | $4,280,244 | DepreciationAmt |
| Book Value | $962,950 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $536,830 | OtherCostOrOtherBasisAmt |
| Depreciation | $289,651 | DepreciationAmt |
| Book Value | $247,179 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $8,514,425 | TotalBookValueLandBuildingsAmt |
| Federal Income Tax Liability | $0 | FederalIncomeTaxLiabilityAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (3 entries)
| DescDesc | AmtAmt |
|---|---|
| INTERCOMPANY PAYABLES (NET) | $436,398 |
| SELF-INSURANCE LIABILITIES | $19,924 |
| DUE TO THIRD-PARTY PAYORS | $1,221,762 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $1,678,084 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Schedule D, Part X, Line 2 - FIN 48 (ASC 740) Footnote | FormAndLineReferenceDesc |
| Explanation | IU Health Blackford Hospital is a subsidiary in IU Health's Consolidated Audited Financial Statements. The Internal Revenue Service (IRS) has determined that IU Health and certain of its affiliated entities are tax-exempt organizations as defined in Section 501(c)(3) of the Internal Revenue Code (IRC). IU Health and its tax-exempt affiliates are, however, subject to federal and state income taxes on unrelated business income under the provision of IRC Section 511. Deferred income taxes, which as of December 31, 2016 and 2015, 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, 2016 and 2015, the Indiana University Health System had gross deferred tax assets of $116,490,000 and $79,469,000, respectively, primarily relating to net operating loss carryovers. Management determined that a full valuation allowance at both December 31, 2016 and 2015 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 valuation allowance for the current year is $37,021,000. At December 31, 2016, the Indiana University Health System has available net operating loss carryforwards of $291,226,000. These net operating losses will expire between 2018 and 2036. Certain subsidiaries of IU Health are taxable entities. The tax expense and liabilities of these subsidiaries are not material to the consolidated financial statements. | ExplanationTxt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (true) | FinancialAssistancePolicyInd |
| Written Policy | Yes (true) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (true) | FPGReferenceFreeCareInd |
| Percent200 | Yes (X) | Percent200Ind |
| FPG Reference Discounted Care | false | FPGReferenceDiscountedCareInd |
| Free Care Medically Indigent | Yes (true) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (true) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | false | ExpensesExceedBudgetInd |
| Annual Community Bnft Report | Yes (true) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (true) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 692 | PersonsServedCnt |
| Total Community Benefit Expns | $479,731 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $479,731 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.03090 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 2461 | PersonsServedCnt |
| Total Community Benefit Expns | $3,280,008 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,000,406 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,279,602 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.14690 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 3153 | PersonsServedCnt |
| Total Community Benefit Expns | $3,759,739 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,000,406 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,759,333 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.17780 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 11 | ActivitiesOrProgramsCnt |
| Persons Served | 1414 | PersonsServedCnt |
| Total Community Benefit Expns | $206,276 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $4,065 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $202,211 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01300 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 2 | ActivitiesOrProgramsCnt |
| Persons Served | 26 | PersonsServedCnt |
| Total Community Benefit Expns | $19,540 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $19,540 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00130 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 2 | ActivitiesOrProgramsCnt |
| Persons Served | 53 | PersonsServedCnt |
| Total Community Benefit Expns | $5,856 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $5,856 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00040 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 15 | ActivitiesOrProgramsCnt |
| Persons Served | 1493 | PersonsServedCnt |
| Total Community Benefit Expns | $231,672 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $4,065 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $227,607 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01470 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 15 | ActivitiesOrProgramsCnt |
| Persons Served | 4646 | PersonsServedCnt |
| Total Community Benefit Expns | $3,991,411 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,004,471 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,986,940 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.19250 | TotalExpensePct |
Community Support CommunitySupportGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 1 | ActivitiesOrProgramsCnt |
| Persons Served | 29 | PersonsServedCnt |
| Total Community Benefit Expns | $3,858 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $3,858 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00020 | TotalExpensePct |
Coalition Building CoalitionBuildingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 1 | ActivitiesOrProgramsCnt |
| Persons Served | 1811 | PersonsServedCnt |
| Total Community Benefit Expns | $6,177 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $6,177 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00040 | TotalExpensePct |
Health Improvement Advocacy HealthImprovementAdvocacyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 1 | ActivitiesOrProgramsCnt |
| Persons Served | 89 | PersonsServedCnt |
| Total Community Benefit Expns | $4,845 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $4,845 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00030 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 3 | ActivitiesOrProgramsCnt |
| Persons Served | 1929 | PersonsServedCnt |
| Total Community Benefit Expns | $14,880 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $14,880 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00090 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | false | BadDebtExpenseReportedInd |
| Bad Debt Expense | $359,294 | BadDebtExpenseAmt |
| Reimbursed By Medicare | $7,793,499 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $7,067,871 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | $725,628 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (true) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (true) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | IU HEALTH BLACKFORD HOSPITAL | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 410 PILGRIM BLVD | AddressLine1Txt |
| City | HARTFORD CITY | CityNm |
| State Abbreviation | IN | StateAbbreviationCd |
| ZIP | 47348 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | HTTP://IUHEALTH.ORG/BLACKFORD/ | WebsiteAddressTxt |
| State License | 16-005101-1 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | IU HEALTH BLACKFORD HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | false | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | false | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (true) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Prior CHNA Impact | Yes (X) | PriorCHNAImpactInd |
| CHNA Conducted | 15 | CHNAConductedYr |
| Take Into Account Others Input | Yes (true) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | false | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | false | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (true) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | SEE PART V, SECTION C | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (true) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 15 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (true) | StrategyPostedWebsiteInd |
| Strategy Website URL | SEE PART V, SECTION C | StrategyWebsiteURLTxt |
| Organization Incur Excise Tax | false | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (true) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 200. | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 0. | FPGFamilyIncmLmtDscntCarePct |
| Income Level Criteria | Yes (X) | IncomeLevelCriteriaInd |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Residency Criteria | Yes (X) | ResidencyCriteriaInd |
| Other Criteria | Yes (X) | OtherCriteriaInd |
| Explained Basis | Yes (true) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (true) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Includes Publicity Measures | Yes (true) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | SEE PART V, SECTION C | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | SEE PART V, SECTION C | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | SEE PART V, SECTION C | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| Notified FAP Copy Bill Display | Yes (X) | NotifiedFAPCopyBillDisplayInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| FAP Translated | Yes (X) | FAPTranslatedInd |
| Other Publicity | Yes (X) | OtherPublicityInd |
| FAP Actions On Nonpayment | Yes (true) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | false | CollectionActivitiesInd |
| Provided Written Notice | Yes (X) | ProvidedWrittenNoticeInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Made Presumptive Elig Determ | Yes (X) | MadePresumptiveEligDetermInd |
| Nondis Emergency Care Policy | Yes (true) | NondisEmergencyCarePolicyInd |
| Look Back Medicare Private | Yes (X) | LookBackMedicarePrivateInd |
| Amounts Generally Billed | false | AmountsGenerallyBilledInd |
| Gross Charges | false | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (10 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Schedule H, Part V, Section B, Line 5 - Input from Community | IU Health Blackford Hospital'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 Blackford Hospital service area. This included the following components: 1. Hosting a community conversation focus group with public health officials and community leaders in attendance to discuss the healthcare needs of the service area and what role IU Health Blackford Hospital could play in addressing the identified needs. 2. Surveying the community at large through the hospital's website, with special effort to gather input from low income, uninsured, or minority groups. To obtain a more complete picture of the factors that play into the Blackford County community's health, input from local health leaders was gathered through a focus group session lasting three hours. IU Health Blackford Hospital representatives mailed letters and made follow-up telephone calls inviting public health officials and community leaders to attend the focus group discussion, paying special attention to including organizations that represent the interest of low-income, minority and uninsured individuals. The goal of soliciting these leaders' feedback was to gather insights into the quantitative data that may not be easily identified from the secondary statistical data alone. Leaders provide insights into the quantitative data and looked for needs not easily identified from the data. Attendees who participated in the focus group included: Robyn Clamme - Nurse, Blackford County Health Department Scot Croner - Superintendent, Blackford County Schools Ben Hodgin - Mayor, City of Blackford Ted Leas - Regional President, Citizens State Bank Carol Robles - Administrator/Co-Owner, Hearts with Integrity Lori Skidmore - Family Practice Physician, Health Officer, Blackford County Health Department Steve West - CEO, IU Health Blackford Hospital Upon arrival to the focus group, participants were asked to list five health needs, which should be prioritized in their opinion, for the Blackford County community served by IU Health Blackford Hospital. 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 Blackford Hospital facilitators then provided participants with a presentation featuring the mission of IU Health Blackford Hospital, 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 Blackford Hospital 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 the IU Health Blackford Hospital could be in meeting the local health needs. IU Health Blackford Hospital also solicited responses from the general public regarding the health of the IU Health Blackford Hospital community through an online survey as well as paper versions of the survey. The survey consisted of approximately 20 multiple choice and open-ended questions that assessed the community members feedback regarding healthcare issues and barriers to access. A link was made available on the hospitals website via an electronic survey tool from December 2014 through June 2015. A paper version was distributed at the Hartford City Senior center, the public libraries in Montpelier and Hartford and at the Blackford YMCA. The web link was promoted at the front desk of IU Health Blackford Hospital. The survey was also sent via e-mail to participants in the needs assessment focus groups to provide an opportunity for these community leaders to pass on to their local community members. 118 people from Blackford County participated in the survey. The majority of respondents represented by the survey were White/Caucasian (98%), which is comparable to the census data for Blackford County. The older adult population (defined as ages 45 to 64) represented over half (51%) of the total respondents. The young adult age group (defined as ages 25 to 44) was also significantly represented as well within Blackford County (20%). 111 of the 118 Blackford County respondents reported their average household income. Of the 111 people, 22% had an average household income within $25,000 - $49,999. About 16% earned $50,000 - $74,999, whereas 17% earned $75,000 - $99,999. Roughly 35% of the respondents reported an average household income of below $24,999. Survey respondents were also asked to report how they pay for health needs. Half of the respondents reported utilizing employer provided insurance. Private insurance was the second most reported payment for health needs (23%). A portion of the respondents (16%) used Medicare to cover health needs. Given the reported demographics above, care should be taken with interpreting the survey results. The reported age demographics of the survey sample versus Blackford Countys census data were disproportionate. The young adult age group was underrepresented in the survey sample, while the older adult age group was overrepresented. |
| Schedule H, Part V, Section B, Line 7a - CHNA Website | A copy of IU Health Blackford Hospital's CHNA is available on its website at the following URL: http://iuhealth.org/about-iu-health/in-the-community/ |
| Schedule H, Part V, Section B, Line 10a - Implementation Strategy Website | A copy of IU Health Blackford Hospital's CHNA implementation strategy is available on its website at the following URL: http://iuhealth.org/about-iu-health/in-the-community/ |
| Schedule H, Part V, Section B, Line 11 - Addressing Identified Needs | IU Health Blackford Hospital prioritized and determined which of the community health needs identified in its most recently conducted CHNA were most critical for it to address 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 Blackford Hospital selected the following five needs to be addressed: - Obesity (Nutrition and Active Living) - Infant Health Factors (Infant Mortality and Prenatal Care) - Mental Health and Substance Abuse - Tobacco and Smoking - Access to Healthcare Obesity (Nutrition and Active Living) IU Health Blackford Hospital's implementation strategy to address the identified need of Obesity includes the following: - Evaluate continuation of IU Health strong school grants to increase the amount of daily physical activity of students - Research investment in farm to table, community gardens, and other food initiatives to provide access to healthy and affordable food - Work with community partners to develop a broad-based collective impact model health coalition targeted to improved nutrition and increased physical activity - Introduce IUH providers to YMCA Diabetes Prevention program - Support for YMCA 7th and 8th Grade free membership initiative - Expand community programming offerings, including video modules for education, walking track promotion at events - Support for walking programs and initiatives including Walk Indiana - Promote Strong Schools funding for obesity prevention programming in area schools, including afterschool childhood obesity prevention programs - Bucks Farmers Market nutrition programs targeted to underserved populations Infant Health Factors (Infant Mortality and Prenatal Care) IU Health Blackford Hospital's implementation strategy to address the identified need of infant health factors includes the following: - Provide expertise and resources for continued operation of Fetal Infant Mortality Review Program and Community Action Teams related to infant health - Offer Pack-n-play infant beds plus Halo Sleep sacks in conjunction with educational programming to families at risk for unsafe sleep practices - Collaborate with community partners to promote ABC's of safe sleep in key locations - Introduce IUH pre-natal practitioners to the Nurse Family Partnership Program - Provide two family medicine doctors and a resident rotation at a subsidized local federally qualified health center open door health services to expand obstetrics capacity to serve low income residents Mental Health and Substance Abuse IU Health Blackford Hospital's implementation strategy to address the identified need of mental health and substance abuse includes the following: - Examine expansion of the academic health center's teen texting pilot project to other IU Health communities and more fully develop current relationships with Mental Health of America Indiana and the National Alliance on Mental Illness - Research new partnerships with statewide community organizations, state and county government offices providing evidence-based programs and services - Family Medicine Residency Screening, Brief Intervention and Referral to Treatment ("SBIRT") screening. SBIRT is an approach to the delivery of early intervention and treatment to people with substance abuse disorders and those at risk of developing these disorders - Provide support for substance abuse teaching in schools, particularly middle schools and Pride Team initiatives - Elevate involvement with the Delaware County Prevention Council - Family medicine residency behavioral health initiative for improved behavioral health assessment and treatment planning - Interventional pain management program to screen and refer patients to behavioral health counseling Tobacco and Smoking IU Health Blackford Hospital's implementation strategy to address the identified need of tobacco and smoking includes the following: - Work with community partners to develop a broad based collective impact model health coalition targeted to reduced tobacco use - Widely publicize 1-800-QUIT-NOW line to patients and families, prepare additional handouts specific to certain populations (i.e. parents with newborns) Access to Healthcare IU Health Blackford Hospital's implementation strategy to address the identified need of access to healthcare includes the following: - Continue to identify collaborative partners and coordinate efforts, leveraging resources - Investigate impact of coordinating and promoting health education - Healthcare education and health insurance enrollment assistance to community members in low-income neighborhoods - Explore strategies to access affordable healthcare including providing vaccinations and health screenings - Leverage resources to expand office/clinic hours at partnering clinics - Investigate potential of advanced community screenings that tie back to a physician navigator, or financial navigator at the event - Explore additional opportunities for a specialty clinic at Blackford Hospital Also, based upon the Hanlon Method of prioritization, the following identified community health needs were not chosen as one of the needs to be addressed: - Prenatal health - Chronic disease - Injury prevention After completing a gap analysis, IU Health Blackford Hospital determined that the severity of and lack of resources available to address the five needs chosen to be addressed outweighed the severity of and resources available to address the three needs not chosen. available to address the three needs not chosen. |
| Schedule H, Part V, Section B, Line 13b - Income Level Other than FPG | In addition to FPG, IU Health Blackford Hospital may take into consideration a patient's income and/or ability to pay in calculation of a financial assistance award. |
| Schedule H, Part V, Section B, Line 13h - Other FAP Factors | IU Health Blackford Hospital takes into consideration several other factors in determining patient eligibility for financial assistance. These factors include the following: 1. IU Health Blackford Hospital's Individual Solutions Department Prior to seeking Financial Assistance under the FAP, all patients or their guarantors must consult with a member of IU 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 Blackford Hospitals 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 Blackford Hospitals 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 Blackford Hospital. Eligible patients who receive medical care from IU Health Blackford Hospital as a result of an injury proximately caused by a third party, and later receive a monetary settlement or award from said third party, may receive Financial Assistance for any outstanding balance not covered by the settlement or award to which IU Health Blackford Hospital is entitled. In the event a Financial Assistance Award has already been granted in such circumstances, IU Health Blackford Hospital reserves the right to reverse the award in an amount equal to the amount IU Health Blackford Hospital would be entitled to receive had no Financial Assistance been awarded. 3. Alternate Methods of Eligibility Determination IU Health Blackford Hospital will conduct a quarterly review of all accounts placed with a collection agency partner for a period of no less than one hundred and twenty (120) days after the account is eligible for an 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 Blackford Hospital will deem patients/guarantors to be presumptively eligible for Financial Assistance if they are found to be eligible for one of the following programs, received emergency or direct admit care, and satisfied his/her required co-pay/deductible: - Indiana 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 Blackford Hospital will deny or revoke Financial Assistance for any patient or guarantor who falsifies any portion of a Financial Assistance application. 5. Non-Emergent Services Down Payment Uninsured Patients presenting for scheduled or other non-emergent services will not be charged more than the Amounts Generally Billed ("AGB") AGB for their services. Patients will receive an estimated AGB cost of their care prior to IU Health Blackford Hospital rendering the services and will be asked to pay a down-payment percentage of the AGB adjusted cost prior to receiving services. In the event a patient is unable to fulfill the down-payment, their service may be rescheduled for a later date as medically prudent and in accordance will 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 Emergency Medical Treatment and Active Labor Act ("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 Blackford Hospitals 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 Blackford Hospital processing said application. Uninsured Patients making payments toward their outstanding non-refundable deposit balance will have said payments applied to their oldest application on file, if applicable. |
| Schedule H, Part V, Section B, Line 16a - FAP Website | A copy of IU Health Blackford Hospital's FAP is available at the following URL: http://iuhealth.org/patients/my-iu-health/pay-a-bill/financial-assistance/ |
| Schedule H, Part V, Section B, Line 16b - FAP Application Website | A copy of IU Health Blackford Hospitals FAP Application is available at the following URL: http://iuhealth.org/patients/my-iu-health/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: http://iuhealth.org/patients/my-iu-health/pay-a-bill/financial-assistance/ |
| Schedule H, Part V, Section B, Line 16j - Other Measures to Publicize | IU Health Blackford Hospital 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 Blackford Hospital will include a conspicuous written notice on all patient billing statements that notifies the patient about the availability of this Policy, and the telephone number of its Customer Service Department which can assist patients with any questions they may have regarding this Policy. 3. IU Health Blackford Hospital Customer Service representatives will be available via telephone Monday through Friday, excluding major holidays, from 8:00 a.m. to 7:00 p.m. Eastern Time to address questions related to this Policy. 4. IU Health Blackford Hospital will broadly communicate this Policy as part of its general outreach efforts. 5. IU Health Blackford Hospital will educate its patient facing team members of the FAP and the process for referring patients to the Program. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | IUH Blackford Hosp Rehab Services | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 400 Pilgrim Blvd Ste 100 | AddressLine1Txt |
| City | Hartford City | CityNm |
| State Abbreviation | IN | StateAbbreviationCd |
| ZIP | 47348 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | Diagnostic and Other Outpatient | FacilityTxt |
Supplemental Information Detail SupplementalInformationDetail (15 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Schedule H, Part I, Line 3c - Other Factors Used in Determining Elig. | IU Health Blackford Hospital 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 Blackford Hospital will employ the same residency test as set forth in Indiana Code 6-3-1-12 to define an Indiana resident. The term Resident includes any individual who was domiciled in Indiana during the taxable year, or any individual who maintains a permanent place of residence in Indiana and spends more than one hundred eight-three (183) days of the taxable year in Indiana. Patients residing in the state of Indiana while attending an institution of higher education may be eligible for assistance under the FAP if they meet the aforementioned residency test and are not claimed as a dependent on a parents or guardians federal income tax return. 2. IU Health Blackford Hospital's Individual Solutions Department Prior to seeking Financial Assistance under the FAP, all patients or their guarantors must consult with a member of IU Health Blackford Hospital's Individual Solutions department to determine if healthcare coverage may be obtained from a government insurance/assistance product or from the Health Insurance Exchange Marketplace. 3. Uninsured Patients All Uninsured Patients presenting for services at IU Health Blackford Hospital eligible under the FAP will not be charged more than the AGB as described in the FAP. 4. Services Rendered by Individual Providers The FAP does not cover services rendered by individual providers. A full listing of providers and services not covered by the FAP is available at www.iuhealth.org/financialassistance 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 Blackford Hospitals 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 Blackford Hospitals 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 Blackford Hospital. Eligible patients who receive medical care from IU Health Blackford Hospital as a result of an injury proximately caused by a third party, and later receive a monetary settlement or award from said third party, may receive Financial Assistance for any outstanding balance not covered by the settlement or award to which IU Health Blackford Hospital is entitled. In the event a Financial Assistance Award has already been granted in such circumstances, IU Health Blackford Hospital reserves the right to reverse the award in an amount equal to the amount IU Health Blackford Hospital would be entitled to receive had no Financial Assistance been awarded. 6. Alternate Methods of Eligibility Determination IU Health Blackford Hospital will conduct a quarterly review of all accounts placed with a collection agency partner for a period of no less than one hundred and twenty (120) days after the account is eligible for an ECA. Said accounts may be eligible for assistance under the FAP based on the patients individual scoring criteria. To ensure all patients potentially eligible for Financial Assistance under the FAP may receive Financial Assistance, IU Health Blackford Hospital will deem patients/guarantors to be presumptively eligible for Financial Assistance if they are found to be eligible for one of the following programs, received emergency or direct admit care, and satisfied his/her required co-pay/deductible: - Indiana 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 Blackford Hospital will deny or revoke Financial Assistance for any patient or guarantor who falsifies any portion of a Financial Assistance application. 8. Patient Assets IU Health Blackford Hospital may consider patient/guarantor Assets in the calculation of a patient's true financial burden. A patient's/guarantor's primary residence and one (1) motor vehicle will be exempted from consideration in most cases. A patient's primary residence is defined as the patient's principal place of residence and will be excluded from a patient's extraordinary asset calculation so long as the patient's equity is less than five-hundred thousand dollars ($500,000) and the home is occupied by the patient/guarantor, patient's/guarantor's spouse or child under twenty-one (21) years of age. One (1) motor vehicle may be excluded as long as the patient's equity in the vehicle is less than fifty-thousand dollars ($50,000). IU Health Blackford Hospital reserves the right to request a list of all property owned by the patient/guarantor and adjust a patient's award of Financial Assistance if the patient demonstrates a claim or clear title to any extraordinary Asset not excluded from consideration under the above guidance. 9. Non-Emergent Services Down Payment Uninsured Patients presenting for scheduled or other non-emergent services will not be charged more than the AGB for their services. Patients will receive an estimated AGB cost of their care prior to IU Health Blackford Hospital rendering the services and will be asked to pay a down-payment percentage of the AGB adjusted cost prior to receiving services. In the event a patient is unable to fulfill the down-payment, their service may be rescheduled for a later date as medically prudent and in accordance will 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 Blackford Hospital Policy ADM 1.32, Screening and Transfer of Emergency or Unstable Patients. Amount of Non-Refundable Deposit All Uninsured Patients presenting for services at IU Health Blackford Hospitals 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 Blackford Hospital processing said application. Uninsured Patients making payments toward their outstanding non-refundable deposit balance will have said payments applied to their oldest application on file, if applicable. |
| Schedule H, Part I, Line 6a - C.B. Report Prepared by a Related Org. | IU Health Blackford Hospitals community benefit and other investments, encompassing its total community investment, are included in the IU Health Community Benefit Report which is prepared on behalf of and includes IU Health and its related hospital entities in the State of Indiana ("IU Health Statewide System"). The IU Health Community Benefit Report is made available to the public on IU Healths website at http://iuhealth.org/communitybenefit/. 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 (f) - Bad Debt Expense | The amount of bad debt expense included on Form 990, Part IX, Line 25, column (A), but subtracted for purposes of calculating the percentage of total expense is $907,537. |
| Schedule H, Part I, Line 7 - Total Community Benefit Expense | Schedule H, Part I, Line 7, Column (f), Percent of Total Expense, is based on column (e) Net Community Benefit Expense. The percent of total expense based on column (c) Total Community Benefit Expense, which does not include direct offsetting revenue, is 25.72%. |
| Schedule H, Part II - Promotion of Health in Communities Served | IU Health Blackford Hospital is a subsidiary of IU Health. IU Health participates in a variety of community-building activities that address the social determinants of health in the communities it serves. IU Health and its related hospital entities across the State of Indiana ("IU Health Statewide System") invest in economic development efforts across the state, collaborate with like-minded organizations through coalitions that address key issues, and advocate for improvements in the health status of vulnerable populations. This includes making contributions to community-building activities by providing investments and resources to local community initiatives that addressed economic development, community support and workforce development. Several examples include IU 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: - Blackford County Health Communities Coalition - Early Learning Indiana - Starfish Initiative - 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 - Methodology Used to Est. Bad Debt Exp. | The bad debt expense of $359,294 reported on Schedule H, Part III, Line 2 is reported at cost, as calculated using the cost to charge ratio methodology. |
| Schedule H, Part III, Line 4 - Bad Debt Expense | IU Health Blackford Hospital 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 | IU Health Blackford Hospital did not have a Medicare shortfall for 2016. IU Health Blackford Hospitals Medicare reimbursements, however, are normally less than the cost of providing patient care and services to Medicare beneficiaries and do not include any amounts that result from inefficiencies or poor management. IU Health Blackford Hospital accepts all Medicare patients knowing that there may be shortfalls; therefore it has taken the position that any shortfall should be counted as part of its community benefit. Additionally, it is implied in Internal Revenue Service Revenue Ruling 69-545 that treating Medicare patients is a community benefit. Revenue Ruling 69-545, which established the community benefit standard for nonprofit hospitals, states that if a hospital serves patients with governmental health benefits, including Medicare, then this is an indication that the hospital operates to promote the health of the community. The amount reported on Schedule H, Part III, Line 6 is calculated, in accordance with the Form 990 instructions, using "allowable costs" from the IU Health Medicare Cost Report. "Allowable costs" for Medicare Cost Report purposes, however, are not reflective of all costs associated with IU Healths participation in Medicare programs. For example, the Medicare Cost Report excludes certain costs such as billed physician services, the costs of Medicare Parts C and D, fee schedule reimbursed services, and durable medical equipment services. Inclusion of all costs associated with IU Health Blackford Hospitals participation in Medicare programs would significantly reduce the Medicare surplus reported on Schedule H, Part III, Line 7. |
| Schedule H, Part III, Line 9b - Written Debt Collection Policy | IU Health Blackford Hospitals 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 Blackford Hospital keeps all applications and supporting documentation confidential. Patients applying for assistance under the FAP will be required to complete a Financial Assistance Application. Patients must include the following documentation with their Financial Assistance Application: - All sources of Income for the last three (3) months; - Most recent three (3) months of pay stubs or Supplemental Security Income via Social Security; - Most recent three (3) statements from checking and savings accounts, certificates of deposit, stocks, bonds and money market accounts; - Most recent state and Federal Income Tax forms including schedules C, D, E, and F. In the event a 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 Blackford Hospital will inform patients or guarantors of the results of their application by providing the patient or guarantor with a Financial Assistance Determination within ninety (90) days of receiving a completed Application and all requested documentation. If a patient or guarantor is granted less than full charity assistance and the patient or guarantor provides additional information for reconsideration, IU Health 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 Blackford Hospital 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 Blackford Hospital and its third-party collection agencies may initiate ECA against a patient or their guarantor in accordance with this Policy and 26 C.F.R. 1.501(r). Said ECA may include the following: - Selling a 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 Blackford Hospital and its third party collection agencies, will engage in fair, respectful and transparent collections activities. Patients or guarantors currently subject to an ECA who have not previously applied for Financial Assistance may apply for assistance up to two-hundred and forty (240) days of the date of their first billing statement from IU Health Blackford Hospital. IU Health Blackford Hospital and their third-party collection agencies will suspend any ECA engaged on a patient or their guarantor while an Application is being processed and considered. 4. Refunds Patients eligible for assistance under the FAP who remitted payment to IU Health Blackford Hospital in excess of their patient responsibility will be alerted to the overpayment as promptly after discovery as is reasonable given the nature of the overpayment. Patients with an outstanding account balance on a separate account not eligible for assistance under the FAP will have their refund applied to the outstanding balance. Patients without an outstanding account balance described above will be issued a refund check for their overpayment as soon as technically feasible. |
| Schedule H, Part VI, Line 2 - Needs Assessment | Communities are multifaceted and so are their health needs. IU Health Blackford Hospital understands that the health of individuals and communities are shaped by various social and environmental factors, along with health behaviors and additional influences. IU Health Blackford Hospital assesses the health care needs of the communities it serves by utilizing the detailed community needs assessments undertaken by organizations such as the Blackford County Health Department, the Indiana State Department of Health, the Centers for Disease Control and Prevention and the United Way. After completion of the CHNA, IU Health Blackford Hospital 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 Healths ability to impact positive change was evaluated. |
| Schedule H, Part VI, Line 3 - Patient Education of Eligibility for Assist. | IU Health Blackford Hospital is committed to serving the healthcare needs of all of its patients regardless of their ability to pay for such services. To assist in meeting those needs, IU Health Blackford Hospital has established a FAP to provide Financial Assistance to Uninsured Patients. IU Health Blackford Hospital is committed to ensuring its patients are compliant with all provisions of the Patient Protection & Affordable Care Act. To that end, IU Health Blackford Hospital will make a good faith effort to locate and obtain health insurance coverage for patients prior to considering patients for coverage under the FAP. IU Health Blackford Hospital takes several measures to inform its patients of the FAP and FAP-eligibility. These measures include the following: 1. 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 Blackford Hospital will include a conspicuous written notice on all patient billing statements that notifies the patient about the availability of this Policy, and the telephone number of its Customer Service Department which can assist patients with any questions they may have regarding this Policy. 3. IU Health 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 Blackford Hospital will broadly communicate this Policy as part of its general outreach efforts. 5. IU Health Blackford Hospital will educate its patient facing team members of the FAP and the process for referring patients to the Program. |
| Schedule H, Part VI, Line 4 - Community Information | IU Health Blackford Hospital is located in Blackford County, Indiana, a county located in east-central Indiana. Its service areas include Blackford, Grant, Delaware, Jay, and Wells counties. Blackford County includes ZIP codes within the towns of Hartford City and Montpelier. Based on the most recent Census Bureau (Estimated 2016) statistics, Blackford Countys population is 12,149 persons with approximately 50.7% being female and 49.3% male. The countys population estimates by race are 94.5% White, 1.6% Hispanic or Latino, 1.3% Black, 0.5% Asian, 0.8% American Indian or Alaska Native, and 1.3% persons reporting two or more races. Blackford County has relatively low levels of educational attainment. The level of education most of the population has achieved is a high school degree (85.5%). As of 2016, 10.1% of the population had a bachelor's degree or higher. |
| Schedule H, Part VI, Line 5 - Promotion of Community Health | During 2016, IU Health Blackford Hospital's promotion of community health included the following highlights: IU Health Blackford Hospital hosted their annual Community Health Fair on November 5, 2016 at Northside Elementary School in Hartford City. Residents of Blackford County and the surrounding areas came out to visit with local medical professionals, receive health and wellness screenings, see activity demonstrations and enjoy family entertainment. The one-day event, sponsored by IU Health Blackford Hospital, focused on specific health needs, including cardiac services, cancer, and diabetes. Heart failure and stroke screenings were offered to visitors, along with free or reduced-cost lab work. Visitors also enjoyed karate and self-defense demonstrations from the Blackford County YMCA, and a childrens chorale. In addition, IU Health Blackford Hospital partnered with the Blackford County YMCA to form the Blackford Community Walking Club. The Club kicked off with weekly Thursday walks from August-October on the athletic track at Blackford High School. A typical gathering of 10-12 people each week participated including seniors all the way to small children taking part with their mothers. |
| Schedule H, Part VI, Line 6 - Affiliated Health Care System | IU Health Blackford Hospital 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 - Ten clinical programs ranked among the top 50 national programs in U.S. News & World Reports 2015-16 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 will invest $150 million over five years in the Strategic Research Initiative, a new research collaboration that will enhance the institutions joint capabilities in fundamental scientific investigation, translational research and clinical trials. The initial focus will be 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 national - 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 critical 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 Goshen Hospital - IUHLP Liquidation, Inc. f/k/a IU Health La Porte Hospital - IU Health North Hospital - IU Health Paoli Hospital - IUHLP-SH, LLC f/k/a IU Health Starke 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 Day 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 20,000 IU Health team member volunteer during the Day 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 2016, 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 pull 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 health 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 - My Healthy Habits App - 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 He |
| Schedule H, Part VI - Other | Disclosure in Accordance with Revenue Procedure 2015-21: In accordance with Revenue Procedure 2015-21, IU Health Blackford Hospital discloses the following information with respect to Section 501(r) issues that were discovered during the 2016 tax year and how they have been corrected, to satisfy Section 501(r)(1) and 501(r)(2)(B) requirements. For all items: The cause was a good-faith effort by IU Health Blackford Hospital to implement the requirements of the Section 501(r) regulations. IU Health Blackford Hospital obtained information about the requirements and implemented them, though there were some gaps due to the detailed nature of the regulations. The issues were discovered in December 2016 when IU Health's System FAP, as applicable to IU Health Blackford Hospital, was reviewed by the IRS as part of a courtesy review in conjunction with an audit of a tax-exempt organization related to IU Health Blackford Hospital. The corrections were completed, in conjunction with the IRS courtesy review, in January 2017. The IRS confirmed in January 2017 that it believed IU Health's System FAP, effective January 2017, was in compliance with Section 501(r) and the Final Regulations. IU Health Blackford Hospital has not identified any persons directly affected by these issues because the discrepancies related primarily to the specificity of information contained in the FAP and did not alter the financial assistance provided to patients, efforts taken to determine financial assistance eligibility, or other operations of the hospital. Thus, all individuals were in the same position as they would have been had the information been in the FAP. After making the substantive corrections described below, IU Health Blackford Hospital communicated the updated FAP to patients and the community and it is widely available as required by the Section 501(r) Final Regulations. Specific Issues and Corrections: 1. Requirement: Inclusion of a Provider List Pursuant to Treas. Reg. 1.501(r)-4(b)(1)(iii)(F), a hospital facility's FAP is required to include a list of providers, other than the hospital facility itself, who are delivering emergency or other medically necessary care in the hospital facility and to be specific about which providers are covered by the hospital facility's FAP (and which are not). Condition: V.B.4.a of IU Health Blackford Hospital's FAP, effective January 2016, stated that it "does not cover services rendered by individual providersthat a "full listing of providers and services not covered by this policy is available at www.iuhealth.org/financialassistance and is updated on a quarterly basis." During 2016, the IU Health Blackford Hospital's Financial Assistance webpage contained a paragraph stating that a "complete list of all IU Health Blackford Hospital providers not covered under IU Health Blackford Hospital's FAP is available via the Find A Doctor page or as a PDF file." The "Find A Doctor page" allowed a search by first or last name of the provider. The result was a listing showing providers' pictures, specialties, and Hospitals & Affiliations. None of the information provided specifically identified whether a provider's services were or were not covered by IU Health Blackford Hospital's FAP. The PDF file, entitled "Find A Doctor Printable Directory", did not specifically identify whose services were covered by IU Health Blackford Hospital's FAP and whose were not. In addition, the listing was dated December 23, 2015 (almost one year old). These omissions led to the conclusion that IU Health Blackford Hospital's FAP, effective January 2016, was not compliant with this sub-element of the regulations, Treas. Reg. 1.501(r)-4(b)(1)(iii)(F). Corrective Action: IU Health Blackford Hospital's Financial Assistance website at http://iuhealth.org/patients/my-iu-health/pay-a-bill/financial-assistance/ was updated in January 2017 to include the following information: "IU Health Blackford Hospital's FAP does not cover individual physician charges. A listing of all providers who render services at an IU Health Blackford Hospital facility and whose individual professional charges are not covered by this FAP, along with a list of any services that are not covered by this FAP, are available "herewas updated on December 31, 2016." By clicking "here" on the website, an individual was able to view a PDF file listing all individual physicians providing medical services at IU Health Blackford Hospital with the specification that their services are not covered under IU Health Blackford Hospital's FAP. Furthermore, IU Health Blackford Hospital now updates the list no less frequently than quarterly. 2. Requirement: Description of Process and Time Frames Regarding FAP-eligibility and ECAs Pursuant to Treas. Reg. 1.501(r)-4(b)(4)(B), a hospital facility's FAP (or a separate written billing & collections policy) must describe the process and time frames that each hospital facility uses with respect to the reasonable efforts it will make to determine whether an individual is FAP eligible before engaging in any ECAs. Treas. Reg. 1.501(r)-6(c) defines two methods that will constitute reasonable efforts under paragraphs (c)(2) and (c)(3) as follows: - (c)(2): Presumptive FAP-eligibility determinations; and - (c)(3): Various, other efforts based on notification and processing of applications Condition: VI.D.1 of IU Health Blackford Hospital's FAP, effective January 2016, provided that IU Health Blackford Hospital may refer delinquent patient accounts to a third-party collection agency after utilizing "reasonable efforts" to determine a patient's eligibility for assistance under the FAP. VI.D.2 stated that IU Health Blackford Hospital and its third-party collection agencies may initiate ECAs against a patient in accordance with the FAP and 26 CFR 1.501(r). The problem with this wording is that IU Health Blackford Hospital did not describe the process and time frames that are involved with its "reasonable efforts". This omission led to the conclusion that IU Health Blackford Hospital's FAP, effective January 2016, was not compliant with this sub-element of the regulations, Treas. Reg. 1.501(r)-4(b)(4)(B). Corrective Action: IU Health Blackford Hospital added language to VI.D.1 and VI.D.2 of its FAP, effective January 2017, to fully describe the process and time frames that are involved with its reasonable efforts to determine a patient's eligibility for assistance under the FAP. 3. Requirement: Description of ECAs and Final Authority in Making Determinations Regarding FAP-eligibility and ECAs IRC 501(r)(4)(A)(iv) requires that a hospital facility's FAP address the actions that the organization may take in event of nonpayment. Treas. Reg. 1.501(r)-(4)(b)(4)(C) requires that a hospital facility's FAP must describe the office, department, committee, or other body with the final authority or responsibility for determining that the hospital facility has made reasonable efforts to determine whether an individual is FAP-eligible and may engage in ECAs against the individual. Condition: IU Health Blackford Hospital's FAP, effective January 2016, did not contain the required wording described above. This omission led to the conclusion that IU Health Blackford Hospital FAP, effective January 2016, was not compliant with this sub-element of the regulations, Treas. Reg. 1.501(r)-4(b)(4)(C). Corrective Action: IU Health Blackford Hospital added language to VI.D.2 through VI.D.4 of its FAP, effective January 2017, to fully describe the actions it may take in the event of nonpayment. Furthermore, IU Health Blackford Hospital's Financial Assistance Committee is identified in IV of the FAP as the body responsible for the effectuation of the FAP including making final determinations if IU Health Blackford Hospital had made reasonable efforts to determine a patient's eligibility for assistance under the FAP. 4. Requirement: Inclusion of a Facilities List Treas. Reg. 1.501(r)-4(d)(3) states that a hospital organization may establish a FAP (and B&CP and EMCP) that is shared with multiple hospital facilities provided that any joint policy clearly identifies each facility to which it applies. Condition: In II, "Scope," IU Health Blackford Hospital's FAP, effective January 2016, stated that it "applies to all Uninsured Patients receiving care rendered at all non-profit IU Health Blackford Hospital hospital facilities, including those receiving emergent and/or medical necessary services." This language did not clearly identify each hospital facility, by name, to which it applied. Lacking this required language resulted in the conclusion that IU Health Blackford Hospital's FAP, effective January 2016, was not compliant with this sub-element of the regulations, Treas. Reg. 1.501(r)-4(d)(3). Corrective Action: IU Health Blackford Hospital added language to VI.B.3 of its FAP, effective January 2017, to clearly identify each hospital facility, by name, to which it applied. |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (true) | GrantRecordsMaintainedInd |
Recipient Table RecipientTable
Recipient Business Name RecipientBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | YMCA OF MUNCIE | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 500 S MULBERRY ST | AddressLine1Txt |
| City | MUNCIE | CityNm |
| State Abbreviation | IN | StateAbbreviationCd |
| ZIP | 47305 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Recipient EIN | 350868215 | RecipientEIN |
| IRC Section | 501(C)(3) | IRCSectionDesc |
| Cash Grant | $42,000 | CashGrantAmt |
| Valuation Method Used | N/A | ValuationMethodUsedDesc |
| Non Cash Assistance | N/A | NonCashAssistanceDesc |
| Purpose Of Grant | GENERAL SUPPORT | PurposeOfGrantTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 1 | Total501c3OrgCnt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Schedule I, Part I, Line 2 - Org's. Proc. for Mon. the Use of Grant Funds | FormAndLineReferenceDesc |
| Explanation | Although IU Health Blackford Hospital 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. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | false | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (true) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | false | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | false | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | false | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | false | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | false | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | Yes (true) | AnyNonFixedPaymentsInd |
| Initial Contract Exception | false | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (9 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| STEVEN J WEST | ||||||||||||||
| DIRECTOR/PRESIDENT | $0 | $146,999 | $0 | $26,650 | $0 | $2,011 | $0 | $8,824 | $0 | $10,917 | $0 | $195,401 | $0 | $0 |
| MICHAEL E HALEY | ||||||||||||||
| DIRECTOR | $0 | $518,156 | $0 | $185,392 | $0 | $24,792 | $0 | $106,194 | $0 | $26,587 | $0 | $861,121 | $0 | $0 |
| JUDITH L COLEMAN | ||||||||||||||
| CFO (PARTIAL YEAR) | $0 | $208,421 | $0 | $27,778 | $0 | $1,976 | $0 | $11,993 | $0 | $27,111 | $0 | $277,279 | $0 | $0 |
| LORI A LUTHER | ||||||||||||||
| CFO | $0 | $294,587 | $0 | $44,181 | $0 | $3,335 | $0 | $13,250 | $0 | $11,311 | $0 | $366,664 | $0 | $0 |
| JEFFREY C BIRD MD | ||||||||||||||
| CMO | $0 | $341,574 | $0 | $41,775 | $0 | $2,322 | $0 | $13,250 | $0 | $21,893 | $0 | $420,814 | $0 | $0 |
| CARLA C COX RN | ||||||||||||||
| VP & CNO | $0 | $185,758 | $0 | $15,443 | $0 | $1,705 | $0 | $10,206 | $0 | $12,280 | $0 | $225,392 | $0 | $0 |
| ELIZABETH A DROEGE MD | ||||||||||||||
| PHYSICIAN | $277,514 | $0 | $75 | $0 | $21,564 | $0 | $13,250 | $0 | $20,895 | $0 | $333,298 | $0 | $0 | $0 |
| CHARLES L CARROLL DO | ||||||||||||||
| PHYSICIAN | $159,565 | $0 | $0 | $0 | $0 | $0 | $6,383 | $0 | $0 | $0 | $165,948 | $0 | $0 | $0 |
| THOMAS M LEE MD | ||||||||||||||
| PHYSICIAN | $94,894 | $212,407 | $26,186 | $58,614 | $734 | $1,642 | $4,092 | $9,158 | $8,334 | $18,653 | $134,240 | $300,474 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Schedule J, Part I, Line 3 - Comp. of the Org.'s CEO/Executive Director | IU Health Blackford Hospitals President is an employee of IU Health Ball Memorial Hospital. IU Health, as the sole member and controlling parent of IU Health Ball Memorial Hospital, has implemented a process for determining the compensation of IU Health Blackford Hospitals President. IU Healths process for determining compensation includes the use of a compensation survey/study conducted by an independent compensation consultant with review and approval by the Committee on Personnel and Compensation and the Board of Directors. Please see Schedule O for additional details. |
| Schedule J, Part I, Line 4b - Supplemental Nonqualified Retirement Plan | Michael E. Haley participates in an IU Health supplemental executive retirement plan, provisions of which are designed to retain its critical employees. The plan provides for an additional retirement benefit for services through normal retirement or other key dates. If the executive leaves prior to retirement or other key dates, the benefit may be forfeited or reduced. Michael E. Haley has an amount included in column c, deferred compensation, representing the current year unvested contributions made under the supplemental retirement plan. No amount was actually paid to Michael E. Haley during the year. |
| Schedule J, Part I, Line 7 - Non-Fixed Payments | Amounts disclosed in Column B(ii) include a long-term and short-term incentive for certain executives and short-term incentive for other employees. Although these plans are based on a fixed formula that has been approved by the Board of Directors based upon certain qualitative and quantitative factors and goals, all discretionary incentive plans must be approved by the Board of Directors prior to any incentive payout. |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (8 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part VI, Section A, Line 2 - Family or Business Relationships | Michael E. Haley and Jeffrey C. Bird, M.D. both served on the board of managers of Ball Outpatient Surgery Center, LLC. |
| Part VI, Section A, Lines 6, 7a and 7b - Members or Stockholders | Line 6: IU Health Blackford Hospital has one class of membership and the sole member is IU Health Ball Memorial Hospital, a wholly owned subsidiary of IU Health. Line 7a: The Board of Directors shall consist of such number of members not fewer than three (3) nor more than five (5) in number. Composition of the Board of Directors shall be consistent with the following criteria: two (2) members appointed by IU Health Ball Memorial Hospital shall be representatives of the local community and one (1) to three (3) members appointed by IU Health Ball Memorial Hospital shall be at-large representatives Line 7b: Notwithstanding any other provisions of the Articles of Incorporation, the following matters require the approval of IU Health Ball Memorial Hospital prior to implementation: -Approve the Governing Documents of the Hospital. -Appoint, upon the recommendation of the Board of the Hospital, or remove, with or without cause, the members of the Board of Directors of the Hospital. Removal does not require a recommendation of the Hospital's Board; provided, however, that IU Health Ball Memorial Hospital will not remove without cause one or more Community Directors prior to consulting with the remaining members of the Board, or remove without cause the County Director prior to consulting with the remaining members of the Board and the Blackford County Commissioners. -Approve the incurrence of debt of the Hospital within limits delegated to the Board of Directors from time to time by IU Health Ball Memorial Hospital -Approve and recommend the formation of legal entities, the sale, transfer or substantial change in use of all or substantially all of the assets of the Hospital or the divestiture, dissolution, closure, merger, consolidation or change in the Corporate Member of the Hospital. -Approve the transfer or encumbrance of the assets of the Hospital, except in the ordinary course of business. -Subject to approval by IU Health, approve the capital and operating budgets for Hospital. |
| Part VI, Section B, Line 11b - Review of Form 990 | The CFO and IU Health Ball Memorial Hospitals Audit Committee reviewed and approved the Form 990. Following their 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 Healths Tax Department to answer any questions. |
| Part VI, Section B, Lines 12, 13, 14, and 16b - Policies | IU Health Blackford Hospital is part of the IU Health system. As the sole member and controlling parent of IU Health Ball Memorial Hospital, Inc., the sole member and controlling parent of IU Health Blackford Hospital, IU Health and its Board of Directors have mandated that certain policies be followed to ensure greater standardization throughout the system. Thus, IU Health Blackford Hospitals Board of Directors was not required to separately adopt a conflict of interest, whistleblower, document retention and destruction and joint venture policies because IU Healths 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 Blackford Hospital 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 Comp. | IU Health Blackford Hospitals President is an employee of IU Health Ball Memorial Hospital. IU Health, as the sole member and controlling parent of IU Health Ball Memorial Hospital, has implemented the following process for determining compensation of IU Health Blackford Hospitals President/Top Management Official: (1) The Board of Directors has established a Committee on Personnel and Compensation. The individuals on this Committee are made up of individuals who are on the Board and who do not have a conflict of interest with IU Health. There are no physicians or employees on this Committee. This Committee develops and reviews annually the executive compensation philosophy, market analysis as to comparability and reasonableness. One of the purposes of this Committee is to review, approve and make recommendations regarding executive compensation and benefits to the IU Health Board. As deemed appropriate, this Committee also reviews the same detail with the Committee on Finance. The Committee on Finance is represented by certain members of the Board as well. (2) Each year the Committee on Personnel and Compensation engages an outside compensation consulting firm to conduct a compensation and benefits study for all senior vice presidents and above. The current compensation advisor is the Hay Group. Hay Group performs an independent compensation survey. The relevant comparability data includes: compensation and benefit levels paid by similarly situated organizations (both governmental and tax exempt) for functionally comparable positions as well as the availability of similar services in the geographic area. The Committee reviews the entire compensation package including: base compensation, short term and long term incentive plans, basic health and welfare benefits, qualified and nonqualified plans as well as any additional fringe benefits. Further, Hay Group will provide recommendations based upon the reasonable compensation information as it relates to salary increases, bonuses and benefits that are consistent with the compensation philosophy of the Committee. A separate analysis using the same methodology is done for the Chief Executive Officer. (3) The Committee reviews the salary survey and, if appropriate, makes recommendations on increases in salary and any changes in bonuses or benefits. The Committee's goal is to ensure that the total compensation and benefits package is reasonable based upon the independent data provided by Hay Group. The Committee votes on any changes in compensation or benefits. This review, discussion and vote are documented in the minutes for the meeting. There are no executives present during the final discussion and approval of compensation. (4) The Board reviews the report prepared by the Hay Group as well as the recommendations of the Committee on Personnel and Compensation as to changes in compensation approved by the Committee. As requested, the Committee on Finance also provides its review of recommendations on changes in executive compensation and benefits. This review, discussion and vote are documented in the minutes. (5) The Board then reviews the recommendations provided by the Committee on Personnel and Compensation and votes on the changes as well. No additional compensation or benefits are paid to the executives until the changes have been approved by the Committee and the Board. The discussion and approval are documented in the minutes of the meeting. There are no executives present during the final discussion and approval of compensation. The General Counsel prepares a formal written opinion reviewing the compensation and benefits approval process, comparing that process to the Intermediate Sanctions Test of IRC Section 4958 and, if the facts warrant, provides comments regarding the compensation and benefits approval process as this relates to meeting the requirements for a rebuttable presumption of reasonableness as provided in the Intermediate Sanctions Test. (6) After the end of each year, the Committee and Board also reviews the achievements of the executive group as it relates to the long-term and short-term shared and individual goals developed by the executive and the Board. These achievements may also be reviewed with the Committee on Finance. The Board, at its discretion, may approve bonus payments based upon the achievement of the goals and the compensation survey. The discussion and vote of the Committee and Board is documented in the minutes for each such meeting. The bonuses are not paid until approval is made by the Board. (7) The Committee on Personnel and Compensation and Audit Committee also review the required Form 990 disclosures related to executive compensation and benefits as well as compensation practices and approval processes prior to the filing of the Form 990 return with the Internal Revenue Service. |
| Part VI, Section C, Line 19 - Public Disclosure | IU Health Blackford Hospitals Articles of Incorporation are available for public inspection through the Indiana Secretary of State's web-site. IU Health Blackford Hospital's conflict of interest procedures are disclosed on the Form 990, Schedule O. IU Health Blackford Hospital is a subsidiary in IU Health's Consolidated Audited Financial Statements. IU Health's Consolidated Audited Financial Statements are available for public inspection through its bond filings and as an attachment to IU Health's Form 990. |
| FORM 990 PART IX LINE 11G | DESCRIPTION:SHARED SERVICES/PROF. FEES TOTAL FEES:5930018 |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (42 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|---|
| Clarian Transplant Institute Inc | ||||||||||
| 950 N Meridian St Ste 800 | Indianapolis | IN | 46204 | 134350599 | Healthcare | IN | 501(c)(3) | 10 | IUH | Yes (true) |
| Goshen Health System Inc | ||||||||||
| 200 High Park Ave | Goshen | IN | 46527 | 351974765 | Healthcare | IN | 501(c)(3) | 12 I | IUH | Yes (true) |
| Goshen Hospital Association Inc | ||||||||||
| 200 High Park Ave | Goshen | IN | 46527 | 356001540 | Healthcare | IN | 501(c)(3) | 3 | GHS | Yes (true) |
| HealthLINC Incorporated | ||||||||||
| 950 N Meridian St Ste 800 | Indianapolis | IN | 46204 | 263571507 | Healthcare | IN | 501(c)(3) | 10 | IUHB | Yes (true) |
| Indiana Health Info Exchange Inc | ||||||||||
| 846 N Senate Ave | Indianapolis | IN | 46202 | 364550324 | Healthcare | IN | 501(c)(3) | 12 I | NA | false |
| Indiana Radiology Partners Inc | ||||||||||
| 950 N Meridian St Ste 800 | Indianapolis | IN | 46204 | 201017034 | Healthcare | IN | 501(c)(3) | 10 | IUH | Yes (true) |
| 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 Foundation Inc | ||||||||||
| 950 N Meridian St Ste 800 | Indianapolis | IN | 46204 | 356079797 | Fundraising | IN | 501(c)(3) | 12 I | IUHA | Yes (true) |
| IU Health Arnett Inc | ||||||||||
| 950 N Meridian St Ste 300 | Indianapolis | IN | 46204 | 263162145 | Healthcare | IN | 501(c)(3) | 3 | IUH | Yes (true) |
| IU Health Ball Memorial Hospital Inc | ||||||||||
| 950 N Meridian St Ste 300 | Indianapolis | IN | 46204 | 350867958 | Healthcare | IN | 501(c)(3) | 3 | IUH | Yes (true) |
| IU Health Ball Memorial Physicians Inc | ||||||||||
| 950 N Meridian St Ste 300 | Indianapolis | IN | 46204 | 351925641 | Healthcare | IN | 501(c)(3) | 10 | IUHBMH | Yes (true) |
| IU Health Bedford Inc | ||||||||||
| 950 N Meridian St Ste 300 | Indianapolis | IN | 46204 | 237042323 | Healthcare | IN | 501(c)(3) | 3 | IUH | Yes (true) |
| IU Health Bloomington Inc | ||||||||||
| 950 N Meridian St Ste 300 | Indianapolis | IN | 46204 | 351720796 | Healthcare | IN | 501(c)(3) | 3 | IUH | Yes (true) |
| IU Health BMH Foundation Inc | ||||||||||
| 950 N Meridian St Ste 800 | Indianapolis | IN | 46204 | 311111784 | Fundraising | IN | 501(c)(3) | 12 I | IUHBMH | Yes (true) |
| IU Health Care Associates Inc | ||||||||||
| 950 N Meridian St Ste 300 | Indianapolis | IN | 46204 | 351747218 | Healthcare | IN | 501(c)(3) | 10 | IUH | Yes (true) |
| IU Health Goshen Foundation Inc | ||||||||||
| 200 High Park Ave | Goshen | IN | 46527 | 462565300 | Fundraising | IN | 501(c)(3) | 12 I | GHS | Yes (true) |
| IUHLP Liquidation Inc | ||||||||||
| 950 N Meridian St Ste 800 | Indianapolis | IN | 46204 | 351125434 | Healthcare | IN | 501(c)(3) | 10 | IUH | Yes (true) |
| IUHLP-P Liquidation Inc | ||||||||||
| 950 N Meridian St Ste 800 | Indianapolis | IN | 46204 | 311070868 | Healthcare | IN | 501(c)(3) | 10 | IUHLP | Yes (true) |
| IU Health Morgan Inc | ||||||||||
| 950 N Meridian St Ste 800 | Indianapolis | IN | 46204 | 273533027 | Healthcare | IN | 501(c)(3) | 10 | IUH | Yes (true) |
| IU Health North Hospital Inc | ||||||||||
| 950 N Meridian St Ste 300 | Indianapolis | IN | 46204 | 351932442 | Healthcare | IN | 501(c)(3) | 3 | IUH | Yes (true) |
| IU Health Paoli Hosp Foundation Inc | ||||||||||
| 950 N Meridian St Ste 800 | Indianapolis | IN | 46204 | 310992486 | Fundraising | IN | 501(c)(3) | 10 | IUHP | Yes (true) |
| IU Health Paoli Inc | ||||||||||
| 950 N Meridian St Ste 300 | Indianapolis | IN | 46204 | 352090919 | Healthcare | IN | 501(c)(3) | 3 | IUHB | Yes (true) |
| IU Health Plans NFP Inc | ||||||||||
| 950 N Meridian St Ste 800 | Indianapolis | IN | 46204 | 463803873 | Insurance | IN | 501(c)(4) | N/A | IUH | Yes (true) |
| IU Health Tipton Hospital Inc | ||||||||||
| 950 N Meridian St Ste 300 | Indianapolis | IN | 46204 | 262772226 | Healthcare | IN | 501(c)(3) | 3 | IUH | Yes (true) |
| IU Health West Hospital Inc | ||||||||||
| 950 N Meridian St Ste 300 | Indianapolis | IN | 46204 | 351814660 | Healthcare | IN | 501(c)(3) | 3 | IUH | Yes (true) |
| IU Health White Mem Hosp Fndtn Inc | ||||||||||
| PO Box 952 | Monticello | IN | 47960 | 351671806 | Fundraising | IN | 501(c)(3) | 12 III-FI | IUHWMH | Yes (true) |
| IU Health White Memorial Hospital Inc | ||||||||||
| 950 N Meridian St Ste 300 | Indianapolis | IN | 46204 | 273532963 | Healthcare | IN | 501(c)(3) | 3 | IUH | Yes (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 |
| 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 | Yes (true) |
| MDwise Network Inc | ||||||||||
| 1200 Madison Ave | Indianapolis | IN | 46225 | 472619552 | Insurance | IN | 501(c)(4) | N/A | IUH | Yes (true) |
| Methodist Health Foundation Inc | ||||||||||
| 1800 N Capitol Ave | Indianapolis | IN | 46202 | 356043086 | Fundraising | IN | 501(c)(3) | 12 I | IUH | Yes (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 Medical Group Inc | ||||||||||
| 950 N Meridian St Ste 800 | Indianapolis | IN | 46204 | 351945384 | Healthcare | IN | 501(c)(3) | 3 | IUH | Yes (true) |
| Methodist Occup Health Centers Inc | ||||||||||
| 950 N Meridian St Ste 300 | Indianapolis | IN | 46204 | 351844176 | Healthcare | IN | 501(c)(3) | 3 | IUH | Yes (true) |
| Methodist Research Institute Inc | ||||||||||
| 950 N Meridian St Ste 800 | Indianapolis | IN | 46204 | 352023710 | Healthcare | IN | 501(c)(3) | 12 I | IUH | Yes (true) |
| MH Healthcare Inc | ||||||||||
| 950 N Meridian St Ste 800 | Indianapolis | IN | 46204 | 351766531 | Healthcare | IN | 501(c)(3) | 3 | MMG | Yes (true) |
| Rehabilitation Hospital of Indiana Inc | ||||||||||
| 4141 Shore Dr | Indianapolis | IN | 46254 | 351786005 | Healthcare | IN | 501(c)(3) | 3 | MHH | Yes (true) |
| RHI Foundation Inc | ||||||||||
| 4141 Shore Dr | Indianapolis | IN | 46254 | 351932349 | Fundraising | IN | 501(c)(3) | 12 I | RHI | Yes (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 |
| Tipton Co Health Care Foundation Inc | ||||||||||
| 950 N Meridian St Ste 800 | Indianapolis | IN | 46204 | 311231905 | Fundraising | IN | 501(c)(3) | 12 I | IUHTH | Yes (true) |
| University Family Physicians Inc | ||||||||||
| 950 N Meridian St Ste 800 | Indianapolis | IN | 46204 | 237427350 | Healthcare | IN | 501(c)(3) | 10 | IUHCA | Yes (true) |
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (23 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt |
|---|---|---|---|---|---|---|---|
| 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 |
| Bloomington Endo Center LLC | |||||||
| PO Box 550 | Bloomington | IN | 47402 | 352117943 | 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 |
| Clarian Health Network LLC | |||||||
| 950 N Meridian St Ste 800 | Indianapolis | IN | 46204 | 352055030 | Healthcare | IN | NA |
| Eagle High Surg Center LLC | |||||||
| 569 Brookwood Village Ste 901 | Birmingham | AL | 35244 | 352259204 | Healthcare | IN | NA |
| EHSC Holdings LLC | |||||||
| 950 N Meridian St Ste 800 | Indianapolis | IN | 46204 | 454147879 | Healthcare | IN | NA |
| EWASC Holdings LLC | |||||||
| 950 N Meridian St Ste 800 | Indianapolis | IN | 46204 | 473087761 | Healthcare | IN | NA |
| Health Venture Management LLC | |||||||
| 950 N Meridian St Ste 300 | Indianapolis | IN | 46204 | 205740218 | Management | IN | NA |
| IEC Holdings LLC | |||||||
| 950 N Meridian St Ste 800 | Indianapolis | IN | 46204 | 454148032 | Healthcare | IN | NA |
| Indiana Endoscopy Centers LLC | |||||||
| 569 Brookwood Village Ste 901 | Birmingham | AL | 35244 | 208398421 | Healthcare | IN | NA |
| IUH EWA Surgery Ctr LLC | |||||||
| 569 Brookwood Village Ste 901 | Birmingham | AL | 35244 | 473102482 | Healthcare | IN | NA |
| IUH Saxony Surgery Ctr LLC | |||||||
| 569 Brookwood Village Ste 901 | Birmingham | AL | 35244 | 275271091 | 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 |
| SSC Holdings LLC | |||||||
| 950 N Meridian St Ste 800 | Indianapolis | IN | 46204 | 464472887 | Healthcare | IN | NA |
| SSSC Holdings LLC | |||||||
| 950 N Meridian St Ste 800 | Indianapolis | IN | 46204 | 454148167 | Healthcare | IN | NA |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (23 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Entity TypeEntityTypeTxt | Controlled OrganizationControlledOrganizationInd | Address Line1ForeignAddress/AddressLine1Txt | CityForeignAddress/CityNm | Province Or StateForeignAddress/ProvinceOrStateNm | CountryForeignAddress/CountryCd | Legal Domicile Foreign CountryLegalDomicileForeignCountryCd |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| BMH Medical Pavilion Association Inc | ||||||||||||||
| 2525 W University Ave | Muncie | IN | 47303 | 351858408 | Condo Management | IN | NA | C | Yes (true) | |||||
| Cardinal Health Ventures Inc | ||||||||||||||
| 950 N Meridian St Ste 800 | Indianapolis | IN | 46204 | 351611424 | Management | IN | NA | C | Yes (true) | |||||
| CHV Capital Inc | ||||||||||||||
| 950 N Meridian St Ste 800 | Indianapolis | IN | 46204 | 260752507 | Venture Capital | IN | NA | C | Yes (true) | |||||
| IU Health 457(B) Plan | ||||||||||||||
| 1100 N Market St | Wilmington | DE | 19890 | 476948347 | Investments | IN | NA | T | Yes (true) | |||||
| IU Health ACO Inc | ||||||||||||||
| 950 N Meridian St Ste 800 | Indianapolis | IN | 46204 | 454421020 | Healthcare | IN | NA | C | Yes (true) | |||||
| IU Health Board Designated Trust | ||||||||||||||
| 400 Howard St | San Francisco | CA | 94105 | 306309021 | Investments | IN | NA | T | Yes (true) | |||||
| IU Health NTGI S&P500 Fund CF | ||||||||||||||
| PO Box 804358 | Chicago | IL | 60680 | 306298263 | Investments | IN | NA | T | Yes (true) | |||||
| IU Health Plans Holding Company Inc | ||||||||||||||
| 950 N Meridian St Ste 800 | Indianapolis | IN | 46204 | 463794815 | Insurance | IN | NA | C | Yes (true) | |||||
| IU Health Plans Inc | ||||||||||||||
| 950 N Meridian St Ste 800 | Indianapolis | IN | 46204 | 262127080 | HMO | IN | NA | C | Yes (true) | |||||
| IU Health Risk Purchasing Group Inc | ||||||||||||||
| 151 Meeting St Ste 301 | Charleston | SC | 29401 | 260202446 | Insurance | IN | NA | C | Yes (true) | |||||
| IU Health Risk Retention Group Inc | ||||||||||||||
| 151 Meeting St Ste 301 | Charleston | SC | 29401 | 201107674 | Insurance | SC | NA | C | Yes (true) | |||||
| IU Health Southern IN Physicians Inc | ||||||||||||||
| 950 N Meridian St Ste 300 | Indianapolis | IN | 46204 | 351913875 | Healthcare | IN | NA | C | Yes (true) | |||||
| IUH Assurance SPC Ltd | ||||||||||||||
| 980395429 | Insurance | NA | C | Yes (true) | PO BOX 69 94 SOLARIS AVE | CAMANA BAY | GRAND CAYMAN | CJ | CJ | |||||
| Occ-Health Revenue Systems Inc | ||||||||||||||
| 950 N Meridian St Ste 800 | Indianapolis | IN | 46204 | 203308057 | Work Comp PPO | IN | NA | C | Yes (true) | |||||
| Parkmor Drug Inc | ||||||||||||||
| 1501 S Main St | Goshen | IN | 46526 | 131394980 | Pharmacy Sales | IN | NA | C | Yes (true) | |||||
| PILR Inc | ||||||||||||||
| 200 High Park Ave | Goshen | IN | 46526 | 204294750 | Development | IN | NA | C | Yes (true) | |||||
| Proteuo Fund LP | ||||||||||||||
| 981075227 | Investments | NA | C | Yes (true) | PO BOX 31106 89 NEXUS WAY | CAMANA BAY | GRAND CAYMAN | CJ | CJ | |||||
| Radiation Oncology Resources Inc | ||||||||||||||
| 200 High Park Ave | Goshen | IN | 46526 | 262008424 | Healthcare | IN | NA | C | Yes (true) | |||||
| SCANS Inc | ||||||||||||||
| 950 N Meridian St Ste 800 | Indianapolis | IN | 46204 | 453080392 | Healthcare | IN | NA | C | Yes (true) | |||||
| Univ Hlth (Shanghai) Mgt Con Co Ltd | ||||||||||||||
| Management | NA | C | Yes (true) | 88 CENTURY AVE | SHANGHAI | CH | CH | |||||||
| University Health Management Inc | ||||||||||||||
| 950 N Meridian St Ste 800 | Indianapolis | IN | 46204 | 272891143 | Management | IN | NA | C | Yes (true) | |||||
| University Health Mgmt (China) Inc | ||||||||||||||
| 950 N Meridian St Ste 800 | Indianapolis | IN | 46204 | 273891311 | Management | IN | NA | C | Yes (true) | |||||
| IU Health Plans Insurance Company | ||||||||||||||
| 950 N Meridian St Ste 800 | Indianapolis | IN | 46204 | 811097215 | Insurance | IN | NA | C | Yes (true) | |||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | false | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | false | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | false | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | false | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | false | DivRelatedOrganizationInd |
| Asset Sale To Other Org | false | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | false | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | false | AssetExchangeInd |
| Rental Of Facilities To Oth Org | Yes (true) | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | Yes (true) | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | Yes (true) | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (true) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | false | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (true) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | false | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | false | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | Yes (true) | TransferToOtherOrgInd |
| Transfer From Other Org | false | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (2 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| IU HEALTH CARE ASSOCIATES INC | ||
| M | $153,158 | FMV |
| IU HEALTH RISK RETENTION GROUP INC | ||
| R | $143,399 | FMV |