INDIANA UNIVERSITY HEALTH BLACKFORD HOSPITAL INC: Form 990, tax year 2013
View the entire original 990 at ProPublica ↗
- Organization
- INDIANA UNIVERSITY HEALTH BLACKFORD HOSPITAL INC (EIN 01-0646166)
- Tax period
- 2013-01-01 to 2013-12-31
- Filed
- 2014-11-17
- IRS object ID
- 201433219349302888
- Schema version
- 2013v3.1
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule H
- Schedule J
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2014-11-17T10:27:22-06:00 | ReturnTs |
| Tax Period End | 2013-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ERNST & YOUNG US LLP | BusinessNameLine1 |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 111 MONUMENT CIRCLE SUITE 4000 | AddressLine1 |
| City | INDIANAPOLIS | City |
| State | IN | State |
| ZIP Code | 46204 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2013-01-01 | 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 | BusinessNameLine1 |
| Business Name Line2 | HOSPITAL INC | BusinessNameLine2 |
| 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 | AddressLine1 |
| Address Line2 | Suite | AddressLine2 |
| City | INDIANAPOLIS | City |
| State | IN | State |
| ZIP Code | 46204 | ZIPCode |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | LORI A LUTHER | PersonNm |
| Person Title | TREASURER | PersonTitleTxt |
| Signature | 2014-11-14 | SignatureDt |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | JENNIFER D RHODERICK | PreparerPersonNm |
| PTIN | P00395735 | PTIN |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2013 | TaxYr |
| Build TS | 2015-11-30 17:44:51Z | 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 | AddressLine1 |
| City | INDIANAPOLIS | City |
| State | IN | State |
| ZIP Code | 46204 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $16,342,703 | 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 | 9 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 6 | VotingMembersIndependentCnt |
| Total Employee | 189 | TotalEmployeeCnt |
| Total Volunteers | 60 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $64,581 | PYContributionsGrantsAmt |
| CY Contributions Grants | $26,491 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $17,645,439 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $16,236,215 | CYProgramServiceRevenueAmt |
| PY Investment Income | $15,712 | PYInvestmentIncomeAmt |
| CY Investment Income | -$33,640 | CYInvestmentIncomeAmt |
| PY Other Revenue | $100,753 | PYOtherRevenueAmt |
| CY Other Revenue | $79,212 | CYOtherRevenueAmt |
| PY Total Revenue | $17,826,485 | PYTotalRevenueAmt |
| CY Total Revenue | $16,308,278 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $4,248 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $2,648 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $7,770,755 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $7,747,171 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $10,245,841 | PYOtherExpensesAmt |
| CY Other Expenses | $9,515,128 | CYOtherExpensesAmt |
| PY Total Expenses | $18,020,844 | PYTotalExpensesAmt |
| CY Total Expenses | $17,264,947 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$194,359 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$956,669 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $14,971,953 | TotalAssetsBOYAmt |
| Total Assets EOY | $13,366,751 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $4,115,242 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $3,457,260 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $10,856,711 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $9,909,491 | 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 | $16,179,152 | ExpenseAmt |
| Grant | $2,648 | GrantAmt |
| Revenue | $16,236,215 | 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 | $16,179,152 | 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 | false | ScheduleORequiredInd |
| IRP Document | 34 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (true) | BackupWthldComplianceInd |
| Employee | 189 | 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 | 9 | 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 | AddressLine1 |
| City | INDIANAPOLIS | City |
| State | IN | State |
| ZIP Code | 46204 | ZIPCode |
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 | 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 | 55.0 | 0.0 | Yes (X) | Yes (X) | $136,903 | $0 | $18,670 | |
| MICHAEL E HALEY | ||||||||
| DIRECTOR | 5.0 | 55.0 | Yes (X) | $0 | $697,569 | $51,259 | ||
| KRISTIE B JENNERJAHN | ||||||||
| DIRECTOR | 5.0 | 0.0 | Yes (X) | $0 | $0 | $0 | ||
| LORI A LUTHER | ||||||||
| DIRECTOR/TREASURER | 5.0 | 55.0 | Yes (X) | Yes (X) | $0 | $239,195 | $18,139 | |
| GARY L RHOTON | ||||||||
| DIRECTOR | 5.0 | 0.0 | Yes (X) | $0 | $0 | $0 | ||
| LORI J SKIDMORE MD | ||||||||
| DIRECTOR (PARTIAL YEAR) | 5.0 | 0.0 | Yes (X) | $0 | $0 | $0 | ||
| MARK W TOWNSEND | ||||||||
| DIRECTOR | 5.0 | 0.0 | Yes (X) | $0 | $0 | $0 | ||
| ELIZABETH A DROEGE MD | ||||||||
| STAFF PHYSICIAN | 55.0 | 0.0 | $284,524 | $0 | $29,467 | Yes (X) | ||
| JOANNA B THOMAS MD | ||||||||
| STAFF PHYSICIAN | 55.0 | 0.0 | $180,448 | $0 | $23,648 | Yes (X) | ||
| ROLAND W JAMES MD | ||||||||
| STAFF PHYSICIAN | 40.0 | 15.0 | $175,947 | $24,343 | $31,278 | Yes (X) | ||
| CHARLES L CARROLL DO | ||||||||
| STAFF PHYSICIAN | 55.0 | 0.0 | $115,011 | $0 | $0 | Yes (X) | ||
| THOMAS M LEE | ||||||||
| STAFF PHYSICIAN | 55.0 | 55.0 | $105,099 | $228,415 | $37,188 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $997,932 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $1,189,522 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $209,649 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 6 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | false | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (true) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (3 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1 | CityContractorAddress/USAddress/City | StateContractorAddress/USAddress/State | ZIP CodeContractorAddress/USAddress/ZIPCode | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| SHAW DO SERVICES LLC | |||||
| 18017 CHERRY WOOD LN | HOMEWOOD | IL | 60430 | MEDICAL | $178,815 |
| ELMER TOLIVER PSC | |||||
| 14412 SMUGGLERS NOTCH | FORT WAYNE | IN | 46814 | MEDICAL | $121,940 |
| INSIGHT HEALTH CORP | |||||
| PO BOX 847689 | DALLAS | TX | 75284 | MEDICAL | $117,559 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 3 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $26,491 | GovernmentGrantsAmt |
| Total Contributions | $26,491 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (4 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| NET PATIENT SERVICE REVENUE | 621110 | $15,847,220 | $15,847,220 |
| ELECTRONIC HEALTH RECORDS INCENTIVE | 900099 | $275,444 | $275,444 |
| INCOME (LOSS) FROM PARTNERSHIPS | 900099 | $28,119 | $28,119 |
| SHARED SERVICES | 541900 | $85,432 | $85,432 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $16,236,215 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $785 | TotalRevenueColumnAmt |
| Exclusion | $785 | 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 | $2,600 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $2,600 | RealAmt |
| Personal | $0 | PersonalAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $2,600 | TotalRevenueColumnAmt |
| Exclusion | $2,600 | ExclusionAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $9,516 | SecuritiesAmt |
| Other | $24,909 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | -$9,516 | SecuritiesAmt |
| Other | -$24,909 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$34,425 | TotalRevenueColumnAmt |
| Exclusion | -$34,425 | ExclusionAmt |
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 (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | ExclusionExclusionAmt |
|---|---|---|---|
| CAFETERIA/FOOD SERVICE | 721110 | $58,796 | $58,796 |
| VENDING | 900099 | $1,083 | $1,083 |
| ALL OTHER REVENUE | 900099 | $16,733 | $16,733 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $76,612 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $16,308,278 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $16,236,215 | RelatedOrExemptFuncIncomeAmt |
| Exclusion | $45,572 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,648 | TotalAmt |
| Program Services | $2,648 | ProgramServicesAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Foreign Grants ForeignGrantsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Benefits To Members BenefitsToMembersGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $155,573 | TotalAmt |
| Program Services | $141,859 | ProgramServicesAmt |
| Management And General | $13,714 | ManagementAndGeneralAmt |
Comp Disqual Persons CompDisqualPersonsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,958,266 | TotalAmt |
| Program Services | $5,433,038 | ProgramServicesAmt |
| Management And General | $525,228 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $176,230 | TotalAmt |
| Program Services | $160,695 | ProgramServicesAmt |
| Management And General | $15,535 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,033,343 | TotalAmt |
| Program Services | $942,253 | ProgramServicesAmt |
| Management And General | $91,090 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $423,759 | TotalAmt |
| Program Services | $386,404 | ProgramServicesAmt |
| Management And General | $37,355 | 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 | $5,873 | TotalAmt |
| Management And General | $5,873 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $34,825 | TotalAmt |
| Management And General | $34,825 | ManagementAndGeneralAmt |
Fees For Services Lobbying FeesForServicesLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,900 | TotalAmt |
| Management And General | $1,900 | 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 | $4,622,361 | TotalAmt |
| Program Services | $4,470,250 | ProgramServicesAmt |
| Management And General | $152,111 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $11,159 | TotalAmt |
| Program Services | $86 | ProgramServicesAmt |
| Management And General | $11,073 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $101,285 | TotalAmt |
| Program Services | $73,270 | ProgramServicesAmt |
| Management And General | $28,015 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $52,816 | TotalAmt |
| Program Services | $52,816 | ProgramServicesAmt |
Royalties RoyaltiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $521,159 | TotalAmt |
| Program Services | $508,863 | ProgramServicesAmt |
| Management And General | $12,296 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $9,405 | TotalAmt |
| Program Services | $6,572 | ProgramServicesAmt |
| Management And General | $2,833 | 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 | $988 | TotalAmt |
| Management And General | $988 | ManagementAndGeneralAmt |
Payments To Affiliates PaymentsToAffiliatesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,183,307 | TotalAmt |
| Program Services | $1,183,307 | ProgramServicesAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $162,733 | TotalAmt |
| Program Services | $30,693 | ProgramServicesAmt |
| Management And General | $132,040 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| BAD DEBT | $749,180 | $749,180 | |
| DRUGS AND MEDICAL SUPPLIES | $1,206,399 | $1,206,399 | |
| INSTITUTIONAL DUES/LICENSES | $12,453 | $12,453 | |
| ALL OTHER EXPENSES | $839,285 | $818,366 | $20,919 |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $17,264,947 | TotalAmt |
| Program Services | $16,179,152 | ProgramServicesAmt |
| Management And General | $1,085,795 | 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 | $12,794 | BOYAmt |
| EOY | $0 | 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 | $2,884,931 | BOYAmt |
| EOY | $2,663,926 | 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 | $173,225 | BOYAmt |
| EOY | $205,225 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $88,170 | BOYAmt |
| EOY | $71,865 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $20,722,207 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $10,334,400 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,977,045 | BOYAmt |
| EOY | $10,387,807 | 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 | $55,773 | BOYAmt |
| EOY | $37,328 | 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 | $779,415 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $14,971,953 | BOYAmt |
| EOY | $13,366,751 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,780,175 | BOYAmt |
| EOY | $1,272,091 | 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 | $6,621 | BOYAmt |
| EOY | $17,915 | 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 | $800,351 | 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 | $1,528,095 | BOYAmt |
| EOY | $2,167,254 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,115,242 | BOYAmt |
| EOY | $3,457,260 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,856,711 | BOYAmt |
| EOY | $9,909,491 | 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 | $10,856,711 | BOYAmt |
| EOY | $9,909,491 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $14,971,953 | BOYAmt |
| EOY | $13,366,751 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | -$956,669 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $9,449 | NetUnrlzdGainsLossesInvstAmt |
| 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 | $1,900 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $1,900 | 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 | Indiana University Health Blackford Hospital, Inc. ("IU Health Blackford Hospital") paid institutional membership dues to the American Hospital Association ("AHA") and Indiana Hospital Association ("IHA") during 2013 in the amount of $7,181 and $3,378, respectively. Each membership organization notified IU Health Blackford Hospital that a portion of the dues it paid were used for lobbying purposes. The AHA used 23.98%, or $1,722 of the 2013 membership dues paid by IU Health Blackford Hospital, for lobbying expenditures. The IHA used 5.26%, or $178 of the 2013 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 2013 that were attributable to lobbying expenditures was $1,900. | 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 | $14,897,100 | OtherCostOrOtherBasisAmt |
| Depreciation | $6,235,403 | DepreciationAmt |
| Book Value | $8,661,697 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $0 | OtherCostOrOtherBasisAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $4,610,125 | OtherCostOrOtherBasisAmt |
| Depreciation | $3,622,268 | DepreciationAmt |
| Book Value | $987,857 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,024,658 | OtherCostOrOtherBasisAmt |
| Depreciation | $476,729 | DepreciationAmt |
| Book Value | $547,928 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $10,387,806 | TotalBookValueLandBuildingsAmt |
| Federal Income Tax Liability | $0 | FederalIncomeTaxLiabilityAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (4 entries)
| DescDesc | AmtAmt |
|---|---|
| INTERCOMPANY PAYABLES (NET) | $360,683 |
| SELF-INSURANCE LIABILITIES | $28,448 |
| DUE TO THIRD-PARTY PAYORS | $1,639,552 |
| PENSION AND OTHER RETIREMENT LIAB. | $138,571 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $2,167,254 | 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 | Indiana University Health Blackford Hospital, 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. | ExplanationTxt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (true) | FinancialAssistancePolicyInd |
| Written Policy | Yes (true) | WrittenPolicyInd |
| FPG Reference Free Care | Yes (true) | FPGReferenceFreeCareInd |
| Percent200 | Yes (X) | Percent200Ind |
| FPG Reference Discounted Care | Yes (true) | FPGReferenceDiscountedCareInd |
Discounted Care Oth Percentage DiscountedCareOthPercentageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Discounted Care Other | 650. | DiscountedCareOtherPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| 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 | 2502 | PersonsServedCnt |
| Total Community Benefit Expns | $1,282,330 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $1,282,330 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.07760 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 2114 | PersonsServedCnt |
| Total Community Benefit Expns | $3,507,138 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,312,995 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,194,143 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.13290 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 4616 | PersonsServedCnt |
| Total Community Benefit Expns | $4,789,468 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,312,995 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $3,476,473 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.21050 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 21 | ActivitiesOrProgramsCnt |
| Persons Served | 2022 | PersonsServedCnt |
| Total Community Benefit Expns | $69,987 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $7,041 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $62,946 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00380 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 2 | ActivitiesOrProgramsCnt |
| Persons Served | 60 | PersonsServedCnt |
| Total Community Benefit Expns | $24,537 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $24,537 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00150 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 3 | ActivitiesOrProgramsCnt |
| Persons Served | 1106 | PersonsServedCnt |
| Total Community Benefit Expns | $5,275 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $5,275 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00030 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 26 | ActivitiesOrProgramsCnt |
| Persons Served | 3188 | PersonsServedCnt |
| Total Community Benefit Expns | $99,799 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $7,041 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $92,758 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00560 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 26 | ActivitiesOrProgramsCnt |
| Persons Served | 7804 | PersonsServedCnt |
| Total Community Benefit Expns | $4,889,267 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,320,036 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $3,569,231 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.21610 | TotalExpensePct |
Physical Imprv And Housing PhysicalImprvAndHousingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 1 | ActivitiesOrProgramsCnt |
| Total Community Benefit Expns | $1,776 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $1,776 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
Community Support CommunitySupportGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 2 | ActivitiesOrProgramsCnt |
| Persons Served | 14 | PersonsServedCnt |
| Total Community Benefit Expns | $1,613 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $1,613 | 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 | $2,141 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $2,141 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
Health Improvement Advocacy HealthImprovementAdvocacyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 1 | ActivitiesOrProgramsCnt |
| Persons Served | 128 | PersonsServedCnt |
| Total Community Benefit Expns | $1,398 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $1,398 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 5 | ActivitiesOrProgramsCnt |
| Persons Served | 912 | PersonsServedCnt |
| Total Community Benefit Expns | $6,928 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $6,928 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00040 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | false | BadDebtExpenseReportedInd |
| Bad Debt Expense | $271,503 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $0 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $8,987,379 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $7,941,296 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | $1,046,083 | 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 | BusinessNameLine1 |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 410 PILGRIM BLVD | AddressLine1 |
| City | HARTFORD CITY | City |
| State | IN | State |
| ZIP Code | 47348 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | HTTP://IUHEALTH.ORG/BLACKFORD/ | WebsiteAddressTxt |
| State License | 13-005101-1 | 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 | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| 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 Report Widely Available | Yes (true) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | HTTP://IUHEALTH.ORG/GETSTRONG/ | OwnWebsiteURLTxt |
| Rpt Available Upon Request | Yes (X) | RptAvailableUponRequestInd |
| Adopt Implementation Strategy | Yes (X) | AdoptImplementationStrategyInd |
| Exec Implementation Strategy | Yes (X) | ExecImplementationStrategyInd |
| Include Operational Plan | Yes (X) | IncludeOperationalPlanInd |
| Adopt Budget | Yes (X) | AdoptBudgetInd |
| Prioritize Health Needs | Yes (X) | PrioritizeHealthNeedsInd |
| Prioritize Services | Yes (X) | PrioritizeServicesInd |
| All Needs Addressed | false | AllNeedsAddressedInd |
| Organization Incur Excise Tax | false | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (true) | EligCriteriaExplainedInd |
| FPG Used Deter Elig Free Care | Yes (true) | FPGUsedDeterEligFreeCareInd |
| FPG Family Incm Lmt Free Care | 200. | FPGFamilyIncmLmtFreeCarePct |
| FPG Used Determ Elig Dscnt Care | Yes (true) | FPGUsedDetermEligDscntCareInd |
| FPG Family Incm Lmt Dscnt Care | 650. | FPGFamilyIncmLmtDscntCarePct |
| Explained Basis | Yes (true) | ExplainedBasisInd |
| Income Level | Yes (X) | IncomeLevelInd |
| Asset Level | Yes (X) | AssetLevelInd |
| Medical Indigency | Yes (X) | MedicalIndigencyInd |
| Insurance Status | Yes (X) | InsuranceStatusInd |
| Uninsured Discount | Yes (X) | UninsuredDiscountInd |
| App Financial Asst Expln | Yes (true) | AppFinancialAsstExplnInd |
| Includes Publicity Measures | Yes (true) | IncludesPublicityMeasuresInd |
| Posted On Website | Yes (X) | PostedOnWebsiteInd |
| Posted In Emergency Room | Yes (X) | PostedInEmergencyRoomInd |
| Posted In Admission Office | Yes (X) | PostedInAdmissionOfficeInd |
| Available On Request | Yes (X) | AvailableOnRequestInd |
| Other Publicity | Yes (X) | OtherPublicityInd |
| FAP Actions On Nonpayment | Yes (true) | FAPActionsOnNonpaymentInd |
| 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 |
| Average Negotiated Rates | Yes (X) | AverageNegotiatedRatesInd |
| Amounts Generally Billed | false | AmountsGenerallyBilledInd |
| Gross Charges | false | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Schedule H, Part V, Section B, Line 3 - Input from Community | In conducting each of its most recent CHNA, Indiana University Health Blackford Hospital, Inc. ("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 7 - Addressing Identified Needs | Indiana University Health Blackford Hospital, Inc. ("IU Health Blackford Hospital") prioritized and determined which of the community health needs identified in its most recently conducted Community Health Needs Assessment ("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 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: - Cancer - Senior Health 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 14g - Other Measures to Publicize | Indiana University Health Blackford Hospital, Inc. 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. |
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 400% 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, Indiana University Health Blackford Hospital, Inc. ("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. | Indiana University Health Blackford Hospital, Inc.'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 on Line 7, column (f) is $749,180. |
| 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 29.60%. |
| Schedule H, Part I, Line 7g - Subsidized Health Services | Indiana University Health Blackford Hospital, Inc. does not include any costs associated with physician clinics as subsidized health services. |
| Schedule H, Part II - Promotion of Health in Communities Served | Indiana University Health Blackford Hospital, Inc. ("IU Health Blackford Hospital") is a subsidiary of Indiana University Health, Inc. ("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: - College Mentors for Kids - Starfish Initiative - Teach for America - 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 2013, almost 80 team members from IU Health gathered to help build a new home for a family as part of a Habitat for Humanity build event. |
| Schedule H, Part III, Line 2 - Methodology Used to Est. Bad Debt Exp. | The bad debt expense of $271,503 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, Indiana University Health Blackford Hospital, Inc. ("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 | Indiana University Health Blackford Hospital, Inc. ("IU Health Blackford Hospital") did not have a Medicare shortfall for 2013. However, in years in which it does experience a Medicare shortfall, the Medicare shortfall that would be reported on Schedule H, Part III, Line 7 is calculated, in accordance with the Form 990 instructions, using "allowable costs" from IU Health Blackford Hospital's Medicare Cost Report. "Allowable costs" for Medicare Cost Report purposes are not reflective of all costs associated with IU Health Blackford Hospital'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 increase the Medicare shortfall reported on Schedule H, Part III, Line 7. IU Health Blackford Hospital'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 Blackford Hospital 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 otherwise meets the financial assistance guidelines established by Indiana University Health Blackford Hospital, Inc. ("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 2 - Needs Assessment | Communities are multifaceted and so are their health needs. Indiana University Health Blackford Hospital, Inc. ("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 conducting a Community Health Needs Assessment ("CHNA"). This assessment includes collaboration with other community 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. |
| Schedule H, Part VI, Line 3 - Patient Education of Eligibility for Assist. | Indiana University Health Blackford Hospital, Inc. ("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 - 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. 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 | Indiana University Health Blackford Hospital, Inc. ("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 (2010) statistics, Blackford County's population is 12,766 persons with approximately 51% being female and 49% male. The county's population estimates by race are 97.7% White, 1.1% Hispanic or Latino, 0.7% Black, 0.2% Asian, 0.2% American Indian or Alaska Native, and 1.2% persons reporting two or more races. Blackford County has relatively low levels of educational attainment. A high school degree is the level of education most have achieved, and the percentage of those with a high school degree has dropped 0.35% from 2000 to 2010 (49.45% to 49.1%). An additional 18% in 2010 had some college, but no degree. Also as of 2010, 13% of the population had an associate's or bachelor's degree, and only 4.5% hold a graduate or professional degree. 83% of IU Health Blackford's inpatient discharge population resides in Blackford County. 84% of community discharges were for patients with Medicare, 9% were for patients with commercial insurance, 6% were for patients with Medicaid, and 1% was for uninsured/self-pay patients. |
| Schedule H, Part VI, Line 5 - Promotion of Community Health | Indiana University Health Blackford Hospital, Inc. ("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. IU Health Blackford Hospital hosted a monthly support group for people with Type 2 diabetes. Nearly 30 people attended each meeting. Participants learned about nutrition and ways to stay healthy with diabetes. The hospital's dietary manager prepared low-carb desserts for each meeting to provide samples of healthy dessert options participants could make at home. IU Health Blackford Hospital also participated in Taylor University's "Well Day", a health fair for the university's 200 employees. The hospital provided diabetes risk assessments, stroke and heart failure screenings, asthma education and blood pressure checks. Eleven university employees participated in the heart screening, which included a one-on-one consultation with a hospital medical professional to discuss the screening results and individual risk. Also during 2013, IU Health Blackford Hospital hosted its annual Community Health Fair, which highlighted obesity prevention and infant health. Approximately 150 people attended the event, which featured free and reduced-fee health screening opportunities, such as cholesterol and blood sugar testing, blood pressure checks, and risk assessments for stroke, heart failure and sleep apnea. |
| Schedule H, Part VI, Line 6 - Affiliated Health Care System | Indiana University Health Blackford Hospital, Inc. 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 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 outreach priority. Tackling the issue of obesity in the communities IU Health serves, the fifth annual Day of Service in 2013 focused on leaving behind key physical assets to help meet a statewide need for more venues for physical activity and recreation. During the 2013 Day of Service: - More than 1,500 IU Health team members gave their time to improve walking trails and park assets, which serve more than 63,000 residents across the state. - 19 community parks were enhanced; IU Health team members spread mulch around play equipment to help ensure safety; put fresh coats of paint on park structures; and improved landscaping to boost aesthetic appeal. - 40 fitness stations were installed to provide community members opportunities for fitness at parks. - 300 sports balls were inflated and donated to the Indiana Sports Corporation to give more children equipment to support play and physical activity. - IU Health Physicians also hosted a Day of Service called "Give Back Day," featuring 15 interactive stations located along a walking path that promoted fun, health-related family-friendly activities. Participants enjoyed "walk with a doc," yoga, volleyball, cardio drumming and Zumba. The event also featured a taste test of healthy snacks. Fifty-two team members from IU Health Physicians, including 27 physicians, volunteered their time to engage in healthy activities with fellow community members. 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. 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 Blackford Hospital, IU Health Saxony Hospital and IU Health Blackford Hospital. There were approximately 2,200 clinical trials conducted in 2013 at IU Health. 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 2013, 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: Veggies and Vaccines Leveraging existing partnerships from the successful IU Health Garden on the Go program, IU Health conducted a seasonal flu campaign for two weeks in October and November 2013. The free |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Personal Services | Yes (X) | PersonalServicesInd |
| Written Policy Ref T And E Expnss | false | WrittenPolicyRefTAndEExpnssInd |
| Substantiation Required | false | SubstantiationRequiredInd |
| Severance Payment | false | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (true) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | false | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | false | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | false | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | false | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | false | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | Yes (true) | AnyNonFixedPaymentsInd |
| Initial Contract Exception | false | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (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 | $129,934 | $0 | $0 | $0 | $6,969 | $0 | $5,437 | $0 | $13,233 | $0 | $155,573 | $0 | $0 | $0 |
| MICHAEL E HALEY | ||||||||||||||
| DIRECTOR | $0 | $485,608 | $0 | $105,447 | $0 | $106,514 | $0 | $21,020 | $0 | $30,239 | $0 | $748,828 | $0 | $0 |
| LORI A LUTHER | ||||||||||||||
| DIRECTOR/TREASURER | $0 | $223,515 | $0 | $12,939 | $0 | $2,741 | $0 | $6,027 | $0 | $12,112 | $0 | $257,334 | $0 | $0 |
| ELIZABETH A DROEGE MD | ||||||||||||||
| STAFF PHYSICIAN | $265,218 | $0 | $0 | $0 | $19,306 | $0 | $3,793 | $0 | $25,674 | $0 | $313,991 | $0 | $0 | $0 |
| JOANNA B THOMAS MD | ||||||||||||||
| STAFF PHYSICIAN | $180,224 | $0 | $0 | $0 | $224 | $0 | $0 | $0 | $23,648 | $0 | $204,096 | $0 | $0 | $0 |
| ROLAND W JAMES MD | ||||||||||||||
| STAFF PHYSICIAN | $173,974 | $24,328 | $0 | $0 | $1,973 | $15 | $0 | $5,166 | $12,999 | $13,113 | $188,946 | $42,622 | $0 | $0 |
| THOMAS M LEE | ||||||||||||||
| STAFF PHYSICIAN | $105,099 | $186,001 | $0 | $40,038 | $0 | $2,376 | $0 | $10,200 | $0 | $26,988 | $105,099 | $265,603 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Schedule J, Part I, Line 1b - Personal Services | Executive physicals were provided for certain board members, including Lori A. Luther, free of charge. |
| Schedule J, Part I, Line 3 - Comp. of the Org.'s CEO/Executive Director | Steven J. West, the CEO of Indiana University Health Blackford Hospital, Inc. ("IU Health Blackford Hospital"), is compensated as an employee of Indiana University Health Ball Memorial Hospital, Inc. ("IU Health Ball Memorial Hospital") for his services performed at IU Health Blackford Hospital. IU Health Ball Memorial Hospital has a process in place to determine the compensation of IU Health Blackford Hospital'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 Ball Memorial Hospital's compensation committee and board of directors. |
| Schedule J, Part I, Line 4b - Supplemental Nonqualified Retirement Plan | Michael E. Haley participates in a supplemental executive retirement plan of Indiana University Health, Inc., 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. Michael E. Haley has 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 O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (8 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part VI, Section A, Line 2 - Family or Business Relationships | Michael E. Haley served on the board of directors of Cardinal Health Ventures, Inc. Additionally, Michael E. Haley and Lori A. Luther served as officers. 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: Indiana University Health Blackford Hospital, Inc. ("IU Health Blackford Hospital") has one class of membership and the sole member is Indiana University Health Ball Memorial Hospital, Inc. ("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 Indiana University Health, Inc., approve the capital and operating budgets for Hospital. |
| Part VI, Section A, Line 11b - Form 990 Provided to Governing Body | Indiana University Health Blackford Hospital, Inc. ("IU Health Blackford Hospital") has established the following process for the review of the Form 990 and related schedules before it is filed: The COO/CFO of Indiana University Health Ball Memorial Hospital, Inc. reviewed and approved the Form 990 and related schedules. After the review and approval from the COO/CFO, a complete final copy, as filed with the Internal Revenue Service, of the Form 990 and related schedules was made available to each board member prior to filing, 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 Blackford Hospital, Inc. ("IU Health Blackford Hospital") is part of the Indiana University Health, Inc. ("IU Health") system. As the sole member and controlling parent of Indiana University 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 | Indiana University Health Blackford Hospital, Inc. ("IU Health Blackford Hospital") has a Conflict of Interest Policy, the purpose of which is to protect IU Health Blackford Hospital'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 President, it is reviewed by the board chairman for approval. If the disclosure is by a member of the board of directors, the IU Health Ball Memorial Hospital's 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 President/Top Management Official for Indiana University Health Blackford Hospital, Inc. ("IU Health Blackford Hospital") is employed by Indiana University Health Ball Memorial Hospital, Inc. ("IU Health Ball Memorial Hospital"). Indiana University Health, Inc. ("IU Health"), as the sole member and controlling parent of IU Health Ball Memorial Hospital, has implemented 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. 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 President. 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 IU Health's 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 | Indiana University Health Blackford Hospital, Inc.'s ("IU Health Blackford Hospital") 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 Indiana University Health, Inc. ("IU Health"). The consolidated financial statements for IU Health are available to the public through its bond filings. |
| Part IX, Line 11g - Other Fees for Services | Line 11g includes amounts paid for the following: Shared Services/Professional Fees - $4,622,361 |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (41 entries)
| Address Line1USAddress/AddressLine1 | CityUSAddress/City | StateUSAddress/State | ZIP CodeUSAddress/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | 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 INC | ||||||||||
| 714 S ROGERS ST | BLOOMINGTON | IN | 47403 | 263571507 | HEALTHCARE | IN | 501(C)(3) | 9 | IUHB | Yes (true) |
| 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 | ||||||||||
| 2900 W 16TH ST | BEDFORD | IN | 47421 | 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 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 HOSPITAL INC | ||||||||||
| 2209 JOHN R WOODEN DR | MARTINSVILLE | IN | 46151 | 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) | 11 III-O | 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 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 |
| 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 | ||||||||||
| 2209 JOHN R WOODEN DR | MARTINSVILLE | IN | 46151 | 352035162 | FUNDRAISING | IN | 501(C)(3) | 11 II | IUHMH | Yes (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 | Yes (true) |
| MORGAN HEALTH SERVICES INC | ||||||||||
| 1949 HOSPITAL DR | MARTINSVILLE | IN | 46151 | 351968564 | HEALTHCARE | IN | 501(C)(3) | 3 | IUHMH | Yes (true) |
| IU HEALTH WHITE MEM HOSP FNDTN INC | ||||||||||
| PO BOX 952 | MONTICELLO | IN | 47960 | 351671806 | FUNDRAISING | IN | 501(C)(3) | 11 III-O | IUHWMH | Yes (true) |
| UNIVERSITY FAMILY PHYSICIANS INC | ||||||||||
| 950 N MERIDIAN ST STE 800 | INDIANAPOLIS | IN | 46204 | 237427350 | HEALTHCARE | IN | 501(C)(3) | 9 | IUHCA | 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) |
| IU HEALTH GOSHEN FOUNDATION INC | ||||||||||
| 200 HIGH PARK AVE | GOSHEN | IN | 46527 | 462565300 | FUNDRAISING | IN | 501(C)(3) | 11 I | GHS | Yes (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 HOS FOR CHILD | ||||||||||
| 705 RILEY HOSPITAL DR | INDIANAPOLIS | IN | 46202 | 356018517 | FUNDRAISING | IN | 501(C)(3) | 11 III-FI | NA | false |
| INDIANA HEALTH INFO EXCHANGE INC | ||||||||||
| 846 N SENATE AVE | INDIANAPOLIS | IN | 46202 | 364550324 | HEALTHCARE | IN | 501(C)(3) | 11 I | NA | false |
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (19 entries)
| Address Line1USAddress/AddressLine1 | CityUSAddress/City | StateUSAddress/State | ZIP CodeUSAddress/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Predominant Income TypePredominantIncomeTypeTxt | Share Of Total IncomeShareOfTotalIncomeAmt | Share Of EOY AssetsShareOfEOYAssetsAmt | Disproportionate AllocationsDisproportionateAllocationsInd | UBI Code VUBICodeVAmt | OwnershipOwnershipPct |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| BALL OUTPATIENT SURGERY CENTER LLC | |||||||||||||
| 3000 RIVERCHASE GALLERIA STE 500 | BIRMINGHAM | AL | 35244 | 270275794 | HEALTHCARE | IN | BOSCH | N/A | $0 | $0 | false | $0 | 0.00000 |
| BELTWAY SURGERY CENTERS LLC | |||||||||||||
| 3000 RIVERCHASE GALLERIA STE 500 | BIRMINGHAM | AL | 35244 | 352072586 | HEALTHCARE | IN | BSCH | N/A | $0 | $0 | false | $0 | 0.00000 |
| BLOOMINGTON ENDOSCOPY CENTERS LLC | |||||||||||||
| PO BOX 1149 | BLOOMINGTON | IN | 47402 | 352117943 | HEALTHCARE | IN | IUHB | N/A | $0 | $0 | false | $0 | 0.00000 |
| BOSC HOLDINGS LLC | |||||||||||||
| 3000 RIVERCHASE GALLERIA STE 500 | BIRMINGHAM | AL | 35244 | 454147343 | HEALTHCARE | IN | IUH | N/A | $0 | $0 | false | $0 | 0.00000 |
| CARDINAL HEALTH INITIATIVES LLC | |||||||||||||
| 950 N MERIDIAN ST STE 800 | INDIANAPOLIS | IN | 46204 | 300102702 | PURCHASING | IN | IUHBMH | RELATED | $29,212 | $18,228 | false | $0 | 0.04750 |
| CHV FUND I LLC | |||||||||||||
| 950 N MERIDIAN ST STE 800 | INDIANAPOLIS | IN | 46204 | 262523206 | VENTURE CAPITAL | IN | IUH | N/A | $0 | $0 | false | $0 | 0.00000 |
| CHV FUND MANAGEMENT LLC | |||||||||||||
| 950 N MERIDIAN ST STE 800 | INDIANAPOLIS | IN | 46204 | 262523151 | VENTURE CAPIT | IN | CHV | N/A | $0 | $0 | false | $0 | 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 | 0.00000 |
| EAGLE HIGHLANDS SURGERY CENTER LLC | |||||||||||||
| 3000 RIVERCHASE GALLERIA STE 500 | BIRMINGHAM | AL | 35244 | 352259204 | HEALTHCARE | IN | EHSCH | N/A | $0 | $0 | false | $0 | 0.00000 |
| EHSC HOLDINGS LLC | |||||||||||||
| 3000 RIVERCHASE GALLERIA STE 500 | BIRMINGHAM | AL | 35244 | 454147879 | HEALTHCARE | IN | IUH | N/A | $0 | $0 | false | $0 | 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 | 0.00000 |
| IEC HOLDINGS LLC | |||||||||||||
| 3000 RIVERCHASE GALLERIA STE 500 | BIRMINGHAM | AL | 35244 | 454148032 | HEALTHCARE | IN | IUH | N/A | $0 | $0 | false | $0 | 0.00000 |
| INDIANA ENDOSCOPY CENTERS LLC | |||||||||||||
| 3000 RIVERCHASE GALLERIA STE 500 | BIRMINGHAM | AL | 35244 | 208398421 | HEALTHCARE | IN | IECH | N/A | $0 | $0 | false | $0 | 0.00000 |
| BSC HOLDINGS LLC | |||||||||||||
| 3000 RIVERCHASE GALLERIA STE 500 | BIRMINGHAM | AL | 35244 | 452314634 | HEALTHCARE | IN | IUH | N/A | $0 | $0 | false | $0 | 0.00000 |
| ROC SURGERY LLC | |||||||||||||
| 3000 RIVERCHASE GALLERIA STE 500 | BIRMINGHAM | AL | 35244 | 271497960 | HEALTHCARE | IN | ROCSH | N/A | $0 | $0 | false | $0 | 0.00000 |
| ROCS HOLDINGS LLC | |||||||||||||
| 3000 RIVERCHASE GALLERIA STE 500 | BIRMINGHAM | AL | 35244 | 454148369 | HEALTHCARE | IN | IUH | N/A | $0 | $0 | false | $0 | 0.00000 |
| SENATE STREET SURGERY CENTER LLC | |||||||||||||
| 3000 RIVERCHASE GALLERIA STE 500 | BIRMINGHAM | AL | 35244 | 421709357 | HEALTHCARE | IN | SSSCH | N/A | $0 | $0 | false | $0 | 0.00000 |
| SSSC HOLDINGS LLC | |||||||||||||
| 3000 RIVERCHASE GALLERIA STE 500 | BIRMINGHAM | AL | 35244 | 454148167 | HEALTHCARE | IN | IUH | N/A | $0 | $0 | false | $0 | 0.00000 |
| CARDINAL HEALTH ALLIANCE LLC | |||||||||||||
| 2401 W UNIVERSITY AVE | MUNCIE | IN | 47303 | 351966281 | MANAGED CARE | IN | IUHBMH | N/A | $0 | $0 | false | $0 | 0.00000 |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (23 entries)
| Address Line1USAddress/AddressLine1 | CityUSAddress/City | StateUSAddress/State | ZIP CodeUSAddress/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Entity TypeEntityTypeTxt | Share Of Total IncomeShareOfTotalIncomeAmt | Share Of EOY AssetsShareOfEOYAssetsAmt | OwnershipOwnershipPct | Controlled OrganizationControlledOrganizationInd | Address Line1ForeignAddress/AddressLine1 | CityForeignAddress/City | Province Or StateForeignAddress/ProvinceOrState | CountryForeignAddress/Country | 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 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 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 LTD | |||||||||||||||||
| 980395429 | INSURANCE | IUH | C | $0 | $0 | 0.00000 | Yes (true) | PO BOX 69 | SOLARIS AVE. | 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 SALE | 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) | |||||
| 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) | |||||
| 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) | |||||
| PROTEUO FUND LP | |||||||||||||||||
| 981075227 | INVESTMENTS | IUH | C | $0 | $0 | 0.00000 | Yes (true) | PO BOX 31106 | 89 NEXUS WAY | GRAND CAYMAN | CJ | CJ | |||||
| 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) | |||||
| UNIV HLTH (SHANGHAI) MGT CON CO LTD | |||||||||||||||||
| MANAGEMENT | UHMC | C | $0 | $0 | 0.00000 | Yes (true) | 88 CENTURY AVE | SHANGHAI | CH | CH | |||||||
| GUGGENHEIM HIGH-YIELD PLUS FUND SPC | |||||||||||||||||
| INVESTMENTS | IUH | C | $0 | $0 | 0.00000 | Yes (true) | PO BOX 309 UGLAND HOUSE | GRAND CAYMAN | CJ | CJ | |||||||
| 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 |
| Asset Sale To Other Org | false | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | false | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | false | AssetExchangeInd |
| Rental Of Facilities To Oth Org | false | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | false | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | Yes (true) | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (true) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | false | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (true) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | false | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | false | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | Yes (true) | TransferToOtherOrgInd |
| Transfer From Other Org | false | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (2 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| IU HEALTH RISK RETENTION GROUP INC | ||
| R | $141,941 | FMV |
| INDIANA RADIOLOGY PARTNERS INC | ||
| M | $150,000 | FMV |