2015-07-10T08:58:20-05:00 2012-12-31 ERNST & YOUNG US LLP 111 MONUMENT CIRCLE SUITE 4000 INDIANAPOLIS IN 46204 990 2012-01-01 263162145 INDIANA UNIVERSITY HEALTH ARNETT INC % BROC BUDDE INDI 3179624575 950 N MERIDIAN STREET SUITE 800 Suite INDIANAPOLIS IN 46204 CARA L BREIDSTER 2015-07-10 JENNIFER D RHODERICK 3176817000 2012 2016-02-25 16:41:14Z X ALFONSO W GATMAITAN 950 N MERIDIAN ST STE 800 INDIANAPOLIS IN 46204 399570160 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. 9 5 2405 164 333112 115881 2494696 33748 311723769 395173565 156519 69977 2590791 2739758 316965775 398017048 124579 188086 0 0 167655583 181127991 0 0 0 171440078 199783135 339220240 381099212 -22254465 16917836 244621436 250745644 304193051 293399423 -59571615 -42653779 Improve the health of our patients and community through innovation and excellence in care, education, research and service. false false 318104491 188086 395173565 Indiana University Health Arnett, Inc. ("IU Health Arnett") offers a variety of services to care for its patients during every phase of life without regard to ability to pay. As an integrated health care system, IU Health Arnett strives to be the preeminent leader in clinical care, education, research and service in the region by providing its patients with access to primary care practitioners, specialists, numerous outpatient facilities, and a 191-bed full-service hospital united together under one umbrella. 318104491 true true false true false false false false false false true false false false true false false true false false false false false false false false true true true false true false false false false false false false false false false false false true true true true false false true 91 0 true 2405 true true true false false false false false false false false false X 9 5 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 VICTOR L LECHTENBERG PHD 5.0 0.0 X X 10500 0 0 ANDREW K EDWARDS MD 55.0 0.0 X 362406 0 55915 SCOTT M BLACK 5.0 55.0 X 0 237931 49830 THOMAS V EASTERDAY 5.0 0.0 X 8250 0 0 DANIEL F EVANS JR 5.0 55.0 X 0 1431721 865442 STEPHEN L HENSON MD 55.0 0.0 X 600307 0 54247 MICHAEL B LOCKWOOD MD 55.0 0.0 X 323537 0 58383 CHRISTOPHER A MANSFIELD MD 55.0 0.0 X 331726 0 52423 RANDALL R MITCHELL 5.0 2.0 X 12000 2700 0 LARRY W PAMPEL DDS 5.0 2.0 X 12000 2700 0 KENNETH S STONE MD 5.0 55.0 X 0 843667 43585 REV KATE L WALKER 5.0 0.0 X 750 0 0 ALFONSO W GATMAITAN 55.0 0.0 X 542844 0 124748 JEROME P KELLY 5.0 55.0 X 0 227794 46364 JEFFREY R NAGY 25.0 0.0 X 53656 0 2683 LORI A LUTHER 55.0 55.0 X 111260 136511 17057 CARA L BREIDSTER 55.0 55.0 X 102971 144867 35756 BRIAN T SHOCKNEY 55.0 0.0 X 207463 0 51529 DONALD E CLAYTON MD 55.0 0.0 X 442064 0 56615 KYLE L ALLEN 55.0 55.0 X 42366 174167 23719 JAMES BIEN MD 55.0 0.0 X 271566 0 61610 HAROLD D GEORGE JR 55.0 0.0 X 167187 0 34202 JOSEPH E HUBBARD MD 55.0 0.0 X 789281 0 28274 RYAN D LOYD MD 55.0 0.0 X 728750 0 58543 ADIL KESKIN MD 55.0 0.0 X 638908 0 58873 CHENG DU MD 55.0 0.0 X 628244 0 64973 PETER A SEYMOUR MD 55.0 0.0 X 621905 0 54452 MICHAEL W SKEHAN MD 0.0 40.0 X 0 290017 35844 7009941 3492075 1935067 235 true true false TURNER CONSTRUCTION COMPANY 9190 PRIORITY WAY WEST DR SUITE 2 INDIANAPOLIS IN 46250 CONSTRUCTION 5184871 TRIMEDX INC 5451 LAKEVIEW PKWY S DR INDIANAPOLIS IN 46268 CLINICAL ENGINEERING 2564065 SODEXO INC AFFILIATES 4880 PAYSPHERE CIRCLE CHICAGO IL 60674 VARIOUS MANAGEMENT 2240059 HORIZON MEDICAL GROUP INC 1345 UNITY PLACE SUITE 345 LAFAYETTE IN 47905 MEDICAL 2157492 THE CORNERSTONE COMPANIES INC 3755 E 82ND STREET SUITE 270 INDIANAPOLIS IN 46240 CONSTRUCTION 1984744 33 10270 23478 33748 NET PATIENT SERVICE REVENUE 621111 390457432 390457432 0 0 ELECTRONIC HEALTH RECORDS INCENTIVE 900099 2303324 2303324 PHARMACY 446110 903532 778907 124625 0 INCOME (LOSS) FROM PARTNERSHIPS 900099 675241 466754 208487 0 CLINICAL RESEARCH 541700 466532 466532 0 0 367504 367504 0 395173565 31626 31626 0 0 0 0 0 1591463 1553112 38351 38351 38351 0 0 0 CAFETERIA/FOOD SERVICE 722320 1040081 0 0 1040081 GIFT SHOP 453220 149710 0 0 149710 VENDING 900099 9668 0 0 9668 1540299 0 0 1540299 2739758 398017048 394840453 333112 2809735 188086 188086 0 0 0 3826877 3337323 489554 0 143565379 125250630 18314749 9066779 8185099 881680 15877933 13852373 2025560 8791023 7780264 1010759 61190 61190 251461 251461 19176 19176 9698 9698 0 0 45729517 19146267 26583250 660825 17031 643794 2902575 804748 2097827 2444009 494834 1949175 0 9830399 9507731 322668 406899 341723 65176 0 7742 6893 849 15989926 14594080 1395846 0 14721053 10462132 4258921 3028463 1440989 1587474 DRUGS AND MEDICAL SUPPLIES 60364589 60364589 0 0 BAD DEBT 28635272 28635272 0 0 RECRUITMENT 341886 3652 338234 0 NONCAPITALIZED EQUIPMENT 238466 167095 71371 0 14139989 13523680 616309 381099212 318104491 62994721 0 15465 15465 0 0 0 0 38884622 41453853 0 0 0 0 725730 949171 3004209 3001543 2098912 2122647 264456859 62445046 198535987 202011813 0 0 0 0 1356511 1191152 0 0 0 0 244621436 250745644 30923918 35220040 0 0 15591 17544 0 0 0 0 0 0 20954971 15472749 0 0 252298571 242689090 304193051 293399423 X -59571615 -42653779 0 0 0 0 -59571615 -42653779 244621436 250745644 16917836 0 0 0 0 0 X false true X true true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false true 9698 9698 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 2012 in the amount of $35,687 and $16,901, respectively. Each membership organization notified IU Health Arnett that a portion of the dues it paid were used for lobbying purposes. The AHA used 24.60%, or $8,779 of 2012 membership dues paid by IU Health Arnett, for lobbying expenditures. The IHA used 5.44%, or $919 of the 2012 membership dues paid by IU Health Arnett, for lobbying expenditures. The total membership dues paid to these organizations by IU Health Arnett during 2012 that were attributable to lobbying expenditures was $9,698. 0 502084 502084 0 178043246 21987305 156055941 0 3508688 349823 3158865 0 65454472 39453534 26000938 0 16948369 654384 16293985 202011813 0 INTERCOMPANY PAYABLES (NET) 206297993 DUE TO THIRD-PARTY PAYORS 35804346 SELF-INSURANCE LIABILITIES 586751 ALL OTHER LIABILITIES 0 242689090 Schedule D, Part X - Other Liabilities Line 2 - FIN 48 (ASC 740) Footnote Indiana University Health Arnett, Inc. is a subsidiary in the consolidated financial statements of Indiana University Health, Inc. ("IU Health"). IU Health adopted FIN 48 in 2007. 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DIAGNOSTIC CENTER Schedule H, Part I - Financial Assistance Line 3c N/A Schedule H, Part I - Financial Assistance Line 6a - Community Benefit Report Prepared by Related Organization Indiana University Health Arnett, Inc.'s ("IU Health Arnett") community benefits and investments are included in the Indiana University Health ("IU Health") Community Benefit Report which is made available to the public on its website at www.iuhealth.org/getstrong. The Community Benefit report is also distributed to numerous key organizations throughout the State of Indiana to broadly share IU Health's community benefit efforts and investments statewide, and is available by request through the Indiana State Department of Health or IU Health. Schedule H, Part I - Financial Assistance Line 7g - Subsidized Health Services Indiana University Health Arnett, Inc. does not include any costs associated with physician clinics as subsidized health services. Schedule H, Part I - Financial Assistance Line 7, Column (f) - Bad Debt Expense The amount of bad debt expense included on Form 990, Part IX, Line 25, column (A), but subtracted for purposes of calculating the percentage of total expense is $28,635,272. The bad debt expense of $9,157,560 on Schedule H, Part III, Line 2 is reported at cost. Schedule H, Part I - Financial Assistance Line 7 - Total Community Benefit Expense Percentage of Total Expenses listed on Schedule H, Part I, Line 7, Column (f) is calculated based on Net Community Benefit Expense. The Percentage of Total Expenses calculated based on Total Community Benefit Expense is 14.69%. Schedule H, Part II - Community Building Activities Promotion of Health in Communities Served 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. IU Health contributed nearly $2 million to community-building activities in 2012, serving over 52,600 people statewide. Locally, IU Health Arnett Hospital invested over $27,000 in community-building activities by providing investments and resources to local community initiatives that addressed economic development, community health improvement and workforce development. A few examples of outreach activities: 1) participating in our local United Way's Read to Succeed child mentoring program and 2) Habitat for Humanity. Additionally, through IU Health's team member community benefit service program, Strength That Cares, team members across the state made a difference in the lives of thousands of Hoosiers. In 2012, team members: - Built 25 Habitat for Humanity home panels throughout Indiana. Three of those homes were given to victims of the Henryville, Ind., tornado. - Impacted the lives of just over 400 at-risk children by serving as camp or reading buddies in IU Health's Kindergarten Countdown program to prepare at-risk children for their first day of kindergarten. Schedule H, Part III - Bad Debt, Medicare, & Collection Practices Line 4 - Bad Debt Expense Indiana University Health Arnett, Inc. ("IU Health Arnett") is included in the consolidated audit report prepared for Indiana University Health, Inc. ("IU Health"). The provision for uncollected patient accounts is based upon management's assessment of historical and expected net collections considering business and economic conditions, changes and trends in health care coverage, and other collection indicators. Periodically, management assesses the adequacy of the allowance for uncollectible accounts based upon accounts receivable payor composition and aging, and historical write-off experience by payor category, as adjusted for collection indicators. The results of the review are then used to make any modifications to the provision for uncollected patient accounts and the allowance for uncollectible accounts. In addition, the IU Health System follows established guidelines for placing certain past due patient balances with collection agencies. Patient accounts that are uncollected, including those placed with collection agencies, are initially charged against the allowance for uncollectible accounts in accordance with collection policies of the IU Health System and, in certain cases, are reclassified to charity care if deemed to otherwise meet charity care and financial assistance policies of the IU Health System. The bad debt expense reported on Line 2 is calculated under the cost to charge ratio methodology. IU Health Arnett provides health care services through various programs that are designed, among other matters, to enhance the health of the community and improve the health of low-income patients. In addition, IU Health Arnett provides services intended to benefit the poor and underserved, including those persons who cannot afford health insurance because of inadequate resources or are uninsured or underinsured. Schedule H, Part III - Bad Debt, Medicare, & Collection Practices Line 8 - Medicare Shortfall The Medicare shortfall reported on Schedule H, Part III, Line 7 is calculated, in accordance with the Form 990 instructions, using "allowable costs" from Indiana University Health Arnett, Inc.'s ("IU Health Arnett") Medicare Cost Report. "Allowable costs" for Medicare Cost Report purposes are not reflective of all costs associated with IU Health Arnett's participation in Medicare programs. For example, the Medicare Cost Report excludes certain costs such as billed physician services, the costs of Medicare Parts C and D, fee schedule reimbursed services, and durable medical equipment services. Inclusion of all costs associated with IU Health Arnett's participation in Medicare programs would significantly increase the Medicare shortfall reported on Schedule H, Part III, Line 7. IU Health Arnett's Medicare shortfall is attributable to reimbursements that are less than the cost of providing patient care and services to Medicare beneficiaries and does not include any amounts that result from inefficiencies or poor management. IU Health Arnett accepts all Medicare patients knowing that there may be shortfalls; therefore it has taken the position that the shortfall should be counted as part of its community benefit. Additionally, it is implied in Internal Revenue Service Revenue Ruling 69-545 that treating Medicare patients is a community benefit. Revenue Ruling 69-545, which established the community benefit standard for nonprofit hospitals, states that if a hospital serves patients with governmental health benefits, including Medicare, then this is an indication that the hospital operates to promote the health of the community. Schedule H, Part III - Bad Debt, Medicare, & Collection Practices Line 9b - Written Debt Collection Policy and Financial Assistance 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. Schedule H, Part VI - Supplement Information Line 2 - Needs Assessment Communities are multifaceted and so are their health needs. Indiana University Health Arnett, Inc. ("IU Health Arnett") understands that the health of individuals and communities are shaped by various social and environmental factors, along with health behaviors and additional influences. IU Health Arnett assesses the health care needs of the communities it serves by utilizing the detailed community needs assessments undertaken by organizations such as the Tippecanoe County Health Department, the Indiana State Department of Health, the Centers for Disease Control and Prevention and the United Way of Central Indiana. Schedule H, Part VI - Supplemental Information Line 3 - Patient Education of Eligibility for Assistance Indiana University Health Arnett, Inc. ("IU Health Arnett") goes to great lengths to ensure patients know that IU Health Arnett treats all patients regardless of their ability to pay. IU Health Arnett shares financial assistance information with patients during the admission process, billing process and online. Helping patients understand that financial support for their care is a part of IU Health Arnett's commitment to its mission. IU Health Arnett's financial assistance policy exists to serve those in need by providing financial relief to patients who ask for assistance after care has been provided. During the admissions process, opportunities for financial assistance are discussed with patients who are identified as uninsured, or requests assistance information. The patient is also provided with an Admissions Packet that provides information regarding IU Health Arnett's financial assistance program. Financial counselors are onsite to assist financial concerns or questions during the patient's stay. Patient Financial Services - Customer Service representatives can help patients apply for financial assistance, understand their bills, explain what they can expect during the billing process, accept payment (if needed), update their insurance or payor information, and update their address or other demographics. A summary of the financial assistance policy is printed on the back of each patient statement. The financial assistance application is mailed to all uninsured IU Health Arnett patients at the conclusion of their treatment along with a summary of the incurred charges. Additionally, on the back of each patient statement is a phone number that will allow patients the ability to request financial assistance. Uninsured patients are also made aware of this process at the time of registration. The IU Health Statewide System website (iuhealth.org) has a page dedicated to financial assistance and offers an online application and phone numbers for customer service representatives to assist with the application process. IU Health Arnett has an expansive financial assistance program, which aligns with IU Health Arnett's policy and utilizes the federal poverty guidelines to determine eligibility, making access to quality care within a patient's reach. The IU Health Arnett Financial Assistance policy provides the following support to patients that qualify. - Free care for those earning up to 200 percent of federal poverty guidelines; - Discounted care on a sliding scale for families earning from 200 to 400 percent of federal poverty guidelines; and - Discounted care on a sliding scale for uninsured families earning from 400 to 650 percent of federal poverty guidelines, and - Financial assistance to patients whose health insurance coverage, if any, does not provide full coverage for all of their medical expenses and whose medical expenses would make them indigent if they were forced to pay full charges. Patients are guided through their course of care with particular sensitivity, reviewing changing circumstances and allowing for financial assistance at any point during the relationship and billing process with the patient. For those inpatients that may qualify for the Medicaid program and have not applied, IU Health Arnett financial counselors will assist patients with the Medicaid application. If a patient does not apply for financial assistance, but meets the financial assistance guidelines established by IU Health Arnett, IU Health Arnett will waive charges and treat the cost of services as financial assistance. Schedule H, Part VI - Supplemental Information Line 4 - Community Information Indiana University Health Arnett, Inc. ("IU Health Arnett") is primarily located in Tippecanoe County but also has medical offices and serves patients in Benton, Carroll, Clinton, and White counties. Tippecanoe County includes ZIP codes within the towns of Battle Ground, Clarks Hill, Dayton, Lafayette, Romney, West Lafayette and West Point. Based on the most recent Census Bureau (2012) statistics, Tippecanoe County's population is 177,513 persons with approximately 49% being female and 51% male. The county's population estimates by race are 86.6% White, 7.8% Hispanic or Latino, 6.5% Asian, 4.6% Black, 0.4% American Indian or Alaska Native, and 1.9% persons reporting two or more races. Tippecanoe County has relatively moderate levels of educational attainment. The level of education most of the population has achieved is a high school degree (90.5%). As of 2011, 35.8% of the population had a bachelor's degree or higher. Schedule H, Part VI - Supplemental Information Line 5 - Promotion of Community Health Indiana University Health Arnett, Inc. ("IU Health Arnett") is an affiliate of Indiana University Health, Inc. ("IU Health"), a tax-exempt hospital, whose 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. IU Health Arnett is committed to providing our youth with a preeminent facility to learn from top physicians and other clinical staff. Several community benefit highlights are described below. IU Health Arnett Hospital hosted a Health and Safety Fair attended by approximately 400 local residents. Participants took advantage of free bike helmet giveaways, and approximately 100 people received free child identification bands. Eighty people benefited from complimentary blood pressure and cholesterol screenings with 33 people identified as high risk and referred for further evaluation. 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 Hospital completed 1,039 free car seat checks in 2012. This resulted in approximately 520 hours of team members' time to help ensure children are properly secured when traveling in cars. In June 2012, IU Health Arnett donated $2,500 to the American Cancer Society's ("ACS") Relay for Life in Tippecanoe County. Team IU Health Arnett included approximately 100 members and raised more than $500. IU Health Arnett's donation of $2,500 was used to carry out the ACS' mission of eliminating cancer as a major health problem. The hospital also donated more than $100,000 to non-profit community organizations in 2012. Some of the groups included the Lafayette Medical Education Foundation, the United Way of Greater Lafayette, the Indiana Blood Center Bone Marrow Registry, and the American Heart Association. Schedule H, Part VI - Supplemental Information Line 6 - Affiliated Health Care System Indiana University Health Arnett, Inc. is part of the Indiana University Health, Inc. ("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 healthcare system. A unique partnership with Indiana University 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. IU Health Arnett is a part of the IU Health statewide healthcare system which continues to broaden its reach and positive impact throughout the state of Indiana. IU Health is Indiana's most comprehensive academic medical center and consists of IU Health Methodist Hospital, IU Health University Hospital, Riley Hospital for Children at IU Health, IU Health West Hospital, IU Health North Hospital, IU Health Ball Memorial, IU Health Blackford Hospital, IU Health Bloomington Hospital, IU Health Paoli Hospital, IU Health Bedford Hospital, IU Health Tipton Hospital, IU Health La Porte Hospital, IU Health Starke Hospital, IU Health Morgan, IU Health White, and IU Health Goshen Hospital. Although each IU Health hospital prepares and submits its own community benefits plan relative to the local community, IU Health Arnett considers its community benefit plan as part of an overall vision for strengthening Indiana's overall health. A comprehensive community outreach strategy and community benefit plan is in place that encompasses the academic medical center downtown Indianapolis, suburban Indianapolis and statewide entities around priority areas that focus on health improvement efforts statewide. IU Health is keenly aware of the positive impact it can have on the communities of need in the state of Indiana by focusing on the most pressing needs in a systematic and strategic way. After taking a careful look into IU Health's communities we serve, and by utilizing the detailed community needs assessments undertaken by public health officials and community partners, IU Health identified the following community health needs for 2012. 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. Garden on the Go reported 18,998 transactions to thousands of community members in underserved neighborhoods across Marion County in 2012. For just $7, Garden on the Go shoppers can purchase one pound of green beans, one pound of bananas, one pound of tomatoes, three pounds of potatoes, a bunch of greens, a head of lettuce, a couple of apples and a couple of oranges. In 2012, Garden on the Go received the Indiana State Health Commissioner Award for Excellence in Public Health. The award is given to programs that contribute to promoting, protecting and providing for the health of the people of Indiana. 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 2012, 1,000 people benefited from Indy Urban Acres produce. The amount of fruits and vegetables generated by the farm and donated to Gleaners totaled 35,619 pounds. To learn about gardening and the importance of good nutrition, 1,000 children from the Indy Parks summer program visited Indy Urban Acres in 2012. The food pantry at IPS #14 serves 40-50 families each week. The produce from Indy Urban Acres helps provide fresh fruits and vegetables and expand the pantry's food supply, making it possible to better serve everyone who visits each week. Food pantry patrons enjoy sharing their recipes of dishes that use fresh produce. Power over Pounds: IU Health Arnett provides a program called Power over Pounds to their community to help parents and caregivers make better nutritional choices and motivate their children (ages 5-15) to engage in healthier behaviors. Each session is four weeks long and is free to all participants. Power over Pounds is designed to help families overcome some of the barriers that exist in our society regarding healthy behaviors. 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 working to identify individuals within our communities that have barriers to care and connect these individuals with better access and consistency of healthcare resources to meet their needs. 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. In 2012 IU Health partnered with CICOA Aging & In-Home Solutions and other area agencies on aging to conduct Safe at Home, a half-day event to assist older adults in making their homes safe and accessible for daily living. Program Highlights and Impact include: 1) Five hundred IU Health and other community volunteers made simple home modifications, such as installing bathroom grab bars, building ramps and repairing stairs to help decrease risk of accidents in the home. 2) During the October event, 128 seniors in seven IU Health communities across Indiana benefited from Safe at Home. K-12 Education Education plays a crucial role in health outcomes. Level of education has an impact not only on personal health, but it has multigenerational implications as well. Children with a solid educational foundation and parents who are involved in their education are more likely to embrace healthy lifestyles and habits and succeed generally in life. Additionally, research from The National Center for Public Policy and Higher Education shows that greater educational attainment is associated with health-promoting behaviors, such as increased consumption of fruits and vegetables and other aspects of healthy eating; engaging in physical activity and refraining from smoking. Realizing that educational disparities appear early, IU Health is committed to enhancing childhood education to improve health and lifelong quality of life. Kindergarten Countdown As one of IU Health Arnett and IU Health's signature programs and a 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. With support from IU Health, Kindergarten Countdown has expanded to 10 communities across Indiana. Program Highlights and Impact include: 1) Kindergarten Countdown improved the school readiness of 400 children in 2012 and 2) Campers achieved a 19 percent increase in Get Ready to Read scores from baseline testing conducted at the beginning of camp. Community Revitalization As an opportunity to give back to the community, more than 2,200 IU Health team member volunteers across the state built Habitat for Humanity home panels during the system-wide "Day of Service" in May 2012. As a result, 25 homes were built, impacting the lives of 100 people in Indiana. Four of the homes were given to victims of the devastating 2012 tornado in Henryville, Ind. 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 2012, IU Health directly invested in partners to carry out such diverse activitie true UNITED WAY OF GREATER LAFAYETTE 1114 E STATE ST LAFAYETTE IN 47905 350891621 501(C)(3) 58142 0 N/A N/A GENERAL SUPPORT RIGGS COMMUNITY HEALTH CENTER INC 1716 HARTFORD ST LAFAYETTE IN 47904 351965865 501(C)(3) 52000 0 N/A N/A RESIDENCY SUPPORT AMERICAN HEART ASSOCIATION INC PO BOX 4002902 DES MOINES IA 50340 135613797 501(C)(3) 32500 0 N/A N/A GENERAL SUPPORT LAFAYETTE MEDICAL EDUCATION FOUNDATION INC PO BOX 4083 LAFAYETTE IN 47909 351314750 501(C)(3) 10000 0 N/A N/A MEDICAL EDUCATION 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 ANDREW K EDWARDS MD 362028 0 0 0 378 0 26490 0 29425 0 418321 0 0 0 SCOTT M BLACK 0 227675 0 0 0 10256 0 21020 0 28810 0 287761 0 0 DANIEL F EVANS JR 0 1043576 0 313408 0 74737 0 838555 0 26887 0 2297163 0 0 STEPHEN L HENSON MD 594973 0 0 0 5334 0 33000 0 21247 0 654554 0 0 0 MICHAEL B LOCKWOOD MD 321731 0 0 0 1806 0 33000 0 25383 0 381920 0 0 0 CHRISTOPHER A MANSFIELD MD 331390 0 0 0 336 0 26490 0 25933 0 384149 0 0 0 KENNETH S STONE MD 0 841861 0 0 0 1806 0 28197 0 15388 0 887252 0 0 ALFONSO W GATMAITAN 400023 0 126016 0 16805 0 94031 0 30717 0 667592 0 0 0 JEROME P KELLY 0 223896 0 0 0 3898 0 21020 0 25344 0 274158 0 0 LORI A LUTHER 89595 117949 10000 0 11665 18562 5971 2515 4859 3712 122090 142738 0 0 CARA L BREIDSTER 92327 144447 0 0 10644 420 5335 2477 10232 17712 118538 165056 0 0 BRIAN T SHOCKNEY 205218 0 0 0 2245 0 26199 0 25330 0 258992 0 0 0 DONALD E CLAYTON MD 439292 0 0 0 2772 0 33000 0 23615 0 498679 0 0 0 KYLE L ALLEN 41831 159631 0 0 535 14536 2135 12294 1968 7322 46469 193783 0 0 JAMES BIEN MD 257808 0 0 0 13758 0 33000 0 28610 0 333176 0 0 0 HAROLD D GEORGE JR 165087 0 0 0 2100 0 17688 0 16514 0 201389 0 0 0 JOSEPH E HUBBARD MD 788903 0 0 0 378 0 26490 0 1784 0 817555 0 0 0 RYAN D LOYD MD 728330 0 0 0 420 0 33000 0 25543 0 787293 0 0 0 ADIL KESKIN MD 638278 0 0 0 630 0 33000 0 25873 0 697781 0 0 0 CHENG DU MD 627614 0 0 0 630 0 33000 0 31973 0 693217 0 0 0 PETER A SEYMOUR MD 621485 0 0 0 420 0 26490 0 27962 0 676357 0 0 0 MICHAEL W SKEHAN MD 0 263500 0 0 0 26517 0 18755 0 17089 0 325861 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 Scott M. Black and Cara L. Breidster served on the board of managers of Beltway Surgery Center, LLC and ROC Surgery, LLC. No additional compensation was 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 up to twelve (12) voting directors whom are appointed by IU Health, as the sole member of the organization. Three (3) of the voting directors are nominated by the IU Health Arnett employed physicians. One (1) of the voting directors is nominated by active medical staff members. IU Health may only either accept director nominees from the IU Health Arnett employed physicians and active medical staff members or reject one or more of such nominees and request different nominees from the employed physicians and active medical staff members. Line 7b: The board of directors may not undertake certain actions without the prior approval of IU Health, as the sole member. Actions that require prior approval include the following: -Authorization of any merger, consolidation, reorganization, sale or transfer of all or substantially all of the assets of IU Health Arnett; -Authorization of any plan of dissolution of IU Health Arnett, any liquidating distribution of IU Health Arnett's assets or other action related to the dissolution or liquidation of IU Health Arnett; -Authorization of any voluntary declaration of bankruptcy of IU Health Arnett; -Amendment, repeal, revision or adoption of changes to the organization documents of IU Health Arnett; -Authorization of the consolidation of any entity with, or acquisition of any entity by IU Health Arnett; -Authorization of any agreement to act as a primary obligor, or to serve as a guarantor, surety or co-obligor with respect to the indebtedness of any other party, to borrow amounts from third-party lenders or to loan money to any person or entity; -Approval of strategic plans and amendments; -Authorization of any pledge of, or grant of any security interest or mortgage in, or otherwise encumber, any tangible assets in excess of an appropriate monetary threshold, other than in the ordinary course of business or pursuant to an approved budget or strategic plan; -Approval of any management agreement for the management of all or a substantial part of IU Health Arnett's operations; or -Authorization of the establishment or acquisition by IU Health Arnett of any subsidiaries, affiliates or joint venture arrangements or the acquisition by IU Health Arnett of the stock or other equity interest or substantially all the assets of any other business or entity. Part VI, Section A - 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 presented and approved by the Audit Committee. After Audit Committee approval, a complete copy of the Form 990 and related schedules was made available to each board member on a secure intranet site. Each member was informed of the availability of the Tax Department to answer any questions. Part VI, Section B - 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. As deemed appropriate, this Committee also reviews the same detail with the Committee on Finance, Planning and Human Resources. The Committee on Finance, Planning and Human Resources is represented by certain members of the Board as well. 2. Each year the Committee on Personnel and Compensation engages an outside compensation consulting firm to conduct a compensation and benefits study for all senior vice presidents and above. The current compensation advisor is the Hay Group. Hay Group performs an independent compensation survey. The relevant comparability data includes: compensation and benefit levels paid by similarly situated organizations (both governmental and tax exempt) for functionally comparable positions as well as the availability of similar services in the geographic area. The Committee reviews the entire compensation package including: base compensation, short term and long term incentive plans, basic health and welfare benefits, qualified and nonqualified plans as well as any additional fringe benefits. Further, Hay Group will provide recommendations based upon the reasonable compensation information as it relates to salary increases, bonuses and benefits that are consistent with the compensation philosophy of the Committee. A separate analysis using the same methodology is done for the Chief Executive Officer. 3. The Committee reviews the salary survey and, if appropriate, makes recommendations on increases in salary and any changes in bonuses or benefits. The Committee's goal is to ensure that the total compensation and benefits package is reasonable based upon the independent data provided by Hay Group. The Committee votes on any changes in compensation or benefits. This review, discussion and vote are documented in the minutes for the meeting. There are no executives present during the final discussion and approval of compensation. 4. The Board reviews the report prepared by the Hay Group as well as the recommendations of the Committee on Personnel and Compensation as to changes in compensation approved by the Committee. As requested, the Finance, Planning and Human Resources Committee also provides its review of recommendations on changes in executive compensation and benefits. This review, discussion and vote are documented in the minutes. 5. The Board then reviews the recommendations provided by the Committee on Personnel and Compensation and votes on the changes as well. No additional compensation or benefits are paid to the executives until the changes have been approved by the Committee and the Board. The discussion and approval are documented in the minutes of the meeting. There are no executives present during the final discussion and approval of compensation. The General Counsel prepares a formal written opinion reviewing the compensation and benefits approval process, comparing that process to the Intermediate Sanctions Test of IRC Section 4958 and, if the facts warrant, provides comments regarding the compensation and benefits approval process as this relates to meeting the requirements for a rebuttable presumption of reasonableness as provided in the Intermediate Sanctions Test. 6. After the end of each year, the Committee and Board also reviews the achievements of the executive group as it relates to the long-term and short-term shared and individual goals developed by the executive and the Board. These achievements may also be reviewed with the Committee on Finance, Planning and Human Resources. The Board, at its discretion, may approve bonus payments based upon the achievement of the goals and the compensation survey. The discussion and vote of the Committee and Board is documented in the minutes for each such meeting. The bonuses are not paid until approval is made by the Board. 7. The Committee on Personnel and Compensation and Audit Committee also review the required Form 990 disclosures related to executive compensation and benefits as well as compensation practices and approval processes prior to the filing of the Form 990 return with the Internal Revenue Service. IU Health Arnett has a process in place to determine the compensation for the other officers and key employees. IU Health Arnett uses an independent compensation consultant who utilizes a variety of methods and procedures to obtain compensation ranges for comparable officer and employee positions. The independent compensation consultant provides IU Health Arnett with recommended compensation ranges for its officers and other employees, which are then used as a guide for setting reasonable compensation by management. Management decisions with regard to determining compensation are subject to the review and approval of the Executive Committee and Board of Directors. Part VI, Section C - Disclosure Line 19 - Public Disclosure Indiana University Health Arnett, Inc.'s ("IU Health Arnett") Articles of Incorporation are available for public inspection through the Indiana Secretary of State's web-site. IU Health Arnett's conflict of interest procedures are disclosed on the Form 990, Schedule O. IU Health Arnett is a consolidated subsidiary in the consolidated financial statements for Indiana University Health, Inc. ("IU Health"). The consolidated financial statements for IU Health are available to the public through its bond filings and attached to the Form 990 Part VII, Section A - Governing Body and Management Line 1a, Column (B) - Average hours per week During different parts of 2012, Lori A. Luther devoted 55 hours per week as the Interim CFO/Chief Practice Officer ("CPO") of Indiana University Health Arnett, Inc. and COO of Indiana University Health Ball Memorial Hospital, Inc. During different parts of 2012, Cara L. Breidster devoted 55 hours per week as the VP, Finance/Controller of Indiana University Health, Inc. and Treasurer/CFO of Indiana University Health Arnett, Inc. and CFO of IU Health White Memorial Hospital, Inc. During different parts of 2012, Kyle L. Allen devoted 55 hours per week as the VP, Primary Care of Indiana University Health Care Associates, Inc. and CPO of Indiana University Health Arnett, Inc. Part IX - Statement of Functional Expenses Line 11g - Other Fees for Services Line 11g includes amounts paid for the following: Shared Services/Professional Fees - $45,729,517 Statement on Amendment During 2014, Indiana University Health Arnett, Inc. issued a 2012 Form W-2c to Alfonso W. Gatmaitan in order to include previously excluded travel and lodging expenses that were reimbursed to him as a taxable fringe benefit. During 2014, Indiana University Health, Inc. issued a 2012 Form W-2c to Daniel F. Evans, Jr. (board member of Indiana University Health Arnett, Inc.) in order to include previously excluded premiums it paid on a life insurance policy, in which Daniel F. Evans, Jr. was the insured party and a family member was the beneficiary, as taxable compensation. The total increase for Alfonso W. Gatmaitan's and Daniel F. Evans, Jr.'s 2012 reportable compensation was $1,555 and $15,887 respectively. This change is reflected on the following parts and schedules of the amended 2012 Form 990: Part I, Line 15 As Originally Filed: $181,126,436 As Amended: $181,127,991 Increase: $1,555 Part I, Line 17 As Originally Filed: $199,784,690 As Amended: $199,783,135 Decrease: $1,555 Part VII, Section A, Line (13), Column (D) As Originally Filed: $541,289 As Amended: $542,844 Increase: $1,555 Part VII, Section A, Line (5), Column (E) As Originally Filed: $1,415,834 As Amended: $1,431,721 Increase: $15,887 Part VII, Section A, Line 1b, Column (D) As Originally Filed: $2,202,765 As Amended: $2,204,320 Increase: $1,555 Part VII, Section A, Line 1b, Column (E) As Originally Filed: $2,730,626 As Amended: $2,746,513 Increase: $15,887 Part VII, Section A, Line 1d, Column (D) As Originally Filed: $7,008,386 As Amended: $7,009,941 Increase: $1,555 Part VII, Section A, Line 1d, Column (E) As Originally Filed: $3,476,188 As Amended: $3,492,075 Increase: $15,887 Part IX, Line 5, Column (A) As Originally Filed: $3,825,322 As Amended: $3,826,877 Increase: $1,555 Part IX, Line 5, Column (C) As Originally Filed: $487,999 As Amended: $489,554 Increase: $1,555 Part IX, Line 17, Column (A) As Originally Filed: $408,454 As Amended: $406,899 Decrease: $1,555 Part IX, Line 17, Column (C) As Originally Filed: $66,731 As Amended: $65,176 Decrease: $1,555 Schedule J, Part II, Line 3(ii), Column (B)(iii) As Originally Filed: $58,850 As Amended: $74,737 Increase: $15,887 Schedule J, Part, II, Line 3 (ii), Column (E) As Originally Filed: $2,281,276 As Amended: $2,297,163 Increase: $15,887 Schedule J, Part II, Line 8, Column (B)(iii) As Originally Filed: $15,250 As Amended: $16,805 Increase: $1,555 Schedule J, Part II, Line 8, Column (E) As Originally Filed: $666,037 As Amended: $667,592 Increase: $1,555 ARNETT CLINIC LLC 950 N MERIDIAN ST STE 800 INDIANAPOLIS IN 46204 352030653 HEALTHCARE IN 119107971 0 IUHA CAH PHYSICIANS LLC 950 N MERIDIAN ST STE 800 INDIANAPOLIS IN 46204 262769447 HEALTHCARE IN 0 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