2012-11-08T13:36:59-06:00 2011-12-31 ERNST & YOUNG US LLP 111 MONUMENT CIRCLE SUITE 2600 INDIANAPOLIS IN 46204 990 2011-01-01 263162145 INDIANA UNIVERSITY HEALTH ARNETT INC % BROC BUDDE INDI 3179624575 950 N MERIDIAN STREET SUITE 800 INDIANAPOLIS IN 46204 CARA L BREIDSTER 2012-11-08 JENNIFER D RHODERICK 3176817000 2011 2016-03-07 17:11:31Z ALFONSO W GATMAITAN 950 N MERIDIAN ST STE 800 INDIANAPOLIS IN 46204 317153870 false X WWW.IUHEALTH.ORG X 2008 IN Improve the health of our patients and community through innovation and excellence in care, education, research and service. 10 4 2187 146 263077 226319 28000 2494696 334105465 311723769 -3267 156519 1941935 2590791 336072133 316965775 83836 124579 0 0 157872993 167655583 0 0 0 158087382 171440078 316044211 339220240 20027922 -22254465 242302885 244621436 279753273 304193051 -37450388 -59571615 Improve the health of our patients and community through innovation and excellence in care, education, research and service. false false 257481269 124579 311723769 Indiana University Health Arnett, Inc. ("IU Health Arnett") offers a variety of services to care for its patients during every phase of life without regard to ability to pay. As an integrated health care system, IU Health Arnett strives to be the preeminent leader in clinical care, education, research and service in the region through providing its patients with access to primary care practitioners, specialists, numerous outpatient facilities, and a 184-bed full-service hospital united together under one umbrella. 257481269 true true false true false false false false false true false false false true false false true false false false false false false false false true true true false true false false false false false false false false false false false false true true true true false false true 111 0 true 2187 true true true false false false false false false false false false X 10 4 true false false false true true true true true false false true true true true true true true true true true IN X BROC BUDDE 3179624575 950 N MERIDIAN STREET SUITE 800 INDIANAPOLIS IN 46204 X DANIEL F EVANS JR 5.0 X 0 1449996 839848 ROBERT W MARTIN MD 55.0 X 504615 0 55767 ANDREW K EDWARDS MD 55.0 X 246996 0 55182 VICTOR L LECHTENBERG PHD 5.0 X 13302 0 0 RANDALL R MITCHELL 5.0 X 0 0 0 LARRY W PAMPEL DDS 5.0 X 0 0 0 MICHAEL B LOCKWOOD MD 55.0 X 325569 0 55589 STEPHEN L HENSON MD 55.0 X 545234 0 54158 KENNETH S STONE MD 5.0 X 2300 709404 43981 SCOTT M BLACK 5.0 X 0 279631 46752 THOMAS V EASTERDAY 5.0 X 10500 0 0 ALFONSO W GATMAITAN 55.0 X 535935 0 122401 JEROME P KELLY 5.0 X 0 219021 41785 JEFFREY R NAGY 25.0 X 185390 0 9270 JAMES BIEN 55.0 X 311367 0 58565 LINDA DECKER 55.0 X 198185 0 30294 HAROLD D GEORGE 55.0 X 178262 0 23967 LORI A LUTHER 55.0 X 181808 0 28641 BRIAN T SHOCKNEY 55.0 X 219241 0 51436 CHENG DU MD 55.0 X 655939 0 60112 MICHAEL L HOGAN MD 55.0 X 594333 0 58670 JOSEPH E HUBBARD MD 55.0 X 624795 0 40732 AYAZ SHAIKH MD 55.0 X 613638 0 55404 RYAN D LOYD MD 55.0 X 719843 0 49989 MICHAEL W SKEHAN MD X 0 270667 19613 6667252 2928719 1802156 218 true true false SODEXO INC AFFILIATES 4880 PAYSPHERE CIRCLE CHICAGO IL 60674 VARIOUS MGMT SRVCS 2158125 HORIZON MEDICAL GROUP 1345 UNITY PLACE SUITE 345 LAFAYETTE IN 47605 MEDICAL 2108874 TURNER CONSTRUCTION COMPANY 9190 PRIORITY WAY WEST DR SUITE 2 INDIANAPOLIS IN 46250 CONSTRUCTION 2006239 TRIMEDX LLC 6325 DIGITAL WAY SUITE 400 INDIANAPOLIS IN 46278 MAINTENANCE 1385899 WURSTER CONSTRUCTION CO INC 6463 CASTLEWOOD DRIVE INDIANAPOLIS IN 46250 CONSTRUCTION 813171 41 2494389 307 0 2494696 NET PATIENT SERVICE REVENUE 621110 310726325 310726325 0 0 INCOME FROM PARTNERSHIPS 900099 580664 317587 263077 0 SHARED SERVICES 541900 228950 228950 0 0 CLINICAL RESEARCH 541700 187830 187830 0 0 311723769 1965 1965 0 0 9395 0 9395 9395 9395 342649 188095 154554 154554 154554 0 0 0 CAFETERIA/FOOD SERVICE 722210 1059387 1059387 GIFT SHOP 453220 121472 121472 VENDING 900099 15226 15226 1385311 1385311 2581396 316965775 311460692 263077 2747310 124579 124579 0 0 0 4239774 3897759 342015 0 131742204 121114799 10627405 8121849 7658772 463077 15289808 13627561 1662247 8261948 7390520 871428 46553 46553 112769 112769 618 618 4775 4775 0 0 45223350 18244954 26978396 597809 71746 526063 2856083 964896 1891187 2352345 471602 1880743 0 9009702 609631 8400071 246552 209091 37461 0 7467 4659 2808 15065607 184652 14880955 0 14523893 4526341 9997552 2935933 1449820 1486113 DRUGS AND MEDICAL SUPPLIES 55639944 55639944 BAD DEBT 20031517 20031517 RECRUITMENT 268808 243718 25090 INSTITUTIONAL DUES/LICENSES 265546 265546 2250807 749162 1501645 339220240 257481269 81738971 0 15465 15465 0 0 0 0 32905415 38884622 0 0 0 0 617997 725730 3552001 3004209 1789120 2098912 247346007 48810020 202240668 198535987 0 0 0 0 1077079 1356511 0 0 105140 0 242302885 244621436 26604437 30923918 0 0 0 15591 0 0 0 0 0 0 0 20954971 0 0 253148836 252298571 279753273 304193051 X -37450388 -59571615 0 0 0 0 -37450388 -59571615 242302885 244621436 X -22254465 133238 X false true true X true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false true 4775 4775 false Schedule C, Part II-B Line 1i - Other Activities Indiana University Health Arnett, Inc. ("IU Health Arnett") paid institutional membership dues to the American Hospital Association ("AHA") and Indiana Hospital Association ("IHA") during 2011 in the amount of $16,946 and $12,030, respectively. Each membership organization notified IU Health Arnett that a portion of the dues it paid were used for lobbying purposes. The AHA used 24.42%, or $4,138 of 2011 membership dues paid by IU Health Arnett, for lobbying expenditures. The IHA used 5.29%, or $636 of the 2011 membership dues paid by IU Health Arnett, for lobbying expenditures. The total membership dues paid to these organizations by IU Health Arnett during 2011 that were attributable to lobbying expenditures was $4,775. 400000 400000 177707825 17526525 160181300 735705 74815 660890 59790111 31154372 28635739 8712366 54308 8658058 198535987 0 INTERCOMPANY PAYABLES (NET) 216876781 DUE TO THIRD-PARTY PAYORS 34155731 SELF-INSURANCE LIABILITIES 540329 ALL OTHER LIABILITIES 725730 252298571 Schedule D, Part X - Other Liabilities Line 2 - FIN 48 (ASC 740) Footnote Indiana University Health Arnett, Inc. ("IU Health Arnett") is a subsidiary in the consolidated financial statements of Indiana University Health, Inc. ("IU Health"). IU Health adopted FIN 48 in 2007. 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DIAGNOSTIC CENTER FEDERAL POVERTY GUIDELINES PART I, LINE 3C: N/A ANNUAL COMMUNITY BENEFIT REPORT PART I, LINE 6A: Indiana University Health Arnett, Inc.'s ("IU Health Arnett") community benefit investments are included in the Indiana University Health's ("IU Health") Community Benefit Report which is made available to the public on its website at iuhealth.org/communitybenefit. The Community Benefit Report is also mailed to numerous key organizations throughout the state of Indiana to broadly share IU Health's community benefit efforts and investments statewide, and is available by request through Indiana State Department of Health or IU Health. SUBSIDIZED HEALTH SERVICES PART I, LINE 7G: Indiana University Health Arnett, Inc. does not include any costs associated with physician clinics as subsidized health services. BAD DEBT EXPENSE PART I, LINE 7, COLUMN F: The Bad Debt Expense included on Form 990, Part IX, Line 25, Column (A), but subtracted for purposes of calculating the community benefit percentage of total expenses is $20,031,517. PERCENTAGE OF TOTAL EXPENSES PART I, LINE 7: Percentage of total expenses listed on Schedule H, Part I, Line 7, Column(f)is calculated based on net community benefit expense. The percentage of total expenses calculated based on total community benefit expense is 11.46% COMMUNITY BUILDING ACTIVITIES PART II IU Health Arnett participated in a variety of community-building activities that address the underlying quality of life in the communities it serves. IU Health as a statewide healthcare system invested in economic development efforts across the state collaborated with like-minded organizations through coalitions that address key issues, and advocated for improvements in the health status of vulnerable populations. In 2011, IU Health System spent over 1.2 million dollars, serving more than 77,000 individuals as a statewide organization. Locally, IU Health Arnett Hospital invested over $23,000 in community-building activities that service more than 4500 individuals by providing expertise and resources to local community initiatives that addressed economic development, community health improvement and workforce development. Outreach activities included teaching CPR to the Lafayette Police Department, participating in our local United Way's Read to Succeed child mentoring program and volunteering as Junior Achievement speakers. BAD DEBT FOOTNOTE AND COSTING METHODOLOGY PART III, LINE 4: Footnote to Financial Statements Indiana University Health Arnett, Inc. ("IU Health Arnett") is included in a consolidated audit report prepared for Indiana University Health, Inc. The provision for uncollected patient accounts is based upon managements assessment of historical and expected net collections considering business and economic conditions, changes and trends in health care coverage, and other collection indicators. Periodically, management assesses the adequacy of the allowance for uncollectible accounts based upon accounts receivable payor composition and aging, the significance of individual payors to outstanding accounts receivable balances, and historical write-off experience by payor category, as adjusted for collection indicators. The results of this review are then used to make any modifications to the provision for uncollected patient accounts and the allowance for uncollectible accounts. In addition, the Indiana University Health System follows established guidelines for placing certain past due patient balances with collection agencies. Patient accounts that are uncollected, including those placed with collection agencies, are initially charged against the allowance for uncollectible accounts in accordance with collection policies of the Indiana University Health System and, in certain cases, are reclassified to charity care if deemed to otherwise meet financial assistance policies of the Indiana University Health System. Costing Methodology The bad debt expense reported on Line 2 is calculated under the cost to charge ratio methodology. IU Health Arnett provides healthcare services through various programs that are designed, among other matters, to enhance the health of the community and improve the health of low-income patients. In addition, IU Health Arnett provides services intended to benefit the poor and underserved, including those persons who cannot afford health insurance because of inadequate resources or are uninsured or underinsured. MEDICARE PART III, LINE 8: The Medicare shortfall reported on Schedule H, Part III, Line 7 is calculated, in accordance with the Form 990 instructions, using "allowable costs" from IU Health Arnett Medicare Cost Report. "Allowable costs" for Medicare Cost Report purposes are not reflective of all costs associated with IU Health Arnett's participation in Medicare programs. For example, the Medicare Cost Report excludes certain costs such as billed physician services, the costs of Medicare Parts C and D, fee schedule reimbursed services, and durable medical equipment services. Inclusion of all costs associated with IU Health Arnett's participation in Medicare programs would significantly increase the Medicare shortfall reported on Schedule H, Part III, Line 7. IU Health Arnett's Medicare shortfall is attributable to reimbursements that are less than the cost of providing patient care and services to Medicare beneficiaries and does not include any amounts that result from inefficiencies or poor management. IU Health Arnett accepts all Medicare patients knowing that there may be shortfalls; therefore it has taken the position that the shortfall should be counted as part of its community benefit. Additionally, it is implied in Internal Revenue Service Revenue Ruling 69-545 that treating Medicare patients is a community benefit. Revenue Ruling 69-545, which established the community benefit standard for nonprofit hospitals, states that if a hospital serves patients with governmental health benefits, including Medicare, then this is an indication that the hospital operates to promote the health of the community. COLLECTION PRACTICES PART III, LINE 9B: If a patient cannot satisfy standard payment expectations, financial assistance screening for alternative sources of balance resolution are completed. Those resolutions may include: a discount on charges; Medicaid enrollment, interest-free loan or application for charity care. If a patient does not apply for charity care but meets the charity care guidelines established by Indiana University Health Arnett, Inc. ("IU Health Arnett"), IU Health Arnett will waive charges and treat the costs of services as charity care. NEEDS ASSESSMENT PART VI, LINE 2 Communities are multifaceted and so are their health needs. IU Health Arnett understands that the health of individuals and communities are shaped by various social and environmental factors, along with health behaviors and additional influences, and this is why IU Health Arnett looks to organizations that are in touch with needs of the community and have expertise in conducting community needs assessments. IU Health Arnett assessed the health care needs of the areas we serve by utilizing the detailed community needs assessments undertaken by organizations such as the County Health Department, the Indiana State Department of Health, the Centers for Disease Control and Prevention and the United Way of Central Indiana. PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE PART VI, LINE 3: IU Health Arnett goes to great lengths to ensure patients know that IU Health Arnett treats all patients regardless of their ability to pay. IU Health Arnett shares financial assistance information with patients during the admission process, billing process and online. Helping patients understand that financial support for their care is a part of IU Health Arnett's commitment to its mission. IU Health Arnett's financial assistance policy exists to serve those in need by providing financial relief to patients who ask for assistance after care has been provided. During the admissions process, opportunities for financial assistance are discussed with patients who are identified as a self-pay patient or if they request assistance information. The patient is also provided with an Admissions Packet that outlines information regarding IU Health Arnett's financial assistance program. Financial counselors are onsite to assist financial concerns or questions during the patient's stay. Patient Financial Services - Customer Service representatives can help patients apply for financial assistance, understand their bills, explain what they can expect during the billing process, accept payment (if needed), update their insurance or payor information and update their address or other demographics. A summary of the financial assistance policy is printed on the back of each patient statement, while the financial assistance application is mailed to all uninsured IU Health Arnett patients at the conclusion of their treatment along with a summary of the incurred charges. Additionally, on the back of each patient statement is a phone number that will allow patients the ability to request financial assistance. Uninsured patients are also made aware of this process at the time of registration. The IU Health statewide system website (iuhealth.org) has a page dedicated to financial assistance and offers and online application and phone numbers for customer service representatives to assist with the application process. IU Health Arnett has an expansive financial assistance policy, which aligns with the IU Health's policy, which utilizes the federal poverty guidelines to determine eligibility; making access to quality care within a patient's reach. The IU Health Arnett's 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, - Discounted care on a sliding scale for uninsured families earning from 400 to 650 percent of federal poverty guidelines, and - Financial assistance to patients whose health insurance coverage, if any, does not provide full coverage for all of their medical expenses and whose medical expenses would make them indigent if they were forced to pay full charges. Patients are guided through their course of care with particular sensitivity, reviewing changing circumstances and allowing for financial assistance at any point during the relationship and billing process with the patient. For those inpatients that may qualify for the Medicaid program and have not applied, IU Health Arnett financial counselors will assist patients with the Medicaid application. If a patient does not apply for financial assistance, but meets the charity care guidelines established by IU Health Arnett, the hospital will waive charges and treat the cost of services as charity care. COMMUNITY INFORMATION PART VI, LINE 4: IU Health Arnett Hospital is located in Tippecanoe County; a county located in central northwest Indiana, but has medical offices and serves patients in Tippecanoe, Benton, White, Carroll and Clinton counties. Tippecanoe County includes ZIP codes within the towns of Battle Ground, Clarks Hill, Dayton, Lafayette, Romney, West Lafayette and West Point. Based on the most recent Census Bureau (2010) statistics, Tippecanoe County's population is 172,780 persons with approximately 49% being female and 51% male. The county's population estimates by race are 79.8% White, 7.7% Hispanic or Latino, 6.5% Asian, 4.4% Black, 0.4% American Indian or Alaska Native, and 1.9% persons reporting two or more races. Tippecanoe County has relatively moderate levels of educational attainment. The level of education most of the population has achieved is a high school degree (29%). An additional 19% had some college, but no degree. As of 2010, 26% of the population had an associate's or bachelor's degree, and 16% hold a graduate or professional degree. PROMOTION OF COMMUNITY HEALTH PART VI, LINE 5: IU Health Arnett is an affiliate of IU Health, a tax-exempt hospital, who Board of Directors is composed of members, of which substantially all are independent community members. IU Health Arnett also extends medical staff privileges to all qualified physicians in the community. Additionally, IU Health Arnett invests in the community to improve the quality of the health of the community members. Several community benefit highlights are described below. IU Health Arnett is committed to providing our youth with a preeminent facility to learn from top physicians and other clinical staff. In 2011, IU Health Arnett employees provided health education/training to more than 600 students studying different health professions including but not limited to medical, nursing and pharmacy students. Breastfeeding has countless benefits for both mom and baby, including but not limited to building immunities and reducing the risk of SIDS in baby, and reducing the risk of cancer for mom. For all of these reasons and many more is why IU Health Arnett promotes breastfeeding to mothers. Every Thursday, IU Health Arnett holds a breastfeeding support group by the hospital's licensed lactation consultant. This class is free and is open to the public - you don't even have to have delivered at IU Health Arnett Hospital to attend. In 2011, 461 local moms took advantage of this free support group. Additionally, Child Passenger Safety Technicians at IU Health Arnett Hospital in Lafayette offered free inspections of infant and child car seats. During the 30-minute checkups, technicians ensured that seats were appropriate and correctly installed for their child's age, size and weight, making recommendations for poor-fitting seats. IU Health Arnett performed 992 inspections at no cost to families. Since each inspection typically takes around 30 minutes to complete, this was a 500 hour commitment by IU Health Arnett employees who are certified child passenger safety technicians. IU Health Arnett also funded over $16,000 in support of local cancer-related walks including but not limited to Relay for Life, Community Cancer Network's Carry the Torch walk and Purdue's Cancer Challenge 5K Walk/Run. AFFILIATED HEALTH CARE SYSTEM PART VI, LINE 6: IU Health Arnett is a part of the IU Health statewide healthcare system which continues to broaden its reach and positive impact throughout the state of Indiana. IU Health is Indiana's most comprehensive academic medical center and consists of IU Health Methodist Hospital, IU Health University Hospital, Riley Hospital for Children at IU Health, IU Health West Hospital, IU Health North Hospital, IU Health Ball Memorial, IU Health Blackford Hospital, IU Health Bloomington Hospital, IU Health Paoli Hospital, IU Health Bedford Hospital, IU Health Tipton Hospital, IU Health La Porte Hospital, IU Health Starke Hospital, IU Health Morgan Hospital, IU Health White Hospital, and IU Health Goshen Hospital. Although each IU Health hospital prepares and submits its own community benefits plan relative to the local community, IU Health Arnett considers its community benefit plan as part of an overall vision for strengthening Indiana's overall health. A comprehensive three-prong community outreach strategy and community benefit plan is in place that encompasses the academic medical center downtown Indianapolis, suburban Indianapolis and statewide entities around priority areas that focus on health improvement efforts statewide. IU Health is keenly aware of the positive impact it can have on the communities of need in the state of Indiana by focusing on the most pressing needs in a systematic and strategic way. After taking a careful look into IU Health's communities we serve, and by utilizing the detailed community needs assessments undertaken by public health officials and community partners, IU Health identified the following community health needs for 2011: Obesity Prevention To improve the lifestyle of Indiana residents, IU Health has utilized best practice methods to attack obesity in our communities. IU Health is working to improve access to nutritious foods and physical activity in low-income neighborhoods, in addition to providing traditional health education and public advocacy efforts. With these initiatives, IU Health strives to prevent chronic diseases such as obesity and diabetes and increase the awareness of the importance of making healthy choices, since Thirty-six percent of Hoosier adults are overweight and 29.5% are obese, costing the nations billions of dollars each year to treat these chronic health conditions. Garden on the Go: Year-round mobile produce delivery program, that aims to increase access to affordable, fresh fruits & vegetables for the city's most disadvantaged neighbors. By the end of December 2011, Garden on the Go served thousands of community members, reaching a total of 8281 residents! Indy Urban Acres: 8-acre organic urban farm that supplies low-income Hoosiers with healthy fruits and vegetables. Produce grown at this site is given to Gleaners Food Bank. In just two months of harvest, more than 1400 pounds of produce was grown on .5 acres and delivered to Gleaners Food Bank. Riley School Gardens: In an effort to increase access to nutritious foods and reduce the incidence of obesity among youth, Riley Hospital for Children at Indiana University Health partnered with Keep Indianapolis Beautiful (KIB) and Indianapolis Public Schools (IPS) to establish school gardens at 10 IPS schools throughout the city. IU Health Bucks: IU Health Bucks is an incentive program designed to increase produce consumption among underserved populations using state-issued Farmers Market Vouchers. Participants who spent their state-issued vouchers at the North United Methodist Church Farmers' Market in Indianapolis received additional IU Health "Market Money" to spend on produce. 233 low-income families participated in the pilot program, spending $3,500 on healthy, local produce. Access to Affordable Healthcare One of the first steps to improved health outcomes is having access to healthcare resources. To show its commitment to providing affordable healthcare access, IU Health treats all patients regardless of their ability to pay. IU Health is also working to raise awareness and work to identify individuals within our communities that have barriers to care and connect these individuals with better access and consistency of healthcare resources to meet their needs. Injury Prevention IU Health strives to create safe communities by helping to reduce preventable injuries such as bicycle, motor vehicle, and fall related injuries, as injuries are the leading cause of death for people 1 - 44 years old. The CDC reports 160,000 people die and 50 million people are injured each year, costing over $80 billion in medical costs. IU Health works to provide the necessary to tools, such as helmets and education to communities of need to prevent injuries for youth and adults. Additionally, IU Health supports the advocacy of policies, such as the texting while driving ban, to help provide infrastructure to instill the awareness of injury prevention in our communities. Bicycle Helmet Safety Campaign: Outfitted 4,042 children statewide (ages 6-14) with free, properly fitted bicycle helmets and provided bicycle safety education. This initiative resulted in a 37% increase in helmet usage post-activation. IU Health Child Passenger Safety Campaign: On National Seat Check Saturday, IU Health launched a statewide campaign to decrease the incidence of children traveling unrestrained or restrained incorrectly. CPS Technicians distributed 122 free car seats and found that 85% of the 205 car seats inspected were installed improperly. CICOA Aging and In-Home Solutions: Safe at Home Event - targeted homeowners over the age of 65 or persons of any age with a disability to make their homes safe and accessible for daily living. Volunteers made safety modifications to 22 homes including securing grab bars in bathrooms, installing handrails and banisters on steps, repairing steps, and installing comfort height toilets. K-12 Education In 2011, IU Health partnered with the United Way to implement a Kindergarten readiness program for at-risk children called Kindergarten Countdown. IU Health's significant investment in this program allowed hundreds of soon-to-be students to receive necessary vaccinations and screenings as well as attend a 4-week summer camp to enhance their school readiness. With IU Health's support, the program was expanded across the IPS district and into 10 additional IU Health communities. Community Revitalization During IU Health's third annual Day of Service, 1,611 employees joined the fight against childhood obesity by increasing access to active places to play and fresh nutritious foods for low-income school children across Indiana. Community assets left behind as a result of the event included: 3 new school playgrounds, 12 improved school playgrounds, and 5 school gardens. Over 65,000 Hoosiers were positively impacted by the construction of new playgrounds and safety improvements made; creating secure & convenient places for community members to play and be active. Additionally, IU Health recognizes that it can extend its impact farther by strategically supporting the efforts of community partners who share IU Health's mission of improving the health and well-being of our neighbors and our neighborhoods. In 2011, IU Health directly invested in partners to carry out such diverse activities as delivering low-cost medical services, raising funding for research, and providing health education. STATE FILING OF COMMUNITY BENEFIT REPORT 990 SCHEDULE H, PART VI IN, true UNITED WAY OF GREATER LAFAYETTE 1114 STATE STREET LAFAYETTE IN 47905 350891621 501(c)(3) 50000 0 CASH N/A GENERAL SUPPORT INDIANA UNIVERSITY FOUNDATION PO BOX 500 BLOOMINGTON IN 47402 356018940 501(C)(3) 15000 CASH N/A EVENT SPONSORSHIP LAFAYETTE MEDICAL EDUCATION FOUNDATION INC PO BOX 4083 LAFAYETTE IN 47903 351314750 501(c)(3) 10000 0 CASH N/A MEDICAL EDUATION AMERICAN HEART ASSOCIATION INC 7272 GREENVILLE AVE DALLAS TX 75231 135613797 501(C)(3) 7500 CASH N/A GENERAL SUPPORT 4 0 Schedule I, Part I - General Information on Grants and Assistance Line 2 - Organization's Procedures for Monitoring the Use of Grant Funds Although Indiana University Health Arnett, Inc. does not monitor the use of grant funds once distributed, through due diligence the organization has reasonably confirmed that the entities to which the contributions are made are highly reputable in the community and use the funds for the purposes intended. false true false false false false false true false DANIEL F EVANS JR 0 1020135 0 373097 0 56764 0 818859 0 20989 0 2289844 0 0 ROBERT W MARTIN MD 490580 0 12229 0 1806 0 32500 0 23267 0 560382 0 0 0 ANDREW K EDWARDS MD 246618 0 0 0 378 0 26070 0 29112 0 302178 0 0 0 MICHAEL B LOCKWOOD MD 323763 0 0 0 1806 0 32500 0 23089 0 381158 0 0 0 STEPHEN L HENSON MD 542462 0 0 2772 0 32500 0 21658 0 599392 0 0 0 KENNETH S STONE MD 2300 688906 0 0 0 20498 0 20652 0 23329 2300 753385 0 0 SCOTT M BLACK 0 223402 0 46155 0 10074 0 20505 0 26247 0 326383 0 0 ALFONSO W GATMAITAN 393762 0 131088 0 11085 0 93663 0 28738 0 658336 0 0 0 JEROME P KELLY 0 209582 0 1562 0 7877 0 18634 0 23151 0 260806 0 0 JEFFREY R NAGY 185390 0 0 0 0 0 9270 0 0 0 194660 0 0 0 JAMES BIEN 250707 0 42199 0 18461 0 32500 0 26065 0 369932 0 0 0 LINDA DECKER 177767 0 16906 0 3512 0 23094 0 7200 0 228479 0 0 0 HAROLD D GEORGE 162603 0 15599 0 60 0 9148 0 14819 0 202229 0 0 0 LORI A LUTHER 166432 0 13154 0 2222 0 20349 0 8292 0 210449 0 0 0 BRIAN T SHOCKNEY 200312 0 16720 0 2209 0 28711 0 22725 0 270677 0 0 0 CHENG DU MD 655309 0 0 0 630 0 32500 0 27612 0 716051 0 0 0 MICHAEL L HOGAN MD 592527 0 0 0 1806 0 32500 0 26170 0 653003 0 0 0 JOSEPH E HUBBARD MD 624459 0 0 0 336 0 26070 0 14662 0 665527 0 0 0 AYAZ SHAIKH MD 613008 0 0 0 630 0 32500 0 22904 0 669042 0 0 0 RYAN D LOYD MD 719423 0 0 0 420 0 26070 0 23919 0 769832 0 0 0 MICHAEL W SKEHAN MD 0 269050 0 0 0 1617 0 0 0 19613 0 290280 0 0 Schedule J, Part I - Questions Regarding Compensation Line 3 - Compensation of the Organization's CEO/Executive Director Alfonso W. Gatmaitan, the CEO of Indiana University Health Arnett, Inc. ("IU Health Arnett"), is compensated as an employee of Indiana University Health, Inc. ("IU Health") for his services performed at IU Health Arnett. IU Health has a process in place to determine the compensation of IU Health Arnett's CEO. This process includes the use of a written employment contract, the terms of which are determined based upon a compensation survey/study conducted by an independent compensation consultant with review and approval by IU Health's compensation committee and board of directors. Schedule J, Part I - Questions Regarding Compensation Line 4b - Supplemental Nonqualified Retirement Plan Daniel F. Evans, Jr. and Alfonso W. Gatmaitan participate in a supplemental executive retirement plan of Indiana University Health, Inc., the provisions of which are designed to retain its critical employees. The plan provides for an additional retirement benefit for service through normal retirement or other key dates. If the executive leaves prior to retirement or other key dates, the benefit may be forfeited or reduced. Daniel F. Evans, Jr. and Alfonso W. Gatmaitan have an amount included in column c, deferred compensation, representing the current year increase in the accrued benefit and/or current contributions. No amount was actually paid to this executive during the year. Schedule J, Part I - Questions Regarding Compensation 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. Part VI, Section A - Governing Body and Management Line 2 - Family or Business Relationships Daniel F. Evans, Jr. serves on the Board of Managers of Clarian Health North, LLC. Jerome P. Kelly serves as an officer of Clarian Health North, LLC. No additional compensation is provided. Part VI, Section A - Governing Body and Management Lines 6, 7a and 7b - Members or Stockholders Line 6: The sole member of Indiana University Health Arnett, Inc. ("IU Health Arnett") is Indiana University Health, Inc. ("IU Health"), a 501(c)(3) tax-exempt hospital. Line 7a: The control and management of the affairs of IU Health Arnett is vested in a board of twelve (12) voting directors whom are appointed by IU Health, as the sole member of the organization. Three (3) of the voting directors are nominated by the IU Health Arnett employed physicians. One (1) of the voting directors is nominated by active medical staff members. IU Health may only either accept director nominees from the IU Health Arnett employed physicians and active medical staff members or reject one or more of such nominees and request different nominees from the employed physicians and active medical staff members. Line 7b: The board of directors may not undertake certain actions without the prior approval of IU Health, as the sole member. Actions that require prior approval include the following: -Authorization of any merger, consolidation, reorganization, sale or transfer of all or substantially all of the assets of IU Health Arnett; -Authorization of any plan of dissolution of IU Health Arnett, any liquidating distribution of IU Health Arnett's assets or other action related to the dissolution or liquidation of IU Health Arnett; -Authorization of any voluntary declaration of bankruptcy of IU Health Arnett; -Amendment, repeal, revision or adoption of changes to the organization documents of IU Health Arnett; -Authorization of the consolidation of any entity with, or acquisition of any entity by IU Health Arnett; -Authorization of any agreement to act as a primary obligor, or to serve as a guarantor, surety or co-obligor with respect to the indebtedness of any other party, to borrow amounts from third-party lenders or to loan money to any person or entity; -Approval of strategic plans and amendments; -Authorization of any pledge of, or grant of any security interest or mortgage in, or otherwise encumber, any tangible assets in excess of an appropriate monetary threshold, other than in the ordinary course of business or pursuant to an approved budget or strategic plan; -Approval of any management agreement for the management of all or a substantial part of IU Health Arnett's operations; or -Authorization of the establishment or acquisition by IU Health Arnett of any subsidiaries, affiliates or joint venture arrangements or the acquisition by IU Health Arnett of the stock or other equity interest or substantially all the assets of any other business or entity. Part VI, Section A - Governing Body and Management Line 11b - Form 990 Provided to Governing Body Indiana University Health Arnett, Inc. ("IU Health Arnett") has established the following process for the review of the Form 990 and related schedules before it is filed: The Chief Financial Officer reviewed and approved the Form 990 and related schedules. After the review and approval from the Chief Financial Officer, a complete copy of the Form 990 and related schedules was made available to each board member on a secure intranet site. Each member was informed of the availability of the Tax Department to answer any questions. Part VI, Section B - Policies Lines 12, 13, 14, and 16b Indiana University Health Arnett, Inc. ("IU Health Arnett") is part of the Indiana University Health, Inc. ("IU Health") system. As the sole member and controlling parent of IU Health Arnett, IU Health and its Board of Directors have mandated that certain policies be followed to ensure greater standardization throughout the system. Thus, IU Health Arnett's Board of Directors was not required to separately adopt a conflict of interest, whistleblower, document retention and destruction and joint venture policies because IU Health's Board of Directors had already adopted and required these policies to be followed by its subsidiaries. Part VI, Section B - Policies Line 12c - Conflict of Interest Policy Indiana University Health Arnett, Inc. ("IU Health Arnett") has a Conflict of Interest Policy, the purpose of which is to protect IU Health Arnett's interests when it is contemplating entering into a transaction or arrangement that might benefit the private interest of an officer, director, or employee. Each employee that is manager level or above, including officers and directors, is required to annually sign a statement which affirms that such person (1) has received a copy of the conflict of interest policy; (2) has read and understands the policy; (3) has agreed to comply with the policy; and (4) understands and acknowledges that the Corporation is a tax-exempt organization and that in order to maintain its federal tax exemption it must engage primarily in activities which accomplish one or more of its tax-exempt purposes. If an interest is disclosed, the form requires that the discloser's supervisor sign the form to indicate his/her knowledge and approval of the interest. The form is then submitted to Corporate Compliance for review. If the disclosure is by the CEO/President, it is reviewed by the board chairman for approval. If the disclosure is by a member of the board of directors, the General Counsel/Chief Compliance Officer reviews the disclosures and determines whether to consent. Board members with a conflict of interest cannot participate in any decision related to that conflict. Breach of the conflict of interest policy, including failure to complete and update the questionnaire and failure to disclose an interest that should be disclosed, may subject an individual to disciplinary action, including dismissal. Part VI, Section B - Policies Line 15 - Process for Determining Compensation The CEO/Top Management Official for Indiana University Health Arnett, Inc. ("IU Health Arnett") is employed by Indiana University Health, Inc. ("IU Health"). IU Health has the following process for determining compensation: 1. The Board of Directors has established a Committee on Personnel and Compensation. The individuals on this Committee are made up of individuals who are on the Board and who do not have a conflict of interest with Indiana University Health, Inc. ("IU Health"). There are no physicians or employees on this Committee. This Committee develops and reviews annually the executive compensation philosophy, market analysis as to comparability and reasonableness. One of the purposes of this Committee is to review, approve and make recommendations regarding executive compensation and benefits to the IU Health Board. 2. Each year the Committee on Personnel and Compensation engages an outside compensation consulting firm to conduct a compensation and benefits study for all senior vice presidents and above. The current compensation advisor is the Hay Group. Hay Group performs an independent compensation survey. The relevant comparability data includes: compensation and benefit levels paid by similarly situated organizations (both governmental and tax exempt) for functionally comparable positions as well as the availability of similar services in the geographic area. The Committee reviews the entire compensation package including: base compensation, short term and long term incentive plans, basic health and welfare benefits, qualified and nonqualified plans as well as any additional fringe benefits. Further, Hay Group will provide recommendations based upon the reasonable compensation information as it relates to salary increases, bonuses and benefits that are consistent with the compensation philosophy of the Committee. A separate analysis using the same methodology is done for the Chief Executive Officer. 3. The Committee reviews the salary survey and, if appropriate, makes recommendations on increases in salary and any changes in bonuses or benefits. The Committee's goal is to ensure that the total compensation and benefits package is reasonable based upon the independent data provided by Hay Group. The Committee votes on any changes in compensation or benefits. This review, discussion and vote are documented in the minutes for the meeting. There are no executives present during the final discussion and approval of compensation. 4. The Board reviews the report prepared by the Hay Group as well as the recommendations of the Committee on Personnel and Compensation as to changes in compensation approved by the Committee. As requested, the Finance, Planning and Human Resources Committee also provides its review of recommendations on changes in executive compensation and benefits. This review, discussion and vote are documented in the minutes. 5. The Board then reviews the recommendations provided by the Committee on Personnel and Compensation and votes on the changes as well. No additional compensation or benefits are paid to the executives until the changes have been approved by the Committee and the Board. The discussion and approval are documented in the minutes of the meeting. There are no executives present during the final discussion and approval of compensation. The General Counsel prepares a formal written opinion reviewing the compensation and benefits approval process, comparing that process to the Intermediate Sanctions Test of IRC Section 4958 and, if the facts warrant, provides comments regarding the compensation and benefits approval process as this relates to meeting the requirements for a rebuttable presumption of reasonableness as provided in the Intermediate Sanctions Test. 6. After the end of each year, the Committee and Board also reviews the achievements of the executive group as it relates to the long-term and short-term shared and individual goals developed by the executive and the Board. These achievements may also be reviewed with the Committee on Finance, Planning and Human Resources. The Board, at its discretion, may approve bonus payments based upon the achievement of the goals and the compensation survey. The discussion and vote of the Committee and Board is documented in the minutes for each such meeting. The bonuses are not paid until approval is made by the Board. 7. The Committee on Personnel and Compensation and Audit Committee also review the required Form 990 disclosures related to executive compensation and benefits as well as compensation practices and approval processes prior to the filing of the Form 990 return with the Internal Revenue Service. IU Health Arnett has a process in place to determine the compensation for the other officers and key employees. IU Health Arnett uses an independent compensation consultant who utilizes a variety of methods and procedures to obtain compensation ranges for comparable officer and employee positions. The independent compensation consultant provides IU Health Arnett with recommended compensation ranges for its officers and other employees, which are then used as a guide for setting reasonable compensation by management. Management decisions with regard to determining compensation are subject to the review and approval of the Compensation Committee and Board of Directors. Part VI, Section B - Policies Line 19 - Public Disclosure Indiana University Health Arnett, Inc.'s ("IU Health Arnett") Articles of Incorporation are available for public inspection through the Indiana Secretary of State's web-site. IU Health Arnett's conflict of interest procedures are disclosed on the Form 990, Schedule O. IU Health Arnett is a consolidated subsidiary in the consolidated financial statements for Indiana University Health, Inc. ("IU Health"). The consolidated financial statements for IU Health are available to the public through its bond filings. Part VII, Section A - Governing Body and Management Line 1a, Column (B) - Average hours per week Daniel F. Evans, Jr. is the President and CEO for Indiana University Health, Inc. and devotes 55 hours per week. Jerome P. Kelly is the Assistant General Counsel for Indiana University Health, Inc. and devotes 55 hours per week. Scott M. Black is the Vice President, Business Development for Indiana University Health, Inc. and devotes 55 hours per week. Kenneth S. Stone, M.D. is a staff physician for Indiana University Health Care Associates, Inc. and devotes 55 hours per week. Michael W. Skehan is the Chief Medical Officer of Clarian Quality Partners, LLC and devotes 55 hours per week. Part XI - Reconciliation of Net Assets Line 5 - Other Changes in Net Assets or Fund Balances During 2011, Indiana University Health Arnett, Inc. recorded the following other changes in net assets or fund balances: Book/Tax Differences - Partnerships: 133,238 Form 5471 Footnote Indiana University Health Arnett, Inc. (FEIN: 26-3162145) constructively owned a controlled foreign corporation in 2011 through its affiliate, Indiana University Health, Inc. (FEIN: 35-1955875). Pursuant to IRC Section 6038, the 2011 controlled foreign corporation filing requirement of Indiana University Health Arnett, Inc. was fulfilled on the 2011 Form 5471 filed on its behalf by: Indiana University Health FEIN: 35-1955872 950 N. 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