2014-11-17T11:33:20-06:00 2013-12-31 ERNST & YOUNG US LLP 111 MONUMENT CIRCLE SUITE 4000 INDIANAPOLIS IN 46204 990 2013-01-01 263162145 INDIANA UNIVERSITY HEALTH ARNETT INC % BROC BUDDE INDI 3179624575 950 N MERIDIAN STREET SUITE 800 Suite INDIANAPOLIS IN 46204 CARA L BREIDSTER CFO 2014-11-14 JENNIFER D RHODERICK P00395735 2013 2015-11-30 17:44:51Z ALFONSO W GATMAITAN 950 N MERIDIAN ST STE 800 INDIANAPOLIS IN 46204 418418068 false X HTTP://IUHEALTH.ORG/ARNETT/ X 2008 IN Improve the health of our patients and community through innovation and excellence in care, education, research and service. 9 5 2437 165 1876247 243805 33748 23762 395173565 403986214 69977 2580614 2739758 2750007 398017048 409340597 188086 501354 0 0 181126436 185476433 0 0 0 199784690 192067387 381099212 378045174 16917836 31295423 250745644 253519309 293399423 264877665 -42653779 -11358356 Improve the health of our patients and community through innovation and excellence in care, education, research and service. false false 326884631 501354 403986214 Indiana University Health Arnett, Inc. ("IU Health Arnett") offers a variety of services to care for its patients during every phase of life without regard to ability to pay. As an integrated health care system, IU Health Arnett strives to be the preeminent leader in clinical care, education, research and service in the region by providing its patients with access to primary care practitioners, specialists, numerous outpatient facilities, and a 191-bed full-service hospital united together under one umbrella. 326884631 true true false true false false false false false false true false false false true false false true false false false false false false false false true true true false true false false false false false false false false false false false false true true true true false false true 113 0 true 2437 true true true false false false false false false false false false X 9 5 false false false false true true true true true false false true true true true true true true true true true IN X BROC BUDDE 3179624575 950 N MERIDIAN STREET SUITE 800 INDIANAPOLIS IN 46204 X VICTOR L LECHTENBERG CHAIRMAN 5.0 0.0 X 6750 0 0 ANDREW K EDWARDS MD VICE CHAIRMAN/STAFF PHYSICIAN 60.0 0.0 X 415591 0 56532 ROGER D BANGS MD DIRECTOR/PHYS. (PARTIAL YEAR) 60.0 0.0 X 585856 0 56500 THOMAS V EASTERDAY DIRECTOR 5.0 0.0 X 7500 0 0 DANIEL F EVANS JR DIRECTOR 5.0 55.0 X 0 1468119 562967 STEPHEN L HENSON MD DIRECTOR/PHYS. (PARTIAL YEAR) 60.0 0.0 X 593296 0 56369 CHRISTOPHER A MANSFIELD MD DIRECTOR/STAFF PHYSICIAN 60.0 0.0 X 401942 0 52067 RANDALL R MITCHELL DIRECTOR 5.0 2.0 X 9000 4500 0 LARRY W PAMPEL DDS DIRECTOR 5.0 2.0 X 6750 4500 0 REV KATE L WALKER DIRECTOR 5.0 0.0 X 0 0 0 ALFONSO W GATMAITAN CEO 55.0 0.0 X 536410 0 130026 JEROME P KELLY SECRETARY 5.0 50.0 X 0 265291 47374 CARA L BREIDSTER TREASURER/CFO 54.0 6.0 X 256458 28496 65032 BRIAN T SHOCKNEY COO 55.0 0.0 X 253185 0 62051 DONALD E CLAYTON MD CMD/PHYSICIAN 55.0 0.0 X 449321 0 63257 JOSHUA B FLEMING RN VP & CNE 55.0 0.0 X 174121 0 45435 KYLE L ALLEN CPO 55.0 0.0 X 225721 2070 41996 JAMES BIEN MD VP, QUALITY & SAFETY 55.0 0.0 X 315357 0 61486 HAROLD D GEORGE JR ADMIN. DIRECTOR 55.0 0.0 X 193312 0 40508 THERESA K LEFFEW RN ADMIN. DIRECTOR 55.0 0.0 X 153954 0 24164 JOSEPH E HUBBARD MD STAFF PHYSICIAN 55.0 0.0 X 796120 0 28631 RYAN D LOYD MD STAFF PHYSICIAN 55.0 0.0 X 707330 0 60712 RICHARD C BERG MD STAFF PHYSICIAN 55.0 0.0 X 664862 0 60213 CHENG DU MD STAFF PHYSICIAN 55.0 0.0 X 757248 0 63680 PETER A SEYMOUR MD STAFF PHYSICIAN 55.0 0.0 X 663457 0 63100 8173541 1772976 1642100 230 false true false THE CORNERSTONE COMPANIES INC 3755 E 82ND STREET SUITE 270 INDIANAPOLIS IN 46240 CONSTRUCTION 4645932 TRIMEDX INC 5451 LAKEVIEW PKWY S DR INDIANAPOLIS IN 46268 CLINICAL ENGINEERING 2617741 SODEXO INC AFFILIATES 4880 PAYSPHERE CIRCLE CHICAGO IL 60674 VARIOUS MANAGEMENT 1814925 HORIZON MEDICAL GROUP INC 1345 UNITY PLACE SUITE 345 LAFAYETTE IN 47905 MEDICAL 1665508 INDIANA HAND SHOULDER CENTER 8501 HARCOURT ROAD INDIANAPOLIS IN 46260 MEDICAL 680379 33 10331 13431 23762 NET PATIENT SERVICE REVENUE 621110 396647800 396647800 EHRC INCENTIVE 900099 2132652 2132652 PHARMACY 446110 2884682 1755894 1128788 INCOME (LOSS) FROM PARTNERSHIPS 900099 1352412 604953 747459 SHARED SERVICES 541700 682178 682178 286490 286490 403986214 23054 23054 0 0 0 0 0 11635031 9077471 2557560 2557560 2557560 0 0 0 CAFETERIA/FOOD SERVICE 722320 815324 815324 GIFT SHOP 453220 159144 159144 VENDING 900099 10441 10441 1765098 1765098 2750007 409340597 402109967 1876247 5330621 501354 501354 0 0 0 5208267 4758029 450238 0 145057041 132517338 12539703 9179146 8713047 466099 17347465 15107916 2239549 8684514 7797000 887514 17004 1339 15665 2188 2188 22990 22990 10410 10410 0 0 42109112 17423309 24685803 426598 59329 367269 2345106 603787 1741319 2295008 589632 1705376 0 9027904 8842618 185286 289675 216436 73239 0 5984 5329 655 14287605 13917069 370536 0 15425327 12494345 2930982 3433285 1407805 2025480 DRUGS AND MEDICAL SUPPLIES 64269971 64260084 9887 BAD DEBT 30674729 30674729 NONCAPITALIZED EQUIPMENT 263320 190767 72553 INSTITUTIONAL DUES/LICENSES 314053 309000 5053 6847118 6494369 352749 378045174 326884631 51160543 0 15465 15465 0 0 0 0 41453853 46194785 0 0 0 0 949171 613824 3001543 4046440 2122647 2482018 270111454 70841214 202011813 199270240 0 0 0 0 1191152 896537 0 0 0 0 250745644 253519309 35220040 34551185 0 0 17544 9657 0 0 0 0 0 0 15472749 2610493 0 0 242689090 227706330 293399423 264877665 X -42653779 -11358356 0 0 0 0 -42653779 -11358356 250745644 253519309 31295423 X false true X true true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false true 10410 10410 false Schedule C, Part II-B, Lines 1i - Other Activities Indiana University Health Arnett, Inc. ("IU Health Arnett") paid institutional membership dues to the American Hospital Association ("AHA") and Indiana Hospital Association ("IHA") during 2013 in the amount of $38,025 and $24,549, respectively. Each membership organization notified IU Health Arnett that a portion of the dues it paid were used for lobbying purposes. The AHA used 23.98%, or $9,119 of 2013 membership dues paid by IU Health Arnett, for lobbying expenditures. The IHA used 5.26%, or $1,291 of the 2013 membership dues paid by IU Health Arnett, for lobbying expenditures. The total membership dues paid to these organizations by IU Health Arnett during 2013 that were attributable to lobbying expenditures was $10,410. 4121457 4121457 185420083 20591557 164828526 3525141 722131 2803010 76477634 49445286 27032348 567139 82240 484899 199270240 0 INTERCOMPANY PAYABLES (NET) 190433552 DUE TO THIRD-PARTY PAYORS 36708417 SELF-INSURANCE LIABILITIES 564361 227706330 Schedule D, Part X, Line 2 - FIN 48 (ASC 740) Footnote Indiana University Health Arnett, Inc. 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 2013 under GAAP as IU Health does not have any material tax contingencies that required disclosures in the footnotes. true true X true X true X 650. true true true false true true 9576 12152609 12152609 0.03500 12847 38390968 23362235 15028733 0.04330 22423 50543577 23362235 27181342 0.07830 19 12792 312547 7305 305242 0.00090 4 590 1126342 1126342 0.00320 1 300 131138 24648 106490 0.00030 6 2523 301741 301741 0.00090 30 16205 1871768 31953 1839815 0.00530 30 38628 52415345 23394188 29021157 0.08360 1 4424 4424 1 3851 3851 1 397 11809 11809 1 5121 5121 1 5847 5847 1 1482 39902 39902 0.00010 1 60 1687 1687 7 1939 72641 72641 0.00010 false 9217756 0 67620580 89200244 -21579664 X true true 1 1 IU HEALTH ARNETT HOSPITAL 5165 MCCARTY LANE LAFAYETTE IN 47905 HTTP://IUHEALTH.ORG/ARNETT/ 13-011506-1 X X X X X IU HEALTH ARNETT HOSPITAL 1 true X X X X X X X X X 13 true false true X HTTP://IUHEALTH.ORG/GETSTRONG/ X X X X X X X X false false true true 200. true 650. true X X X X X X X true true X X X X X true false X X X X true X false false SCHEDULE H, PART V, SECTION B, LINE 3 - INPUT FROM COMMUNITY Indiana University Health Arnett, Inc. ("IU Health Arnett") operates one hospital location licensed as a single hospital by the Indiana State Department of Health. IU Health Arnett is located in Lafayette, Tippecanoe County, Indiana. In conducting its most recent CHNA, IU Health Arnett took into account input from persons who represent the broad interests of the communities 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 Arnett could play in addressing the identified needs. To obtain a more complete picture of the factors that play into the Tippecanoe County community's health, input from local health leaders was gathered through two separate focus group sessions. The first live group session lasted two hours and was held at IU Health Arnett Hospital and the second session was held via conference call. IU Health Arnett 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. Kathy Murray - Health and Human Sciences Educator, Purdue Extension of Tippecanoe County - Ms. Murray is a representative of education. As an educator for Purdue Extension, she is focused on improving educational opportunities for young adults. Laura Carson - Finance & Community Impact Director, United Way of Greater Lafayette - Ms. Carson is a representative of healthy living. As a director for United Way, she works for an organization that believes in helping people learn more, earn more, and lead safe and healthy lives, and creates programs to assist in those goals, especially for the underserved populations. Michael D. Bohlin - Local Health Officer, Tippecanoe County Health Department - Dr. Bohlin is a public health expert. As a local health officer, he is knowledgeable in public health needs in the community, including in low income and underserved populations. Ron Cripe - Local Health Administrator, Tippecanoe County Health Department - Mr. Cripe is a public health expert. As a local health administrator, he is knowledgeable in public health needs in the community, including in low income and underserved populations. James Taylor - Executive Director, United Way of Greater Lafayette - Mr. Taylor is a representative of healthy living. As Executive Director United Way, he works for an organization that believes in helping people learn more, earn more, and lead safe and healthy lives, and creates programs to assist in those goals, especially for the underserved populations. David Byers - Tippecanoe County Commissioner - Mr. Byers is a representative of healthy living. As county commissioner, he is knowledgeable in the community's needs and resources available to address those needs. Tom Murtaugh - Tippecanoe County Commissioner - Mr. Murtaugh is a representative of healthy living. As county commissioner, he is knowledgeable in the community's needs and resources available to address those needs. Rabbi Audrey Pollack - Rabbi of Temple Israel, West Lafayette - Rabbi Pollack is a representative of community needs. As a rabbi in the community, she is well-informed of the community's various needs and issues. Jennifer Flora - CEO, Mental Health America of Tippecanoe County - Ms. Flora is a representative of mental health issues and community awareness. As CEO, she is well-versed in the areas surrounding mental health and how it is affecting the community. Aadron Rausch - Director of Strategic Engagement, IU Health Arnett - Mr. Rausch is a representative of healthy living and community awareness and needs. As Director of Strategic Engagement, she is knowledgeable in the community market and the needs within the community. Sue Bergstrom - Nurse, Lafayette School Corporation - Ms. Bergstrom is a representative of children's health. As a school nurse in the community, she is familiar with school-age children's health issues and needs. Veronica Jalomo - Board Member, Hanna Community Center - Ms. Jalomo is a representative of children's health. As a child care provider in the community, Ms. Jalomo is familiar with children's health issues and needs. Carol Lancaster Deno - Nurse, West Lafayette Community School Corporation - Ms. Lancaster Deno is a representative of children's health. As a school nurse in the community, she is familiar with children's health issues and needs. Upon arrival to the focus group, participants were asked to list their believed five prioritized health needs for the IU Health Arnett community. These responses were collected and aggregated into a comprehensive list of identified needs to be further discussed later in the session and ranked for severity of need within the community. IU Health Arnett facilitators then provided participants with a presentation featuring the mission of IU Health, 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 Arnett facilitated a discussion on the comprehensive list of identified needs from earlier in the session. The objective of this method was intended to inspire candid discussions prior to a second identification of five prioritized health needs by each participant. The votes on the five prioritized health needs were tallied and final input from the group was encouraged during this process in order to validate the previously identified needs. Following additional discussion, participants were also asked to address what they thought the role of IU Health Arnett could be in meeting the local health needs. IU Health Arnett also solicited responses from the general public regarding the health of the IU Health Arnett community through an online survey. The survey consisted of approximately 15 multiple choice and open-ended questions that assessed the community members' feedback regarding healthcare issues and barriers to access. A link was made available on the hospital's Web site via an electronic survey tool from April 2012 through June 2012. A paper version was distributed to local community centers, health clinics, community health fairs and events, as well as within some hospital patient waiting areas. Additionally, an estimated 25,000 surveys were e-mailed, direct-mailed, or sent via newsletter. In addition to disseminating directly to the general public of the community, the survey was also sent via e-mail to participants in the needs assessment focus groups to provide an opportunity for these community leaders to pass on to their local community members. Respondent Demographics 9 respondents participated in the survey. All of the participants were from the PSA (Tippecanoe County). All but one participant (89%) was Caucasian (white), and the majority of respondents were 18-40 (77%) years of age, with only two respondents above the age of 60. The educational attainment of the sample was relatively high for the nine individuals who reported it, with more than 66% of respondents indicating they had completed either a college undergraduate (44%) or graduate degree (22%). One respondent indicated completing vocational or technical schooling, and another respondent reported completing some high school or a high school degree/GED only. A majority of survey participants reported a household income of over $44,701 (78%), with the majority of participants indicating an income of $44,701-$67,050 (56%). Only two respondents (22%) reported a household income lower than $44,701. Survey respondents were also asked to report their insurance status. Of the nine respondents who reported their insurance status, the majority had commercial/private insurance (67%). Two individuals also reported either being uninsured or self-pay (22%), and one respondent was covered by Medicaid. SCHEDULE H, PART V, SECTION B, LINE 7 - ADDRESSING IDENTIFIED NEEDS IU Health Arnett's entire community service area extends into seven counties: Tippecanoe, Clinton, White, Carroll, Benton, Fountain, Montgomery, and Jasper. Social and economic factors may contribute to the poor lifestyle choices that are prevalent in the community, such as substance abuse, poor diet, and lack of physical activity. Top Community Health Needs The needs listed below specify the health issues identified by the assessment as priority needs across the entire community served by the hospital. These problems affect most of the community service area counties, but particularly apply to the PSA of Tippecanoe County. Access to healthcare Mental health Obesity and lack of physical activity Substance abuse Senior health IU Health Arnett has chosen not to address the following community health needs: Tobacco & Substance Abuse This need is currently being met and addressed in our community through the Tobacco Free Partnership of Tippecanoe County. IU Health Arnett collaborates with the Tobacco Free Partnership of Tippecanoe County as needed and provides educational material to patients seeking information. Senior Health To promote senior health, IU Health Arnett actively collaborates with the Area IV Council on Aging and Community Action Programs and Healthy Active Tippecanoe programs. These programs include Senior Fairs and Health Fairs. Mental Health This need is currently being met and addressed in our community through Mental Health America Lafayette and Sycamore Springs. SCHEDULE H, PART V, SECTION B, LINE 14G - OTHER MEASURES TO PUBLICIZE Indiana University Health Arnett, Inc. ("IU Health Arnett") 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. 25 IU HEALTH ARNETT - NORTH 2600 GREENBUSH STREET LAFAYETTE IN 47904 PHYSICIAN OFFICE / URGENT CARE CENTER IU HEALTH ARNETT IMAGING CENTER 2403 LOY DR LAFAYETTE IN 47909 DIAGNOSTIC CENTER IU HEALTH ARNETT CANCER CARE CENTER 420 N 26TH STREET LAFAYETTE IN 47904 PHYSICIAN OFFICE IU HEALTH ARNETT - FERRY 2600 FERRY STREET LAFAYETTE IN 47904 PHYSICIAN OFFICE IU HEALTH ARNETT - SALEM 1500 SALEM STREET LAFAYETTE IN 47904 PHYSICIAN OFFICE IU HEALTH ARNETT CARDIOLOGY 1116 N 16TH STREET LAFAYETTE IN 47904 PHYSICIAN OFFICE IU HEALTH ARNETT HORIZON ONCOLOGY 1345 UNITY PL STE 345 LAFAYETTE IN 47905 PHYSICIAN OFFICE IU HEALTH ARNETT PHYSICIANS - WEST LAFAY 2995 SALISBURY STREET WEST LAFAYETTE IN 47906 PHYSICIAN OFFICE / URGENT CARE CENTER IU HEALTH ARNETT GYNECOLOGY 904 SOUTH ST LAFAYETTE IN 47901 PHYSICIAN OFFICE IU HEALTH ARNETT PHYSICIANS - FRANKFORT 550 S HOKE AVE FRANKFORT IN 46041 PHYSICIAN OFFICE IU HEALTH ARNETT OCCUPATIONAL HLTH SRVCS 810 S 6TH ST STE A MONTICELLO IN 47960 PHYSICIAN OFFICE IU HEALTH ARNETT PHYSICIANS 1 WALTER SCHOLER DR LAFAYETTE IN 47909 PHYSICIAN OFFICE / URGENT CARE CENTER IU HEALTH ARNETT PAIN MEDICINE 415 N 26TH STREET LAFAYETTE IN 47904 PHYSICIAN OFFICE IU HEALTH ARNETT NEPHROLOGY 915 MEZZANINE LAFAYETTE IN 47905 PHYSICIAN OFFICE IU HEALTH ARNETT OBSTETRICS & GYNECOLOGY 938 MEZZANINE LAFAYETTE IN 47905 PHYSICIAN OFFICE IU HEALTH ARNETT FAMILY MEDICINE - FERRY 2800 FERRY STREET LAFAYETTE IN 47904 PHYSICIAN OFFICE IU HEALTH ARNETT PHYSICIANS - CARROLL 104 S HOWARD DR FLORA IN 46929 PHYSICIAN OFFICE IU HEALTH ARNETT PHYSICIANS - MONTICELLO 720 S 6TH ST MONTICELLO IN 47960 PHYSICIAN OFFICE IU HEALTH ARNETT PHYSICIANS - DELPHI 651 ARMORY RD DELPHI IN 46923 PHYSICIAN OFFICE IU HEALTH ARNETT PHYSICIANS - OTTERBEIN 407 N MEADOW ST OTTERBEIN IN 47970 PHYSICIAN OFFICE IU HEALTH ARNETT PHYSICIANS - ROSSVILLE 14 S PLANK ST ROSSVILLE IN 46065 PHYSICIAN OFFICE IU HEALTH ARNETT REHABILITATION 2601 FERRY STREET LAFAYETTE IN 47904 REHABILITATION CLINIC IU HEALTH ARNETT PHYSICIANS - FLORA 203 DIVISION ST FLORA IN 46929 PHYSICIAN OFFICE IU HEALTH ARNETT OCCUPATIONAL HLTH SRVCS 3746 ROME DRIVE LAFAYETTE IN 46905 OCCUPATIONAL THERAPY IU HEALTH ARNETT SLEEP LAB CASCADE CTR 3900 MCCARTHY LN STE 101 LAFAYETTE IN 47905 DIAGNOSTIC CENTER Schedule H, Part I, Line 3c - Other Factors Used in Determining Elig. N/A Schedule H, Part I, Line 6a - C.B. Report Prepared by a Related Org. Indiana University Health Arnett, Inc.'s ("IU Health Arnett") community benefits and investments are included in the Indiana University Health ("IU Health") Community Benefit Report which is made available to the public on its website at www.iuhealth.org/getstrong. The Community Benefit report is also distributed to numerous key organizations throughout the State of Indiana to broadly share IU Health's community benefit efforts and investments statewide, and is available by request through the Indiana State Department of Health or IU Health. Schedule H, Part I, Line 7g - Subsidized Health Services Indiana University Health Arnett, Inc. does not include any costs associated with physician clinics as subsidized health services. 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 $30,674,729. The bad debt expense of $9,217,756 on Schedule H, Part III, Line 2 is reported at cost. Schedule H, Part I, Line 7 - Total Community Benefit Expense Percentage of Total Expenses listed on Schedule H, Part I, Line 7, Column (f) is calculated based on Net Community Benefit Expense. The Percentage of Total Expenses calculated based on Total Community Benefit Expense is 15.09%. Schedule H, Part II - Promotion of Health in Communities Served IU Health Arnett Hospital participated in a variety of community-building activities that address the underlying quality of life in the communities it serves. IU Health as a statewide healthcare system invested in economic development efforts across the state collaborated with like-minded organizations through coalitions that address key issues, and advocated for improvements in the health status of vulnerable populations. IU Health contributed more than $1.3 million to community-building activities in 2013, serving over 37,600 people statewide. Locally, IU Health Arnett Hospital invested over $72,000 in community-building activities by providing investments and resources to local community initiatives that addressed economic development, community health improvement and workforce development. A few examples of outreach activities: 1) participating in our local United Way's Read to Succeed child mentoring program and 2) Get Strong Walking Groups. Additionally, through IU Health's team member community benefit service program, Strength That Cares, team members across the state made a difference in the lives of thousands of Hoosiers. On a local level, throughout 2013, more than 40 IU Health Arnett employees volunteered their time with the parks department to improve walking trails, landscape, place signage and general clean up at both Armstrong and Trailhead Parks in Tippecanoe County for the annual IU Health Day of Service. Throughout 2013, IU Health Arnett employees volunteered at local schools through United Way's Read to Succeed program. Employees donated more than 290 volunteer hours throughout the year, improving reading skills for at least 240 children in the classrooms they served. Schedule H, Part III, Line 4 - Bad Debt Expense Indiana University Health Arnett, Inc. ("IU Health Arnett") is included in the consolidated audit report prepared for Indiana University Health, Inc. ("IU Health"). The provision for uncollected patient accounts is based upon management's assessment of historical and expected net collections considering 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, 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, the IU Health System follows established guidelines for placing certain past due patient balances with collection agencies. Patient accounts that are uncollected, including those placed with collection agencies, are initially charged against the allowance for uncollectible accounts in accordance with collection policies of the IU Health System and, in certain cases, are reclassified to charity care if deemed to otherwise meet charity care and financial assistance policies of the IU Health System. The bad debt expense reported on Line 2 is calculated under the cost to charge ratio methodology. IU Health Arnett provides health care services through various programs that are designed, among other matters, to enhance the health of the community and improve the health of low-income patients. In addition, IU Health Arnett provides services intended to benefit the poor and underserved, including those persons who cannot afford health insurance because of inadequate resources or are uninsured or underinsured. Schedule H, Part III, Line 8 - Medicare Shortfall The Medicare shortfall reported on Schedule H, Part III, Line 7 is calculated, in accordance with the Form 990 instructions, using "allowable costs" from Indiana University Health Arnett, Inc.'s ("IU Health Arnett") Medicare Cost Report. "Allowable costs" for Medicare Cost Report purposes are not reflective of all costs associated with IU Health Arnett'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 Arnett's participation in Medicare programs would significantly increase the Medicare shortfall reported on Schedule H, Part III, Line 7. IU Health Arnett's Medicare shortfall is attributable to reimbursements that are less than the cost of providing patient care and services to Medicare beneficiaries and does not include any amounts that result from inefficiencies or poor management. IU Health Arnett accepts all Medicare patients knowing that there may be shortfalls; therefore it has taken the position that the shortfall should be counted as part of its community benefit. Additionally, it is implied in Internal Revenue Service Revenue Ruling 69-545 that treating Medicare patients is a community benefit. Revenue Ruling 69-545, which established the community benefit standard for nonprofit hospitals, states that if a hospital serves patients with governmental health benefits, including Medicare, then this is an indication that the hospital operates to promote the health of the community. Schedule H, Part III, Line 9b - Written Debt Collection Policy 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 meets the financial assistance guidelines established by Indiana University Health Arnett, Inc. ("IU Health Arnett"), IU Health Arnett will waive charges and treat the cost of services as financial assistance. Schedule H, Part VI, Line 2 - Needs Assessment Communities are multifaceted and so are their health needs. Indiana University Health Arnett, Inc. ("IU Health Arnett") 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 Arnett assesses the health care needs of the communities it serves by utilizing the detailed community needs assessments undertaken by organizations such as the Tippecanoe County Health Department, the Indiana State Department of Health, the Centers for Disease Control and Prevention and the United Way of Central Indiana. Schedule H, Part VI, Line 3 - Patient Education of Eligibility for Assist. Indiana University Health Arnett, Inc. ("IU Health Arnett") goes to great lengths to ensure patients know that IU Health Arnett treats all patients regardless of their ability to pay. IU Health Arnett shares financial assistance information with patients during the admission process, billing process and online. Helping patients understand that financial support for their care is a part of IU Health Arnett's commitment to its mission. IU Health Arnett'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 uninsured, or requests assistance information. The patient is also provided with an Admissions Packet that provides information regarding IU Health Arnett's financial assistance program. Financial counselors are onsite to assist financial concerns or questions during the patient's stay. Patient Financial Services - Customer Service representatives can 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 demographics. A summary of the financial assistance policy is printed on the back of each patient statement. The financial assistance application is mailed to all uninsured IU Health Arnett patients at the conclusion of their treatment along with a summary of the incurred charges. Additionally, on the back of each patient statement is a phone number that will allow patients the ability to request financial assistance. Uninsured patients are also made aware of this process at the time of registration. The IU Health Statewide System website (iuhealth.org) has a page dedicated to financial assistance and offers an online application and phone numbers for customer service representatives to assist with the application process. IU Health Arnett has an expansive financial assistance program, which aligns with IU Health Arnett's policy and utilizes the federal poverty guidelines to determine eligibility, making access to quality care within a patient's reach. The IU Health Arnett 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 - Discounted care on a sliding scale for uninsured families earning from 400 to 650 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 with the patient. For those inpatients that may qualify for the Medicaid program and have not applied, IU Health Arnett 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 Arnett, IU Health Arnett will waive charges and treat the cost of services as financial assistance. Schedule H, Part VI, Line 4 - Community Information Indiana University Health Arnett, Inc. ("IU Health Arnett") is primarily located in Tippecanoe County but also has medical offices and serves patients in Benton, Carroll, Clinton, and White counties. Tippecanoe County includes ZIP codes within the towns of Battle Ground, Clarks Hill, Dayton, Lafayette, Romney, West Lafayette and West Point. Based on the most recent Census Bureau (2012) statistics, Tippecanoe County's population is 180,184 persons with approximately 49% being female and 51% male. The county's population estimates by race are 78.9% White, 7.9% Hispanic or Latino, 6.8% Asian, 4.7% Black, 0.4% American Indian or Alaska Native, and 1.9% persons reporting two or more races. Tippecanoe County has relatively moderate levels of educational attainment. The level of education most of the population has achieved is a high school degree (90.6%). As of 2013, 35.7% of the population had a bachelor's degree or higher. IU Health Arnett Hospital has a varied mix of pay for inpatient services with 51% Medicare, 32% commercial, 11% Medicaid, 5% self-pay and 1% government or other. Outpatient services follow a similar pattern with 43% commercial, 32% Medicare, 13% Medicaid, 8% self-pay and 4% other. Discharge information for the hospital shows the majority of patients coming from Tippecanoe County at 57.9%, Clinton - 8%, Carroll - 7.5%, White - 7.1% and Other 19.5%. Schedule H, Part VI, Line 5 - Promotion of Community Health IU Health Arnett is an affiliate of IU Health, a tax-exempt hospital, whose Board of Directors is composed of members, of which substantially all are independent community members. Additionally, IU Health Arnett invests in the community to improve the quality of the health of the community members. Several community benefit highlights are described below. In order to provide educational information and promote health and safety to the local communities it serves, IU Health Arnett hosted its second annual Health & Safety Fair on May 18, 2013. Over 800 people attended the Health & Safety Fair, which focused on providing education to children and their families about their health and well-being. Dozens of community organizations provided educational booths including a smoke trailer to learn how to escape from a smoky house, blood pressure and cholesterol screenings, balance screenings, free bike helmets, hands-on CPR and AED training for families and free car seat safety checks. Community partners also provided information about services for cancer patients, calling 911 and a system that helps locate lost children with disabilities. 75 blood pressure and cholesterol screenings were administered and 41 new car seats were given away. As a part of Indiana University Health's mission to improve the health of the community, a free walking program was developed in 2013. IU Health Arnett with support from the YMCA and Lafayette Parks & Recreation Department collaborated to provide the community with health and fitness experts to motivate the group to "get strong" by providing a fun and safe way to increase physical activity. The goal was to dedicate 30 minutes of activity that could help achieve numerous health benefits such as improved blood pressure and cholesterol level. Once a month, each of the IU Health supported walking sites hosted a gathering with a special guest speaker who demonstrated more ways to help participants get strong. Each week individuals had the option of having their body mass index and blood pressure screened, as a way to track how the walking was impacting their health. Over the course of the four-month program, 49 people registered for the group with 20 percent of participants improving their distance walked. Four people improved their blood pressure from the beginning of the program to the end. Six people reduced their body mass index. The hospital also donated more than $500,000 to non-profit community organizations in 2013. Some of the groups included the Riggs Community Health Center, Lafayette Medical Education Foundation, the United Way of Greater Lafayette and the American Heart Association. Schedule H, Part VI, Line 6 - Affiliated Health Care System IU Health Arnett is a part of the IU Health statewide healthcare system which continues to broaden its reach and positive impact throughout the state of Indiana. IU Health is Indiana's most comprehensive academic medical center and consists of IU Health Methodist Hospital, IU Health University Hospital, Riley Hospital for Children at IU Health, IU Health West Hospital, IU Health North Hospital, IU Health Ball Memorial, IU Health Blackford Hospital, IU Health Bloomington Hospital, IU Health Paoli Hospital, IU Health Bedford Hospital, IU Health Tipton Hospital, IU Health La Porte Hospital, IU Health Starke Hospital, IU Health Morgan, IU Health White, and IU Health Goshen Hospital. Although each IU Health hospital prepares and submits its own community benefits plan relative to the local community, IU Health Arnett 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. After taking a careful look into IU Health's communities we serve, and by utilizing the detailed community needs assessments undertaken by public health officials and community partners, IU Health identified the following community health needs for 2013. Obesity Prevention To improve the lifestyle of Indiana residents, IU Health has utilized 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 thirty-six percent of Hoosier adults are overweight and 29.5% are obese, costing the nations billions of dollars each year to treat these chronic health conditions. Get Strong Walking Group As part of IU Health Arnett's mission to reduce area obesity rates, the free Get Walking groups were launched in 2013. IU Health Arnett hosted two walking groups every Monday from July through October. The groups met at Armstrong Park and Riehle Plaza in Lafayette and West Lafayette. The walking groups were developed to educate community members on the benefits of walking, in an encouraging atmosphere. The program was supported by the Lafayette Parks & Recreation Department as well as The Lafayette YMCA who provided certified walking instructors. IU Health Arnett physicians and Wellness Coordinators volunteered their time to provide additional resources and health screenings to participants. Twenty-eight members participated throughout the course of the program, with six improving their BMI rates and four showing reduced blood pressure after completion of the program. Day of Service In conjunction with the 2013 IU Health Day of Service, IU Health Arnett collaborated locally with the Lafayette Parks & Recreation department. More than 40 IU Health Arnett employees volunteered their time to improve walking trails, landscape, place signage and general cleanup at both Armstrong and Trailhead Parks in Tippecanoe County. Helping to improve local parks is a simple way for IU Health Arnett to encourage the local community to get out and be active! Access to Affordable 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 Arnett treats all patients regardless of their ability to pay. IU Health Arnett is also working to raise awareness and working 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. K-12 Education Education plays a crucial role in health outcomes. Level of education has an impact not only on personal health, but it has multigenerational implications as well. Children with a solid educational foundation and parents who are involved in their education are more likely to embrace healthy lifestyles and habits and succeed generally in life. Additionally, research from The National Center for Public Policy and Higher Education shows that greater educational attainment is associated with health-promoting behaviors, such as increased consumption of fruits and vegetables and other aspects of healthy eating; engaging in physical activity and refraining from smoking. Realizing that educational disparities appear early, IU Health is committed to enhancing childhood education to improve health and lifelong quality of life. Kindergarten Countdown Kindergarten Countdown is a free, four-week summer camp, sponsored by IU Health Arnett. The United Way of Greater Lafayette and IU Health Arnett piloted this program at Miller Elementary during the summer of 2011. Kindergarten Countdown is designed to prepare children with little to no preschool experience for their new roles as kindergarten students. The camp is taught by licensed, experienced teachers and takes place in a school setting. Students attend school for half a day to adjust to the routines and procedures of kindergarten to help them transition into school. IU Health Arnett supports Kindergarten Countdown as a community initiative to strengthen K-12 education. Since launching the program, IU Health Arnett has provided volunteers, school supplies and books to approximately 200 area children who participate in the program each year. Read to Succeed As part of its commitment to education and the community, IU Health Arnett continues to provide volunteers for the Read to Succeed program. This program is a partnership between three public school corporations, Greater Lafayette Commerce and the United Way of Greater Lafayette. The program's goal is to ensure that every third-grader leaves third grade reading at grade level or better. This age is the point when students shift from learning to read toward reading to learn. Without these skills, students get further behind each year, and they are dramatically more likely to drop out of school. This program was developed to help children in the community succeed. IU Health Arnett encourages employees to volunteer for this program weekly throughout the school year. Nearly 15 schools in the Lafayette area participated in 2013, and more than 4,000 local children benefited from the program. true UNITED WAY OF GREATER LAFAYETTE 1114 E STATE ST LAFAYETTE IN 47905 350891621 501(C)(3) 70000 N/A N/A GENERAL SUPPORT RIGGS COMMUNITY HEALTH CENTER INC 1716 HARTFORD ST LAFAYETTE IN 47904 351965865 501(C)(3) 164000 N/A N/A RESIDENCY SUPPORT AMERICAN HEART ASSOCIATION INC PO BOX 4002902 DES MOINES IA 50340 135613797 501(C)(3) 15000 N/A N/A GENERAL SUPPORT LAFAYETTE MEDICAL EDUCATION FOUNDATION INC PO BOX 4083 LAFAYETTE IN 47909 351314750 501(C)(3) 10000 N/A N/A MEDICAL EDUCATION PURDUE FOUNDATION 403 W WOOD ST LAFAYETTE IN 47907 310958507 501(C)(3) 150000 N/A N/A Med. Edu. Facility INDIANA UNIVERSITY HEALTH ARNETT FNDTN 950 N MERIDIAN ST INDIANAPOLIS IN 46204 356079797 501(C)(3) 50000 N/A N/A Medical Education INDIANA UNIVERSITY FOUNDATION PO BOX 500 BLOOMINGTON IN 47402 356018940 501(C)(3) 15000 N/A N/A Scholarship 7 0 Schedule I, Part I, Line 2 - Org.'s Proc. for Mon. the Use of Grant Funds Although Indiana University Health Arnett, Inc. does not monitor the use of grant funds once distributed, through due diligence the organization has reasonably confirmed that the entities to which the contributions are made are highly reputable in the community and use the funds for the purposes intended. false true false false false false false true false ANDREW K EDWARDS MD VICE CHAIRMAN/STAFF PHYSICIAN 412341 0 2830 0 420 0 26880 0 29652 0 472123 0 0 0 ROGER D BANGS MD DIRECTOR/PHYS. (PARTIAL YEAR) 564359 0 7406 0 14091 0 33500 0 23000 0 642356 0 0 0 DANIEL F EVANS JR DIRECTOR 0 1054492 0 301421 0 112206 0 533606 0 29361 0 2031086 0 0 STEPHEN L HENSON MD DIRECTOR/PHYS. (PARTIAL YEAR) 587051 0 911 0 5334 0 33597 0 22772 0 649665 0 0 0 CHRISTOPHER A MANSFIELD MD DIRECTOR/STAFF PHYSICIAN 397230 0 4334 0 378 0 26880 0 25187 0 454009 0 0 0 ALFONSO W GATMAITAN CEO 408328 0 115007 0 13075 0 96951 0 33075 0 666436 0 0 0 JEROME P KELLY SECRETARY 0 238449 0 25513 0 1329 0 20950 0 26424 0 312665 0 0 CARA L BREIDSTER TREASURER/CFO 217319 24147 29132 3237 10007 1112 30150 3350 28379 3153 314987 34999 0 0 BRIAN T SHOCKNEY COO 211058 0 31204 0 10923 0 33500 0 28551 0 315236 0 0 0 DONALD E CLAYTON MD CMD/PHYSICIAN 397139 0 24410 0 27772 0 33500 0 29757 0 512578 0 0 0 JOSHUA B FLEMING RN VP & CNE 148601 0 23892 0 1628 0 16249 0 29186 0 219556 0 0 0 KYLE L ALLEN CPO 212104 0 6551 2070 7066 0 28052 0 13944 0 267717 2070 0 0 JAMES BIEN MD VP, QUALITY & SAFETY 243602 0 40243 0 31512 0 33500 0 27986 0 376843 0 0 0 HAROLD D GEORGE JR ADMIN. DIRECTOR 173645 0 19577 0 90 0 22453 0 18055 0 233820 0 0 0 THERESA K LEFFEW RN ADMIN. DIRECTOR 131847 0 16630 0 5477 0 14098 0 10066 0 178118 0 0 0 JOSEPH E HUBBARD MD STAFF PHYSICIAN 785821 0 9921 0 378 0 26880 0 1751 0 824751 0 0 0 RYAN D LOYD MD STAFF PHYSICIAN 689410 0 0 0 17920 0 33500 0 27212 0 768042 0 0 0 RICHARD C BERG MD STAFF PHYSICIAN 642414 0 4318 0 18130 0 33500 0 26713 0 725075 0 0 0 CHENG DU MD STAFF PHYSICIAN 734244 0 4874 0 18130 0 33500 0 30180 0 820928 0 0 0 PETER A SEYMOUR MD STAFF PHYSICIAN 658297 0 4740 0 420 0 33500 0 29600 0 726557 0 0 0 Schedule J, Part I, Line 3 - Comp. of the Org.'s CEO/Executive Director Alfonso W. Gatmaitan, the CEO of Indiana University Health Arnett, Inc. ("IU Health Arnett"), is compensated as an employee of Indiana University Health, Inc. ("IU Health") for his services performed at IU Health Arnett. IU Health has a process in place to determine the compensation of IU Health Arnett's CEO. This process includes the use of a written employment contract, the terms of which are determined based upon a compensation survey/study conducted by an independent compensation consultant with review and approval by IU Health's compensation committee and board of directors. Schedule J, Part I, Line 4b - Supplemental Nonqualified Retirement Plan Daniel F. Evans, Jr. and Alfonso W. Gatmaitan participate in a supplemental executive retirement plan of Indiana University Health, Inc., the provisions of which are designed to retain its critical employees. The plan provides for an additional retirement benefit for service through normal retirement or other key dates. If the executive leaves prior to retirement or other key dates, the benefit may be forfeited or reduced. Daniel F. Evans, Jr. and Alfonso W. Gatmaitan have an amount included in column c, deferred compensation, representing the current year increase in the accrued benefit and/or current contributions. No amount was actually paid to this executive during the year. Schedule J, Part I, Line 7 - Non-Fixed Payments Amounts disclosed in Column B(ii) include a long-term and short-term incentive for certain executives and short-term incentive for other employees. Although these plans are based on a fixed formula that has been approved by the Board of Directors based upon certain qualitative and quantitative factors and goals, all discretionary incentive plans must be approved by the Board of Directors prior to any incentive payout. Schedule J, Part III - Daniel F. Evans, Jr. - 2009 through 2013 Forms W-2c Indiana University Health, Inc. ("IU Health") issued 2009, 2010, 2011, 2012, and 2013 Forms W-2c to Daniel F. Evans, Jr. in order to include previously excluded premiums it paid on a life insurance policy, in which Daniel F. Evans, Jr. was the insured party and a family member was the beneficiary, as taxable compensation. Furthermore, IU Health amended its 2010, 2011, and 2012 Forms 990 to reflect the changes in Daniel F. Evans, Jr.'s taxable compensation. Part VI, Section A, Lines 6, 7a and 7b - Members or Stockholders Line 6: The sole member of Indiana University Health Arnett, Inc. ("IU Health Arnett") is Indiana University Health, Inc. ("IU Health"), a 501(c)(3) tax-exempt hospital. Line 7a: The control and management of the affairs of IU Health Arnett is vested in a board of up to twelve (12) voting directors whom are appointed by IU Health, as the sole member of the organization. Three (3) of the voting directors are nominated by the IU Health Arnett employed physicians. One (1) of the voting directors is nominated by active medical staff members. IU Health may only either accept director nominees from the IU Health Arnett employed physicians and active medical staff members or reject one or more of such nominees and request different nominees from the employed physicians and active medical staff members. Line 7b: The board of directors may not undertake certain actions without the prior approval of IU Health, as the sole member. Actions that require prior approval include the following: -Authorization of any merger, consolidation, reorganization, sale or transfer of all or substantially all of the assets of IU Health Arnett; -Authorization of any plan of dissolution of IU Health Arnett, any liquidating distribution of IU Health Arnett's assets or other action related to the dissolution or liquidation of IU Health Arnett; -Authorization of any voluntary declaration of bankruptcy of IU Health Arnett; -Amendment, repeal, revision or adoption of changes to the organization documents of IU Health Arnett; -Authorization of the consolidation of any entity with, or acquisition of any entity by IU Health Arnett; -Authorization of any agreement to act as a primary obligor, or to serve as a guarantor, surety or co-obligor with respect to the indebtedness of any other party, to borrow amounts from third-party lenders or to loan money to any person or entity; -Approval of strategic plans and amendments; -Authorization of any pledge of, or grant of any security interest or mortgage in, or otherwise encumber, any tangible assets in excess of an appropriate monetary threshold, other than in the ordinary course of business or pursuant to an approved budget or strategic plan; -Approval of any management agreement for the management of all or a substantial part of IU Health Arnett's operations; or -Authorization of the establishment or acquisition by IU Health Arnett of any subsidiaries, affiliates or joint venture arrangements or the acquisition by IU Health Arnett of the stock or other equity interest or substantially all the assets of any other business or entity. Part VI, Section A, Line 11b - Form 990 Provided to Governing Body Indiana University Health Arnett, Inc. ("IU Health Arnett") has established the following process for the review of the Form 990 and related schedules before it is filed: The Chief Financial Officer reviewed and approved the Form 990 and related schedules. After the review and approval from the Chief Financial Officer, a complete copy of the Form 990 and related schedules was presented and approved by the Audit Committee. After Audit Committee approval, a complete copy of the Form 990 and related schedules was made available to each board member on a secure intranet site. Each member was informed of the availability of the Tax Department to answer any questions. Part VI, Section B, Lines 12, 13, 14, and 16b - Policies Indiana University Health Arnett, Inc. ("IU Health Arnett") is part of the Indiana University Health, Inc. ("IU Health") system. As the sole member and controlling parent of IU Health Arnett, IU Health and its Board of Directors have mandated that certain policies be followed to ensure greater standardization throughout the system. Thus, IU Health Arnett'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 Indiana University Health Arnett, Inc. ("IU Health Arnett") has a Conflict of Interest Policy, the purpose of which is to protect IU Health Arnett's interests when it is contemplating entering into a transaction or arrangement that might benefit the private interest of an officer, director, or employee. Each employee that is manager level or above, including officers and directors, is required to annually sign a statement which affirms that such person (1) has received a copy of the conflict of interest policy; (2) has read and understands the policy; (3) has agreed to comply with the policy; and (4) understands and acknowledges that the Corporation is a tax-exempt organization and that in order to maintain its federal tax exemption it must engage primarily in activities which accomplish one or more of its tax-exempt purposes. If an interest is disclosed, the form requires that the discloser's supervisor sign the form to indicate his/her knowledge and approval of the interest. The form is then submitted to Corporate Compliance for review. If the disclosure is by the CEO/President, it is reviewed by the board chairman for approval. If the disclosure is by a member of the board of directors, the General Counsel/Chief Compliance Officer reviews the disclosures and determines whether to consent. Board members with a conflict of interest cannot participate in any decision related to that conflict. Breach of the conflict of interest policy, including failure to complete and update the questionnaire and failure to disclose an interest that should be disclosed, may subject an individual to disciplinary action, including dismissal. Part VI, Section B, Line 15 - Process for Determining Compensation The CEO/Top Management Official for Indiana University Health Arnett, Inc. ("IU Health Arnett") is employed by Indiana University Health, Inc. ("IU Health"). IU Health has the following process for determining compensation: 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 Indiana University Health, Inc. ("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, Planning and Human Resources. The Committee on Finance, Planning and Human Resources 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 Finance, Planning and Human Resources Committee 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, Planning and Human Resources. 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. IU Health Arnett has a process in place to determine the compensation for the other officers and key employees. IU Health Arnett uses an independent compensation consultant who utilizes a variety of methods and procedures to obtain compensation ranges for comparable officer and employee positions. The independent compensation consultant provides IU Health Arnett with recommended compensation ranges for its officers and other employees, which are then used as a guide for setting reasonable compensation by management. Management decisions with regard to determining compensation are subject to the review and approval of the Executive Committee and Board of Directors. Part VI, Section C, Line 19 - Public Disclosure Indiana University Health Arnett, Inc.'s ("IU Health Arnett") Articles of Incorporation are available for public inspection through the Indiana Secretary of State's web-site. IU Health Arnett's conflict of interest procedures are disclosed on the Form 990, Schedule O. IU Health Arnett is a consolidated subsidiary in the consolidated financial statements for Indiana University Health, Inc. ("IU Health"). The consolidated financial statements for IU Health are available to the public through its bond filings and attached to the Form 990 Part IX, Line 11g - Other Fees for Services Line 11g includes amounts paid for the following: Shared Services/Professional Fees - $42,109,112 ARNETT CLINIC LLC 950 N MERIDIAN ST STE 800 INDIANAPOLIS IN 46204 352030653 HEALTHCARE IN 117408307 0 IUHA CAH PHYSICIANS LLC 950 N MERIDIAN ST STE 800 INDIANAPOLIS IN 46204 262769447 HEALTHCARE IN 0 0 IUHA CLARIAN-ARNETT OCCUP HEALTH CTRS LLC 950 N MERIDIAN ST STE 800 INDIANAPOLIS IN 46204 271973115 HEALTHCARE IN 2768441 0 IUHA CLARIAN TRANSPLANT INSTITUTE INC 950 N MERIDIAN ST STE 800 INDIANAPOLIS IN 46204 134350599 HEALTHCARE IN 501(C)(3) 9 IUH true GOSHEN HEALTH SYSTEM INC 200 HIGH PARK AVE GOSHEN IN 46527 351974765 HEALTHCARE IN 501(C)(3) 11 I IUH true GOSHEN HOSPITAL ASSOCIATION INC 200 HIGH PARK AVE GOSHEN IN 46527 356001540 HEALTHCARE IN 501(C)(3) 3 GHS true HEALTHLINC INC 714 S ROGERS ST BLOOMINGTON IN 47403 263571507 HEALTHCARE IN 501(C)(3) 9 IUHB true INDIANA RADIOLOGY PARTNERS INC 950 N MERIDIAN ST STE 800 INDIANAPOLIS IN 46204 201017034 HEALTHCARE IN 501(C)(3) 3 IUH 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 true IU HEALTH BALL MEMORIAL HOSPITAL INC 950 N MERIDIAN ST STE 800 INDIANAPOLIS IN 46204 350867958 HEALTHCARE IN 501(C)(3) 3 IUH true IU HEALTH BALL MEMORIAL PHYSICIANS INC 950 N MERIDIAN ST STE 800 INDIANAPOLIS IN 46204 351925641 HEALTHCARE IN 501(C)(3) 9 IUHBMH true IU HEALTH BEDFORD INC 2900 W 16TH ST BEDFORD IN 47421 237042323 HEALTHCARE IN 501(C)(3) 3 IUH true IU HEALTH BLACKFORD HOSPITAL INC 950 N MERIDIAN ST STE 800 INDIANAPOLIS IN 46204 010646166 HEALTHCARE IN 501(C)(3) 3 IUHBMH true IU HEALTH BLOOMINGTON INC PO BOX 1149 BLOOMINGTON IN 47403 351720796 HEALTHCARE IN 501(C)(3) 3 IUH true IU HEALTH BMH FOUNDATION INC 950 N MERIDIAN ST STE 800 INDIANAPOLIS IN 46204 311111784 FUNDRAISING IN 501(C)(3) 11 I IUHBMH true IU HEALTH CARE ASSOCIATES INC 950 N MERIDIAN ST STE 800 INDIANAPOLIS IN 46204 351747218 HEALTHCARE IN 501(C)(3) 9 IUH true IU HEALTH LAPORTE HOSPITAL INC PO BOX 250 LAPORTE IN 46352 351125434 HEALTHCARE IN 501(C)(3) 3 IUH true IU HEALTH LAPORTE PHYSICIANS INC PO BOX 250 LAPORTE IN 46352 311070868 HEALTHCARE IN 501(C)(3) 3 IUHLH true IU HEALTH MORGAN HOSPITAL INC 2209 JOHN R WOODEN DR MARTINSVILLE IN 46151 273533027 HEALTHCARE IN 501(C)(3) 3 IUH true IU HEALTH NORTH HOSPITAL INC 950 N MERIDIAN ST STE 800 INDIANAPOLIS IN 46204 351932442 HEALTHCARE IN 501(C)(3) 3 IUH true IU HEALTH PAOLI HOSP FOUNDATION INC PO BOX 499 PAOLI IN 47454 310992486 FUNDRAISING IN 501(C)(3) 11 III-O IUHP true IU HEALTH PAOLI INC PO BOX 499 PAOLI IN 47454 352090919 HEALTHCARE IN 501(C)(3) 3 IUHB true IU HEALTH TIPTON HOSPITAL INC 950 N MERIDIAN ST STE 800 INDIANAPOLIS IN 46204 262772226 HEALTHCARE IN 501(C)(3) 3 IUH true IU HEALTH WEST HOSPITAL INC 950 N MERIDIAN ST STE 800 INDIANAPOLIS IN 46204 351814660 HEALTHCARE IN 501(C)(3) 3 IUH true IU HEALTH WHITE MEMORIAL HOSPITAL INC 950 N MERIDIAN ST STE 800 INDIANAPOLIS IN 46204 273532963 HEALTHCARE IN 501(C)(3) 3 IUH true IU MEDICAL GROUP FOUNDATION INC 340 W 10TH ST NO FS5100 INDIANAPOLIS IN 46202 201093251 FUNDRAISING IN 501(C)(3) 11 II NA false METHODIST HEALTH FOUNDATION INC 1800 N CAPITOL AVE INDIANAPOLIS IN 46202 356043086 FUNDRAISING IN 501(C)(3) 11 I IUH 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 true METHODIST OCCUP HEALTH CENTERS INC 950 N MERIDIAN ST STE 800 INDIANAPOLIS IN 46204 351844176 HEALTHCARE IN 501(C)(3) 3 IUH true METHODIST RESEACH INSTITUTE INC 950 N MERIDIAN ST STE 800 INDIANAPOLIS IN 46204 352023710 HEALTHCARE IN 501(C)(3) 11 I IUH true MH HEALTHCARE INC 950 N MERIDIAN ST STE 800 INDIANAPOLIS IN 46204 351766531 HEALTHCARE IN 501(C)(3) 3 MMG true MORGAN CO MEM HOSP FOUNDATION INC 2209 JOHN R WOODEN DR MARTINSVILLE IN 46151 352035162 FUNDRAISING IN 501(C)(3) 11 II IUHMH true MORGAN CO MEM HOSP GUILD INC 2209 JOHN R WOODEN DR MARTINSVILLE IN 46151 310886844 FUNDRAISING IN 501(C)(3) 11 III-FI IUHMH true MORGAN HEALTH SERVICES INC 1949 HOSPITAL DR MARTINSVILLE IN 46151 351968564 HEALTHCARE IN 501(C)(3) 3 IUHMH true IU HEALTH WHITE MEMORIAL FOUNDATION PO BOX 952 MONTICELLO IN 47960 351671806 FUNDRAISING IN 501(C)(3) 11 III-O IUHWMH true UNIVERSITY FAMILY PHYSICIANS INC 950 N MERIDIAN ST STE 800 INDIANAPOLIS IN 46204 237427350 HEALTHCARE IN 501(C)(3) 9 IUHCA true REHABILITATION HOSPITAL OF INDIANA INC 4141 SHORE DR INDIANAPOLIS IN 46254 351786005 HEALTHCARE IN 501(C)(3) 3 MHH true RHI FOUNDATION INC 4141 SHORE DR INDIANAPOLIS IN 46254 351932349 FUNDRAISING IN 501(C)(3) 11 I RHI true IU HEALTH GOSHEN FOUNDATION INC 200 HIGH PARK AVE GOSHEN IN 46527 462565300 FUNDRAISING IN 501(C)(3) 11 I GHS true LAPORTE HOSPITAL FOUNDATION INC PO BOX 250 LAPORTE IN 46352 310952775 FUNDRAISING IN 501(C)(3) 11 I NA false THE CHEER GUILD OF RILEY HOSP FOR CHILD 705 RILEY HOSPITAL DR INDIANAPOLIS IN 46202 356018517 FUNDRAISING IN 501(C)(3) 11 III-FI NA false INDIANA HEALTH INFORMATION EXCHANGE INC 846 N SENATE AVE INDIANAPOLIS IN 46202 364550324 HEALTHCARE IN 501(C)(3) 11 I NA false BALL OUTPATIENT SURGERY CENTER LLC 3000 RIVERCHASE GALLERIA STE 500 BIRMINGHAM AL 35244 270275794 HEALTHCARE IN BOSCH false 0 BELTWAY SURGERY CENTERS LLC 3000 RIVERCHASE GALLERIA STE 500 BIRMIMGHAM AL 35244 352072586 HEALTHCARE IN BSCH false 0 BLOOMINGTON ENDOSCOPY CENTERS LLC PO BOX 1149 BLOOMINGTON IN 47402 352117943 HEALTHCARE IN IUHB false 0 BOSC HOLDINGS LLC 3000 RIVERCHASE GALLERIA STE 500 BIRMINGHAM AL 35244 454147343 HEALTHCARE IN IUH false 0 CARDINAL HEALTH INITIATIVES LLC 950 N MERIDIAN ST STE 800 INDIANAPOLIS IN 46204 300102702 PURCHASING IN IUHBMH false 0 CHV FUND I LLC 950 N MERIDIAN ST STE 800 INDIANAPOLIS IN 46204 262523206 VENTURE CAPITAL IN IUH false 0 CHV FUND MANAGEMENT LLC 950 N MERIDIAN ST STE 800 INDIANAPOLIS IN 46204 262523151 VENTURE CAPITAL IN CHV false 0 CLARIAN HEALTH NETWORK LLC 950 N MERIDIAN ST STE 800 INDIANAPOLIS IN 46204 352055030 HEALTHCARE IN IUH false 0 EAGLE HIGHLANDS SURGERY CENTER LLC 3000 RIVERCHASE GALLERIA STE 500 BIRMINGHAM AL 35244 352259204 HEALTHCARE IN EHSCH false 0 EHSC HOLDINGS LLC 3000 RIVERCHASE GALLERIA STE 500 BIRMINGHAM AL 35244 454147879 HEALTHCARE IN IUH false 0 HEALTH VENTURE MANAGEMENT LLC 950 N MERIDIAN ST STE 800 INDIANAPOLIS IN 46204 205740218 MANAGEMENT IN IUH false 0 IEC HOLDINGS LLC 3000 RIVERCHASE GALLERIA STE 500 BIRMINGHAM AL 35244 454148032 HEALTHCARE IN IUH false 0 INDIANA ENDOSCOPY CENTERS LLC 3000 RIVERCHASE GALLERIA STE 500 BIRMINGHAM AL 35244 208398421 HEALTHCARE IN IECH false 0 BSC HOLDINGS LLC 3000 RIVERCHASE GALLERIA STE 500 BIRMINGHAM AL 35244 452314634 HEALTHCARE IN IUH false 0 ROC SURGERY LLC 3000 RIVERCHASE GALLERIA STE 500 BIRMINGHAM AL 35244 271497960 HEALTHCARE IN ROCSH false 0 ROCS HOLDINGS LLC 3000 RIVERCHASE GALLERIA STE 500 BIRMINGHAM AL 35244 454148369 HEALTHCARE IN IUH false 0 SENATE STREET SURGERY CENTER LLC 3000 RIVERCHASE GALLERIA STE 500 BIRMINGHAM AL 35244 421709357 HEALTHCARE IN SSSCH false 0 SSSC HOLDINGS LLC 3000 RIVERCHASE GALLERIA STE 500 BIRMINGHAM AL 35244 454148167 HEALTHCARE IN IUH false 0 CARDINAL HEALTH ALLIANCE LLC 2401 W UNIVERSITY AVE MUNCIE IN 47303 351966281 MANAGED CARE IN IUHBMH false 0 BMH MEDICAL PAVILION ASSOCIATION INC 2525 W UNIVERSITY AVE MUNCIE IN 47303 351858408 CONDO MANAGEMENT IN IUHBMH C 0 0 0.00000 true CARDINAL HEALTH VENTURES INC 950 N MERIDIAN ST STE 800 INDIANAPOLIS IN 46204 351611424 MANAGEMENT IN IUHBMH C 0 0 0.00000 true CHV CAPITAL INC 950 N MERIDIAN ST STE 800 INDIANAPOLIS IN 46204 260752507 VENTURE CAPITAL IN IUH C 0 0 0.00000 true IU HEALTH ACO INC 950 N MERIDIAN ST STE 800 INDIANAPOLIS IN 46204 454421020 HEALTHCARE IN IUH C 0 0 0.00000 true IU HEALTH BOARD DESIGNATED TRUST 400 HOWARD ST SAN FRANCISCO CA 94105 306309021 INVESTMENTS IN IUH T 0 0 0.00000 true IU HEALTH NTGI S&P500 FUND CF PO BOX 804358 CHICAGO IL 60680 306298263 INVESTMENTS IN IUH T 0 0 0.00000 true IU HEALTH PLANS INC 950 N MERIDIAN ST STE 800 INDIANAPOLIS IN 46204 262127080 HMO IN IUH C 0 0 0.00000 true IU HEALTH RISK PURCHASING GROUP INC 151 MEETING ST STE 301 CHARLESTON SC 29401 260202446 INSURANCE IN IUH C 0 0 0.00000 true IU HEALTH RISK RETENTION GROUP INC 151 MEETING ST STE 301 CHARLESTON SC 29401 201107674 INSURANCE SC IUH C 0 0 0.00000 true IU HEALTH SOUTHERN IN PHYSICIANS INC PO BOX 1149 BLOOMINGTON IN 47402 351913875 HEALTHCARE IN IUHB C 0 0 0.00000 true IU HEALTH ASSURANCE LTD PO BOX 69 SOLARIS AVE. GRAND CAYMAN CJ 980395429 INSURANCE CJ IUH C 0 0 0.00000 true 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 true PARKMOR DRUG INC 1501 S MAIN ST GOSHEN IN 46526 131394980 PHARMACY SALE IN GHS C 0 0 0.00000 true PILR INC 200 HIGH PARK AVE GOSHEN IN 46526 204294750 DEVELOPMENT IN GHS C 0 0 0.00000 true RADIATION ONCOLOGY RESOURCES INC 200 HIGH PARK AVE GOSHEN IN 46526 262008424 HEALTHCARE IN GHS C 0 0 0.00000 true SCANS INC 950 N MERIDIAN ST STE 800 INDIANAPOLIS IN 46204 453080392 HEALTHCARE IN CHVF1 C 0 0 0.00000 true UNIVERSITY HEALTH MANAGEMENT INC 950 N MERIDIAN ST STE 800 INDIANAPOLIS IN 46204 272891143 MANAGEMENT IN CHV C 0 0 0.00000 true UNIVERSITY HEALTH MGMT (CHINA) INC 950 N MERIDIAN ST STE 800 INDIANAPOLIS IN 46204 273891311 MANAGEMENT IN CHV C 0 0 0.00000 true PROTEUO FUND LP PO BOX 31106 89 NEXUS WAY GRAND CAYMAN CJ 981075227 Investments CJ IUH C 0 0 0.00000 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 true IU HEALTH PLANS NFP INC 950 N MERIDIAN ST STE 800 INDIANAPOLIS IN 46204 463803873 INSURANCE IN IUHPHC C 0 0 0.00000 true UNIV HLTH (SHANGHAI) MGT CON CO LTD MANAGEMENT CH UHMC C 0 0 0.00000 true GUGGENHEIM HIGH-YIELD PLUS FUND SPC PO BOX 309 UGLAND HOUSE GRAND CAYMAN CJ INVESTMENT CJ IUH C 0 0 0.00000 true false false false false true false false false true true true true false true false false true false IU HEALTH WHITE MEMORIAL HOSPITAL INC O 143255 FMV IU HEALTH WHITE MEMORIAL HOSPITAL INC L 257976 FMV INDIANA RADIOLOGY PARTNERS INC M 122100 FMV INDIANA UNIVERSITY HEALTH CARE ASSOC INC M 1279772 FMV METHODIST OCCUPATIONAL HEALTH CENTER INC M 340663 FMV IU HEALTH RISK RETENTION GROUP INC R 2528820 FMV IUH ASSURANCE LTD R 644141 FMV