INDIANA UNIVERSITY HEALTH BLACKFORD HOSPITAL INC: Form 990, tax year 2014
View the entire original 990 at ProPublica ↗
- Organization
- INDIANA UNIVERSITY HEALTH BLACKFORD HOSPITAL INC (EIN 01-0646166)
- Tax period
- 2014-01-01 to 2014-12-31
- Filed
- 2015-11-12
- IRS object ID
- 201543169349301779
- Schema version
- 2014v5.0
- 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 J
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2015-11-12T09:52:18-06:00 | ReturnTs |
| Tax Period End | 2014-12-31 | 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 | 2014-01-01 | 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 | % BROC BUDDE | InCareOfNm |
| Business Name Control | INDI | BusinessNameControlTxt |
| Phone | 3179624575 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 950 N MERIDIAN STREET SUITE 800 | AddressLine1Txt |
| City | INDIANAPOLIS | CityNm |
| State Abbreviation | IN | StateAbbreviationCd |
| ZIP | 46204 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Judith L Coleman | PersonNm |
| Person Title | CFO | PersonTitleTxt |
| Signature | 2015-11-11 | SignatureDt |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | JENNIFER D RHODERICK | PreparerPersonNm |
| PTIN | P00395735 | PTIN |
| Phone | 3176817000 | PhoneNum |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2014 | TaxYr |
| Build TS | 2016-04-25 22:37:26Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | STEVEN J WEST | PrincipalOfficerNm |
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) |
|---|---|---|
| Gross Receipts | $19,088,083 | 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 | 8 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 6 | VotingMembersIndependentCnt |
| Total Employee | 158 | TotalEmployeeCnt |
| Total Volunteers | 52 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| PY Contributions Grants | $26,491 | PYContributionsGrantsAmt |
| CY Contributions Grants | $21,278 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $16,236,215 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $18,978,752 | CYProgramServiceRevenueAmt |
| PY Investment Income | -$33,640 | PYInvestmentIncomeAmt |
| CY Investment Income | $1,158 | CYInvestmentIncomeAmt |
| PY Other Revenue | $79,212 | PYOtherRevenueAmt |
| CY Other Revenue | $86,895 | CYOtherRevenueAmt |
| PY Total Revenue | $16,308,278 | PYTotalRevenueAmt |
| CY Total Revenue | $19,088,083 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $2,648 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $7,747,171 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $6,205,322 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $9,515,128 | PYOtherExpensesAmt |
| CY Other Expenses | $10,029,442 | CYOtherExpensesAmt |
| PY Total Expenses | $17,264,947 | PYTotalExpensesAmt |
| CY Total Expenses | $16,234,764 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$956,669 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $2,853,319 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $13,366,751 | TotalAssetsBOYAmt |
| Total Assets EOY | $16,570,097 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $3,457,260 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $3,807,287 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $9,909,491 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $12,762,810 | NetAssetsOrFundBalancesEOYAmt |
| 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 | $15,124,552 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $18,978,752 | RevenueAmt |
| Desc | Indiana University Health Blackford Hospital, Inc. ("IU Health Blackford Hospital") 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 provides unsurpassed care to the people of Blackford County, and boasts a specialty clinic, outpatient surgical services, and a paramedic-level ambulance service. At IU Health Blackford Hospital, patients and their loved ones experience superior care in a familiar community atmosphere. | Desc |
| Total Program Service Expenses | $15,124,552 | 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 | false | 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 | false | 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 | 26 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (true) | BackupWthldComplianceInd |
| Employee | 158 | 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 | 8 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 6 | 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 | Yes (true) | InvestmentInJointVentureInd |
| Written Policy Or Procedure | Yes (true) | WrittenPolicyOrProcedureInd |
| 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 | BROC BUDDE | PersonNm |
| Phone | 3179624575 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 950 N MERIDIAN STREET SUITE 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 (14 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 | ||
| J NOLAN WILLMAN | |||||||||
| VICE-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 | $132,691 | $17,460 | ||
| LORI A LUTHER | |||||||||
| DIRECTOR/TREASURER (PART YR) | 5.0 | 55.0 | Yes (X) | Yes (X) | $0 | $299,948 | $18,508 | ||
| MICHAEL E HALEY | |||||||||
| DIRECTOR | 5.0 | 55.0 | Yes (X) | $0 | $716,954 | $39,055 | |||
| KRISTIE B JENNERJAHN | |||||||||
| DIRECTOR | 5.0 | 0.0 | Yes (X) | $0 | $0 | $0 | |||
| GARY L RHOTON | |||||||||
| DIRECTOR | 5.0 | 0.0 | Yes (X) | $0 | $0 | $0 | |||
| LORI J SKIDMORE MD | |||||||||
| DIRECTOR | 5.0 | 0.0 | Yes (X) | $0 | $0 | $0 | |||
| MARK W TOWNSEND | |||||||||
| DIRECTOR | 5.0 | 0.0 | Yes (X) | $0 | $0 | $0 | |||
| JUDITH L COLEMAN | |||||||||
| CFO (PARTIAL YEAR) | 0.0 | 55.0 | Yes (X) | $0 | $152,988 | $35,204 | |||
| JEFFREY C BIRD MD | |||||||||
| CMO | 0.0 | 55.0 | $0 | $289,563 | $40,507 | Yes (X) | |||
| ELIZABETH A DROEGE MD | |||||||||
| PHYSICIAN | 55.0 | 0.0 | $317,825 | $0 | $31,087 | Yes (X) | |||
| THOMAS M LEE MD | |||||||||
| PHYSICIAN | 55.0 | 55.0 | $129,990 | $263,545 | $37,179 | Yes (X) | |||
| CHARLES L CARROLL DO | |||||||||
| PHYSICIAN | 55.0 | 0.0 | $128,193 | $0 | $5,128 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $576,008 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $1,855,689 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $224,128 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 3 | 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 | $250,916 | CompensationAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 1 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $21,278 | GovernmentGrantsAmt |
| Total Contributions | $21,278 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| NET PATIENT SERVICE REVENUE | 621110 | $18,942,477 | $18,942,477 |
| INCOME (LOSS) FROM PARTNERSHIPS | 900099 | $2,800 | $2,800 |
| SHARED SERVICES | 541900 | $33,475 | $33,475 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $18,978,752 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,158 | TotalRevenueColumnAmt |
| Exclusion | $1,158 | 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 | $36,488 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $36,488 | RealAmt |
| Personal | $0 | PersonalAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $36,488 | TotalRevenueColumnAmt |
| Exclusion | $36,488 | ExclusionAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Net Income From Gaming NetIncomeFromGamingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Net Income Or Loss NetIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Other Revenue Misc OtherRevenueMiscGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | ExclusionExclusionAmt |
|---|---|---|---|
| CAFETERIA/FOOD SERVICE | 721110 | $47,606 | $47,606 |
| VENDING | 900099 | $2,801 | $2,801 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $50,407 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $19,088,083 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $18,978,752 | RelatedOrExemptFuncIncomeAmt |
| Exclusion | $88,053 | 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 | $0 | TotalAmt |
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 | $4,940,408 | TotalAmt |
| Program Services | $4,349,762 | ProgramServicesAmt |
| Management And General | $590,646 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $183,011 | TotalAmt |
| Program Services | $161,131 | ProgramServicesAmt |
| Management And General | $21,880 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $741,238 | TotalAmt |
| Program Services | $652,620 | ProgramServicesAmt |
| Management And General | $88,618 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $340,665 | TotalAmt |
| Program Services | $299,937 | ProgramServicesAmt |
| Management And General | $40,728 | 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 | $6,976 | TotalAmt |
| Management And General | $6,976 | ManagementAndGeneralAmt |
Fees For Services Lobbying FeesForServicesLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,680 | TotalAmt |
| Management And General | $1,680 | 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 | $4,590,844 | TotalAmt |
| Program Services | $4,419,833 | ProgramServicesAmt |
| Management And General | $171,011 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,144 | TotalAmt |
| Management And General | $5,144 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $61,343 | TotalAmt |
| Program Services | $38,739 | ProgramServicesAmt |
| Management And General | $22,604 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $45,640 | TotalAmt |
| Program Services | $45,640 | ProgramServicesAmt |
Royalties RoyaltiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $453,717 | TotalAmt |
| Program Services | $442,780 | ProgramServicesAmt |
| Management And General | $10,937 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,924 | TotalAmt |
| Program Services | $2,806 | ProgramServicesAmt |
| Management And General | $1,118 | 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 | $0 | TotalAmt |
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 | $1,042,021 | TotalAmt |
| Program Services | $1,039,204 | ProgramServicesAmt |
| Management And General | $2,817 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $156,645 | TotalAmt |
| Program Services | $39,892 | ProgramServicesAmt |
| Management And General | $116,753 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt |
|---|---|---|
| BAD DEBT | $1,200,638 | $1,200,638 |
| DRUGS AND MEDICAL SUPPLIES | $1,012,642 | $1,012,642 |
| INSTITUTIONAL DUES/LICENSES | $10,561 | $10,561 |
| HOSPITAL ASSESSMENT FEE | $1,286,623 | $1,286,623 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $151,044 | TotalAmt |
| Program Services | $121,744 | ProgramServicesAmt |
| Management And General | $29,300 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $16,234,764 | TotalAmt |
| Program Services | $15,124,552 | ProgramServicesAmt |
| Management And General | $1,110,212 | 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 | $0 | BOYAmt |
| EOY | $3,517,754 | 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 | $2,663,926 | BOYAmt |
| EOY | $2,981,066 | 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 | $205,225 | BOYAmt |
| EOY | $204,831 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $71,865 | BOYAmt |
| EOY | $65,640 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $20,590,806 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $10,790,600 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,387,807 | BOYAmt |
| EOY | $9,800,206 | 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 | $37,328 | 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 | $13,366,751 | BOYAmt |
| EOY | $16,570,097 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,272,091 | BOYAmt |
| EOY | $1,233,871 | 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 | $17,915 | BOYAmt |
| EOY | $21,684 | 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 | $2,167,254 | BOYAmt |
| EOY | $2,551,732 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,457,260 | BOYAmt |
| EOY | $3,807,287 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,909,491 | BOYAmt |
| EOY | $12,762,810 | 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 | $9,909,491 | BOYAmt |
| EOY | $12,762,810 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $13,366,751 | BOYAmt |
| EOY | $16,570,097 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $2,853,319 | 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 | $1,680 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $1,680 | 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 2014 in the amount of $6,735 and $2,673, 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 22.80%, or $1,536 of the 2014 membership dues paid by IU Health Blackford Hospital, for lobbying expenditures. The IHA used 5.38%, or $144 of the 2014 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 2014 that were attributable to lobbying expenditures was $1,680. | 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 | $15,007,745 | OtherCostOrOtherBasisAmt |
| Depreciation | $6,911,208 | DepreciationAmt |
| Book Value | $8,096,537 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Leasehold Improvements | LeaseholdImprovementsGrp |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $5,093,309 | OtherCostOrOtherBasisAmt |
| Depreciation | $3,624,948 | DepreciationAmt |
| Book Value | $1,468,361 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $299,428 | OtherCostOrOtherBasisAmt |
| Depreciation | $254,444 | DepreciationAmt |
| Book Value | $44,984 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $9,800,206 | TotalBookValueLandBuildingsAmt |
| Federal Income Tax Liability | $0 | FederalIncomeTaxLiabilityAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (3 entries)
| DescDesc | AmtAmt |
|---|---|
| INTERCOMPANY PAYABLES | $284,898 |
| SELF-INSURANCE LIABILITIES | $28,035 |
| DUE TO THIRD-PARTY PAYORS | $2,238,799 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $2,551,732 | TotalLiabilityAmt |
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 the consolidated financial statements of Indiana University Health, Inc. ("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. | 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 | Yes (true) | FPGReferenceDiscountedCareInd |
| Percent400 | Yes (X) | Percent400Ind |
| Free Care Medically Indigent | Yes (true) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (true) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | Yes (true) | ExpensesExceedBudgetInd |
| Unable To Provide Care | false | UnableToProvideCareInd |
| 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 | 2313 | PersonsServedCnt |
| Total Community Benefit Expns | $1,046,592 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $1,046,592 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.06960 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 2111 | PersonsServedCnt |
| Total Community Benefit Expns | $2,680,173 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,345,038 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,335,135 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.08880 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 4424 | PersonsServedCnt |
| Total Community Benefit Expns | $3,726,765 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,345,038 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,381,727 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.15840 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 15 | ActivitiesOrProgramsCnt |
| Persons Served | 2663 | PersonsServedCnt |
| Total Community Benefit Expns | $127,680 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $14,359 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $113,321 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00750 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 2 | ActivitiesOrProgramsCnt |
| Persons Served | 45 | PersonsServedCnt |
| Total Community Benefit Expns | $25,670 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $25,670 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00170 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 2 | ActivitiesOrProgramsCnt |
| Total Community Benefit Expns | $1,066 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $1,066 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 19 | ActivitiesOrProgramsCnt |
| Persons Served | 2708 | PersonsServedCnt |
| Total Community Benefit Expns | $154,416 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $14,359 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $140,057 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00930 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 19 | ActivitiesOrProgramsCnt |
| Persons Served | 7132 | PersonsServedCnt |
| Total Community Benefit Expns | $3,881,181 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,359,397 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,521,784 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.16770 | TotalExpensePct |
Physical Imprv And Housing PhysicalImprvAndHousingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 1 | ActivitiesOrProgramsCnt |
| Persons Served | 28 | PersonsServedCnt |
| Total Community Benefit Expns | $3,134 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $3,134 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00020 | TotalExpensePct |
Community Support CommunitySupportGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 2 | ActivitiesOrProgramsCnt |
| Persons Served | 45 | PersonsServedCnt |
| Total Community Benefit Expns | $2,119 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $2,119 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
Coalition Building CoalitionBuildingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 1 | ActivitiesOrProgramsCnt |
| Persons Served | 770 | PersonsServedCnt |
| Total Community Benefit Expns | $2,822 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $2,822 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00020 | TotalExpensePct |
Health Improvement Advocacy HealthImprovementAdvocacyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 2 | ActivitiesOrProgramsCnt |
| Persons Served | 89 | PersonsServedCnt |
| Total Community Benefit Expns | $3,886 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $3,886 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00030 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 6 | ActivitiesOrProgramsCnt |
| Persons Served | 932 | PersonsServedCnt |
| Total Community Benefit Expns | $11,961 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $11,961 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00080 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | false | BadDebtExpenseReportedInd |
| Bad Debt Expense | $443,516 | BadDebtExpenseAmt |
| Reimbursed By Medicare | $8,948,434 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $8,255,365 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | $693,069 | 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 | 14-005101-1 | 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 |
| Information Gaps | Yes (X) | InformationGapsInd |
| CHNA Conducted | 13 | 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 | 13 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (true) | StrategyPostedWebsiteInd |
| Strategy Website URL | SEE PART V, SECTION C | StrategyWebsiteURLTxt |
| Strategy Attached | false | StrategyAttachedInd |
| 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 | 400. | 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 | X | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | X | FAPAppAvailableOnWebsiteURLTxt |
| 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 |
| FAP Notice Displayed | Yes (X) | FAPNoticeDisplayedInd |
| Other Publicity | Yes (X) | OtherPublicityInd |
| FAP Actions On Nonpayment | Yes (true) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | false | CollectionActivitiesInd |
| FAP Notified Upon Admission | Yes (X) | FAPNotifiedUponAdmissionInd |
| FAP Notified Before Discharge | Yes (X) | FAPNotifiedBeforeDischargeInd |
| FAP Notified All Patients | Yes (X) | FAPNotifiedAllPatientsInd |
| Documented Elig Determination | Yes (X) | DocumentedEligDeterminationInd |
| Nondis Emergency Care Policy | Yes (true) | NondisEmergencyCarePolicyInd |
| Other Method Used | Yes (X) | OtherMethodUsedInd |
| 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 | In conducting each of its most recent CHNA, IU Health Blackford Hospital 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 could play in addressing the identified needs. To obtain a more complete picture of the factors that play into IU Health Blackford Hospital's community's health, input from public health officials and community leaders in Blackford County was gathered through two separate focus group sessions. The first was a two hour live group session at IU Health Blackford Hospital, and the other was held via a phone conference call for those who were not able to meet in person. IU Health Blackford Hospital 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: Ted Leas - President, Pacesetter Bank - Mr. Leas is representative of a community perspective regarding healthy living. As President of the bank, he is familiar with the market and income of the community, as well as the issues surrounding low income individuals. Cheryl Heflin - Patient Access Specialist, IU Health Blackford Hospital - Ms. Heflin is representative of a community perspective regarding access to care. As a patient access specialist, she is familiar with the barriers to care that are present in the community and the type of individuals affected. Kathy Bantz - Mayor of Montpelier, Indiana - Mayor Bantz is representative of a community perspective regarding healthy living. AS a government official, she is knowledgeable of the community's needs and resources available to address those needs. Carol Robles - Administrator, Hearts with Integrity (Home Health) - Ms. Robles is representative of a community perspective on senior health. As a senior care administrator, she works to provide access to various services for seniors within the community. John Lancaster - Sheriff, Blackford County - Mr. Lancaster is representative of a community perspective regarding safety within the community. As a sheriff, he is familiar with the safety issues in Blackford County and the well-being of the community as a whole. Rob Cleveland - Executive Director, Blackford County Economic Foundation - Mr. Cleveland is representative of a community perspective regarding economic development. As a community foundation director, he is knowledgeable in the financial stability of the community and the resources available. Patty Poulson - Executive Director, Blackford County Community Foundation - Ms. Poulson is representative of a community perspective regarding community development. As a community foundation director, she is knowledgeable in the financial stability of the community and the resources available. 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. |
| Schedule H, Part V, Section B, Line 7a - CHNA Website | A copy of IU Health'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'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 Prevention - Access to Healthcare - Infant Health Factors - Tobacco Use Prevention - Mental Health/Behavioral Health Obesity Prevention To improve the lifestyle of Indiana residents, IU Health has utilized innovative and best practice methods to attack obesity in our communities. IU Health is working to improve access to nutritious foods and physical activity in low-income neighborhoods, in addition to providing traditional health education and public advocacy efforts. With these initiatives, IU Health strives to prevent chronic diseases such as obesity and diabetes and increase the awareness of the importance of making healthy choices, since Indiana ranks 8th in obesity in the nation. Some ways that IU Health Blackford Hospital addresses Obesity Prevention include partnering with the local YMCA to offer Active Afterschool for the two elementary schools in Hartford City and supporting the walk Indiana initiative, which offers a community walking group called "Walk with a Doc." 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 work 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 IU Health Blackford Hospital addresses Access to Healthcare include operating a multi-specialty clinic a limited number of times each month to minimize the travel distances for those in the community seeking specialty care and offering an annual community health fair that provides testing, screenings, and a wide range of resources. Infant Health Factors IU Health Ball Memorial Hospital is the area's tertiary referral system and serves as a referral site for community members in the IU Health Blackford Hospital service area for services related to preconception, prenatal care, obstetrics, mother/baby care, neonatal intensive care, and pediatrics. IU Health Ball Memorial Hospital offers one of the few Perinatal Centers in Indiana, caring for pregnant women with maternal and/or fetal complications and those who are at high risk of developing complications. Tobacco Use Prevention IU Health recognizes that one of the most important and effective ways of maintaining good health is to not use tobacco products. Cigarette smoking is identified as a cause of various cancers, cardiovascular disease, and respiratory conditions, as well as low birthweight and other adverse health outcomes. IU Health Blackford Hospital provides education to patients about the harmful effects of tobacco use and promotes the free cessation service 1-800-QuitNow offered by the Indiana Tobacco Quitline. Mental Health/Behavioral Health Behavioral health covers a range of conditions from depression, anxiety and other psychological disorders to issues related to substance abuse and alcohol addiction. Many Indiana communities report a need to improve access to behavioral health services and reduce the stigma often associated with mental health and addictions. The IU Health Behavioral Health program includes a wide range of services designed to support patients with behavioral, psychiatric and psychological needs. Multidisciplinary teams at IU Health Blackford Hospital work to improve the overall health and well-being of every patient. 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: - K-12 Education - Health Literacy 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 two 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 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'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'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. Eligible patients who receive medical care from an IU Health facility 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 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 Blackford Hospital 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 Blackford Hospital 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 Blackford Hospital'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 Blackford Hospital goes to great lengths to ensure patients know that it treats all patients regardless of their ability to pay. Although a complete copy of the financial assistance policy is not attached to each patient statement, a plain language summary is included instead. Additionally, on the back of each patient statement is a telephone number that allows patients to ask any questions about the policy and request financial assistance. |
| Schedule H, Part V, Section B, Line 22d - Other Determination of Charges | IU Health Blackford Hospital 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 Blackford Hospital's FAP are applied to the chargemaster or physician fee schedule calculated amount. IU Health Blackford Hospital does not use gross charges in the calculation of the amount to charge a Financial Assistance eligible patient. |
| 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. | Eligibility for financial assistance is determined based upon a patient's household income and number of members in the household. A patient is eligible for financial assistance, when the patient's: - Household income is equal to or less than 200% of the Federal Poverty Guidelines ("FPG"); or - Household income is greater than 400% of the FPG, the patient is an uninsured patient, and qualifies based on an established sliding scale. Patients in the following categories are presumed to be eligible for financial assistance, without a determination of household income: - Patients whose financial need has been determined by the following third parties: Wishard, Project Health, Children's Special Health Care Services, Medicaid, or Out-of-State Medicaid; - Patients who are pending Medicaid approval; - Homeless patients; and - Patients who have a hospital bill with a maximum balance to be determined by the Executive Director of Revenue Cycle Services and who meet credit scoring and asset determination criteria. Additional requirements for eligibility include: - For patients/guarantors who are otherwise eligible for Financial Assistance and whose hospital and/or physician liability is greater than $60,000, IU Health Blackford Hospital may review available assets in determining eligibility and amount of Financial Assistance provided. This dollar threshold may be increased annually based on IU Health Blackford Hospital price increases and at the discretion of Revenue Cycle Leadership. - Financial assistance may be granted to patients/guarantors who qualify for government programs when funding has been delayed. If later government assistance is approved, the financial assistance awarded will be reversed. This includes, but is not limited to, when a patient's account is pending Medicaid approval. - Financial Assistance may be granted to a deceased patient whose estate has been determined to be without valuable assets. - Financial assistance will not be granted to non-consolidated patient statements of patients that have a physician bill with a balance of less than $240.00. - IU Health Blackford Hospital will deny financial assistance for any patient/guarantor who falsifies any portion of an application. - All third party resources and non-hospital financial aid programs, including public assistance available through Medicaid, must be exhausted before financial assistance will be awarded. |
| Schedule H, Part I, Line 6a - C.B. Report Prepared by a Related Org. | IU Health Blackford Hospital'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 ("IU Health Statewide System"). 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 (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 $1,200,638. |
| 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 25.82%. |
| Schedule H, Part I, Line 7g - Subsidized Health Services | IU Health Blackford Hospital 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 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 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: - Blackford County Health Communities Coalition - Early Learning Indiana - Starfish Initiative - 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 - Methodology Used to Est. Bad Debt Exp. | The bad debt expense of $443,516 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 | 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 the review are then used to make any modifications to the provision for uncollected patient accounts and the allowance for uncollectible accounts. In addition, IU Health Blackford Hospital 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 Blackford Hospital and, in certain cases, are reclassified to charity care if deemed to otherwise meet financial assistance policies of IU Health Blackford Hospital. |
| Schedule H, Part III, Line 8 - Medicare Shortfall | IU Health Blackford Hospital did not have a Medicare shortfall for 2014. IU Health Blackford Hospital's 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 Health's participation in Medicare programs. For example, the Medicare Cost Report excludes certain costs such as billed physician services, the costs of Medicare Parts C and D, fee schedule reimbursed services, and durable medical equipment services. Inclusion of all costs associated with IU Health Blackford Hospital's participation in Medicare programs would significantly reduce the Medicare surplus reported on Schedule H, Part III, Line 7. |
| Schedule H, Part III, Line 9b - Written Debt Collection Policy | If a patient cannot satisfy standard payment expectations, a financial assistance screening process for alternative sources of balance resolution is completed. Those resolutions may include a discount on charges, Medicaid enrollment, interest-free loan or application for financial assistance. If a patient does not apply for financial assistance but otherwise meets the financial assistance guidelines established by IU Health Blackford Hospital, the charges will be waived and the cost of services treated as financial assistance. |
| 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 Health's ability to impact positive change was evaluated. |
| Schedule H, Part VI, Line 3 - Patient Education of Eligibility for Assist. | IU Health Blackford Hospital goes to great lengths to ensure patients know that it treats all patients regardless of their ability to pay. IU Health Blackford Hospital shares financial assistance information with patients during the admission process, billing process, and online. Helping patients understand that financial support for their care is available is a part of IU Health Blackford Hospital's commitment to its mission. IU Health Blackford Hospital's financial assistance policy exists to serve those in need by providing financial relief to patients who ask for assistance after care has been provided. 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 Blackford Hospital'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. A plain language summary of the financial assistance policy is printed on the back of each patient statement, while the financial assistance application is mailed to all IU Health Blackford Hospital patients with a patient balance due after insurance. Additionally, on the back of each patient statement is a telephone number that allows patients the ability to request financial assistance. Uninsured patients are also made aware of this process at the time of registration. The IU Health website has a page (http://iuhealth.org/helpwithbills) dedicated to financial assistance and offers an online application and telephone numbers for customer service representatives to assist with the application process. IU Health Blackford Hospital has an expansive financial assistance policy which utilizes the federal poverty guidelines to determine eligibility. The goal is to make access to quality care within a patient's reach. The IU Health Blackford Hospital Financial Assistance policy provides the following support to patients that qualify: - Free care for those earning up to 200 percent of federal poverty guidelines; - Discounted care on a sliding scale for families earning from 200 to 400 percent of federal poverty guidelines; and - Financial assistance to patients whose health insurance coverage, if any, does not provide full coverage for all of their medical expenses and whose medical expenses would make them indigent if they were forced to pay full charges. Patients are guided through their course of care with particular sensitivity, reviewing changing circumstances and allowing for financial assistance at any point during the relationship and billing process. For those inpatients that may qualify for the Medicaid program and have not applied, IU Health Blackford Hospital financial counselors will assist patients with the Medicaid application. If a patient does not apply for financial assistance, but meets the financial assistance guidelines established by IU Health Blackford Hospital, IU Health Blackford Hospital will waive charges and treat the cost of services as financial assistance. |
| 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 2014) statistics, Blackford County's population is 12,401 persons with approximately 50% being female and 50% male. The county's population estimates by race are 95.9% White, 1.6% Hispanic or Latino, 0.6% Black, 0.3% Asian, 0.2% American Indian or Alaska Native, and 1.4% 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 (86%). As of 2014, 9.8% of the population had a bachelor's degree or higher. 86.7% of community discharges were for patients with Medicare, 5.9 % with commercial insurance/managed care, 4.9% with Medicaid, and 2.5% were uninsured/self-pay patients. IU Health Blackford Hospital has a varied mix of pay for outpatient services with 40.6% Medicare, 31.5% commercial insurance/managed care, 16.8% Medicaid, and 11.1% self-pay/uninsured. Discharge information for the hospital shows the majority of patients coming from Blackford County at 78.1%, Grant - 11.8%, Delaware - 6%, Jay - 1.8%, and Other - 2.3%. |
| Schedule H, Part VI, Line 5 - Promotion of Community Health | IU Health Blackford Hospital invests in its community to improve the quality of life of its community members. Several community benefit highlights are described below. As part of a strategic effort to prevent obesity and the resulting negative health effects in the community, IU Health Blackford and Ball Memorial Hospitals partnered with the YMCA of Muncie to promote healthy lifestyle changes in children with a program called Active Afterschool. The Active Afterschool program is offered to children in grades K-5 at elementary schools in Hartford City, as well as elementary schools and the Ross Community Center in Muncie. The goal of the program is to help children learn lessons that will help them make healthy choices regarding exercising and eating for the rest of their lives. More than 150 residents of Blackford County and the surrounding areas interacted with local medical professionals from IU Health Blackford and Ball Memorial Hospitals at the annual Community Health Fair that took place on October 4, 2014 at Northside Elementary School in Hartford City. There were a total of 34 informative displays which included screening stations and featured diabetes educators from IU Health Ball Memorial Hospital, who offered diabetes risk assessments and a host of literature about educational programs and risk avoidance. Additionally, stroke risk assessments for over 50 individuals were performed as well as cholesterol and hemoglobin A1C screenings. In total, 43 employees from IU Health Blackford Hospital participated in hosting the fair, including representatives from outpatient rehabilitation, who conducted foot screenings and distributed information about preventing foot and ankle injuries; Radiology services displayed information about IU Health Blackford Hospital's new radiology digital x-ray system and respiratory therapy conducted pulmonary function tests for visitors. IU Health Ball Memorial and Blackford Hospitals, in partnership with Open Door Health Services of Muncie, initiated the Fetal Infant Mortality Review ("FIMR") program, with a grant from the Indiana State Department of Health. In addition, the IU Health Ball Memorial Hospital Foundation purchased software called BASINET, (Baby Abstracting System and Information NETwork), for FIMR. BASINET is a web-based project management system which enhances evaluation of the factors contributing to fetal and infant mortality, improving efficiency of the project and the capacity to focus on interventions to make a difference. IU Health Ball Memorial Hospital provides staff members from the Neonatal Intensive Care Unit as well as other clinical support areas to help facilitate the overall work of the project. Objectives of the program include establishing a FIMR case review team to discover the root causes of infant mortality and creating a FIMR community action team to coordinate the efforts of community-based organizations in implementing the CRT recommendations to decrease cost and improve effectiveness. The community action team is also instrumental in providing resources and information to new mothers and moms-to-be through enrollment in weareindiana.com, a source of information about healthy living, having a healthy pregnancy and caring for an infant. |
| 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 Indiana's most comprehensive healthcare system. A unique partnership with the Indiana University School of Medicine ("IU School of Medicine"), one of the nation's leading medical schools, gives patients access to innovative treatments and therapies. IU Health is comprised of hospitals, physicians and allied services dedicated to providing preeminent care throughout Indiana and beyond. National Recognition - 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 - IU Health Blackford Hospital recognized as a National Most Wired Hospital by the American Hospital Association in 2014-2015 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 the five 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 Obesity Prevention To improve the lifestyle of Indiana residents, IU Health has utilized innovative and best practice methods to atta |
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 | false | AnyNonFixedPaymentsInd |
| Initial Contract Exception | false | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (7 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 | $130,915 | $0 | $0 | $0 | $1,776 | $0 | $5,484 | $0 | $11,976 | $0 | $150,151 | $0 | $0 |
| LORI A LUTHER | ||||||||||||||
| DIRECTOR/TREASURER (PART YR) | $0 | $262,043 | $0 | $28,000 | $0 | $9,905 | $0 | $10,104 | $0 | $8,404 | $0 | $318,456 | $0 | $0 |
| MICHAEL E HALEY | ||||||||||||||
| DIRECTOR | $0 | $484,864 | $0 | $118,283 | $0 | $113,807 | $0 | $10,400 | $0 | $28,655 | $0 | $756,009 | $0 | $0 |
| JUDITH L COLEMAN | ||||||||||||||
| CFO (PARTIAL YEAR) | $0 | $141,669 | $0 | $10,613 | $0 | $706 | $0 | $6,305 | $0 | $28,899 | $0 | $188,192 | $0 | $0 |
| JEFFREY C BIRD MD | ||||||||||||||
| CMO | $0 | $287,241 | $0 | $0 | $0 | $2,322 | $0 | $10,400 | $0 | $30,107 | $0 | $330,070 | $0 | $0 |
| ELIZABETH A DROEGE MD | ||||||||||||||
| PHYSICIAN | $296,753 | $0 | $0 | $0 | $21,072 | $0 | $10,400 | $0 | $20,687 | $0 | $348,912 | $0 | $0 | $0 |
| THOMAS M LEE MD | ||||||||||||||
| PHYSICIAN | $129,990 | $185,243 | $0 | $75,926 | $0 | $2,376 | $3,233 | $7,167 | $0 | $26,779 | $133,223 | $297,491 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Schedule J, Part I, Line 3 - Comp. of the Org.'s CEO/Executive Director | IU Health Blackford Hospital's CEO/Executive Director 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 Hospital's CEO/Executive Director. IU Health's 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 $89,015 included in column b(iii), other reportable compensation, representing the current year vested amounts received under the supplemental executive retirement plan. |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (9 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. No additional compensation was provided to these individuals for their service. |
| 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. Line 7a: The Board of Directors may consist of no fewer than 3 and no more than 13 members and shall be at least 70% representing the local community. Five directors shall be "Community Directors" and shall be appointed by IU Health Ball Memorial Hospital subject to the recommendation of the Nominating Committee. All Community Directors shall be residents of Blackford County. Two directors shall be appointed by IU Health Ball Memorial Hospital to represent the Corporate Member. One director shall be appointed by the Board of Directors from a slate of three candidates nominated by the Commissioners. 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 A, Line 11b - Review of Form 990 | IU Health Ball Memorial Hospital's CFO and 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 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 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 Hospital's Board of Directors was not required to separately adopt a conflict of interest, whistleblower, document retention and destruction and joint venture policies because IU Health's Board of Directors had already adopted and required these policies to be followed by its subsidiaries. |
| Part VI, Section B, Line 12c - Conflict of Interest Policy | IU Health Blackford Hospital follows IU Health's Conflict of Interest Policy. IU Health's Conflict of Interest Policy includes the following provisions: All IU Health employees, associates, colleagues and contracted personnel, including employed physicians and paid medical directors ("IU Health Representatives") are covered by and subject to its Conflict of Interest Policy. IU Health regularly and consistently monitors and enforces compliance with the policy through the following procedures: (a) On an annual basis, each IU Health Representative at the level of Manager or above, together with every other person designated by the Corporate Compliance Department ("Department"), must complete, sign and submit a Conflict of Interest Questionnaire ("Questionnaire") to the Department. Governing board members, committee members, corporate officers, medical staff and researchers must comply with the administrative requirements noted in the respective policies and procedures relative to those areas. (b) An IU Health Representative must supplement a Questionnaire in writing, if after completion of the original Questionnaire, a situation arises, or may reasonably be expected to arise, that would change any answer or information on the original Questionnaire if the situation had existed or been anticipated at the time of completion of the original Questionnaire. (c) If a fully and properly completed Questionnaire reveals facts or other information that might reasonably indicate a Conflict of Interest or violation of the policy, the IU Health Representative completing the questionnaire must secure approval by his/her supervisor, evidenced in writing. (d) The Department will review each Questionnaire and determine whether a Conflict of Interest exists and, if so, whether and how it should or may be eliminated, avoided or managed in order to comply with the spirit of the policy and with the best interests of IU Health and its patients. In making the determination, the Corporate Compliance Department may consult with the IU Health Representative's supervisor and other appropriate individuals and groups. (e) The scope of the policy is not limited to those who are required to complete Questionnaires. If an IU Health Representative is involved in a situation or relationship that would constitute a violation of the policy in the absence of disclosure and approval as described above, then the IU Health Representative must disclose the matter to his/her supervisor, secure his/her supervisor's approval in writing, and disclose the matter to the Department. Otherwise, the IU Health Representative is in violation of the policy and subject to corrective action, up to and including termination. (f) The Chief Compliance Officer, in consultation with onsite Compliance personnel, may from time to time appoint standing or ad hoc committees to assist in resolving issues that arise under provisions of the policy. |
| Part VI, Section B, Line 15 - Process for Determining Compensation | IU Health Blackford Hospital's CEO/Top Management Official 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 Hospital's CEO/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 Hospital's 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 consolidated subsidiary in the consolidated financial statements for IU Health, Inc. The consolidated financial statements for IU Health are available to the public through its bond filings. |
| Part VII, Section A, Line 1a, Column (B) - Average hours per week | Thomas M. Lee, M.D. was an employee of IU Health Blackford Hospital during a portion of 2014 in which he devoted an average of 55 hours per week. He was also an employee of IU Health Ball Memorial Hospital during a portion of 2014 in which he devoted an average of 55 hours per week. |
| FORM 990 PART IX LINE 11G | DESCRIPTION:SHARED SERVICES/PROF. FEES TOTAL FEES:4590844 |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (44 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) | 9 | IUH | Yes (true) |
| Goshen Health System Inc | ||||||||||
| 200 High Park Ave | Goshen | IN | 46527 | 351974765 | Healthcare | IN | 501(c)(3) | 11 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) | 9 | IUHB | Yes (true) |
| Indiana Health Info Exchange Inc | ||||||||||
| 846 N Senate Ave | Indianapolis | IN | 46202 | 364550324 | Healthcare | IN | 501(c)(3) | 11 I | NA | false |
| Indiana Radiology Partners Inc | ||||||||||
| 950 N Meridian St Ste 800 | Indianapolis | IN | 46204 | 201017034 | Healthcare | IN | 501(c)(3) | 3 | IUH | Yes (true) |
| Indiana University Health Inc | ||||||||||
| 950 N Meridian St Ste 800 | 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) | 11 I | IUHA | Yes (true) |
| IU Health Arnett Inc | ||||||||||
| 950 N Meridian St Ste 800 | Indianapolis | IN | 46204 | 263162145 | Healthcare | IN | 501(c)(3) | 3 | IUH | Yes (true) |
| IU Health Ball Memorial Hospital Inc | ||||||||||
| 950 N Meridian St Ste 800 | Indianapolis | IN | 46204 | 350867958 | Healthcare | IN | 501(c)(3) | 3 | IUH | false |
| IU Health Ball Memorial Physicians Inc | ||||||||||
| 950 N Meridian St Ste 800 | Indianapolis | IN | 46204 | 351925641 | Healthcare | IN | 501(c)(3) | 9 | IUHBMH | Yes (true) |
| IU Health Bedford Inc | ||||||||||
| 950 N Meridian St Ste 800 | Indianapolis | IN | 46204 | 237042323 | Healthcare | IN | 501(c)(3) | 3 | IUH | Yes (true) |
| IU Health Bloomington Inc | ||||||||||
| 950 N Meridian St Ste 800 | 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) | 11 I | IUHBMH | Yes (true) |
| IU Health Care Associates Inc | ||||||||||
| 950 N Meridian St Ste 800 | Indianapolis | IN | 46204 | 351747218 | Healthcare | IN | 501(c)(3) | 9 | IUH | Yes (true) |
| IU Health Goshen Foundation Inc | ||||||||||
| 200 High Park Ave | Goshen | IN | 46527 | 462565300 | Fundraising | IN | 501(c)(3) | 11 I | GHS | Yes (true) |
| IU Health LaPorte Hospital Inc | ||||||||||
| PO Box 250 | LaPorte | IN | 46352 | 351125434 | Healthcare | IN | 501(c)(3) | 3 | IUH | Yes (true) |
| IU Health LaPorte Physicians Inc | ||||||||||
| PO Box 250 | LaPorte | IN | 46352 | 311070868 | Healthcare | IN | 501(c)(3) | 3 | IUHLH | Yes (true) |
| IU Health Morgan Inc | ||||||||||
| 950 N Meridian St Ste 800 | Indianapolis | IN | 46204 | 273533027 | Healthcare | IN | 501(c)(3) | 3 | IUH | Yes (true) |
| IU Health North Hospital Inc | ||||||||||
| 950 N Meridian St Ste 800 | 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) | 9 | IUHP | Yes (true) |
| IU Health Paoli Inc | ||||||||||
| 950 N Meridian St Ste 800 | Indianapolis | IN | 46204 | 352090919 | Healthcare | IN | 501(c)(3) | 3 | IUHB | Yes (true) |
| IU Health Tipton Hospital Inc | ||||||||||
| 950 N Meridian St Ste 800 | Indianapolis | IN | 46204 | 262772226 | Healthcare | IN | 501(c)(3) | 3 | IUH | Yes (true) |
| IU Health West Hospital Inc | ||||||||||
| 950 N Meridian St Ste 800 | 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) | 11 III-FI | IUHWMH | Yes (true) |
| IU Health White Memorial Hospital Inc | ||||||||||
| 950 N Meridian St Ste 800 | 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) | 11 II | NA | false |
| LaPorte Hospital Foundation Inc | ||||||||||
| PO Box 250 | LaPorte | IN | 46352 | 310952775 | Fundraising | IN | 501(c)(3) | 11 I | NA | false |
| Methodist Health Foundation Inc | ||||||||||
| 1800 N Capitol Ave | Indianapolis | IN | 46202 | 356043086 | Fundraising | IN | 501(c)(3) | 11 I | IUH | Yes (true) |
| Methodist Health Group Inc | ||||||||||
| 950 N Meridian St Ste 800 | Indianapolis | IN | 46204 | 350876390 | Healthcare | IN | 501(c)(3) | 11 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 800 | 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) | 11 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) |
| Morgan Co Mem Hosp Foundation Inc | ||||||||||
| 950 N Meridian St Ste 800 | Indianapolis | IN | 46204 | 352035162 | Fundraising | IN | 501(c)(3) | 11 II | IUHMH | Yes (true) |
| Morgan Co Mem Hosp Guild Inc | ||||||||||
| 950 N Meridian St Ste 800 | Indianapolis | IN | 46204 | 310886844 | Fundraising | IN | 501(c)(3) | 11 III-FI | IUHMH | Yes (true) |
| Morgan Health Services Inc | ||||||||||
| 950 N Meridian St Ste 800 | Indianapolis | IN | 46204 | 351968564 | Healthcare | IN | 501(c)(3) | 3 | IUHMH | 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) | 11 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) | 11 III-FI | NA | false |
| University Family Physicians Inc | ||||||||||
| 950 N Meridian St Ste 800 | Indianapolis | IN | 46204 | 237427350 | Healthcare | IN | 501(c)(3) | 9 | IUHCA | Yes (true) |
| 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) |
| Tipton Co Health Care Foundation Inc | ||||||||||
| 950 N Meridian St Ste 800 | Indianapolis | IN | 46204 | 311231905 | Fundraising | IN | 501(c)(3) | 11 I | IUHTH | Yes (true) |
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (22 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Predominant Income TypePredominantIncomeTypeTxt | Share Of Total IncomeShareOfTotalIncomeAmt | Share Of EOY AssetsShareOfEOYAssetsAmt | Disproportionate AllocationsDisproportionateAllocationsInd | UBI Code VUBICodeVAmt | General Or Managing PartnerGeneralOrManagingPartnerInd | OwnershipOwnershipPct |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Ball Outpatient Sur Ctr LLC | ||||||||||||||
| 569 Brookwood Village Ste 901 | Birmingham | AL | 35209 | 270275794 | Healthcare | IN | BOSCH | N/A | $0 | $0 | false | $0 | false | 0.00000 |
| Beltway Surgery Centers LLC | ||||||||||||||
| 569 Brookwood Village Ste 901 | Birmingham | AL | 35209 | 352072586 | Healthcare | IN | BSCH | N/A | $0 | $0 | false | $0 | false | 0.00000 |
| Bloomington Endo Centers LLC | ||||||||||||||
| PO Box 1149 | Bloomington | IN | 47402 | 352117943 | Healthcare | IN | IUHB | N/A | $0 | $0 | false | $0 | false | 0.00000 |
| BOSC Holdings LLC | ||||||||||||||
| 950 N Meridian St Ste 800 | Indianapolis | IN | 46204 | 454147343 | Healthcare | IN | IUH | N/A | $0 | $0 | false | $0 | false | 0.00000 |
| BSC Holdings LLC | ||||||||||||||
| 950 N Meridian St Ste 800 | Indianapolis | IN | 46204 | 452314634 | Healthcare | IN | IUH | N/A | $0 | $0 | false | $0 | false | 0.00000 |
| Cardinal Health Init LLC | ||||||||||||||
| 950 N Meridian St Ste 800 | Indianapolis | IN | 46204 | 300102702 | Purchasing | IN | IUHBMH | N/A | $2,799 | $0 | false | $0 | false | 0.00000 |
| CHV Fund I LLC | ||||||||||||||
| 950 N Meridian St Ste 800 | Indianapolis | IN | 46204 | 262523206 | Venture Capital | IN | IUH | N/A | $0 | $0 | false | $0 | false | 0.00000 |
| CHV Fund II Management LLC | ||||||||||||||
| 950 N Meridian St Ste 800 | Indianapolis | IN | 46204 | 371717823 | Venture Capital | IN | CHV | N/A | $0 | $0 | false | $0 | false | 0.00000 |
| CHV Fund II LLC | ||||||||||||||
| 950 N Meridian St Ste 800 | Indianapolis | IN | 46204 | 800902337 | Venture Capital | IN | IUH | N/A | $0 | $0 | false | $0 | false | 0.00000 |
| CHV Fund Management LLC | ||||||||||||||
| 950 N Meridian St Ste 800 | Indianapolis | IN | 46204 | 262523151 | Venture Capital | IN | CHV | N/A | $0 | $0 | false | $0 | false | 0.00000 |
| Clarian Health Network LLC | ||||||||||||||
| 950 N Meridian St Ste 800 | Indianapolis | IN | 46204 | 352055030 | Healthcare | IN | IUH | N/A | $0 | $0 | false | $0 | false | 0.00000 |
| Eagle High Surg Center LLC | ||||||||||||||
| 569 Brookwood Village Ste 901 | Birmingham | AL | 35209 | 352259204 | Healthcare | IN | EHSCH | N/A | $0 | $0 | false | $0 | false | 0.00000 |
| EHSC Holdings LLC | ||||||||||||||
| 950 N Meridian St Ste 800 | Indianapolis | IN | 46204 | 454147879 | Healthcare | IN | IUH | N/A | $0 | $0 | false | $0 | false | 0.00000 |
| Health Venture Management LLC | ||||||||||||||
| 950 N Meridian St Ste 800 | Indianapolis | IN | 46204 | 205740218 | Management | IN | IUH | N/A | $0 | $0 | false | $0 | false | 0.00000 |
| IEC Holdings LLC | ||||||||||||||
| 950 N Meridian St Ste 800 | Indianapolis | IN | 46204 | 454148032 | Healthcare | IN | IUH | N/A | $0 | $0 | false | $0 | false | 0.00000 |
| Indiana Endoscopy Centers LLC | ||||||||||||||
| 569 Brookwood Village Ste 901 | Birmingham | AL | 35209 | 208398421 | Healthcare | IN | IECH | N/A | $0 | $0 | false | $0 | false | 0.00000 |
| IUH Saxony Surgery Ctr LLC | ||||||||||||||
| 569 Brookwood Village Ste 901 | Birmingham | AL | 35209 | 275271091 | Healthcare | IN | SSCH | N/A | $0 | $0 | false | $0 | false | 0.00000 |
| ROC Surgery LLC | ||||||||||||||
| 569 Brookwood Village Ste 901 | Birmingham | AL | 35209 | 271497960 | Healthcare | IN | ROCSH | N/A | $0 | $0 | false | $0 | false | 0.00000 |
| ROCS Holdings LLC | ||||||||||||||
| 950 N Meridian St Ste 800 | Indianapolis | IN | 46204 | 454148369 | Healthcare | IN | IUH | N/A | $0 | $0 | false | $0 | false | 0.00000 |
| Senate St Surgery Center LLC | ||||||||||||||
| 569 Brookwood Village Ste 901 | Birmingham | AL | 35209 | 421709357 | Healthcare | IN | SSSCH | N/A | $0 | $0 | false | $0 | false | 0.00000 |
| SSC Holdings LLC | ||||||||||||||
| 950 N Meridian St Ste 800 | Indianapolis | IN | 46204 | 464472887 | Healthcare | IN | IUH | N/A | $0 | $0 | false | $0 | false | 0.00000 |
| SSSC Holdings LLC | ||||||||||||||
| 950 N Meridian St Ste 800 | Indianapolis | IN | 46204 | 454148167 | Healthcare | IN | IUH | N/A | $0 | $0 | false | $0 | false | 0.00000 |
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 | Share Of Total IncomeShareOfTotalIncomeAmt | Share Of EOY AssetsShareOfEOYAssetsAmt | OwnershipOwnershipPct | 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 | IUHBMH | C | $0 | $0 | 0.00000 | Yes (true) | |||||
| Cardinal Health Ventures Inc | |||||||||||||||||
| 950 N Meridian St Ste 800 | Indianapolis | IN | 46204 | 351611424 | Management | IN | IUHBMH | C | $0 | $0 | 0.00000 | Yes (true) | |||||
| CHV Capital Inc | |||||||||||||||||
| 950 N Meridian St Ste 800 | Indianapolis | IN | 46204 | 260752507 | Venture Capital | IN | IUH | C | $0 | $0 | 0.00000 | Yes (true) | |||||
| IU Health 457(B) Plan | |||||||||||||||||
| 1100 N Market St | Wilmington | DE | 19890 | 476948347 | Investments | IN | IUH | T | $0 | $0 | 0.00000 | Yes (true) | |||||
| IU Health ACO Inc | |||||||||||||||||
| 950 N Meridian St Ste 800 | Indianapolis | IN | 46204 | 454421020 | Healthcare | IN | IUH | C | $0 | $0 | 0.00000 | Yes (true) | |||||
| IU Health Board Designated Trust | |||||||||||||||||
| 400 Howard St | San Francisco | CA | 94105 | 306309021 | Investments | IN | IUH | T | $0 | $0 | 0.00000 | Yes (true) | |||||
| IU Health NTGI S&P500 Fund CF | |||||||||||||||||
| PO Box 804358 | Chicago | IL | 60680 | 306298263 | Investments | IN | IUH | T | $0 | $0 | 0.00000 | Yes (true) | |||||
| IU Health Plans Holding Company Inc | |||||||||||||||||
| 950 N Meridian St Ste 800 | Indianapolis | IN | 46204 | 463794815 | Insurance | IN | IUH | C | $0 | $0 | 0.00000 | Yes (true) | |||||
| IU Health Plans NFP Inc | |||||||||||||||||
| 950 N Meridian St Ste 800 | Indianapolis | IN | 46204 | 463803873 | Insurance | IN | IUHPHC | C | $0 | $0 | 0.00000 | Yes (true) | |||||
| IU Health Plans Inc | |||||||||||||||||
| 950 N Meridian St Ste 800 | Indianapolis | IN | 46204 | 262127080 | HMO | IN | IUH | C | $0 | $0 | 0.00000 | Yes (true) | |||||
| IU Health Risk Purchasing Group Inc | |||||||||||||||||
| 151 Meeting St Ste 301 | Charleston | SC | 29401 | 260202446 | Insurance | IN | IUH | C | $0 | $0 | 0.00000 | Yes (true) | |||||
| IU Health Risk Retention Group Inc | |||||||||||||||||
| 151 Meeting St Ste 301 | Charleston | SC | 29401 | 201107674 | Insurance | SC | IUH | C | $0 | $0 | 0.00000 | Yes (true) | |||||
| IU Health Southern IN Physicians Inc | |||||||||||||||||
| PO Box 1149 | Bloomington | IN | 47402 | 351913875 | Healthcare | IN | IUHB | C | $0 | $0 | 0.00000 | Yes (true) | |||||
| IUH Assurance SPC Ltd | |||||||||||||||||
| 980395429 | Insurance | IUH | C | $0 | $0 | 0.00000 | 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 | MOHC | C | $0 | $0 | 0.00000 | Yes (true) | |||||
| Parkmor Drug Inc | |||||||||||||||||
| 1501 S Main St | Goshen | IN | 46526 | 131394980 | Pharmacy Sales | IN | GHS | C | $0 | $0 | 0.00000 | Yes (true) | |||||
| PILR Inc | |||||||||||||||||
| 200 High Park Ave | Goshen | IN | 46526 | 204294750 | Development | IN | GHS | C | $0 | $0 | 0.00000 | Yes (true) | |||||
| Proteuo Fund LP | |||||||||||||||||
| 981075227 | Investments | IUH | C | $0 | $0 | 0.00000 | 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 | GHS | C | $0 | $0 | 0.00000 | Yes (true) | |||||
| SCANS Inc | |||||||||||||||||
| 950 N Meridian St Ste 800 | Indianapolis | IN | 46204 | 453080392 | Healthcare | IN | CHVF1 | C | $0 | $0 | 0.00000 | Yes (true) | |||||
| Univ Hlth (Shanghai) Mgt Con Co Ltd | |||||||||||||||||
| Management | UHMC | C | $0 | $0 | 0.00000 | Yes (true) | 88 CENTURY AVE | SHANGHAI | CH | CH | |||||||
| University Health Management Inc | |||||||||||||||||
| 950 N Meridian St Ste 800 | Indianapolis | IN | 46204 | 272891143 | Management | IN | CHV | C | $0 | $0 | 0.00000 | Yes (true) | |||||
| University Health Mgmt (China) Inc | |||||||||||||||||
| 950 N Meridian St Ste 800 | Indianapolis | IN | 46204 | 273891311 | Management | IN | CHV | C | $0 | $0 | 0.00000 | 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 (3 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| INDIANA RADIOLOGY PARTNERS INC | ||
| M | $62,500 | FMV |
| IU HEALTH CARE ASSOCIATES INC | ||
| M | $90,658 | FMV |
| IU HEALTH RISK RETENTION GROUP INC | ||
| R | $91,340 | FMV |