2015-11-13T15:11:27-06:00 2014-12-31 ERNST & YOUNG US LLP 111 MONUMENT CIRCLE SUITE 4000 INDIANAPOLIS IN 46204 990 2014-01-01 351720796 INDIANA UNIVERSITY HEALTH BLOOMINGTON INC % BROC L BUDDE INDI 3179624575 950 N MERIDIAN STREET SUITE 800 INDIANAPOLIS IN 46204 MICHAEL L CRAIG VP & CFO 2015-11-13 JENNIFER D RHODERICK P00395735 3176817000 2014 2016-03-07 17:11:31Z MARK E MOORE 950 N MERIDIAN ST STE 800 INDIANAPOLIS IN 46204 456184097 false X HTTP://IUHEALTH.ORG/BLOOMINGTON/ X 1988 IN Improve the health of our patients and community through innovation and excellence in care, education, research and service. 18 15 2910 150 5372369 135569 1712882 1652104 378211173 408294091 36101942 5187499 5590103 5103110 421616100 420236804 3000 3000 0 0 166792293 140569029 0 0 0 163785469 186825284 330580762 327397313 91035338 92839491 377689634 469625345 39486289 79832356 338203345 389792989 Improve the health of our patients and community through innovation and excellence in care, education, research and service. false false 266166336 3000 408294091 Indiana University Health Bloomington, Inc. ("IU Health Bloomington") is a 293-bed full service hospital that offers a broad range of services to care for its patients without regard to their ability to pay. Based upon the values of trust, excellence, accountability, and mutual respect, IU Health Bloomington enhances the health of its patients and community in south-central Indiana by advancing the art and science of medicine through the use of new technologies, procedures, and care. 266166336 true true false true false false false false false true true false false false true false false true false false false false false false false false true true false false true false false false false false false false false false false false false false true true true false false true 370 0 true 2910 true true true false false false false false false false false false X 18 15 true false false false true true true true true false false true true true true true true true true true true IN X BROC L BUDDE 3179624575 950 N MERIDIAN STREET SUITE 800 INDIANAPOLIS IN 46204 X JOYCE B POLING CHAIR 2.0 0.0 X X 0 0 0 LYNN H COYNE VICE CHAIR 2.0 0.0 X X 0 0 0 LINDA S WILLIAMSON DIRECTOR/SECRETARY 2.0 0.0 X X 0 0 0 SUSAN D WIER DIRECTOR/TREASURER 2.0 0.0 X X 0 0 0 ALLEN W DUNN MD DIRECTOR 2.0 0.0 X 0 0 0 DANIEL F EVANS JR DIRECTOR 2.0 55.0 X 0 8074963 31654 JAMES V FARIS MD DIRECTOR 2.0 0.0 X 0 0 0 JAMES GARDNER MD DIRECTOR 2.0 0.0 X 0 0 0 MICHAEL L GENTILE MD DIRECTOR 2.0 0.0 X 0 0 0 CHAD A JOHNSON MD DIRECTOR 2.0 0.0 X 0 0 0 CHRISTOPHER J KROLL DIRECTOR 2.0 0.0 X 0 0 0 JAMES J LAUGHLIN MD DIRECTOR 2.0 40.0 X 0 605260 10400 DENNIS M MURPHY DIRECTOR (PARTIAL YEAR) 2.0 55.0 X 0 1254844 439919 MICHAEL A ROBBINS DIRECTOR 2.0 0.0 X 0 0 0 KENT N RODGERS DIRECTOR 2.0 0.0 X 0 0 0 ELEANOR H ROGERS RN DIRECTOR 2.0 0.0 X 0 0 0 LINDA L SIMON DIRECTOR 2.0 0.0 X 0 0 0 BRADLEY C WHEELER DIRECTOR 2.0 0.0 X 0 0 0 BARBARA A WRENN DIRECTOR 2.0 0.0 X 0 0 0 MARK E MOORE PRESIDENT & CEO 50.0 0.0 X 498632 0 155216 MICHAEL L CRAIG VP & CFO 50.0 0.0 X 210132 0 33994 KENNETH E MARSHALL MD VP & CMO 50.0 0.0 X 324575 0 77172 RUTH ANN MORRIS RN VP & CNO 50.0 0.0 X 277868 0 36495 MARK W MCMATH VP & CIO 50.0 0.0 X 209959 0 60106 STEVEN D DECKARD VP, HUMAN RESOURCES 50.0 0.0 X 180211 0 38649 LARRY R BAILEY VP 50.0 0.0 X 224391 0 48381 AMARTYADEB GOSWAMI MD PHYSICIAN 50.0 0.0 X 351275 0 41355 CAREY C MAYER MD PSYCHIATRIST 50.0 0.0 X 218823 0 23102 STEVEN M GOAD MD PSYCHIATRIST 50.0 0.0 X 218174 0 31264 CHAD W SHULTHEIS MD PSYCHIATRIST 50.0 0.0 X 214202 0 32119 A PERRY GRIFFITH MD PSYCHIATRIST 50.0 0.0 X 213965 0 28497 JAMES J MYERS FORMER VP & CFO 0.0 0.0 X 439969 0 46446 3582176 9935067 1134769 85 true true false PREMIER HEALTHCARE LLC 550 S LANDMARK AVE BLOOMINGTON IN 47403 MEDICAL 3224142 COGENT HMG PO BOX 645037 CINCINNATI OH 45264 MEDICAL 1482238 MAYO COLLABORATIVE SERVICES INC PO BOX 1787 MINNEAPOLIS MN 55480 LABORATORY 1276543 IU HEALTH CARE ASSOCIATES INC 950 N MERIDIAN ST STE 800 INDIANAPOLIS IN 46204 MEDICAL 943772 TOTAL RENAL CARE INC PO BOX 8500-1607 PHILADELPHIA PA 19178 MEDICAL 882052 19 1488792 163312 1652104 NET PATIENT SERVICE REVENUE 621110 299760289 299760289 0 0 REFERENCE LABORATORY 621500 106232655 101093695 5138960 INCOME (LOSS) FROM PASS-THROUGH ENTITIES 532000 1400775 1400775 SHARED SERVICES 541900 859192 852592 6600 RENT FROM RELATED 501(C)(3) ORGS. 532000 41180 41180 408294091 3347272 3347272 0 0 1027055 803065 223990 0 223990 226809 -2819 36984455 35144228 1840227 1840227 1840227 0 0 0 CAFETERIA/FOOD SERVICE 721110 1322693 1322693 VENDING 900099 283074 283074 EDUCATION 900099 82055 82055 3191298 3191298 4879120 420236804 403148531 5372369 10063800 X 3000 3000 0 0 0 2375781 2046051 329730 0 110864949 95478237 15386712 4533301 3904134 629167 14510833 12496905 2013928 8284165 7134423 1149742 0 262138 262138 163806 163806 9986 9986 0 505704 505704 35273287 5239060 30034227 0 1181575 971650 209925 2213133 864475 1348658 6210017 4481527 1728490 0 7832142 6431105 1401037 704749 609916 94833 0 712226 585585 126641 1615724 1454709 161015 0 17626309 17213707 412602 2450065 267250 2182815 DRUGS AND MEDICAL SUPPLIES 53585412 53585412 BAD DEBT 23662889 23662889 HOSPITAL ASSESSMENT FEE 23423953 23423953 UBI TAX (REFUND) 443827 443827 8948342 6312348 2635994 327397313 266166336 61230977 0 0 13848 6042571 117560959 0 0 46223552 47425831 0 0 0 0 0 2904121 2809771 4248774 4971820 2212828 382347372 278106673 110524218 104240699 180739011 179758391 0 0 3891502 2768776 3583576 3583576 18903613 4907542 377689634 469625345 23249339 29929973 0 0 0 35005 0 0 0 0 0 0 6203495 216497 0 0 10033455 49650881 39486289 79832356 X 333386021 384886335 4182693 4272023 634631 634631 338203345 389792989 377689634 469625345 X 92839491 -1307094 -85694 -39857059 X false true X true true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 9986 9986 false false Schedule C, Part II-B, Line 1i - Other Activities IU Health Bloomington paid institutional membership dues to the American Hospital Association ("AHA") and Indiana Hospital Association ("IHA") during 2014 in the amount of $36,019 and $27,289, respectively. Each membership organization notified IU Health Bloomington that a portion of the dues it paid were used for lobbying purposes. The AHA used 23.65%, or $8,518 of the 2014 membership dues paid by IU Health Bloomington, for lobbying expenditures. The IHA used 5.38%, or $1,468 of the 2014 membership dues paid by IU Health Bloomington, for lobbying expenditures. The total membership dues paid to these organizations by IU Health Bloomington during 2014 that were attributable to lobbying expenditures was $9,986. 4817324 89330 4906654 4104847 712477 4817324 3571184 533663 4104847 4313701 742517 3571184 4108745 204956 4313701 0.00000 0.12934 0.87066 true false 19707250 19707250 158269639 103827368 54442271 6260615 4800676 1459939 194181962 167933502 26248460 3927906 1545127 2382779 104240699 0 INTERCOMPANY PAYABLES (NET) 32790539 PENSION AND OTHER RETIREMENT LIAB. 10934581 DUE TO THIRD-PARTY PAYORS 4749260 SELF-INSURANCE LIABILITIES 585751 ENVIRONMENTAL OBLIGATIONS 412602 ACCRUED LOAN GUARANTEES 178148 49650881 Schedule D, Part V, Line 4 - Intended Uses of Org.'s Endowment Funds Temporarily and permanently restricted net assets are generally restricted for indigent and other patient care services, medical education and research programs, and medical supplies and equipment. Schedule D, Part X, Line 2 - FIN 48 (ASC 740) Footnote IU Health Bloomington is a subsidiary in the consolidated financial statements of IU Health. IU Health adopted FIN 48 in 2007. No disclosures were required in 2014 under GAAP as IU Health does not have any material tax contingencies that required disclosures in the footnotes. true true X true X true X true true true false true true 11948 10611150 10611150 0.03490 41406 52088631 40177500 11911131 0.03920 53354 62699781 40177500 22522281 0.07410 42 113673 1910798 377373 1533425 0.00500 3 2595 379734 6773 372961 0.00120 3 231 12305550 8527020 3778530 0.01240 1 6 2327 2327 6 30290 514752 474413 40339 0.00010 55 146795 15113161 9385579 5727582 0.01870 55 200149 77812942 49563079 28249863 0.09280 1 163 163 4 86 9178 5922 3256 4 72 3858 2499 1359 9 158 13199 8421 4778 false 7498770 0 85180755 106903679 -21722924 X true true SEE PART VI AMBULATORY SURGERY CENTER 0.51000 0.00000 0.49000 SEE PART VI DIAG. AND OTHER OUTPATIENT 0.50000 0.00000 0.50000 SEE PART VI AMBULATORY SURGERY CENTER 0.50000 0.00000 0.50000 1 1 IU HEALTH BLOOMINGTON HOSPITAL 601 WEST SECOND STREET BLOOMINGTON IN 47403 HTTP://IUHEALTH.ORG/BLOOMINGTON/ 14-005047-1 X X X IU HEALTH BLOOMINGTON HOSPITAL false false true X X X X X X X X X 13 true false false true X SEE PART V, SECTION C X true 13 true SEE PART V, SECTION C false false true X 200. 400. X X X X X X true true X X X true X X X X X X X X X true X false X X X X true X false false Schedule H, Part V, Section B, Line 5 - Input from Community In conducting its most recent CHNA, IU Health Bloomington took into account input from persons who represent the broad interests of the community it serves by hosting several community conversation focus groups. These focus groups included public health officials and community leaders to discuss the healthcare needs of the service area and what role IU Health Bloomington could play in addressing the identified needs. To obtain a more complete picture of the factors that play into IU Health Bloomington's community's health, input from public health officials and community leaders in Bloomington County was gathered through two separate two-hour community conversation focus group sessions. The first was a two hour live group session at IU Health Bloomington, and the second was held via a phone conference call for those who were not able to meet in person. IU Health Bloomington facilitators 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. Attendees who participated in the focus group included: Elizabeth Thompson - Former Executive Director, Volunteer's in Medicine ("VIM") - Ms. Thompson is representative of a community perspective regarding access to care. As former Executive Director of VIM, she works to provide access to care for underserved and low-income populations. Barry Lessow - Executive Director, United Way of Monroe County - Mr. Lessow is representative of a community perspective toward healthy living. As Executive Director of the United Way of Monroe County, he works for an organization that believes in helping people learn more, earn more, and lead safe and healthy lives in order to create programs that assist in accomplishing those goals. Mark Kruzan - Mayor of Bloomington - Mr. Kruzan is representative of a community perspective toward healthy living. As mayor of Bloomington, Mayor Kruzan is knowledgeable on what the community's needs are, and the resources that are available to address those needs. Penny Caudill - Administrator, Monroe County Health Department - Ms. Caudill is representative of a community perspective toward overall public health. As an employee of the health department, she understands the issues and obstacles involved in the area of public health, as well as ways to address and improve them. Daniel Peterson - Board Member, IU Health Bloomington - Mr. Peterson is representative of a community perspective toward healthy living. As a board member at IU Health Bloomington, he is knowledgeable on what the community's needs are, and the resources that are available to address those needs. Ellie Rogers - Board Member, IU Health Bloomington & Member of Local Council of Women - Ms. Rogers is representative of a community perspective toward healthy living. As a board member at IU Health Bloomington, she is knowledgeable on what the community's needs are, and the resources that are available to address those needs. Mark Moore - CEO, IU Health Bloomington - Mr. Moore is representative of a community perspective toward healthy living. As CEO of IU Health Bloomington, he is knowledgeable on what the community's needs are, and the resources that are available to address those needs. Carol Weiss-Kennedy - Director, Community Health, IU Health Bloomington - Ms. Weiss-Kennedy is representative of a community perspective toward healthy living. As Director of Community Health at IU Health Bloomington, she is knowledgeable on what the community's needs are, and the resources that are available to address those needs. Upon arrival to the focus group, participants were asked to list five health needs, which should be prioritized in their opinion, for the Marion County community served by IU Health Bloomington. 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 Bloomington facilitators then provided participants with a presentation featuring the mission of IU Health Bloomington, 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 Bloomington 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 Bloomington could be in meeting the local health needs. Schedule H, Part V, Section B, Line 7a - CHNA Website A copy of IU Health Bloomington's CHNA is available on its website at the following URL: 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 Bloomington'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 Bloomington chose to address all six of the community health needs identified in its most recently conducted CHNA. These include the following: - Access to Healthcare - Behavioral Health - PreK-12 Education - Obesity and Diabetes Prevention - Chronic Disease Prevention - Senior Health Access to Healthcare IU Health Bloomington's implementation strategy to address the identified need of access to healthcare includes the following: - Collaborate and promote continuity and support programs for inpatient and outpatient initiatives by educating staff on current healthcare resources - Support and promote Individual Solutions in community health programming and events - Provide appropriate clinical staffing and support for VIM program along with promoting volunteer opportunities - Quarterly Wellness screenings - Increase access to IU Health financial assistance program and other government-sponsored programs Behavioral Health IU Health Bloomington's implementation strategy to address the identified need of behavioral health: - Establish Behavioral Health Task Force and collaborate with existing providers - Provide community education when appropriate via health fairs and awareness events and collaborate with community agencies in suicide prevention activities. - Provide behavioral health screening and continue substance abuse counseling through Positive Link PreK-12 Education IU Health Bloomington's implementation strategy to address the identified need of PreK-12 education includes the following: - Support instruction on healthy lifestyles and programming, High School Initiative, Health School challenge - Implementation of an elementary school garden Obesity and Diabetes Prevention IU Health Bloomington's implementation strategy to address the identified need of Obesity and Diabetes Prevention includes the following; - Develop, provide and support walking groups, Adult obesity intervention and mobile food deployment - Well checks and A1C screening throughout community - Develop Registered Dietician relationship in South Indiana Physician Group Clinics Chronic Disease Prevention IU Health Bloomington's implementation strategy to address the identified need of Chronic Disease Prevention includes the following: - Promote positive choices in nutrition and exercise in all community programming - Support monthly well checks - Care Coordination of Positive Link Clients - Integrate community health with marketing - Support walking groups - Partner with SIP to include discussion of activity and diet with each client visit Senior Health IU Health Bloomington's implementation strategy to address the identified need of Senior Health includes the following: - Provide well checks at targeted sites and low cost immunizations - Support Senior Wellness Committee - Establish walking groups - Collaboration with the Bloomington Commission on Aging and Geriatric Clinical Nurse Specialist Schedule H, Part V, Section B, Line 13b - Income Level Other than FPG In addition to FPG, IU Health Bloomington may take into consideration a patient's income and/or ability to pay in calculation of a financial assistance award. Schedule H, Part V, Section B, Line 13h - Other FAP Factors IU Health Bloomington takes into consideration several other factors in determining patient eligibility for financial assistance. These factors include the following: 1. Alternate Sources of Assistance When technically feasible, a patient will be required to exhaust all other state and federal assistance programs prior to receiving an award from IU Health Bloomington's Financial Assistance Program. Patients who may be eligible for coverage under an applicable insurance policy, including, but not limited to, health, automobile, and homeowner's, must exhaust all insurance benefits prior to receiving an award from IU Health Bloomington's Financial Assistance Program. This includes patients covered under their own policy and those who may be entitled to benefits from a third-party policy. Patients may be asked to show proof that such a claim was properly submitted to their insurance provider at the request of IU Health Bloomington. Eligible patients who receive medical care from IU Health Bloomington as a result of an injury proximately caused by a third party, and later receive a monetary settlement or award from said third party, may receive Financial Assistance for any outstanding balance not covered by the settlement or award to which IU Health Bloomington is entitled. Said patients may be asked to complete a financial assistance application. 2. Presumptive Financial Assistance Eligibility Patients who are deemed to be presumptively eligible for Financial Assistance will receive a Financial Adjustment to their final statement balance based on the patient's individual scoring criteria. Patients are considered to be presumptively eligible for Financial Assistance if the financial need has been determined by the following third parties: Eskenazi Health, formerly Wishard Memorial Hospital, Project Health, Indiana Children's Special Health Care Services, Medicaid, Out-of-State Medicaid, Healthy Indiana Plan, or Volunteers in Medicine. Patients are also considered to be presumptively eligible if they are pending Medicaid approval or have a hospital bill with a maximum balance to be determined by the Financial Assistance Committee and who meet certain risk segmentation scoring criteria. 3. Additional Considerations Financial Assistance may be granted to a deceased patient's account if said patient is found to have no estate. Additionally, IU Health Bloomington will deny or revoke Financial Assistance for any patient or guarantor who falsifies any portion of a Financial Assistance application. Schedule H, Part V, Section B, Line 16a - FAP Website A copy of IU Health Bloomington's FAP is available on the following website: http://iuhealth.org/patients/my-iu-health/billing-services/financial-assis tance/ Schedule H, Part V, Section B, Line 16b - FAP Application Website A copy of IU Health Bloomington's FAP Application is available on the following website: http://iuhealth.org/patients/my-iu-health/billing-services/financial-assis tance/ Schedule H, Part V, Section B, Line 16i - Other Measures to Publicize IU Health Bloomington takes several other measures to publicize its FAP within the community. These measures include the following: 1. Signs are posted in appropriate acute care settings such as the emergency department and registration areas describing the available assistance and directing eligible patients to the Financial Assistance Application. 2. IU Health Bloomington includes a plain language description of its FAP with all patient bills and statements of services. 3. IU Health Revenue Cycle Services representatives are available via telephone Monday through Friday, excluding major holidays, from 8 a.m. to 7 p.m. (Eastern Time) to address questions related to Financial Assistance. 4. IU Health Revenue Cycle Services educates its patient facing team members of its FAP and the process for referring patients to the Program. Schedule H, Part V, Section B, Line 22d - Other Determination of Charges IU Health Bloomington limits the amounts charged for Emergency or other Medically Necessary Services provided to individuals eligible for assistance under its FAP to not more than amounts generally billed to individuals who have insurance coverage for such care. The basis for calculating the amount charged to all patients, including those who are eligible for Financial Assistance, is derived through the use of a chargemaster or physician fee schedule and are uniformly applied. All additional discounts required by insurance contract or IU Health Bloomington's FAP are applied to the chargemaster or physician fee schedule calculated amount. IU Health Bloomington does not use gross charges in the calculation of the amount to charge a Financial Assistance eligible patient. 24 BLOOMINGTON ENDOSCOPY CENTER 550 LANDMARK AVE BLOOMINGTON IN 47402 AMBULATORY SURGERY SOUTHERN INDIANA SURGERY CENTER 2800 REX GROSSMAN BLVD BLOOMINGTON IN 47403 AMBULATORY SURGERY GREEN COUNTY WIC 200 E MAIN ST STE 1 BLOOMFIELD IN 47424 DIAGNOSTIC AND OTHER OUTPATIENT IU HEALTH ADVANCED HEART CARE CENTER 714 S ROGERS ST BLOOMINGTON IN 47403 DIAGNOSTIC AND OTHER OUTPATIENT IU HEALTH ANTICOAGULATOIN CLINIC 451 LANDMARK AVE BLOOMINGTON IN 47403 DIAGNOSTIC AND OTHER OUTPATIENT IU HEALTH BEHAVIORAL HEALTH 445 LANDMARK AVE BLOOMINGTON IN 47404 DIAGNOSTIC AND OTHER OUTPATIENT IU HEALTH BLOOMINGTON OCCUP SERVICES 326 S WOODCREST DR BLOOMINGTON IN 47401 DIAGNOSTIC AND OTHER OUTPATIENT IU HEALTH BLOOMINGTON URGENT CARE EAST 326 S WOODCREST BLOOMINGTON IN 47401 DIAGNOSTIC AND OTHER OUTPATIENT IU HEALTH CANCER RADIATION CENTER 2620 COTA DR BLOOMINGTON IN 47404 DIAGNOSTIC AND OTHER OUTPATIENT IU HEALTH CANCER RADIATION CNETER 9149 SR 37 RR 11 BEDFORD IN 47421 DIAGNOSTIC AND OTHER OUTPATIENT IU HEALTH CHILDREN'S THERAPY CENTER 4935 W ARLINGTON RD STE B C BLOOMINGTON IN 47404 DIAGNOSTIC AND OTHER OUTPATIENT IU HEALTH COMMUNITY HEALTH 333 E MILLER DR BLOOMINGTON IN 47401 DIAGNOSTIC AND OTHER OUTPATIENT IU HEALTH COMMUNITY HEALTH EDUC CENTER 431 S COLLEGE BLOOMINGTON IN 47403 DIAGNOSTIC AND OTHER OUTPATIENT IU HEALTH DIABETES CENTER 727 W 2ND ST BLOOMINGTON IN 47403 DIAGNOSTIC AND OTHER OUTPATIENT IU HEALTH EMERGENCY MEDICAL TRANSPORT 601 W 1ST ST BLOOMINGTON IN 47403 DIAGNOSTIC AND OTHER OUTPATIENT IU HEALTH OCCUPATIONAL HEALTH 3443 W 3RD ST BLOOMINGTON IN 47403 DIAGNOSTIC AND OTHER OUTPATIENT IU HEALTH PAIN CENTER 888 AUTO MALL RD BLOOMINGTON IN 47401 DIAGNOSTIC AND OTHER OUTPATIENT IU HEALTH REHAB AND SPORTS MDEDICINE 5 CRANE AVE SPENCER IN 47460 DIAGNOSTIC AND OTHER OUTPATIENT IU HEALTH REHAB AND SPORTS MEDICINE 328 S WOODCREST DR BLOOMINGTON IN 47401 DIAGNOSTIC AND OTHER OUTPATIENT IU HEALTH REHAB AND SPORTS MEDICINE 2499 W COTA DR BLOOMINGTON IN 47403 DIAGNOSTIC AND OTHER OUTPATIENT IU HEALTH WOUND CENTER 2920 MCINTIRE DR BLOOMINGTON IN 47404 DIAGNOSTIC AND OTHER OUTPATIENT IU HEALTH BLOOMINGTON HOSP HOME HEALTH 333 E MILLER DR BLOOMINGTON IN 47402 HOME HEALTH IU HEALTH HOSPICE 619 W 1ST ST BLOOMINGTON IN 47403 HOSPICE SIRA IMAGING CENTER 500 S LANDMARK AVE BLOOMINGTON IN 47403 DIAGNOSTIC AND OTHER OUTPATIENT Schedule H, Part IV, Line 1(a) - Name of Entity Bloomington Endoscopy Center, LLC Schedule H, Part IV, Line 2(a) - Name of Entity SIRA Imaging Center, LLC Schedule H, Part IV, Line 3(a) - Name of Entity Southern Indiana Surgery Center, LLC Schedule H, Part I, Line 3c - Other Factors Used in Determining Elig. IU Health Bloomington uses several factors other than Federal Poverty Guidelines ("FPGs") in determining eligibility for free or discounted care under its FAP. These factors include the following: 1. Indiana Residency Requirement IU Health Bloomington only makes Financial Assistance available to residents of the State of Indiana. IU Health Bloomington employs the same residency test as set forth in Indiana Code 6-3-1-12 to define as resident any individual who was domiciled in Indiana during the taxable year, or any individual who maintains a permanent place of residence in this state and spends more than one hundred eighty-three (183) days of the taxable year in Indiana. 2. Alternate Sources of Assistance When technically feasible, patients must exhaust all other state and federal assistance programs prior to receiving an award from IU Health Bloomington's Financial Assistance Program. Patients who may be eligible for coverage under an applicable insurance policy, including, but not limited to, health, automobile, and homeowner's, must exhaust all insurance benefits prior to receiving an award form IU Health Bloomington's Financial Assistance Program. This includes patients covered under their own policy and those who may be entitled to benefits from a third-party policy. Patients may be asked to show proof that such a claim was properly submitted to their insurance provider at the request of IU Health Bloomington. Eligible patients who receive medical care from IU Health Bloomington as a result of an injury proximately caused by a third party, and later receive a monetary settlement or award from said third party, may receive Financial Assistance for any outstanding balance not covered by the settlement or award to which IU Health Bloomington is entitled. Said patients may be asked to complete a financial assistance application. 3. Presumptive Financial Assistance Eligibility Patients who are deemed to be presumptively eligible for Financial Assistance will receive a Financial Adjustment to their final statement balance based on the patient's individual scoring criteria. Patients are considered to be presumptively eligible if the financial need has been determined by the following third parties: Eskenazi Health, formerly Wishard Memorial Hospital, Project Health, Indiana Children's Special Health Care Services, Medicaid, Out-of-State Medicaid, Healthy Indiana Plan, or Volunteers in Medicine. Patients may also be considered presumptively eligible if they are pending Medicaid approval or have a hospital bill with a maximum balance to be determined by the Financial Assistance Committee and who meet certain risk segmentation scoring criteria. 4. Additional Considerations Financial Assistance may be granted to a deceased patient's account if said patient is found to have no estate. IU Health Bloomington will deny or revoke Financial Assistance for any patient or guarantor who falsifies any portion of a Financial Assistance Application. A patient's income and/or ability to pay may be taken into consideration in the calculation of a financial assistance award. 5. Patient Assets IU Health Bloomington will consider patient Assets in the calculation of a patient's true financial burden. A patient's primary residence and one (1) motor vehicle will be exempted from consideration in most cases. IU Health Bloomington will apply the definitions set for in Indiana Administrative Code 405 IAC 2-3-15 to define a patient's primary residence and motor vehicle. A patient's primary residence is defined as the patient's principal place of residence. The patient's primary residence 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 not occupied by the patient's spouse or child under twenty-one (21) years of age. One (1) motor vehicle, regardless of its fair market value, may be excluded in limited circumstances defined in Indiana Administrative Code 405 IAC 2-3-15(d)(6). IU Health Bloomington reserves the right to adjust a patient's Federal Poverty Level ("FPL") if the patient demonstrates a claim or clear title to any extraordinary Asset not excluded from consideration under the above guidance. IU Health Bloomington will not seek the title to discovered Assets without the express authorization of the Financial Assistance Committee. Schedule H, Part I, Line 6a - C.B. Report Prepared by a Related Org. IU Health Bloomington's community benefit and other investments, encompassing its total community investment, are included in the IU Health Community Benefit Report which is prepared on behalf of and includes IU Health and its related hospital entities in the State of Indiana. The IU Health Community Benefit Report is made available to the public on IU Health's website at 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 System's community benefit efforts. It is also available by request through the Indiana State Department of Health or IU Health. Schedule H, Part I, Line 7, Column (c) - Total Community Benefit Expense Schedule H, Part I, Line 7, Column (f), Percent of Total Expense, is based on column (e) Net Community Benefit Expense. The percent of total expense based on column (c) Total Community Benefit Expense, which excludes direct offsetting revenue, is 25.62%. Schedule H, Part I, Line 7, Column (f) - Percent of Total Expense The amount of bad debt expense subtracted for purposes of calculating the percentage of total expense on Line 7, column (f) is $23,662,889. Schedule H, Part I, Line 7g - Subsidized Health Services IU Health Bloomington does not include any costs associated with physician clinics as subsidized health services. Schedule H, Part II - Promotion of Health in Communities Served IU Health Bloomington is part of the IU Health Statewide System. The IU Health Statewide System participates in a variety of community-building activities that address the social determinants of health in the communities it serves through investments in economic development efforts across the state, collaboration with like-minded organizations through coalitions that address key issues, and advocacy for improvements in the health status of vulnerable populations. This includes making contributions to community-building activities by providing investments and resources to local community initiatives that addressed economic development, community support and workforce development. Several examples include IU Health's support of the following organizations and initiatives that focus on some of the root causes of health issues, such as lack of education, employment and poverty: - Indianapolis Public Schools - Starfish Initiative - Early Learning Indiana - United Way Additionally, through the IU Health Statewide System's team member community benefit service program, "Strength That Cares", team members across the state make a difference in the lives of thousands of Hoosiers every year. For example, in 2014, almost 2,200 team members from IU Health worked together to create trails, install outdoor fitness equipment and beautify parks. Schedule H, Part III, Line 2 - Bad Debt Expense Methodology The amount reported on line 2 as bad debt is reported at cost, as calculated using the cost to charge ratio methodology. Schedule H, Part III, Line 4 - Bad Debt Expense IU Health Bloomington is a subsidiary in the consolidated financial statements of IU Health. IU Health's bad debt expense footnote is as follows: The provision for uncollected patient accounts, for all payors, is recognized when services are provided based upon management's 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 payor composition and aging, the significance of individual payors to outstanding accounts receivable balances, and historical write-off experience by payor category, as adjusted for collection indicators. The results of this review are then used to make any modifications to the provision for uncollected accounts and the allowance for uncollectible accounts. In addition, IU Health 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 IU Health and, in certain cases, are reclassified to charity care if deemed to otherwise meet financial assistance policies of IU Health. Schedule H, Part III, Line 8 - Medicare Shortfall The amount reported on Schedule H, Part III, Line 6 is calculated, in accordance with the Form 990 instructions, using "allowable costs" from the IU Health Bloomington Medicare Cost Report. "Allowable costs" for Medicare Cost Report purposes, however, are not reflective of all costs associated with IU Health Bloomington's participation in Medicare programs. For example, the Medicare Cost Report excludes certain costs such as billed physician services, the costs of Medicare Parts C and D, fee schedule reimbursed services, and durable medical equipment services. Inclusion of all costs associated with IU Health Bloomington's participation in Medicare programs would significantly increase the Medicare shortfall reported on Schedule H, Part III, Line 7. IU Health Bloomington's Medicare shortfall is attributable to reimbursements that are less than the cost of providing patient care and services to Medicare beneficiaries and does not include any amounts that result from inefficiencies or poor management. IU Health Bloomington accepts all Medicare patients knowing that there may be shortfalls; therefore it has taken the position that any shortfall should be counted as part of its community benefit. Additionally, it is implied in Internal Revenue Service Revenue Ruling 69-545 that treating Medicare patients is a community benefit. Revenue Ruling 69-545, which established the community benefit standard for nonprofit hospitals, states that if a hospital serves patients with governmental health benefits, including Medicare, then this is an indication that the hospital operates to promote the health of the community. Schedule H, Part III, Line 9b - Written Debt Collection Policy IU Health Bloomington's FAP and Bad Debt Referral 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 must submit a Financial Assistance Application within twenty-one (21) days of receiving their first billing statement from IU Health Bloomington. Individuals other than the patient, such as the patient's physician, family members, community or religious groups, social services or hospital personnel may request a Financial Assistance Application to be mailed to a patient's primary mailing address free of charge. IU Health Bloomington keeps all applications and supporting documentation confidential. 2. Eligibility Determination IU Health Bloomington informs 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 assistance and the patient or guarantor provides additional information for reconsideration, 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 may be submitted, along with the supporting documentation, to the Financial Assistance Committee for additional review/reconsideration. All decisions of the Financial Assistance Committee are final. A patient's Financial Assistance Application and eligibility determination will remain in effect for three-hundred-sixty-five (365) days from the date of receipt of a completed application. 3. Extraordinary Collection Actions IU Health Bloomington only implements its "Bad Debt Referral Policy" or other Extraordinary Collection Action after it has made reasonable efforts to determine whether the patient account is eligible for assistance under its FAP. When it is necessary to engage in such action, IU Health Bloomington, and its contracted third parties, will engage in fair, respectful and transparent collections activities. Patients or guarantors who have not applied for Financial Assistance and whose accounts have been engaged in Extraordinary Collection Actions may request Financial Assistance, complete an Application with requested documentation, and be considered for a reduction in their bill if it is within the two-hundred-forty (240) days of receiving their first billing statement. IU Health Bloomington may also suspend collection activity on an account while an Application is being processed and considered. IU Health Bloomington and its collection agencies will not provide assistance after an account has entered into legal proceedings without first obtaining written consent from its Financial Assistance Committee. The award of Financial Assistance may be subject to successful completion of a payment plan. In the event a patient or guarantor who is receiving Financial Assistance fails to complete the terms of their payment plan, IU Health Bloomington reserves the right to submit the unadjusted account balance, less any amount previously paid by the patient, to an Extraordinary Collection Action. Schedule H, Part VI, Line 2 - Needs Assessment Communities are multifaceted and so are their health needs. IU Health Bloomington understands that the health of individuals and communities are shaped by various social and environmental factors, along with health behaviors and additional influences. IU Health Bloomington assesses the health care needs of the communities it serves by conducting a CHNA. This assessment includes collaboration with other community organizations such as the Bloomington County Health Department, the Indiana State Department of Health, the Centers for Disease Control and Prevention and the United Way of Central Indiana. After completion of the CHNA, IU Health Bloomington reviewed the information gathered from community leader focus groups, community input surveys and statistical data. The needs identified were analyzed and ranked using the Hanlon method of prioritization to determine the prevalence and severity of community health needs and which ones were most critical. Additionally, the effectiveness of an intervention for each need and IU Health Bloomington's ability to impact positive change was evaluated. Schedule H, Part VI, Line 3 - Patient Education of Eligibility for Assist. IU Health Bloomington is committed to serving the healthcare needs of all of its patients regardless of their ability to pay for such services. To assist in meeting those needs, IU Health Bloomington has adopted a Financial Assistance Policy that provides Financial Assistance to eligible patients receiving Emergency or Medically-Necessary Services. This policy was developed and is utilized to determine a patient's financial ability to pay for services. IU Health Bloomington goes to great lengths to publicize its financial assistance policy and ensure that patients know they will be treated regardless of their ability to pay. IU Health Bloomington shares financial assistance information with patients throughout their entire episode of care and beyond including the admissions process, billing process, and online. 1. Admissions Process IU Health Bloomington educates all patient facing team members on its Financial Assistance Policy and the process for referring patients to the program. During the admissions process, opportunities for financial assistance are discussed with patients who are identified as self-pay (uninsured) or if they request assistance information. The patient is also provided with an Admissions Packet that outlines information regarding IU Health Bloomington's financial assistance program. Financial counselors are onsite to assist with financial concerns or questions during the patient's stay. Patient Financial Services Customer Service representatives are also available after the patient's stay to help patients apply for financial assistance, understand their bills, explain what they can expect during the billing process, accept payment (if needed), update their insurance or payor information, and update their address or other demographic information. 2. Billing Process IU Health Bloomington includes a plain language summary of its Financial Assistance Policy with all patient bills and statements of services. The plain language summary includes contact information allowing patients the ability to request financial assistance. Additionally, a Financial Assistance Application is mailed to all IU Health Bloomington patients with a patient balance due after insurance. IU Health Revenue Cycle Services representatives are available via telephone Monday through Friday, excluding major holidays, from 8 a.m. to 7 p.m. (Eastern Time) to address questions related to Financial Assistance. Customer Service team members will also mail paper applications to a patient at their request. 3. Online IU Health Bloomington's Financial Assistance Policy and Financial Assistance Application is available on its website at http://iuhealth.org/patients/my-iu-health/billing-services/financial-assis tance/. The website also includes contact information for customer service representatives to assist with the application process. Schedule H, Part VI, Line 4 - Community Information IU Health Bloomington is located in Monroe County, Indiana, a county located in south central Indiana. Monroe County includes ZIP codes within the towns of Bloomington, Ellettsville, and Unionville. Based on the most recent Census Bureau (2010) statistics, Monroe County's population is 137,974 persons with approximately 50% being female and 50% male. The county's population estimates by race are 85.8% White, 3.1% Hispanic or Latino, 3.4% Black, 5.6% Asian, 0.3% American Indian or Alaska Native, and 2.3% persons reporting two or more races. Monroe County has relatively high levels of educational attainment, as compared to other Indiana counties. Almost half of the population had an associate's, bachelor's or graduate/professional degree, a percentage that has increased slightly since 2000 (44.5% to 48%). An additional 18.8% had some college, but no degree. As of 2010, 24.3% of the population was a high school graduate or equivalent; however, this percentage has decreased by 1.9% since 2000. 35.8% of the IU Health Bloomington inpatient discharge population resides in Monroe County. 38% of community discharges were for patients with Medicare, 36% were for patients with commercial insurance, 18% were for patients with Medicaid, 7% were for self-pay (uninsured patients), and 1% was for other. Schedule H, Part VI, Line 5 - Promotion of Community Health IU Health Bloomington's promotion of community health included the following highlight: IU Health Bloomington continued outreach through the Get Onboard Active Living (G.O.A.L.) program. This family-focused community initiative targets childhood obesity by helping children and families live healthier lives. In addition, IU Health Bloomington's after-school program, G.O.A.L. University, was offered in 14 elementary schools in 2014, reaching more than 425 children in the Bloomington area. Schedule H, Part VI, Line 6 - Affiliated Health Care System IU Health Bloomington is part of the IU Health Statewide System. The IU Health Statewide System is Indiana's most comprehensive healthcare system. A unique partnership with the IU School of Medicine, one of the nation's leading medical schools, gives patients access to innovative treatments and therapies. IU Health is comprised of hospitals, physicians and allied services dedicated to providing preeminent care throughout Indiana and beyond. National Recognition - Six hospitals designated as Magnet by the American Nurses Credentialing Center recognizing excellence in nursing care. - Named to the 2013-2014 U.S. News & World Report's Best Hospitals Honor Roll, their highest distinction. - Eleven adult clinical programs ranked among the top 50 national programs in U.S. News & World Report - Ten pediatric clinical programs ranked among the top 50 national programs in the U.S. News & World Report 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. Research conducted by IU School of Medicine faculty gives IU Health physicians and patients access to the most leading-edge and comprehensive treatment options. Collaborative Strategic Research Initiative Conceived by IU Health and the IU School of Medicine in 2012, the Strategic Research Initiative aims to enhance the institutions' joint capabilities in fundamental scientific investigation, translational research and clinical trials targeting innovative treatments for disease. The two organizations committed to invest $150 million over five years to this new research collaboration. Established in 2013, the Center for Innovation and Implementation Science is partially supported by the Strategic Research Initiative. The new center, launched by the IU School of Medicine and the Indiana Clinical and Translational Sciences Institute, focuses on increasing efficacy and reducing costs at IU Health. With oversight of four specialized research and discovery units managed by IU School of Medicine researchers, the center will address problems with the potential to reduce costs or generate new revenue estimated at $5 million per year or more. IU Health Statewide System IU Health is a part of the IU Health Statewide System which continues to broaden its reach and positive impact throughout the state of Indiana. IU Health is Indiana's most comprehensive academic health center and consists of IU Health Methodist Hospital, IU Health University Hospital, Riley Hospital for Children at IU Health, and IU Health Saxony Hospital. Other hospitals in the IU Health Statewide System include the following: - IU Health Arnett Hospital - IU Health Ball Memorial Hospital - IU Health Bedford Hospital - IU Health Blackford Hospital - IU Health Bloomington Hospital - IU Health Goshen Hospital - IU Health La Porte Hospital - IU Health Morgan Hospital - IU Health North Hospital - IU Health Paoli Hospital - 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 Indiana's overall health. A comprehensive community outreach strategy and community benefit plan is in place that encompasses the academic medical center downtown Indianapolis, suburban Indianapolis and statewide entities around priority areas that focus on health improvement efforts statewide. IU Health is keenly aware of the positive impact it can have on the communities of need in the state of Indiana by focusing on the most pressing needs in a systematic and strategic way. Some ways we address our community health priorities as a system include: IU Health Day of Service The annual IU Health Day of Service is a high-impact, one-day event aimed at engaging IU Health team members in activities that address an identified community need. Tackling the issue of obesity in the communities IU Health serves, the sixth annual Day of Service in 2014 focused on leaving behind key physical assets to help meet a statewide need for more venues for physical activity and recreation. During the 2014 Day of Service: - More than 6,700 volunteer hours were dedicated by IU Health team members - IU Health team members gave their time to improve walking trails and park assets, which serve more than 63,000 residents across the state. - Over a dozen community parks were enhanced. - A new community-envisioned pocket park was created. - A community garden was improved with educational information. - Third grade classes at three schools were provided with free bikes, helmets, and locks. Additionally, the students were led through a bicycle safety course. - 125,000 pounds of debris were removed from 107 abandoned properties; 98 tons of mulch, 7 trees, and 3,424 flowers were planted to boost aesthetic appeal. Kindergarten Countdown As one of IU Health's signature programs and collaboration with United Way, Kindergarten Countdown helps hundreds of soon-to-be kindergartners improve their readiness for school. In addition to providing health screenings and vaccinations to students, the program offers assistance to parents in registering their kindergartners for school. Kindergarten Countdown summer camps are designed to provide at-risk youngsters the basic skills they need to succeed in their first year of school. From "Get Ready to Read" pre- and post-tests, campers in the IU Health camps achieved a 21 percent average increase in scores from the beginning of the four-week camp to the end. The program also creates positive impact by increasing awareness of kindergarten readiness, improving parent engagement and strengthening relationships between volunteers and team members at hospitals, schools and community organizations. IU Health recognizes that in some cases we don't have all the expertise or resources to address the needs of the community and other organizations are better suited to tackle some of the specific needs of the community. IU Health, therefore, provided financial support to like-minded non-profit organizations that are working to improve the health of the community in our identified priorities of need. Clinical Research Clinical trials are conducted at the following IU Health locations: Academic Health Center (IU Health Methodist Hospital, IU Health University Hospital, and Riley Hospital for Children at IU Health), IU Health Arnett Hospital, IU Health Bloomington Hospital, IU Health La Porte Hospital, IU Health North Hospital, IU Health Saxony Hospital and IU Health West Hospital. Methodist Research Institute ("MRI") The Biorepository at MRI, under IRB approval, collects human biological materials (blood, bone, tissue, urine) vital for medical research to provide the best way to study a variety of diseases and their potential treatments. Basic science researchers at MRI publish the results of their innovative grant-supported research in prestigious peer-reviewed journals. Their work has been recognized both nationally and internationally as they participate in system-wide collaborative efforts within IU Health as well as with the IU School of Medicine. 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 2014, 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 One of the first steps to improved health outcomes is having access to healthcare resources. To show its commitment to providing affordable healthcare access, IU Health treats all patients regardless of their ability to pay. IU Health is also working to raise awareness and works to identify individuals within our communities that have barriers to care and connect these individuals with better access and consistency of healthcare resources to meet their needs. Some ways that these IU Health hospitals address Access to Healthcare include: - Public Assistance Enrollment - Veggies and Vaccines - Indiana University Student Outreach Clinic - Indianapolis Public Schools Student Athlete Physicals - Fishers Fire Department QR Code Magnet Program for Immediate Access to Patient Medical Records - Partnership for a Healthy Hamilton County Obesity Prevention To improve the lifestyle of Indiana residents, IU Health has utilized innovative and best practice me X X X X true true false false false false false true false DANIEL F EVANS JR DIRECTOR 0 1110823 0 245134 0 6719006 0 13000 0 18654 0 8106617 0 0 JAMES J LAUGHLIN MD DIRECTOR 0 603280 0 0 0 1980 0 10400 0 0 0 615660 0 0 DENNIS M MURPHY DIRECTOR (PARTIAL YEAR) 0 971186 0 243000 0 40658 0 410500 0 29419 0 1694763 0 0 MARK E MOORE PRESIDENT & CEO 490615 0 0 0 8017 0 130296 0 24920 0 653848 0 0 0 MICHAEL L CRAIG VP & CFO 209468 0 0 0 664 0 9792 0 24202 0 244126 0 0 0 KENNETH E MARSHALL MD VP & CMO 322650 0 0 0 1925 0 45012 0 32160 0 401747 0 0 0 RUTH ANN MORRIS RN VP & CNO 230933 0 0 0 46935 0 11700 0 24795 0 314363 0 0 0 MARK W MCMATH VP & CIO 208956 0 0 0 1003 0 36204 0 23902 0 270065 0 0 0 STEVEN D DECKARD VP, HUMAN RESOURCES 177978 0 0 0 2233 0 16017 0 22632 0 218860 0 0 0 LARRY R BAILEY VP 210007 0 0 0 14384 0 31830 0 16551 0 272772 0 0 0 AMARTYADEB GOSWAMI MD PHYSICIAN 292018 0 0 0 59257 0 11700 0 29655 0 392630 0 0 0 CAREY C MAYER MD PSYCHIATRIST 217080 0 250 0 1493 0 9902 0 13200 0 241925 0 0 0 STEVEN M GOAD MD PSYCHIATRIST 216681 0 0 0 1493 0 10002 0 21262 0 249438 0 0 0 CHAD W SHULTHEIS MD PSYCHIATRIST 213229 0 250 0 723 0 9942 0 22177 0 246321 0 0 0 A PERRY GRIFFITH MD PSYCHIATRIST 209065 0 4380 0 520 0 9585 0 18912 0 242462 0 0 0 JAMES J MYERS FORMER VP & CFO 160525 0 0 0 279444 0 30891 0 15555 0 486415 0 0 0 Schedule J, Part I, Line 4a - Severance Payments James J. Myers received severance of $193,314 from IU Health Bloomington during 2014. This amount is included in column b (iii), other reportable compensation. Schedule J, Part I, Line 4b - Supplemental Nonqualified Retirement Plan Mark E. Moore, Kenneth E. Marshall, M.D., Ruth Ann Morris, R.N., Mark W. McMath, Steven D. Deckard, Larry R. Bailey, and James J. Myers participate in a supplemental executive retirement plan, provisions of which are designed to retain these critical employees. The plan provides for an additional retirement benefit for service through normal retirement or other key dates. If the executive leaves prior to retirement or other key dates, the benefit may be forfeited or reduced. With the exception of Ruth Ann Morris, R.N., each executive has an amount included in column c, deferred compensation, representing the current year unvested contributions made under the supplemental executive retirement plan. No amounts were actually paid to these executives during the year. Ruth Ann Morris, R.N. has $26,508 included in column b(iii), other reportable compensation, representing the current year vested amounts received under the supplemental executive retirement plan. Daniel F. Evans, Jr and Dennis M. Murphy participate in an IU Health supplemental executive retirement plan, provisions of which are designed to retain these critical employees. The plan provides for an additional retirement benefit for service through normal retirement or other key dates. If the executive leaves prior to retirement or other key dates, the benefit may be forfeited or reduced. Daniel F. Evans, Jr. has $6,645,085 included in column b(iii), other reportable compensation, representing the current year vested amounts received under the supplemental executive retirement plan. Dennis M. Murphy has an amount included in column c, deferred compensation, Schedule J, Part I, Line 7 - Non-Fixed Payments Amounts disclosed in Column B(ii) include incentives for certain executives. As part of IU Health Bloomington's executive compensation plan, annual goals are set for each member of the senior leadership group with each members' annual incentive determined upon the degree of successful completion of his or her set goals. Any incentive payouts are made in the form of a lump sum payment and do not affect the executive's base pay. Alternatively, the executive may elect to defer any or all of the incentive compensation through IU Health Bloomington's 457(f) plan, subject to any plan restrictions. Any incentive amounts for the President & CEO must receive approval from the Compensation Committee. All other incentive amounts must receive approval from the President & CEO and the Compensation Committee. Part VI, Section A, Line 2 - Family or Business Relationships Lynn H. Coyne, Christopher J. Kroll, M.D., Mark E. Moore, Michael L. Craig, Kenneth E. Marshall, M.D., and Larry R. Bailey served on the board of directors of Indiana University Health Southern Indiana Physicians, Inc. No additional compensation was provided to these individuals for their service. Chad A. Johnson, M.D. and Allen W. Dunn, M.D. served as members of Bloomington Anesthesiologists, P.C. Part VI, Section A, Lines 6, 7a and 7b - Members or Stockholders Line 6: The sole member of IU Health Bloomington is IU Health, a 501(c)(3) tax-exempt organization. Line 7A: The Board of Directors of the IU Health Bloomington shall consist of nineteen (19) directors. IU Health shall appoint and may remove ten (10) members of the Board. At all times (a) at least two (2) IU Health appointed directors shall be members of the hospital's active Medical Staff, (b) at least one (1) IU Health appointed director shall be a member of the IU Health Board of Directors and (c) at least one (1) IU Health appointed director shall be a senior IU Health executive. Line 7B: IU Health Bloomington shall not, without the prior approval of IU Health, do the following: - Authorize the establishment or acquisition of any subsidiaries, affiliates or joint venture arrangements or acquisition of all or substantially all of the assets of any other business entity; - Approve or amend any operating or capital budget; - Authorize any unbudgeted operating or capital budget item or deviations, including any issuance or guarantee of any unbudgeted debt, greater than the budgeted amount by $1 million for any individual item or $3 million per fiscal year in the aggregate; - Authorize any agreement to act as primary obligor, or to serve as a guarantor, surety or co-obligor with respect to the indebtedness of any other person or entity, to borrow amounts from third-party lenders or to loan money to any person or entity; - Approve any strategic plans and amendments thereto, which will be integrated with IU Health's strategic plan; - Subject to a supermajority vote of the Board and any approvals required, amend or repeal its Articles of Incorporation or By-Laws in any manner, including without limitation any change relating to the nonprofit purposes of the hospital; - Subject to a supermajority vote of the Board, authorize any merger, consolidation, reorganization, sale or transfer of all or substantially all of its assets; - Subject to a supermajority vote of the Board, authorize any voluntary declaration of bankruptcy, plan of dissolution, liquidating distribution of assets or other action related to its dissolution or liquidation; - Subject to a supermajority vote of the Board, authorize any pledge of, or grant any security interest or mortgage in, or otherwise encumber, any tangible assets in excess of $1 million for any individual pledge, grant or encumbrance or $3 million per fiscal year in the aggregate, other than in the ordinary course of business or pursuant to an approved budget; or - Subject to a supermajority vote of the Board, approve any management agreement for the management of all or a substantial part of the hospital's or any of its affiliate's operations. Part VI, Section B, Line 11b - Review of Form 990 The VP & CFO reviewed and approved the Form 990. Following the VP & CFO's review and approval, a complete copy of the Form 990 was made available to each board member prior to its filing. Each member was also informed of the availability of IU Health's Tax Department to answer any questions. Part VI, Section B, Lines 12, 13, 14, and 16b - Policies IU Health Bloomington is part of the IU Health system. As the sole member and controlling parent of IU Health Bloomington, IU Health and its Board of Directors have mandated that certain policies be followed to ensure greater standardization throughout the system. Thus, IU Health Bloomington's Board of Directors was not required to separately adopt a conflict of interest, whistleblower, document retention and destruction and joint venture policies because IU Health's Board of Directors had already adopted and required these policies to be followed by its subsidiaries. Part VI, Section B, Line 12c - Conflict of Interest Policy IU Health Bloomington follows IU Health's Conflict of Interest Policy. IU Health's Conflict of Interest Policy includes the following provisions: All IU Health employees, associates, colleagues and contracted personnel, including employed physicians and paid medical directors ("IU Health Representatives") are covered by and subject to its Conflict of Interest Policy. IU Health regularly and consistently monitors and enforces compliance with the policy through the following procedures: (a) On an annual basis, each IU Health Representative at the level of Manager or above, together with every other person designated by the Corporate Compliance Department ("Department"), must complete, sign and submit a Conflict of Interest Questionnaire ("Questionnaire") to the Department. Governing board members, committee members, corporate officers, medical staff and researchers must comply with the administrative requirements noted in the respective policies and procedures relative to those areas. (b) An IU Health Representative must supplement a Questionnaire in writing, if after completion of the original Questionnaire, a situation arises, or may reasonably be expected to arise, that would change any answer or information on the original Questionnaire if the situation had existed or been anticipated at the time of completion of the original Questionnaire. (c) If a fully and properly completed Questionnaire reveals facts or other information that might reasonably indicate a Conflict of Interest or violation of the policy, the IU Health Representative completing the questionnaire must secure approval by his/her supervisor, evidenced in writing. (d) The Department will review each Questionnaire and determine whether a Conflict of Interest exists and, if so, whether and how it should or may be eliminated, avoided or managed in order to comply with the spirit of the policy and with the best interests of IU Health and its patients. In making the determination, the Corporate Compliance Department may consult with the IU Health Representative's supervisor and other appropriate individuals and groups. (e) The scope of the policy is not limited to those who are required to complete Questionnaires. If an IU Health Representative is involved in a situation or relationship that would constitute a violation of the policy in the absence of disclosure and approval as described above, then the IU Health Representative must disclose the matter to his/her supervisor, secure his/her supervisor's approval in writing, and disclose the matter to the Department. Otherwise, the IU Health Representative is in violation of the policy and subject to corrective action, up to and including termination. (f) The Chief Compliance Officer, in consultation with onsite Compliance personnel, may from time to time appoint standing or ad hoc committees to assist in resolving issues that arise under provisions of the policy. Part VI, Section B, Line 15 - Process for Determining Compensation IU Health Bloomington has the following process for determining the compensation of its officers and key employees: IU Health Bloomington has a formal written policy governing the compensation for its President & CEO, VP & CFO, and all other members of its senior leadership group ("SLG"). The policy provides that the compensation and/or benefits for the SLG are to be reviewed on an annual basis, with any changes approved, by the Compensation Committee. The Compensation Committee is comprised of independent members and members of IU Health Bloomington's administrative staff shall not be present while discussions are being held. Any proposed changes in compensation and/or benefits for the SLG that come before the Compensation Committee are required to be reasonable and market competitive based upon market comparability data supplied by an independent compensation consulting firm directly hired by the Compensation Committee. Written minutes of the Compensation Committee's meetings shall be kept, containing a list of the members involved in the decision-making process, documentation of the independence of such members, and what decisions were made. Following approval by the Compensation Committee, any changes are then disclosed to the Board of Directors at its next regularly scheduled meeting. Part VI, Section C, Line 19 - Public Disclosure IU Health Bloomington's Articles of Incorporation are available to the public through the Indiana Secretary of State's web-site. IU Health Bloomington's conflict of interest policy is described on Form 990, Schedule O. IU Health Bloomington is a consolidated subsidiary in the consolidated financial statements for Indiana University Health, Inc. ("IU Health"). The consolidated financial statements for IU Health are available to the public through its bond filings. Part XI, Line 9 - Other Changes in Net Assets or Fund Balances During 2014, IU Health Bloomington recorded the following other changes in net assets or fund balances: Change in Interest in Net Assets of Foundation: $89,330 Change in Pension Obligation: -$12,913,909 Equity Transfers (Additional Paid-in-Capital): -$27,032,480 FORM 990 PART IX LINE 11G DESCRIPTION:SHARED SERVICES/PROF. 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