2023-11-15T08:28:29+00:00 2022-12-31 990 2022-01-01 263162145 Indiana University Health Arnett Inc INDI 3179634842 950 N MERIDIAN STREET 1200 INDIANAPOLIS IN 46204 Todd A Williams CFO 2023-11-15 Todd Williams 999009999 2022 2023-04-26 12:10:37Z Arthur Vasquez 950 N MERIDIAN STREET 1200 INDIANAPOLIS IN 46204 585983905 false X SEE SCHEDULE O X 2008 IN Lead the transformation of healthcare through quality, innovation & education, and make Indiana one of the nation's healthiest states. 14 9 2915 153 656682 27516 707018 1464610 587775324 583099392 -231525 189537 1959958 1069924 590210775 585823463 1034745 805855 0 270408740 307048822 0 0 250994598 284545719 522438083 592400396 67772692 -6576933 371491097 352808000 67971714 55865550 303519383 296942450 X Lead the transformation of healthcare through quality, innovation & education, and make Indiana one of the nation's healthiest states. false false 552595609 805855 569098281 Indiana University Health Arnett in Lafayette, Indiana is a full-service, 191-bed hospital that includes more than 40 specialties and 23 outpatient clinics. The hospital features an adjacent outpatient surgery center, cancer center and several medical offices serving Lafayette and the surrounding counties. IU Health Arnett is a Magnet-designated hospital recognized by the American Nurses Credentialing Center for demonstrating excellence in nursing services and high-quality clinical outcomes for patients. 8472566 0 8725590 OUR NETWORK OF PHARMACIES OFFERS THE CONVENIENCE OF ONE-STOP SHOPPING. WE PROVIDE EXPERT CARE AND HELP PATIENTS MAKE THE BEST USE OF THEIR MEDICATIONS. 4570235 0 4706720 IU Health Arnett provides services to related tax-exempt organizations and one related government entity. IU Health entities facilitates efforts and shared services on behalf of and for the benefit of IU Health and its affiliates, certain costs related to providing these shared services are allocated out or charged to the affiliates. Facilitating these efforts and services allows IU Health and its affiliates to better carry out their exempt functions by reducing costs, having standardized practices and procedures, and creating economies of scale. 505924 0 521033 INCOME (LOSS) FROM PASS-THROUGH ENTITIES 35053 0 36100 Clinical Research 11330 0 11668 RENT FROM RELATED 501(C)(3) ORGANIZATIONS 552307 568801 566190717 true true false true false false false false false true false false false true true 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 0 0 2915 true true true false false false false false false false false false false false X 14 9 false false false false true true true true true false false true true true true true true false true true true IN X CRAIG J JONES 3179634842 950 N MERIDIAN STREET SUITE 800 INDIANAPOLIS IN 46204 DAVID HUMMELS DIRECTOR/CHAIR (PART YEAR) 2.0 4.0 X X 0 1500 0 GARY D HENRIOTT DIRECTOR/CHAIR (PART YEAR) 2.0 5.0 X X 0 6750 0 AMANDA WHITLOCK DIRECTOR 2.0 4.0 X 0 3750 0 ERIKA UGIANSKIS MD DIRECTOR 51.0 4.0 X 739272 0 74127 JESSE MOORE DIRECTOR 2.0 4.0 X 0 9000 0 MARION UNDERWOOD DIRECTOR (PART YEAR) 2.0 4.0 X 0 0 0 MARK BUONO MD DIRECTOR 51.0 4.0 X 659611 0 51239 MICHELE S SAYSANA MD DIRECTOR 51.0 4.0 X 0 569965 19743 RANDALL R MITCHELL DIRECTOR 2.0 4.0 X 0 18750 0 RANDY W PRICE DIRECTOR 2.0 4.0 X 0 9000 0 REV KATE L WALKER DIRECTOR 2.0 4.0 X 0 13500 0 RUBAN NIRMALAN MD DIRECTOR 51.0 4.0 X 806165 0 60121 SHAN SHERIDAN DIRECTOR 2.0 4.0 X 0 9000 0 UMESH PATEL DIRECTOR (PART YEAR) 2.0 4.0 X 0 2000 0 VICTOR L LECHTENBERG DIRECTOR (PART YEAR) 2.0 4.0 X 0 1500 0 WILLIAM Y LI MD DIRECTOR 51.0 4.0 X 336285 0 37439 ARTHUR VASQUEZ REGIONAL PRESIDENT (WCR) 33.0 22.0 X 0 592106 122681 PHILIP LIST SECRETARY (WCR) 35.0 20.0 X 0 183142 46537 TODD A WILLIAMS CFO/TREASURER (WCR) 35.0 20.0 X 0 331667 67328 ALLISON SHUTTZ CNO (PART YEAR) 35.0 20.0 X 450214 0 51218 CHRISTOPHER A MANSFIELD MD VP-CMO (WCR) 35.0 20.0 X 519089 0 67170 JEFFREY C ZEH COO (WCR) 35.0 20.0 X 367543 0 39284 KISHAN PATEL MD VP-Chief Physician Executive (WCR) (Part Year) 35.0 20.0 X 411678 0 40797 KOREEN C KYHNELL VP - HUMAN RESOURCES (WCR) 35.0 20.0 X 0 229165 67740 GARRETT JACKSON MD PHYSICIAN 55.0 0 X 1377737 0 60870 JOSEPH E HUBBARD MD PHY. DEPT. CHAIR 55.0 0 X 1071534 0 66725 PETER SEYMOUR Director-Chief of Surgery Regional 55.0 0 X 783066 0 70207 RAYHAN JALAL MD PHYSICIAN 55.0 0 X 797961 0 70834 STANTON M REGAN MD PHYSICIAN 55.0 0 X 1027649 0 66612 CARA L BREIDSTER FORMER OFFICER 0.0 55.0 X 0 338130 66652 DANIEL E NEUFELDER FORMER OFFICER 0.0 0.0 X 0 188587 0 DEREK E EMPIE FORMER OFFICER 0.0 55.0 X 0 311467 61837 JAMES H PARSONS FORMER KEY EMPLOYEE 35.0 10.0 X 192093 0 46116 9539898 2818979 1255278 598 true true false 0 1354813 108832 965 1464610 NET PATIENT SERVICE REVENUE 622110 569098281 569098281 SHARED SERVICES 541900 4706720 4706720 PHARMACY 446110 8725590 8092358 633232 INCOME (LOSS) FROM PASS-THROUGH ENTITIES 900099 521033 497583 23450 Rent from Related 501(c)(3) Orgs. 532000 11668 11668 36100 36100 0 0 583099392 349979 349979 20097 20097 0 20097 20097 0 160442 -160442 0 -160442 -160442 CAFETERIA/FOOD SERVICE 722210 7255 7255 GIFT SHOP 453220 141430 141430 EDUCATION 900099 30701 30701 870441 818323 0 52118 1049827 585823463 583261033 656682 441138 X 805855 805855 4949461 4788689 160772 258473445 250077526 8395919 7593701 7347037 246664 22427823 21699306 728517 13604392 13162484 441908 50215 25108 25107 19238 19238 104313023 95887341 8425682 0 862106 862106 790282 726449 63833 721357 360679 360678 13160747 13160747 250731 230479 20252 670261 616122 54139 1068 1068 15592385 14915697 676688 4942584 4942584 DRUGS AND MEDICAL SUPPLIES 98372227 98372227 BAD DEBT 14125965 14125965 HOSPITAL ASSESSMENT FEE 23365273 23365273 INSTITUTIONAL DUES/LICENSES 101632 60979 40653 7206625 6461686 744939 0 592400396 566190717 26209679 0 79405557 65184507 149225 198691 68536022 65378661 0 0 0 0 804054 1268500 11371848 12614198 2488791 2320792 344792266 153234224 198638564 191558042 0 4377499 4788872 5719537 9495737 371491097 352808000 66975531 54537976 0 0 996183 1327574 67971714 55865550 303519383 296942450 303519383 296942450 371491097 352808000 -6576933 0 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 19238 19238 false Schedule C, Part II-B, Line 1 DETAILED DESCRIPTION OF THE LOBBYING ACTIVITY IU Health Arnett paid institutional membership dues to the American Hospital Association ("AHA"), Indiana Hospital Association ("IHA") and Greater Lafayette Commerce during 2022 in the amount of $57,755, $42,899, and $12,400, respectively. Each membership organization notified IU Health Arnett that a portion of the dues it paid were used for lobbying purposes. The AHA used 26.47%, or $15,288 of 2022 membership dues paid by IU Health Arnett, for lobbying expenditures. The IHA used 8.63%, or $3,702 of the 2022 membership dues paid by IU Health Arnett, for lobbying expenditures. Greater Lafayette Commerce used 2.00%, or $248 of 2022 membership dues paid by IU Health Arnett, for lobbying expenditures. The total membership dues paid to these organizations by IU Health Arnett during 2022 that were attributable to lobbying expenditures was $19,238. 6761733 6761733 226047790 73774725 152273065 7213 7213 0 106003079 78999436 27003643 5972451 452850 5519601 191558042 SELF-INSURANCE LIABILITIES 825654 OPERATING LEASE LIABILITIES 501920 1327574 X Schedule D, Part X, Line 2 FIN 48 (ASC 740) footnote IU HEALTH ARNETT IS A SUBSIDIARY IN INDIANA UNIVERSITY HEALTH, INC.'S ("IU HEALTH") CONSOLIDATED AUDITED FINANCIAL STATEMENTS. The Internal Revenue Service has determined that Indiana University Health and certain of its affiliated entities are tax-exempt organizations as defined in Section 501(c)(3) of the Internal Revenue Code (IRC). Indiana University Health and its tax-exempt affiliates are, however, subject to federal and state income taxes on unrelated business income under the provisions of IRC Section 511. Deferred income taxes that, as of December 31, 2022 and 2021, have no net carrying value reflect the net tax effect of temporary differences between the carrying amounts of assets and liabilities for financial reporting and the amounts used for income tax purposes. As of December 31, 2022 and 2021, the Indiana University Health System had gross deferred tax assets of $145,194,000 and $146,281,000, respectively, primarily relating to net operating loss carryovers. Management determined that a full valuation allowance at December 31, 2022 and 2021, was necessary to reduce the deferred tax assets to the amount that would more likely than not be realized. Based on the weight of the evidence, if it is more likely than not that some portion or all of the deferred tax assets will not be realized, a valuation allowance to reduce the deferred tax assets is recorded. At December 31, 2022, Indiana University Health System has available net operating loss carryforwards of $583,788,000. Net operating losses generated from 2001 through 2017 will expire between 2022 and 2037. Net operating losses generated after 2017 do not expire. true true X true X 300 false true true false true true 15868 6016878 6016878 0.0104 45880 99651211 81720084 17931127 0.0310 0 0 0 0 0.0 0 61748 105668089 81720084 23948005 0.0414 4 6846 2371497 118227 2253270 0.0039 1 27 3356720 1160331 2196389 0.0038 1 268477 170855107 146601848 24253259 0.0419 1 71 112387 0 112387 0.0002 3 13594 1145515 727000 418515 0.0007 10 289015 177841226 148607406 29233820 0.0506 10 350763 283509315 230327490 53181825 0.0920 0 0.0 0 0.0 1 13576 13576 0.0000 0 0.0 1 20 850 850 0.0000 0 0.0 0 0.0 0 0.0 0 0.0 2 20 14426 0 14426 0.0000 false 5100365 76509263 94225739 -17716476 X true true 1 1 IU HEALTH ARNETT HOSPITAL 5165 MCCARTY LANE LAFAYETTE IN 47905 HTTPS://IUHEALTH.ORG/FIND-LOCATIONS/IU-HEALTH-ARNETT-HOSPITAL 23-011506-1 X X X X X IU HEALTH ARNETT HOSPITAL 1 false false true X X X X X X X X X 21 true false false true X HTTPS://IUHEALTH.ORG/IN-THE-COMMUNITY/COMMUNITY-BENEFIT true 22 true https://iuhealth.org/in-the-community/community-benefit false true X 300.0 0.0 X X X X X X X true true X X X true X HTTPS://IUHEALTH.ORG/PAY-A-BILL/FINANCIAL-ASSISTANCE X HTTPS://IUHEALTH.ORG/PAY-A-BILL/FINANCIAL-ASSISTANCE X HTTPS://IUHEALTH.ORG/PAY-A-BILL/FINANCIAL-ASSISTANCE X X X X X X X true X false X X X X true X false false Schedule H, Part V, Section B, Line 3E IU Health Arnett's 2021 Community Health Needs Assessment (CHNA) Report includes a prioritized description of significant health needs in the community. The CHNA report identified the following needs as priorities for IU Health Arnett: 1. Access to Healthcare Services 2. Behavioral Health 3. Maternal and Infant Health and Child Well-being 4. Smoking, Tobacco Use and Exposure to Secondhand Smoke 5. Social Determinants of Health Schedule H, Part V, Section B, Line 5 Facility , 1 Facility , 1 - IU HEALTH ARNETT HOSPITAL. In conducting its most recent CHNA, IU Health Arnett took into account input from persons who represent the broad interests of the communities it serves by hosting six community focus groups. These events engaged public health officials and community-based organizations that provide services and/or reflect community members who are medically underserved, low-income, or of a minority subpopulation to discuss the health needs of the service area and what role IU Health could play in addressing the identified needs. IU Health Arnett The defined community per the most recent CHNA is Benton, Carroll, Tippecanoe and White Counties. The hospital resides in Tippecanoe County. Benton County - Community Meeting A community meeting was held on April 7, 2021, to receive input from stakeholders regarding the health needs in Benton County. Secondary data and a preliminary list of community health need priorities was presented at the meeting. Each group was then asked questions about the preliminary list, including their reactions, additions to the proposed needs, thoughts regarding the causes of the needs, impacts of the COVID-19 pandemic and others. After this discussion, participants were given the opportunity to make additional comments before being asked to vote on what they believed were the most significant needs in the county. Participants were asked to choose three to five significant health needs in a poll during the meeting until the group was able to reach some consensus regarding the priority needs. Preliminary needs identified include a wide array of topics, including mental health and access to mental health providers, smoking, lack of exercise, alcohol abuse, food insecurity, insurance, housing, high-school graduation rates, teen births and others. In addition to these topics, participants focused discussion on cancer and cancer screenings, child abuse and trauma, substance abuse, transportation, the cost of care and difficulties with insurance, mental health access and lack of knowledge of available community resources. From this process, participants identified the following needs as most significant for Benton County: * Access to mental health providers * Child abuse * Insurance barriers and uninsured populations Although the following issues did not make the top three from voting, substance use, long commutes and severe housing problems were all tied for fourth place. In discussing the impacts of the COVID-19 pandemic on health, participants focused on the migration of community members to other areas with more job opportunities, housing issues for low-income populations, isolation leading to poor health and a rise in alcohol misuse. An additional community survey was issued to stakeholders unable to attend community meetings, asking them to identify priority needs. Among five responses, the following issues were identified as the most significant: * Mental health, suicide and access to mental health services * The need for more community resources, action and interventions * Access to healthcare services * Childcare * Severe housing problems The survey also asked about the impacts of the COVID-19 pandemic. Issues most often selected as significant impacts include: * Social isolation and loneliness * Poverty and economic disparities * Lack of access to healthcare services * Childcare difficulties and cost Carroll County - Community Meeting A community meeting was held on April 13, 2021, to receive input from stakeholders regarding the health needs in Carroll County. Secondary data and a preliminary list of community health need priorities was presented at the meeting. Each group was then asked questions about the preliminary list, including their reactions, additions to the proposed needs, thoughts regarding the causes, impacts of the COVID-19 pandemic and others. After this discussion, participants were given the opportunity to make additional comments before being asked to vote on what they believed were the most significant needs in the county. Participants were asked to choose three to five significant health needs in a poll during the meeting until the group was able to reach some consensus regarding the priority needs. Preliminary needs identified include a wide collection of topics, including food insecurity, physical inactivity, housing, educational achievement, teen births, access to primary care, income inequality and others. In addition to these topics, participants focused discussion on lack of knowledge on places to exercise, transportation, mental health, child abuse, internet access and availability as a barrier for care, housing (particularly for seniors) and costs of housing, homelessness and lack of shelters, the lack of resources due to rural community, substance abuse and others. From this process, participants identified the following needs as most significant for Carroll County: * Mental health * Internet access * Transportation * Severe housing problems * Access to primary care providers Although the issue was not selected as a top-five need, two of the meeting participants strongly believed that substance use should be prioritized. In discussing the impacts of the COVID-19 pandemic on health, participants focused on isolation and its impacts on mental health (particularly on children, leading to outbursts), the general uncertainty and fear that the pandemic caused and misinformation about the virus. Schedule H, Part V, Section B, Line 5 Facility , 2 Facility , 2 - IU HEALTH ARNETT HOSPITAL (continued). Tippecanoe County - Community Meetings Two community meetings were held in 2021 to receive input from stakeholders regarding the health needs in Tippecanoe County - one on April 6 and another on April 16. Secondary data and a preliminary list of community health need priorities was presented at both meetings. Each group was then asked questions about the preliminary list, including their reactions, additions to the proposed needs, thoughts regarding the causes, impacts of the COVID-19 pandemic and others. After these discussions, participants were given the opportunity to make additional comments before being asked to vote on the significant needs in the county. Participants were asked to choose three to five significant health needs in a poll during the meeting until each group was able to reach some consensus regarding the priority needs. Preliminary needs identified include a wide array of topics, including food insecurity, drunk-driving deaths, lack of health insurance, sexually transmitted infections, high school graduation, income inequality, housing and teen births. In addition to these topics, participants focused discussion on child abuse and adolescent trauma/mental health, youth suicide ideation, substance abuse and access to substance abuse services, infant mortality, mental health and access to services, lack of health insurance, racism and health disparities for minorities, generational poverty, housing, transportation and others. From this process, participants from the April 6 community meeting identified the following needs as most significant for Tippecanoe County: * Mental health * Substance abuse * Child abuse Participants from the April 16 community meeting identified the following needs as most significant for Tippecanoe County: * Mental health * Substance abuse * Food insecurity In discussing the impacts of the COVID-19 pandemic on health, participants focused on isolation and its impacts on mental health, increased alcohol usage and substance abuse, impacts on child development and the overtaxing of support services. An additional community survey was issued to stakeholders unable to attend community meetings, asking them to identify priority needs. Among 29 responses, the following issues identified as the most significant: * Mental health and access to mental health services * Substance abuse and access to substance abuse treatment * Access to primary care and the cost of care * Housing affordability and homelessness * The need for more community partnerships and resources * Health inequities and disparities, including disparities by race/ethnicity and poverty The survey also asked about the impacts of the COVID-19 pandemic. Issues most often selected as significant impacts include: * Social isolation and loneliness * Food access and affordability * Unemployment and underemployment * Economic disparities White County - Community Meetings Two community meetings were held in 2021 to receive input from stakeholders regarding the health needs in White County - one on April 13 and another on April 19. Secondary data and a preliminary list of community health need priorities was presented at both meetings. Each group was then asked questions about the preliminary list, including their reactions, additions to the proposed needs, thoughts regarding the causes, impacts of the COVID-19 pandemic and others. After these discussions, participants were given the opportunity to make additional comments before being asked to vote on the significant needs in the county. Participants were asked to choose three to five significant health needs in a poll during the meeting until each group was able to reach some consensus regarding the priority needs. Preliminary needs identified include a wide collection of topics, including teen births, high school graduation, access to exercise opportunities, access to care (primary, dental and mental health) and a lack of social associations and organizations. In addition to these topics, participants focused discussion on child mental health and ACEs, child sexual abuse, mental health training, prenatal care, birth control, transportation, substance abuse, accessing care and a lack of knowledge around available resources, health insurance and others. From this process, participants from the April 13 community meeting identified the following needs as most significant for White County: * Mental health, including youth suicide ideation and access to mental health providers * Transportation * Substance abuse * Child abuse and ACEs Participants from the April 16 community meeting identified the following needs as most significant for White County: * Mental health * Substance abuse * Teen births In discussing the impacts of the COVID-19 pandemic on health, participants focused on isolation and its impacts on mental health, impacts on child development and learning, increased substance abuse and a lack of preventive care as people did not go to providers outside of emergencies. An additional community survey was issued to stakeholders unable to attend community meetings, asking them to identify priority needs. Among 19 responses, the following issues identified as the most significant: * Mental health * Access to healthcare services and resources * Substance abuse * Transportation The survey also asked about the impacts of the COVID-19 pandemic. Issues most often selected as significant impacts include: * Social isolation and loneliness * Poverty * Lack of access to healthcare services * Learning and development impacts among children Schedule H, Part V, Section B, Line 5 Facility , 3 Facility , 3 - IU HEALTH ARNETT HOSPITAL (continued). Community meeting and survey participants Individuals from a wide variety of organizations and communities participated in community meetings and surveys. Participants included representatives from the following organizations: * Anthem * Bauer Family Resources * Benton Community School Corporation * Benton County Health Department * Boswell Public Library * Central Catholic Schools * City of Monticello * Community Foundation of White County * Delphi Schools * Food Finders Food Bank, Inc. * Four County * Healthy Communities of Clinton County Coalition * Heartford House Child Advocacy Center * Home with Hope, Inc. * IU Health * IU Health Arnett * IU Health Frankfort * IU Health Quality Board * IU Health West Central Region * Indiana Professional Management Group (IPMG) * Junior Achievement * Lafayette Adult Resource Academy * Lafayette Family YMCA * Lafayette School Corporation * LTHC Homeless Services * Mental Health America Wabash Valley Region * Meridian Health Services * Monticello Fire Department * Monticello Spring Corporation * Monticello-Union Township Public Library * NAMI West Central Indiana * North Central Health Services * North Central Nursing Clinic * North White School Corporation * Nurse-Family Partnership * Phoenix Paramedic Solutions * Purdue Extension * Purdue North Central Nursing Clinics * Otterbein Public Library * Purdue Extension * Riggs CHC * River City Community Center * Saving Grace Harm Reduction * SHIP of Indiana * 6th Alarm Peer Support * Terra Drive Systems * Tippecanoe County Health Department * Tippecanoe County Sheriff's Office * Twin Lakes School Corporation * United Way of Greater Lafayette * Valley Oaks Health * White County Government * White County Boys and Girls Club * White County Council on Aging * White County Economic Development * White County Health 4 All Coalition * White County Health Department * White County Sheriff's Office * White County United Way * Willowstone Family Services Schedule H, Part V, Section B, Line 11 Facility , 1 Facility , 1 - IU HEALTH ARNETT HOSPITAL. Along with the CHNA, IU Health Arnett's Board adopted an implementation strategy in April 2022 in response to the 2021 CHNA. IU Health Arnett, along with community partners, prioritized and determined which of the significant needs identified in its most recently conducted CHNA could be adequately addressed by current or future initiatives, programs, resources, and collaborations. The 2022-2024 implementation strategy outlines how IU Health Arnett plans to address significant needs including initiatives, strategies, internal/external collaborators, anticipated impact, and hospital resources. Significant Needs Hospital Will Address Below is the progress of the implementation strategy by significant need and its respective initiative(s). The hospital is addressing the following significant needs between 2022 and 2024: Access to Healthcare Services; Behavioral Health; Maternal and Infant Health and Child Well-being; Smoking, Tobacco Use and Exposure to Secondhand Smoke; and Social Determinants of Health. Access to Healthcare Services * Create a pipeline, targeting youth and adults, for future healthcare leaders to access local opportunities. * In 2022, IU Health partnered with Greater Lafayette Career Academy to provide access to our facilities for their students to complete clinical rotations for the Medical Assistant program. In addition to providing the clinical access, IU Health also funded the necessary background checks and occupational health services needed for the students to be allowed onsite in that capacity. * Support community members accessing healthcare services regardless of their ability to pay. * IU Health Arnett provides financial assistance to patients each year. * Offer community Emergency Medical Technician (EMT) classes. * IU Health no longer provides EMT classes at Greater Lafayette Career Academy. * Launch Integrated Social Work Initiative in IU Health clinical settings. * This program is no longer offered in the West Central Region. Behavioral Health * Support community access to strategies to prevent opioid overdose in the community. * During outreach events, Community Outreach and Engagement team members distributed Deterra pouches for proper and safe medication disposal. * IU Health Arnett Retail Pharmacy distributed naloxone kits in 2022. * Further implement Virtual Care Peer Recovery Coaching Program (provides patients with substance use concerns virtual behavioral health services). * In 2022, IU Health Arnett served 166 new patients for the peer recovery coaching services. Forty-eight were repeat patients. There is a total of 1,637 active patients. Peer recovery coaches spent more than 34,000 minutes with patients. * Develop hospital and community infrastructure for crisis care to support community members with behavioral health concerns. * In 2022, IU Health conducted a pilot program in collaboration with Riverbend Hospital in Lafayette. The pilot targeted the amount of time and bed space utilized by behavioral health patients in the emergency department. The average wait time went from more than 12 hours to 4.5 hours. Riverbend's acceptance rate of referrals went from 6% to 71%. * Further implement emergency department (ED) virtual care program (provides patients virtual access to behavioral health services). * In 2022, IU Health Arnett served 940 patients, of which 273 were repeat patients. * Provide comprehensive suicide prevention through the Zero Suicide Initiative. * The Zero Suicide Initiative was launched in the West Central Region (including IU Health Arnett Hospital) in March 2022 through November 2022 when services were paused due to staffing. During that time, 44 patients were referred to the program, though none of them accepted treatment. More than 1,700 team members were trained in suicide prevention. * Further implement Virtual Behavioral Health Pediatric Crisis Therapy (PCT) Program. * During 2022, 33 patients received PCT services. Over half the patients were treated and discharged home and 15 were referred to inpatient hospitalization. The WCR had 47 team members attended training on the PCT Program. * IU Health Community Outreach and Engagement provided community grant awards to organizations addressing behavioral health. In addition to these grants, IU Health collaborated with Franciscan Health and North Central Health Services to offer a grant opportunity for youth-serving organizations to host WOWTalk Cafes from Be Strong Families. Thirteen organizations received funding totaling $135,000 in 2022. Maternal and Infant Health and Child Well-being * Deliver maternal and infant health support groups and education opportunities to community. * IU Health Arnett provides many opportunities for patients and community members to attend education and support group sessions for childbirth, breastfeeding, car seat safety, and postpartum mental health. * Provide onsite and local access to programs and services for new families and victims of sexual assault. * IU Health Arnett is a site for the Center of Hope, IU Health's sexual assault nurse examiner program. * Contribute leadership and expertise to Fetal Infant Mortality Review Team. * IU Health Arnett has team members who actively attend meetings and contribute to the Tippecanoe County Fetal Infant Mortality Review Team and Community Action Team. The Case Review Team reviewed 7 fetal deaths and 17 infant deaths in 2022 and provided recommendations for the Community Action Team to implement for further prevention and education. * Develop Child Care Partnership to address childcare needs in the community. * IU Health continues to be part of community conversations around childcare needs. Smoking, Tobacco Use and Exposure to Secondhand Smoke * Implement Tobacco Cessation Programs. * During 2022, the IU Health Foundation provided funding for free Nicotine Replacement Therapy for those whose insurance does not cover medications or those who cannot afford this medication. * IU Health taught 3 tobacco cessation group classes at local recovery houses with 16 participants in each of these classes. * Further implement the Centralized Tobacco Treatment Program (CTTP) (provides patients access to evidence-based tobacco treatment). * The CTTP was launched in September 2022 in the WCR. There were 117 total participants. Of those 117 referrals, 55 did not continue with the program, 25 quit smoking and 37 are working on a plan to quit or are in the process of quitting. Social Determinants of Health * Establish strategic collaborative relationships with local community-based organizations addressing social determinants of health. * IU Health Arnett has established partnerships with the Upper Room Youth Center, Hanna Center, and other organizations that help address the social determinants of health. * Support career pathway development program. * IU Health is the official healthcare sponsor for the Junior Achievement BizTown program at the Lafayette Family YMCA. Thousands of students from the region attended simulation events at BizTown. * Support the Bridging the Gap. * The Bridging the Gap program was paused due to system level initiatives around language services. * Provide fiscal support to organizations addressing social determinants of health. * IU Health Community Outreach and Engagement awarded grants to organizations that address social determinants of health. In 2022, these organizations included Junior Achievement, WonderLand Education, Community Cancer Network, and the Lafayette Family YMCA. Significant Needs Hospital Will Not Address IU Health Arnett addressed all the significant health needs identified in the 2021 Community Health Needs Assessment. Schedule H, Part V, Section B, Line 13 Facility , 1 Facility , 1 - IU HEALTH ARNETT HOSPITAL. IN ADDITION TO FPG, IU HEALTH ARNETT MAY TAKE INTO CONSIDERATION A PATIENT'S INCOME AND/OR ABILITY TO PAY IN CALCULATION OF A FINANCIAL ASSISTANCE AWARD. Schedule H, Part V, Section B, Line 13 Facility , 1 Facility , 1 - IU HEALTH ARNETT HOSPITAL. IU Health Arnett takes into consideration several other factors in determining patient eligibility for financial assistance. These factors include the following: 1. Eligibility for Financial Assistance due to Financial or Personal Hardship In order to be eligible for Financial Assistance due to Financial or Personal Hardship under this Policy, a patient or guarantor must: - Submit a completed Financial Assistance Application with all supporting documentation and be approved in accordance with this Policy; - Be an Indiana Resident as defined in this Policy; and - If Uninsured, consult with a member of IU Health's Individual Solutions department to determine if health care coverage may be obtained from a government insurance or assistance product, the Health Insurance Marketplace, or from any other source of coverage. Financial Assistance due to Financial Hardship is only available for encounters where care was initiated via an eligible facility's emergency department, direct admission from a physician's office, or transfer from another hospital facility. 2. Financial Assistance due to Financial Hardship The FPL income threshold under this section is as follows: - If one or more adults and zero dependents are in the household, the FPL Income Threshold is 200%. - If two or more adults and one or more dependents are in the household, the FPL Income Threshold is 250%. - If one adult and one or more dependents are in the household, the FPL Income Threshold is 300%. In some instances, an adult will also qualify as a dependent. When this occurs, IU Health Arnett will treat the adult as a dependent for purposes of the FPL calculation. IU Health Arnett will utilize the most recent FPL data available and will apply the FPL data to a patient or guarantor's account balance based upon the calendar date a completed Financial Assistance Application was received, not a patient's date of service. An Uninsured Patient or their guarantor whose household income is less than or equal to the FPL income threshold may be eligible for full Financial Assistance up to 100% of Gross Charges if approved. An Underinsured Patient or their guarantor whose household income is less than or equal to the FPL income threshold may be eligible for full Financial Assistance up to 100% of Patient Responsibility if approved. 3. Financial Assistance due to Personal Hardship An Uninsured or Underinsured patient or their guarantor whose household income is above the FPL income threshold may be eligible for Financial Assistance if the patient's outstanding Patient Responsibility exceeds 20% of the patient's or their guarantor's annual household income. - If approved, the patient's balance will be reduced to 20% of the patient or guarantor's annual household income or the Amounts Generally Billed, whichever is less. - IU Health will work with the patient or guarantor to identify a reasonable payment plan on the remainder of the balance. 4. Eligibility Period If approved for financial assistance by IU Health Arnett, the patient will be guaranteed financial assistance for treatment related to the underlying condition, for which the patient was originally screened and approved, through the remainder of the calendar year. As a condition of extending the on-going Financial Assistance, the patient must comply with requests from IU Health to verify that the patient continues to meet the conditions for qualification. 5. Appeals and Assistance Granted By the Financial Assistance Committee The Financial Assistance Committee will review and make determinations on all requests for appeals related to Financial Assistance. If a patient or guarantor seeks to appeal a Financial Assistance Determination, a written request must be submitted, along with the supporting documentation. The Financial Assistance Committee will review requests for and may grant additional Financial Assistance, including but not limited to, the following: - Assistance to patients who are seeking treatment that can only be provided in Indiana by IU Health or who would benefit from continued medical services from IU Health for continuity of care; - Care approved by the IU Health Chief Medical Officer (CMO) or the Chief Executive Officer (CEO) or CMO of an IU Health facility or region, including medically necessary non-elective services for which no payment source can be identified; - Care provided when it is known no payment source exists; - International humanitarian aid; and - Other care identified by the Financial Assistance Committee that fulfills the IU Health Mission. All decisions of the Financial Assistance Committee are final. 6. Presumptive Eligibility No Financial Assistance Application is required to receive Financial Assistance under this Presumptive Eligibility section. IU Health Arnett will deem patients or their guarantors presumptively eligible for Financial Assistance if they are found to be eligible for one of the following programs and care was initiated via an eligible facility's emergency department, direct admission from a physician's office, or transfer from another hospital facility: - Medicaid (any state) - Indiana Children's Special Health Care Services - Healthy Indiana Plan - Patients who are awarded Hospital Presumptive Eligibility (HPE) - A state and/or federal program that verifies the patient or guarantor's gross household income meets the FPL income threshold. IU Health Arnett will conduct a quarterly review of all accounts placed with a collection agency partner for at least one hundred and twenty (120) days after the account is eligible for an ECA as set forth in this Policy. If the patient or guarantor's individual scoring criteria demonstrates the patient has a low likelihood and/or propensity to pay or no credit, the patient or guarantor may be deemed presumptively eligible for Financial Assistance. Financial Assistance may additionally be granted in the following circumstances: - If the patient or their guarantor is found to have filed a petition for bankruptcy. - If the patient is deceased and found to have no estate. - If the patient is deceased and was under 21 years of age at the time of death. 7. Exhaustion of Alternate Sources of Assistance Patients must exhaust all other state and federal assistance programs prior to receiving Financial Assistance due to Financial or Personal Hardship under this Policy including, but not limited to, Medicaid. Patients who may be eligible for coverage under an applicable health insurance policy must exhaust all insurance benefits. - This includes patients covered under their own policy and those who may be entitled to benefits from a third-party policy. - IU Health may request patients show proof that such a claim was properly submitted to the appropriate insurance provider before awarding Financial Assistance. Eligible patients who receive medical care from an IU Health facility as a result of an injury proximately caused by a third party, and later receive a monetary settlement or award from said third party, may receive Financial Assistance for any outstanding balance not covered by the settlement or award. In the event Financial Assistance has already been granted in the above circumstances, IU Health reserves the right to reverse the Financial Assistance Determination in an amount equal to the amount IU Health would be entitled to receive had no Financial Assistance been awarded. 8. Patient Assets There are situations where a patient or their guarantor may have significant income or assets available to pay for healthcare services such as a legal settlement. The Financial Assistance Committee may evaluate the income or assets in determining Financial Hardship. IU Health Arnett may require a list of all property owned by the patient or guarantor and adjust a Financial Assistance Determination as a result. Schedule H, Part V, Section B, Line 16 Facility , 1 Facility , 1 - IU HEALTH ARNETT HOSPITAL. IU Health Arnett takes several other measures to broadly publicize its FAP within the community. These measures include the following: 1. Post this Policy, a Plain Language Summary of this Policy, and the Financial Assistance Application on its website. 2. Provide patients with a Plain Language Summary of this Policy during registration and/or discharge. 3. Post conspicuous displays in appropriate acute care settings such as emergency departments and registration areas describing the available assistance and directing eligible patients to the Financial Assistance Application. 4. Include a conspicuous written notice on all patient post-discharge billing statements notifying the patient about this Policy and the telephone number of the Customer Service Department which can assist patients with questions regarding this Policy. 5. Make available Customer Service representatives via telephone during normal business hours. 6. Mail copies of this Policy, a Plain Language Summary of this Policy, and a Financial Assistance Application to patients or their guarantor free of charge upon request. 7. Broadly communicate this Policy as a part of its general outreach efforts. 8. Educate patient-facing team members on this Policy and the process for referring patients to the program. 78 IUH ARNETT OUTPATIENT SURGERY CENTER 1327 VETERANS MEMORIAL PKWY E LAFAYETTE IN 47905 SURGERY CENTER IUH ARNETT PHYSICIANS ANESTHESIOLOGY - JACKSON ST 1300 S JACKSON ST FRANKFORT IN 46041 SPECIALTY CARE IUH ARNETT PHYSICIANS GASTROENTEROLOGY 1300 S JACKSON ST FRANKFORT IN 46041 SPECIALTY CARE IU HEALTH ARNETT WOUND CARE CENTER 1327 VETERANS MEMORIAL PKWY E ENTR LAFAYETTE IN 47905 SPECIALTY CARE IU Health ARNETT ANTICOAGULATION CLINIC 1327 VETERANS MEMORIALl PKWY E ENT LAFAYETTE IN 47905 SPECIALTY CARE IU HEALTH ARNETT CARDIOLOGY - S JACKSON ST 1458 S JACKSON ST FRANKFORT IN 46041 SPECIALTY CARE IUH ARNETT PHYSICIANS ALLERGY & ASTHMA - JACKSON ST 1458 S JACKSON ST FRANKFORT IN 46041 SPECIALTY CARE IUH ARNETT PHYSICIAN MEDICAL WEIGHT LOSS - JACKSON ST 1458 S JACKSON ST SUITE A FRANKFORT IN 46041 SPECIALTY CARE IU HEALTH ARNETT PHYSICIANS GENERAL SURGERY - JACKSON ST 1458 S JACKSON ST SUITE A FRANKFORT IN 46041 SPECIALTY CARE IUH ARNETT PHYSICIANS ANESTHESIOLOGY - SAGAMORE PKWY 253 SAGAMORE PKWY W SUITE 101 WEST LAFAYETTE IN 47906 SPECIALTY CARE RILEY PHYSICIANS AT IU HEALTH ARNETT - SAGAMORE PKWY 253 SAGAMORE PKWY W WEST LAFAYETTE IN 47906 SPECIALTY CARE IU HEALTH ARNETT OBSTETRICS & GYNECOLOGY - SAGAMORE PKWY 253 SAGAMORE PKWY W WEST LAFAYETTE IN 47906 SPECIALTY CARE IU HEALTH ARNETT PHYSICIANS INTERNAL MEDICINE - SAGAMORE PKWY 253 SAGAMORE PKWY W WEST LAFAYETTE IN 47906 SPECIALTY CARE IU HEALTH ARNETT PAIN MGMT-LAFAYETTE 2600 FERRY ST LAFAYETTE IN 47904 SPECIALTY CARE IUH ARNETT PHYSICIANS ALLERGY & ASTHMA - FERRY ST 2600 FERRY ST LAFAYETTE IN 47904 SPECIALTY CARE RILEY PHYSICIANS AT IU HEALTH ARNETT - FERRY ST 2600 FERRY ST LAFAYETTE IN 47904 SPECIALTY CARE IU HEALTH ARNETT PHYSICIANS DERMATOLOGY 2600 FERRY ST LAFAYETTE IN 47904 SPECIALTY CARE IU HEALTH ARNETT PHYSICIANS ENDOCRINOLOGY & METABOLISM 2600 FERRY ST LAFAYETTE IN 47904 SPECIALTY CARE IU HEALTH ARNETT PHYSICIANS GERIATRICS 2600 FERRY ST LAFAYETTE IN 47904 SPECIALTY CARE IU HEALTH ARNETT PHYSICIANS REHABILITATION SERVICES - FERRY ST 2600 FERRY ST LAFAYETTE IN 47904 SPECIALTY CARE IU HEALTH ARNETT PHYSICIANS RHEUMATOLOGY 2600 FERRY ST LAFAYETTE IN 47904 SPECIALTY CARE IU HEALTH ARNETT EAR NOSE & THROAT 2600 GREENBUSH ST LAFAYETTE IN 47904 SPECIALTY CARE IU HEALTH ARNETT PHYSICIANS GENERAL SURGERY - GREENBUSH ST 2600 GREENBUSH ST LAFAYETTE IN 47904 SPECIALTY CARE IU HEALTH ARNETT PHYSICIANS INTERNAL MEDICINE - GREENBUSH ST 2600 GREENBUSH ST LAFAYETTE IN 47904 SPECIALTY CARE IU HEALTH ARNETT PHYSICIANS NEUROLOGY 2600 GREENBUSH ST LAFAYETTE IN 47904 SPECIALTY CARE IU HEALTH ARNETT PHYSICIANS OPHTHALMOLOGY 2600 GREENBUSH ST LAFAYETTE IN 47904 SPECIALTY CARE IU HEALTH ARNETT PHYSICIANS PULMONARY DISEASES & CRITICAL CARE 2600 GREENBUSH ST LAFAYETTE IN 47904 SPECIALTY CARE IU HEALTH ARNETT PHYSICIANS REHABILITATION 2600 GREENBUSH ST LAFAYETTE IN 47904 SPECIALTY CARE RILEY PHYSICIANS AT IU HEALTH ARNETT - GREENBUSH ST 2600 GREENBUSH ST LAFAYETTE IN 47904 SPECIALTY CARE IU HEALTH ARNETT PHYSICIANS NEUROSURGERY 3750 LANDMARK DR SUITE B LAFAYETTE IN 47905 SPECIALTY CARE IU HEALTH ARNET CANCER CENTER 420 N 26TH ST LAFAYETTE IN 47904 SPECIALTY CARE IU HEALTH ARNETT CARDIOLOGY - McCarty LN 5175 MCCARTY LANE LAFAYETTE IN 47905 SPECIALTY CARE IU HEALTH ARNETT OBSTETRICS & GYNECOLOGY - McCarty LN 5177 MCCARTY LANE LAFAYETTE IN 47905 SPECIALTY CARE IU HEALTH ARNETT PHYSICIANS BARIATRICS 5177 MCCARTY LANE LAFAYETTE IN 47905 SPECIALTY CARE IU HEALTH ARNETT PHYSICIANS GASTROENTEROLOGY - LAFAYETTE 5177 MCCARTY LANE LAFAYETTE IN 47905 SPECIALTY CARE IU HEALTH ARNETT PHYSICIANS GENERAL SURGERY - MCCARTY LANE 5177 MCCARTY LANE LAFAYETTE IN 47905 SPECIALTY CARE IU HEALTH ARNETT PHYSICIANS INFECTIOUS DISEASE 5177 MCCARTY LANE LAFAYETTE IN 47905 SPECIALTY CARE IU HEALTH ARNETT PHYSICIANS REHABILITATION SERVICES - McCARTY LN 5177 MCCARTY LANE LAFAYETTE IN 47905 SPECIALTY CARE IU HEALTH ARNETT PHYSICIANS UROLOGY 5177 MCCARTY LANE LAFAYETTE IN 47905 SPECIALTY CARE IU HEALTH ARNETT PHYSICIANS VASCULAR SURGERY 5177 MCCARTY LANE LAFAYETTE IN 47905 SPECIALTY CARE IUH ARNETT PHYS ORTHO & SPORTS MED - McCARTY LN 5177 MCCARTY LANE LAFAYETTE IN 47905 SPECIALTY CARE IUH ARNETT PHYSICIAN MEDICAL WEIGHT LOSS - McCARTY LN 5177 MCCARTY LANE LAFAYETTE IN 47905 SPECIALTY CARE IU HEALTH ARNETT OBSTETRICS & GYNECOLOGY - SHOKE AVE 550 S HOKE AVE FRANKFORT IN 46041 SPECIALTY CARE IU HEALTH ARNETT PHYSICIANS CANCER SERVICES - S HOKE AVE 550 S HOKE AVE FRANKFORT IN 46041 SPECIALTY CARE IU HEALTH ARNETT PHYSICIANS NEPHROLOGY 550 S HOKE AVE FRANKFORT IN 46041 SPECIALTY CARE IUH ARNETT PHYS ORTHO & SPORTS MED - S HOKE AVE 550 S HOKE AVE FRANKFORT IN 46041 SPECIALTY CARE IU HEALTH ARNETT PHYSICIANS CANCER SERVICES - S SIXTH ST 720 S SIXTH ST MONTICELLO IN 47960 SPECIALTY CARE IU HEALTH ARNETT CARDIOLOGY - S SIXTH ST 810 S SIXTH ST MONTICELLO IN 47960 SPECIALTY CARE IU HEALTH ARNETT OBSTETRICS & GYNECOLOGY - S SIXTH ST 810 S SIXTH ST MONTICELLO IN 47960 SPECIALTY CARE IU HEALTH ARNETT PHYSICIANS GENERAL SURGERY - S SIXTH ST 810 S SIXTH ST MONTICELLO IN 47960 SPECIALTY CARE IU HEALTH ARNETT PHYSICIANS NEPHROLOGY - S SIXTH ST 810 S SIXTH ST MONTICELLO IN 47960 SPECIALTY CARE IUH ARNETT PHYS ORTHO & SPORTS MED - S SIXTH ST 810 S SIXTH ST MONTICELLO IN 47960 SPECIALTY CARE RILEY PHYSICIANS AT IU HEALTH ARNETT - S SIXTH ST 810 S SIXTH ST MONTICELLO IN 47960 SPECIALTY CARE IU HEALTH ARNETT PHYSICIANS NEPHROLOGY - MEZZANINE RD 915 MEZZANINE DR LAFAYETTE IN 47905 SPECIALTY CARE IU HEALTH ARNETT PHYSICIANS FAMILY MEDICINE - LAFAYETTE 1 WALTER SCHOLER DR LAFAYETTE IN 47909 PRIMARY CARE IU HEALTH ARNETT PHYSICIANS INTERNAL MEDICINE - WALTER SCHOLER DR 1 WALTER SCHOLER DR LAFAYETTE IN 47909 PRIMARY CARE IUH ARNETT PHYSICIANS FAMILY MEDICINE - W LAFAYETTE 253 SAGAMORE PKWY W WEST LAFAYETTE IN 47906 PRIMARY CARE CONNECTED CARE AT IU HEALTH ARNETT 2600 GREENBUSH ST LAFAYETTE IN 47904 PRIMARY CARE IUH ARNETT PHYSICIANS FAMILY MEDICINE - GREENBUSH ST 2600 GREENBUSH ST LAFAYETTE IN 47905 PRIMARY CARE IU HEALTH ARNETT PHYSICIANS FAMILY MEDICINE - OTTERBEIN 407 N MEADOW ST OTTERBEIN IN 47970 PRIMARY CARE IU HEALTH ARNETT PHYSICIANS FAMILY MEDICINE - McCarty Ln 5177 MCCARTY LANE LAFAYETTE IN 47905 PRIMARY CARE IU HEALTH ARNETT PHYSICIANS FAMILY MEDICINE - S HOKE AVE 550 S HOKE AVE FRANKFORT IN 46041 PRIMARY CARE IUH ARNETT PHYSICIANS INTERNAL MEDICINE & PEDIATRICS 550 S HOKE AVE FRANKFORT IN 46041 PRIMARY CARE IU HEALTH ARNETT PHYSICIANS FAMILY MEDICINE - S SIXTH ST 810 S SIXTH ST MONTICELLO IN 47960 PRIMARY CARE IUH ARNETT PHYS PRIMARY CARE WALK-IN 810 S SIXTH ST MONTICELLO IN 47960 PRIMARY CARE IU HEALTH ARNETT PHYSICIANS RADIOLOGY 1300 S JACKSON ST FRANKFORT IN 46041 RADIOLOGY IU HEALTH ARNETT PHYSICIANS RADIOLOGY - SAGAMORE PKWY 253 SAGAMORE PKWY W SUITE 101 WEST LAFAYETTE IN 47906 RADIOLOGY IU HEALTH ARNETT PHYSICIANS INTERVENTIONAL RADIOLOGY - GREENBUSH ST 2600 GREENBUSH ST LAFAYETTE IN 47904 RADIOLOGY IU HEALTH ARNETT PHYSICIANS INTERVENTIONAL RADIOLOGY - McCarty LN 5165 MCCARTY LN ENTRANCE 4 LAFAYETTE IN 47905 RADIOLOGY IU HEALTH ARNETT PHYSICIANS RADIOLOGY - McCarty LN 5165 MCCARTY LN ENTRANCE 4 LAFAYETTE IN 47905 RADIOLOGY IU HEALTH ARNETT SOUTHSIDE LAB 1 WALTER SCHOLER DR LAFAYETTE IN 47909 LAB IU HEALTH ARNETT WEST SIDE LAB 253 SAGAMORE PKWY W WEST LAFAYETTE IN 47906 LAB IU HEALTH ARNETT 2600 FERRY STREET LAB 2600 FERRY ST LAFAYETTE IN 47904 LAB IU HEALTH ARNETT GREENBUSH LAB 2600 GREENBUSH ST LAFAYETTE IN 47904 LAB IU HEALTH ARNETT CANCER CARE LAB 420 N 26TH ST LAFAYETTE IN 47904 LAB IU HEALTH ARNETT HOSPITAL LAB 5165 MCCARTY LN LAFAYETTE IN 47905 LAB IU HEALTH ARNETT RETAIL PHARMACY 5165 MCCARTY LN ENTRANCE 4 LAFAYETTE IN 47905 PHARMACY IU HEALTH ARNETT PHYSICIANS BEHAVIORAL HEALTH 2600 GREENBUSH ST LAFAYETTE IN 47904 BEHAVIORAL HEALTH Schedule H, Part I, Line 6a C.B. REPORT PREPARED BY A RELATED ORG. IU HEALTH ARNETT'S COMMUNITY BENEFIT AND OTHER INVESTMENTS, ENCOMPASSING ITS TOTAL COMMUNITY INVESTMENT, ARE INCLUDED IN THE IU HEALTH COMMUNITY BENEFIT REPORT WHICH IS PREPARED ON BEHALF OF AND INCLUDES IU HEALTH AND ITS RELATED HOSPITAL ENTITIES IN THE STATE OF INDIANA. THE IU HEALTH COMMUNITY BENEFIT REPORT IS MADE AVAILABLE TO THE PUBLIC ON IU HEALTH'S WEBSITE AT HTTPS://IUHEALTH.ORG/IN-THE-COMMUNITY/COMMUNITY-BENEFIT. THE IU HEALTH COMMUNITY BENEFIT REPORT IS ALSO DISTRIBUTED TO NUMEROUS KEY ORGANIZATIONS THROUGHOUT THE STATE OF INDIANA IN ORDER TO BROADLY SHARE THE IU HEALTH STATEWIDE SYSTEM'S COMMUNITY BENEFIT EFFORTS. IT IS ALSO AVAILABLE BY REQUEST THROUGH THE INDIANA STATE DEPARTMENT OF HEALTH OR IU HEALTH. Schedule H, Part I, Line 7f PERCENT OF TOTAL EXPENSE THE AMOUNT OF BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE OF TOTAL EXPENSE ON LINE 7, COLUMN (F) IS $14,125,965. Schedule H, Part I, Line 7c 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 49.03%. Schedule H, Part II PROMOTION OF HEALTH IN COMMUNITIES SERVED IU Health Arnett supports and/or participates in a variety of community-building activities that address the non-medical root causes of health problems in the communities it serves. IU Health Arnett and its related hospital entities across the state of Indiana ("IU Health Statewide System") investments include economic development efforts across the state, workforce development opportunities, collaborate with like-minded organizations through coalitions that address key issues, and advocate for improvements in the health status of vulnerable populations. Some activities meet the definition of community benefit and have been reported as such. In 2022, IU Health Arnett supported community building activity to promote the health of the community. IU Health Arnett employees participated in regional emergency management and response in 2022. Schedule H, Part I, Line 7g DESCRIBE SUBSIDIZED HEALTH SERVICE COSTS FROM PHYSICIAN CLINIC IU HEALTH ARNETT INCLUDES COSTS ASSOCIATED WITH PHYSICIAN CLINICS AS SUBSIDIZED HEALTH SERVICES BUT IS NOT ABLE TO SEGREGATE THE COSTS ASSOCIATED WITH PHYSICIAN CLINICS. Schedule H, Part I, Line 3c Eligibility criteria for free or discounted care IU HEALTH ARNETT USES SEVERAL FACTORS OTHER THAN FEDERAL POVERTY GUIDELINES ("FPG") IN DETERMINING ELIGIBILITY FOR FREE CARE UNDER ITS FAP. THESE FACTORS INCLUDE THE FOLLOWING: 1. ELIGIBILITY FOR FINANCIAL ASSISTANCE DUE TO FINANCIAL OR PERSONAL HARDSHIP IN ORDER TO BE ELIGIBLE FOR FINANCIAL ASSISTANCE DUE TO FINANCIAL OR PERSONAL HARDSHIP UNDER THIS POLICY, A PATIENT OR GUARANTOR MUST: - SUBMIT A COMPLETED FINANCIAL ASSISTANCE APPLICATION WITH ALL SUPPORTING DOCUMENTATION AND BE APPROVED IN ACCORDANCE WITH THIS POLICY; - BE AN INDIANA RESIDENT AS DEFINED IN THIS POLICY; AND - IF UNINSURED, CONSULT WITH A MEMBER OF IU HEALTH'S INDIVIDUAL SOLUTIONS DEPARTMENT TO DETERMINE IF HEALTH CARE COVERAGE MAY BE OBTAINED FROM A GOVERNMENT INSURANCE OR ASSISTANCE PRODUCT, THE HEALTH INSURANCE MARKETPLACE, OR FROM ANY OTHER SOURCE OF COVERAGE. FINANCIAL ASSISTANCE DUE TO FINANCIAL HARDSHIP IS ONLY AVAILABLE FOR ENCOUNTERS WHERE CARE WAS INITIATED VIA AN ELIGIBLE FACILITY'S EMERGENCY DEPARTMENT, DIRECT ADMISSION FROM A PHYSICIAN'S OFFICE, OR TRANSFER FROM ANOTHER HOSPITAL FACILITY. 2. FINANCIAL ASSISTANCE DUE TO FINANCIAL HARDSHIP THE FPL INCOME THRESHOLD UNDER THIS SECTION IS AS FOLLOWS: -IF ONE OR MORE ADULTS AND ZERO DEPENDENTS ARE IN THE HOUSEHOLD, THE FPL INCOME THRESHOLD IS 200%. -IF TWO OR MORE ADULTS AND ONE OR MORE DEPENDENTS ARE IN THE HOUSEHOLD, THE FPL INCOME THRESHOLD IS 250%. -IF ONE ADULT AND ONE OR MORE DEPENDENTS ARE IN THE HOUSEHOLD, THE FPL INCOME THRESHOLD IS 300%. IN SOME INSTANCES, AN ADULT WILL ALSO QUALIFY AS A DEPENDENT. WHEN THIS OCCURS, IU HEALTH ARNETT WILL TREAT THE ADULT AS A DEPENDENT FOR PURPOSES OF THE FPL CALCULATION. IU HEALTH ARNETT WILL UTILIZE THE MOST RECENT FPL DATA AVAILABLE AND WILL APPLY THE FPL DATA TO A PATIENT OR GUARANTOR'S ACCOUNT BALANCE BASED UPON THE CALENDAR DATE A COMPLETED FINANCIAL ASSISTANCE APPLICATION WAS RECEIVED, NOT A PATIENT'S DATE OF SERVICE. AN UNINSURED PATIENT OR THEIR GUARANTOR WHOSE HOUSEHOLD INCOME IS LESS THAN OR EQUAL TO THE FPL INCOME THRESHOLD MAY BE ELIGIBLE FOR FULL FINANCIAL ASSISTANCE UP TO 100% OF GROSS CHARGES IF APPROVED. AN UNDERINSURED PATIENT OR THEIR GUARANTOR WHOSE HOUSEHOLD INCOME IS LESS THAN OR EQUAL TO THE FPL INCOME THRESHOLD MAY BE ELIGIBLE FOR FULL FINANCIAL ASSISTANCE UP TO 100% OF PATIENT RESPONSIBILITY IF APPROVED. 3. FINANCIAL ASSISTANCE DUE TO PERSONAL HARDSHIP AN UNINSURED OR UNDERINSURED PATIENT OR THEIR GUARANTOR WHOSE HOUSEHOLD INCOME IS ABOVE THE FPL INCOME THRESHOLD MAY BE ELIGIBLE FOR FINANCIAL ASSISTANCE IF THE PATIENT'S OUTSTANDING PATIENT RESPONSIBILITY EXCEEDS 20% OF THE PATIENT'S OR THEIR GUARANTOR'S ANNUAL HOUSEHOLD INCOME. -IF APPROVED, THE PATIENT'S BALANCE WILL BE REDUCED TO 20% OF THE PATIENT OR GUARANTOR'S ANNUAL HOUSEHOLD INCOME OR THE AMOUNTS GENERALLY BILLED, WHICHEVER IS LESS. -IU HEALTH ARNETT WILL WORK WITH THE PATIENT OR GUARANTOR TO IDENTIFY A REASONABLE PAYMENT PLAN ON THE REMAINDER OF THE BALANCE. 4. ELIGIBILITY PERIOD IF APPROVED FOR FINANCIAL ASSISTANCE BY IU HEALTH ARNETT, THE PATIENT WILL BE GUARANTEED FINANCIAL ASSISTANCE FOR TREATMENT RELATED TO THE UNDERLYING CONDITION, FOR WHICH THE PATIENT WAS ORIGINALLY SCREENED AND APPROVED, THROUGH THE REMAINDER OF THE CALENDAR YEAR. AS A CONDITION OF EXTENDING THE ON-GOING FINANCIAL ASSISTANCE, THE PATIENT MUST COMPLY WITH REQUESTS FROM IU HEALTH ARNETT TO VERIFY THAT THE PATIENT CONTINUES TO MEET THE CONDITIONS FOR QUALIFICATION. 5. APPEALS AND ASSISTANCE GRANTED BY THE FINANCIAL ASSISTANCE COMMITTEE THE FINANCIAL ASSISTANCE COMMITTEE WILL REVIEW AND MAKE DETERMINATIONS ON ALL REQUESTS FOR APPEALS RELATED TO FINANCIAL ASSISTANCE. IF A PATIENT OR GUARANTOR SEEKS TO APPEAL A FINANCIAL ASSISTANCE DETERMINATION, A WRITTEN REQUEST MUST BE SUBMITTED, ALONG WITH THE SUPPORTING DOCUMENTATION. THE FINANCIAL ASSISTANCE COMMITTEE WILL REVIEW REQUESTS FOR AND MAY GRANT ADDITIONAL FINANCIAL ASSISTANCE, INCLUDING BUT NOT LIMITED TO, THE FOLLOWING: -ASSISTANCE TO PATIENTS WHO ARE SEEKING TREATMENT THAT CAN ONLY BE PROVIDED IN INDIANA BY IU HEALTH OR WHO WOULD BENEFIT FROM CONTINUED MEDICAL SERVICES FROM IU HEALTH FOR CONTINUITY OF CARE; -CARE APPROVED BY THE IU HEALTH CHIEF MEDICAL OFFICER (CMO) OR THE CHIEF EXECUTIVE OFFICER (CEO) OR CMO OF AN IU HEALTH FACILITY OR REGION, INCLUDING MEDICALLY NECESSARY NON-ELECTIVE SERVICES FOR WHICH NO PAYMENT SOURCE CAN BE IDENTIFIED; -CARE PROVIDED WHEN IT IS KNOWN NO PAYMENT SOURCE EXISTS; -INTERNATIONAL HUMANITARIAN AID; AND -OTHER CARE IDENTIFIED BY THE FINANCIAL ASSISTANCE COMMITTEE THAT FULFILLS THE IU HEALTH MISSION. ALL DECISIONS OF THE FINANCIAL ASSISTANCE COMMITTEE ARE FINAL. 6. PRESUMPTIVE ELIGIBILITY NO FINANCIAL ASSISTANCE APPLICATION IS REQUIRED TO RECEIVE FINANCIAL ASSISTANCE UNDER THIS PRESUMPTIVE ELIGIBILITY SECTION. IU HEALTH ARNETT WILL DEEM PATIENTS OR THEIR GUARANTORS PRESUMPTIVELY ELIGIBLE FOR FINANCIAL ASSISTANCE IF THEY ARE FOUND TO BE ELIGIBLE FOR ONE OF THE FOLLOWING PROGRAMS AND CARE WAS INITIATED VIA AN ELIGIBLE FACILITY'S EMERGENCY DEPARTMENT, DIRECT ADMISSION FROM A PHYSICIAN'S OFFICE, OR TRANSFER FROM ANOTHER HOSPITAL FACILITY: -MEDICAID (ANY STATE) -INDIANA CHILDREN'S SPECIAL HEALTH CARE SERVICES -HEALTHY INDIANA PLAN -PATIENTS WHO ARE AWARDED HOSPITAL PRESUMPTIVE ELIGIBILITY (HPE) -A STATE AND/OR FEDERAL PROGRAM THAT VERIFIES THE PATIENT OR GUARANTOR'S GROSS HOUSEHOLD INCOME MEETS THE FPL INCOME THRESHOLD. IU HEALTH ARNETT WILL CONDUCT A QUARTERLY REVIEW OF ALL ACCOUNTS PLACED WITH A COLLECTION AGENCY PARTNER FOR AT LEAST ONE HUNDRED AND TWENTY (120) DAYS AFTER THE ACCOUNT IS ELIGIBLE FOR AN ECA AS SET FORTH IN THIS POLICY. IF THE PATIENT OR GUARANTOR'S INDIVIDUAL SCORING CRITERIA DEMONSTRATES THE PATIENT HAS A LOW LIKELIHOOD AND/OR PROPENSITY TO PAY OR NO CREDIT, THE PATIENT OR GUARANTOR MAY BE DEEMED PRESUMPTIVELY ELIGIBLE FOR FINANCIAL ASSISTANCE. FINANCIAL ASSISTANCE MAY ADDITIONALLY BE GRANTED IN THE FOLLOWING CIRCUMSTANCES: -IF THE PATIENT OR THEIR GUARANTOR IS FOUND TO HAVE FILED A PETITION FOR BANKRUPTCY. -IF THE PATIENT IS DECEASED AND FOUND TO HAVE NO ESTATE. -IF THE PATIENT IS DECEASED AND WAS UNDER 21 YEARS OF AGE AT THE TIME OF DEATH. 7. EXHAUSTION OF ALTERNATE SOURCES OF ASSISTANCE PATIENTS MUST EXHAUST ALL OTHER STATE AND FEDERAL ASSISTANCE PROGRAMS PRIOR TO RECEIVING FINANCIAL ASSISTANCE DUE TO FINANCIAL OR PERSONAL HARDSHIP UNDER THIS POLICY INCLUDING, BUT NOT LIMITED TO, MEDICAID. PATIENTS WHO MAY BE ELIGIBLE FOR COVERAGE UNDER AN APPLICABLE HEALTH INSURANCE POLICY MUST EXHAUST ALL INSURANCE BENEFITS. -THIS INCLUDES PATIENTS COVERED UNDER THEIR OWN POLICY AND THOSE WHO MAY BE ENTITLED TO BENEFITS FROM A THIRD-PARTY POLICY. -IU HEALTH MAY REQUEST PATIENTS SHOW PROOF THAT SUCH A CLAIM WAS PROPERLY SUBMITTED TO THE APPROPRIATE INSURANCE PROVIDER BEFORE AWARDING FINANCIAL ASSISTANCE. ELIGIBLE PATIENTS WHO RECEIVE MEDICAL CARE FROM AN IU HEALTH FACILITY AS A RESULT OF AN INJURY PROXIMATELY CAUSED BY A THIRD PARTY, AND LATER RECEIVE A MONETARY SETTLEMENT OR AWARD FROM SAID THIRD PARTY, MAY RECEIVE FINANCIAL ASSISTANCE FOR ANY OUTSTANDING BALANCE NOT COVERED BY THE SETTLEMENT OR AWARD. IN THE EVENT FINANCIAL ASSISTANCE HAS ALREADY BEEN GRANTED IN THE ABOVE CIRCUMSTANCES, IU HEALTH RESERVES THE RIGHT TO REVERSE THE FINANCIAL ASSISTANCE DETERMINATION IN AN AMOUNT EQUAL TO THE AMOUNT IU HEALTH WOULD BE ENTITLED TO RECEIVE HAD NO FINANCIAL ASSISTANCE BEEN AWARDED. 8. PATIENT ASSETS THERE ARE SITUATIONS WHERE A PATIENT OR THEIR GUARANTOR MAY HAVE SIGNIFICANT INCOME OR ASSETS AVAILABLE TO PAY FOR HEALTHCARE SERVICES SUCH AS A LEGAL SETTLEMENT. THE FINANCIAL ASSISTANCE COMMITTEE MAY EVALUATE THE INCOME OR ASSETS IN DETERMINING FINANCIAL HARDSHIP. IU HEALTH MAY REQUIRE A LIST OF ALL PROPERTY OWNED BY THE PATIENT OR GUARANTOR AND ADJUST A FINANCIAL ASSISTANCE DETERMINATION AS A RESULT. Schedule H, Part I, Line 6a Community benefit report prepared by related organization INDIANA UNIVERSITY HEALTH, INC. Schedule H, Part I, Line 7 Bad Debt Expense excluded from financial assistance calculation 14125965 Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount THE AMOUNT REPORTED ON LINE 2 AS BAD DEBT IS REPORTED AT COST, AS CALCULATED USING THE COST TO CHARGE RATIO METHODOLOGY. Schedule H, Part III, Line 3 Bad Debt Expense Methodology IU Health Arnett will deem patients or their guarantors presumptively eligible for Financial Assistance if they are found to be eligible for one of the following programs and care was initiated via an eligible facility's emergency department, direct admission from a physician's office, or transfer from another hospital facility: 1. Medicaid (any state) 2. Indiana Children's Special Health Care Services 3. Healthy Indiana Plan 4. Patients who are awarded Hospital Presumptive Eligibility (HPE) 5. A state and/or federal program that verifies the patient or guarantor's gross household income meets the FPL income threshold. No Financial Assistance Application is required to receive Financial Assistance under this Presumptive Eligibility section. IU Health Arnett will conduct a quarterly review of all accounts placed with a collection agency partner for at least one hundred and twenty (120) days after the account is eligible for an ECA as set forth in this Policy. If the patient or guarantor's individual scoring criteria demonstrates the patient has a low likelihood and/or propensity to pay or no credit, the patient or guarantor may be deemed presumptively eligible for Financial Assistance. Financial Assistance may additionally be granted in the following circumstances: a) If the patient or their guarantor is found to have filed a petition for bankruptcy. b) If the patient is deceased and found to have no estate. c) If the patient is deceased and was under 21 years of age at the time of death. Due to this comprehensive methodology, IU Health Arnett does not believe any amount of bad debt is attributable to patients who may be eligible under the financial assistance policy and no portion of bad debt is included as community benefit. Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote IU HEALTH'S CONSOLIDATED FINANCIAL STATEMENTS, FOOTNOTE 5, ADDRESSES BAD DEBT EXPENSE AS FOLLOWS: The Indiana University Health System does not require collateral or other security from its patients, substantially all of whom are residents of the State, for the delivery of health care services. However, consistent with industry practice, the Indiana University Health System routinely obtains assignment of (or is otherwise entitled to receive) patients' benefits payable under their health insurance programs, plans, or policies (e.g., Medicare, Medicaid, managed care payers, and commercial insurance policies). The Indiana University Health System uses a portfolio approach to account for categories of patient contracts as a collective group, rather than recognizing revenue on an individual contract basis. The portfolios consist of major payer classes for inpatient revenue and outpatient revenue. Based on the historical collection trends and other analysis, the Indiana University Health System believes that revenue recognized by utilizing the portfolio approach approximates the revenue that would have been recognized if an individual contract approach were used. In support of its mission, the Indiana University Health System provides care to uninsured and underinsured patients. The Indiana University Health System provides charity care to patients who lack the financial resources to pay for their medical care. Financial assistance is available to qualifying uninsured and underinsured patients receiving care at an Indiana University Health System hospital location. Under its financial assistance policy, the Indiana University Health System provides medically necessary care to uninsured patients. Financial assistance up to the full amount of patient financial responsibility is available for uninsured and underinsured patients receiving care via the emergency department, direct admission from a physician's office, or transfer from another hospital. The federal poverty level (FPL) thresholds are used when determining the level of financial assistance based on household makeup. Households without dependents are eligible for assistance if household income is less than or equal to 200% FPL, two adults and at least one dependent are eligible if household income is less than or equal to 250% FPL, and households with one adult and at least one dependent are eligible if household income is less than or equal to 300% FPL. Individuals with medical bills totaling more than 20% of annual household income, regardless of FPL, qualify for catastrophic assistance and are eligible for a reduction in patient financial responsibility to 20% of annual household income. Since the Indiana University Health System does not pursue collection of these amounts, the discounted amounts are not reported as patient service revenue. The Indiana University Health System uses presumptive eligibility screening procedures for some forms of financial assistance and recognizes net patient service revenue on services provided to self-pay patients at the discounted rate at the time services are rendered. The estimated cost of charity care, using the consolidated cost to charge ratio, was $88,213,000 and $133,584,000 in 2022 and 2021, respectively. Schedule H, Part III, Line 8 Community benefit & methodology for determining medicare costs THE AMOUNT REPORTED ON SCHEDULE H, PART III, LINE 6 IS CALCULATED, IN ACCORDANCE WITH THE FORM 990 INSTRUCTIONS, USING "ALLOWABLE COSTS" FROM THE IU HEALTH ARNETT MEDICARE COST REPORT. "ALLOWABLE COSTS" FOR MEDICARE COST REPORT PURPOSES, HOWEVER, 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 ARNETT ACCEPTS ALL MEDICARE PATIENTS KNOWING THAT THERE MAY BE SHORTFALLS; THEREFORE IT HAS TAKEN THE POSITION THAT ANY SHORTFALL SHOULD BE COUNTED AS PART OF ITS COMMUNITY BENEFIT. ADDITIONALLY, IT IS IMPLIED IN INTERNAL REVENUE SERVICE REVENUE RULING 69-545 THAT TREATING MEDICARE PATIENTS IS A COMMUNITY BENEFIT. REVENUE RULING 69-545, WHICH ESTABLISHED THE COMMUNITY BENEFIT STANDARD FOR NONPROFIT HOSPITALS, STATES THAT IF A HOSPITAL SERVES PATIENTS WITH GOVERNMENTAL HEALTH BENEFITS, INCLUDING MEDICARE, THEN THIS IS AN INDICATION THAT THE HOSPITAL OPERATES TO PROMOTE THE HEALTH OF THE COMMUNITY. Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance IU Health Arnett follows IU Health's FAP and written debt collection policy describe the collection practices applicable to patients, including those who may qualify for financial assistance. 1. Financial Assistance Application Financial Assistance Applications must include the following documentation: - All sources of Income for the last three (3) months. - Most recent three (3) months of pay stubs or Supplemental Security Income via Social Security. - Most recent three (3) statements from checking and savings accounts, certificates of deposit, stocks, bonds and money market accounts. - Most recent state and Federal Income Tax forms including Schedules C, D, E, and F. In the event the patient or guarantor's income does not warrant the filing of a federal tax statement, the individual may submit a notarized affidavit attesting to the foregoing. - Most recent W-2 statement. - For patients or members of the Household who are currently unemployed, Wage Inquiry from WorkOne. - If applicable, divorce/dissolution decrees and child custody order. Patients or their guarantors wishing to apply for Financial Assistance due to Financial Hardship are encouraged to submit an Application within ninety (90) days of discharge. Patients or their guarantors may submit an Application up to two-hundred and forty (240) days from the date of their initial post-discharge billing statement from IU Health, however, accounts may be subject to Extraordinary Collection Actions (ECA) as soon as one-hundred and twenty (120) days after receipt of the initial post-discharge billing statement. Patients or their guarantors submitting an incomplete Financial Assistance Application will receive written notification of the Application's deficiency upon discovery by IU Health. The Application will be pended for a period of forty-five (45) days from the date the notification is mailed. IU Health will suspend any ECA until the Application is complete or the expiration of the forty-five (45) day period. Patients with limited English proficiency may request a copy of this Policy, a Financial Assistance Application, and a Plain Language Summary in one of the below languages: - Arabic; - Burmese; - Burmese - Falam; - Burmese - Hakha Chin; - Mandarin/Chinese; or - Spanish The patient, and/or their representative, such as the patient's physician, family members, legal counsel, community or religious groups, social services or hospital personnel may request a Financial Assistance Application be mailed to a patient's primary mailing address free of charge. IU Health maintains the confidentiality of all Financial Assistance Applications and supporting documentation. IU Health will deny or revoke Financial Assistance for any patient or guarantor who falsifies any portion of a Financial Assistance Application. 2. Financial Assistance Determinations IU Health will inform patients or guarantors of the results of their Application by providing the patient or guarantor with a Financial Assistance Determination within ninety (90) days of receiving a completed Application and all requested documentation. A patient's Financial Assistance Application and Financial Assistance Determination are specific to each date(s) of service and approved related encounters. If a patient or guarantor is granted less than full charity assistance and the patient or guarantor provides additional information for reconsideration, Revenue Cycle Services may amend a prior Financial Assistance Determination. 3. Extraordinary Collection Actions IU Health may refer delinquent patient accounts to a third-party collection agency after utilizing reasonable efforts to determine a patient's eligibility for assistance under this Policy. Reasonable efforts include the following: - IU Health will notify the patient of this Policy at least thirty (30) days prior to initiating an ECA. - IU Health will not initiate an ECA for at least one-hundred and twenty (120) days after the patient's initial post-discharge billing statement. - IU Health will review all Financial Assistance Applications received up to and including two-hundred and forty (240) days after the patient's initial post-discharge billing statement. IU Health will cease any ECAs it has initiated upon receipt of a Financial Assistance Application until a Financial Assistance Determination is made under this policy. - If an Application is Approved, IU Health will issue a revised statement, issue refunds, and make reasonable efforts to reverse ECAs as necessary. IU Health and its third-party collection agencies may initiate an ECA against a patient or their guarantor in accordance with this Policy and 26 C.F.R. § 1.501(r). ECAs may include the following: - Selling a patient or their guarantor's outstanding financial responsibility to a third party. - Reporting adverse information about the patient or their guarantor to consumer credit reporting agencies or credit bureaus. - Deferring or denying, or requiring a payment before providing, medically necessary care because of a patient or their guarantor's nonpayment of one or more bills for previously provided care covered under this Policy. - Actions requiring a legal or judicial process, including but not limited to placing a lien on a patient's or their guarantor's property, foreclosing on a patient's or their guarantor's real property, attaching or seizing a patient's or their guarantor's bank account or other personal property, commencing a civil action against a patient or their guarantor, causing a patient or guarantor's arrest, causing a patient and/or guarantor to be subject to a writ of body attachment, and garnishing a patient or guarantor's wages When it is necessary to engage in such action, IU Health and its third party collection agencies, will engage in fair, respectful and transparent collections activities. 4. Refunds Patients eligible for Financial Assistance under this Policy who remitted payment to IU Health in excess of their Patient Responsibility will be alerted to the overpayment as promptly after discovery as is reasonable given the nature of the overpayment. Patients with an outstanding account balance due on a separate account will have their refund applied to the outstanding balance. Patients without an outstanding account balance described above will be issued a refund check for their overpayment as soon as technically feasible. Schedule H, Part V, Section B, Line 16a FAP website - IU HEALTH ARNETT HOSPITAL: Line 16a URL: HTTPS://IUHEALTH.ORG/PAY-A-BILL/FINANCIAL-ASSISTANCE; Schedule H, Part V, Section B, Line 16b FAP Application website - IU HEALTH ARNETT HOSPITAL: Line 16b URL: HTTPS://IUHEALTH.ORG/PAY-A-BILL/FINANCIAL-ASSISTANCE; Schedule H, Part V, Section B, Line 16c FAP plain language summary website - IU HEALTH ARNETT HOSPITAL: Line 16c URL: HTTPS://IUHEALTH.ORG/PAY-A-BILL/FINANCIAL-ASSISTANCE; Schedule H, Part VI, Line 2 Needs assessment Though IU Health Arnett believes its CHNA process is comprehensive, the CHNA is done on a triennial basis. Between CHNA cycles, IU Health Arnett gathers data and information to monitor the most current needs of the community. Additional sources of data and information include: * IU Health data analytics and information service teams; * Secondary data sources from Federal, state, and local entities with a focus on health behaviors, health outcomes, and social determinants of health; * Obtaining community organization and governmental agency perspectives; priority population perspectives; and other healthcare and hospital perspectives; * Reports that share findings and recommendations on certain populations within the community and/or health behaviors, health outcomes, or social determinants of health; * Evidence informed sources; and * Team member participation in partnering efforts (e.g., coalitions, advisory committees, task forces, etc.). The regular review of these sources of data and information rarely impact what the significant needs are between CHNA cycles. However, it does help influence the types or level of interventions to address the significant needs; prioritize resources to those groups or neighborhoods experiencing health disparities in the community; identify funding opportunities to support interventions; and strengthen or mobilize partnerships to improve health. Schedule H, Part VI, Line 3 Patient education of eligibility for assistance IU Health Arnett takes several measures to inform its patients of the FAP and FAP-eligibility. These measures include the following: 1. Post this Policy, a Plain Language Summary of this Policy, and the Financial Assistance Application on its website. 2. Provide patients with a Plain Language Summary of this Policy during registration and/or discharge. 3. Post conspicuous displays in appropriate acute care settings such as emergency departments and registration areas describing the available assistance and directing eligible patients to the Financial Assistance Application. 4. Include a conspicuous written notice on all patient post-discharge billing statements notifying the patient about this Policy and the telephone number of the Customer Service Department which can assist patients with questions regarding this Policy. 5. Make available Customer Service representatives via telephone during normal business hours. 6. Mail copies of this Policy, a Plain Language Summary of this Policy, and a Financial Assistance Application to patients or their guarantor free of charge upon request. 7. Broadly communicate this Policy as a part of its general outreach efforts. 8. Educate patient-facing team members on this Policy and the process for referring patients to the program. Schedule H, Part VI, Line 4 Community information 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 (2022 ESTIMATE) STATISTICS, TIPPECANOE COUNTY'S POPULATION IS 188,717 PERSONS WITH APPROXIMATELY 49% BEING FEMALE AND 51% MALE. THE COUNTY'S POPULATION ESTIMATES BY RACE ARE 73.9% WHITE, 4.1% HISPANIC OR LATINO, 6.9% ASIAN, 3.9% BLACK, .3% AMERICAN INDIAN OR ALASKA NATIVE, AND 2.9% PERSONS REPORTING TWO OR MORE RACES. TIPPECANOE COUNTY HAS RELATIVELY MODERATE LEVELS OF EDUCATIONAL ATTAINMENT. AMONG RESIDENTS AGES 25 AND UP, 92.6% ENDED THEIR FORMAL EDUCATION WITH A HIGH SCHOOL DIPLOMA OR EQUIVALENT. AMONG RESIDENTS AGES 25 AND UP, 40.6% EARNED A BACHELOR'S DEGREE OR HIGHER. Schedule H, Part VI, Line 5 Promotion of community health IU Health Arnett is a subsidiary of Indiana University Health, Inc., a tax-exempt healthcare organization, whose Board of Directors is composed of members, of which substantially all are independent community members. IU Health and its related hospital entities across the state of Indiana, including IU Health Arnett, extend medical privileges to all physicians who meet the credentialing qualifications necessary for appointment to its medical staff. IU Health does not deny appointments based on gender, race, creed or national origin. IU Health, in conjunction with the IU School of Medicine, trains the next generation of physicians in an exceptional environment. Blending breakthrough research and treatments with the highest quality of patient care. Schedule H, Part VI, Line 6 Affiliated health care system Indiana University Health Arnett is part of Indiana University Health ("IU Health "the healthcare system"), which is Indiana's most comprehensive healthcare system. A unique partnership with the Indiana University School of Medicine ("IU School of Medicine"), one of the nation's leading medical schools, gives patients access to innovative treatments and therapies. The healthcare system is comprised of hospitals, physicians and allied services dedicated to providing preeminent patient care and community health improvement throughout Indiana. IU Health's affiliate hospitals are divided into five regions that serve communities in Northwest, Northeast, Central and Southern Indiana. The 16 hospitals in the healthcare system include IU Health Inc. (i.e., the IU Health Academic Health Center consists of IU Health Methodist Hospital, IU Health University Hospital, Riley Hospital for Children at IU Health and IU Health Saxony Hospital); IU Health Arnett; IU Health Ball; IU Health Bedford Hospital; IU Health Blackford Hospital; IU Health Bloomington Hospital; IU Health Frankfort; IU Health Jay; IU Health North Hospital; IU Health Paoli Hospital; IU Health Tipton Hospital; IU Health West Hospital; and IU Health White Memorial Hospital. Each affiliate hospital in the healthcare system, along with community stakeholders, conducts and adopts its own community health needs assessment (CHNA) and implementation strategy. IU Health considers the sum of these CHNAs and the implementation strategies part of a system wide vision of making Indiana one of the healthiest states in the nation. The healthcare system and its affiliate hospitals are keenly aware of the positive impact it can have on improving the health of communities throughout the state of Indiana by investing in local, community-based activities. The healthcare system includes an Academic Health Center (i.e., IU Health Inc.), a regional academic health center (i.e., IU Health Bloomington Hospital) and several affiliate hospitals that work in partnership with the IU School of Medicine to train physicians, blending breakthrough research and treatments with the highest quality of patient care throughout IU Health. Each year, more than 1,000 residents and fellows receive training in affiliate hospitals. Research conducted by IU School of Medicine faculty gives IU Health physicians and patients access to the most leading-edge and comprehensive treatment options. To further promote the health of the communities served by IU Health, the system-level Community Health Division team partners with state and local community-based organizations, community coalitions and governmental agencies to focus on innovative models of care; community alliances and partnerships; anchor institution and advocacy strategies; and social determinants of health. All affiliate hospitals in the healthcare system identify and address significant needs unique to the communities they serve. These needs are identified through the CHNA process. Some of these needs are common in communities served by multiple affiliate hospitals in the healthcare system and align with system priority areas, warranting a system level strategy. The Community Health Division, along with additional internal stakeholders such as the Office of Health Equity Research and Evaluation, plans and provides technical assistance for system-level strategies that address these common needs including health equity, tobacco, behavioral health access, infant and maternal health, hypertension, and social determinants of health. Each affiliate hospital works collaboratively with the Community Health Division to align and activate local resources to support these strategies. This benefits the community each affiliate hospital serves and works towards a statewide impact (system-level) on health outcomes. As part of the Community Health Division, Community Outreach and Engagement Program's IU Health Serves, a system-level team member volunteer program, seeks to positively impact the health of communities IU Health affiliate hospitals serve and foster a culture of engagement and social responsibility. Each affiliate hospital coordinates the different initiatives of the program, including Days of Service. This is the largest volunteer event of the year, consisting of projects designed to engage each affiliate hospitals' team members in activities that address local, significant needs. The Community Impact and Investment (CII) Fund is a $200 million dollar board designated fund that is managed by the IU Health Foundation to financially support high impact community investing. The focus of these efforts will address social determinants of health and health disparities that impact marginalized and minoritized populations in the communities IU Health serves. Through the grants provided by this CII Fund, IU Health can strategically and intentionally address the social, economic, and environmental factors that impact the health of affiliate hospitals' surrounding communities. Each affiliate hospital and its team members are eligible to pursue this grant opportunity with a community organization or agency. Schedule H, Part VI, Line 7 State filing of community benefit report IN true Wabash River Enhancement Corp 1281 WIN HENTSCHEL BLVD Suite 2161 WEST LAFAYETTE IN 47906 201337591 501(C)(3) 200000 General support Young Mens Christian Association Foundation of Greater Lafayette 3001 SOUTH CREASY LN 0 LAFAYETTE IN 47905 351765431 501(C)(3) 120000 General support City of Monticello 225 N MAIN ST 0 Monticello IN 47960 000000000 Gov't 100000 General support GREATER LAFAYETTE CHAMBER COMM 337 COLUMBIA ST PO BOX 348 LAFAYETTE IN 479020348 813745360 501(C)(6) 12400 General support INDIANA LATINO INSTITUTE INC 2126 N MERIDIAN ST STE 100 0 Indianapolis IN 46202 260036285 501(C)(3) 5000 General support 4 1 Schedule I, Part I, Line 2 Procedures for monitoring use of grant funds. ALTHOUGH IU HEALTH ARNETT 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. true true false false false false false true false RUBAN NIRMALAN MD DIRECTOR 328044 0 462032 0 16089 0 10958 0 49164 0 866287 0 0 0 WILLIAM Y LI MD DIRECTOR 236088 0 97875 0 2322 0 12200 0 25239 0 373724 0 0 0 MICHELE S SAYSANA MD DIRECTOR 0 515754 0 51401 0 2810 0 4333 0 15410 0 589708 0 0 ERIKA UGIANSKIS MD DIRECTOR 477683 0 73763 0 187826 0 12200 0 61927 0 813399 0 0 0 MARK BUONO MD DIRECTOR 580797 0 75250 0 3564 0 9586 0 41653 0 710850 0 0 0 CARA L BREIDSTER FORMER OFFICER 0 277473 0 36663 0 23994 0 12119 0 54533 0 404782 0 0 DEREK E EMPIE FORMER OFFICER 0 285471 0 24754 0 1242 0 12200 0 49637 0 373304 0 0 DANIEL E NEUFELDER FORMER OFFICER 0 0 0 188587 0 0 0 0 0 0 0 188587 0 0 ARTHUR VASQUEZ REGIONAL PRESIDENT (WCR) 0 500988 0 89248 0 1869 0 88651 0 34029 0 714786 0 0 TODD A WILLIAMS CFO/TREASURER (WCR) 0 279626 0 29218 0 22822 0 12173 0 55155 0 398994 0 0 PHILIP LIST SECRETARY (WCR) 0 164687 0 18161 0 294 0 7651 0 38887 0 229680 0 0 JAMES H PARSONS FORMER KEY EMPLOYEE 173618 0 18096 0 378 0 8209 0 37906 0 238208 0 0 0 CHRISTOPHER A MANSFIELD MD VP-CMO (WCR) 387881 0 122976 0 8232 0 12200 0 54970 0 586259 0 0 0 JEFFREY C ZEH COO (WCR) 318873 0 31441 0 17229 0 12057 0 27227 0 406827 0 0 0 KOREEN C KYHNELL VP - HUMAN RESOURCES (WCR) 0 187140 0 20092 0 21933 0 10677 0 57064 0 296906 0 0 ALLISON SHUTTZ CNO (PART YEAR) 221295 0 24469 0 204450 0 10131 0 41086 0 501432 0 0 0 KISHAN PATEL MD VP-Chief Physician Executive (WCR) (Part Year) 387221 0 23918 0 540 0 12200 0 28597 0 452475 0 0 0 JOSEPH E HUBBARD MD PHY. DEPT. CHAIR 687729 0 382995 0 810 0 12200 0 54525 0 1138259 0 0 0 STANTON M REGAN MD PHYSICIAN 729888 0 276220 0 21540 0 8793 0 57820 0 1094261 0 0 0 GARRETT JACKSON MD PHYSICIAN 1028897 0 324854 0 23986 0 12200 0 48670 0 1438607 0 0 0 RAYHAN JALAL MD PHYSICIAN 481241 0 316180 0 540 0 12124 0 58710 0 868795 0 0 0 PETER SEYMOUR Director-Chief of Surgery Regional 512786 0 269038 0 1242 0 12200 0 58007 0 853274 0 0 0 Schedule J, Part I, Line 3 Arrangement used to establish the top management official's compensation IU HEALTH ARNETT'S REGIONAL PRESIDENT IS EMPLOYED BY IU HEALTH, INC. IU HEALTH, INC., IU HEALTH ARNETT, AND OTHER RELATED ENTITIES HAVE A PROCESS IN PLACE TO DETERMINE THE COMPENSATION FOR THE OTHER OFFICERS AND KEY EMPLOYEES. IU HEALTH HUMAN RESOURCES USES MARKET DATA FROM MULTIPLE COMPENSATION EXPERTS/VENDORS WHO UTILIZE A VARIETY OF METHODS AND PROCEDURES TO OBTAIN COMPENSATION RANGES FOR COMPARABLE OFFICER AND EMPLOYEE POSITIONS. THIS MARKET DATA AND MULTIPLE OTHER FACTORS (INCLUDING MARKET PAY BENCHMARKS, INTERNAL EQUITY, CANDIDATE/EMPLOYEE QUALIFICATIONS & PERFORMANCE, AND BUSINESS NEEDS) ARE USED TO RECOMMEND COMPENSATION RANGES FOR ITS OFFICERS AND OTHER EMPLOYEES, WHICH ARE THEN USED AS A GUIDE FOR SETTING REASONABLE COMPENSATION BY MANAGEMENT. PLEASE SEE SCHEDULE O FOR ADDITIONAL DETAILS. Schedule J, Part I, Line 4a Severance or change-of-control payment ALLISON SHUTTZ ENTERED INTO A SEVERANCE AGREEMENT WITH IU HEALTH ARNETT DURING 2022. SHE RECEIVED SEVERANCE OF $203,980 DURING 2022. Schedule J, Part I, Line 4b Supplemental nonqualified retirement plan ARTHUR VASQUEZ PARTICIPATES IN AN IU HEALTH SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN, PROVISIONS OF WHICH ARE DESIGNED TO RETAIN ITS CRITICAL EMPLOYEES. THE PLAN PROVIDES FOR AN ADDITIONAL RETIREMENT BENEFIT FOR 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. ARTHUR VASQUEZ HAS AN AMOUNT INCLUDED IN COLUMN C, DEFERRED COMPENSATION, REPRESENTING THE CURRENT YEAR UNVESTED CONTRIBUTIONS MADE UNDER THE SUPPLEMENTAL RETIREMENT PLAN. NO AMOUNTS WERE ACTUALLY PAID TO THESE EXECUTIVES DURING THE YEAR. Schedule J, Part I, Line 7 Non-fixed payments AMOUNTS DISCLOSED IN COLUMN B(II) INCLUDE A LONG-TERM AND SHORT-TERM INCENTIVE FOR CERTAIN EXECUTIVES AND SHORT-TERM INCENTIVE FOR OTHER EMPLOYEES. ALTHOUGH THESE PLANS ARE BASED ON A FIXED FORMULA THAT HAS BEEN APPROVED BY THE BOARD OF DIRECTORS BASED UPON CERTAIN QUALITATIVE AND QUANTITATIVE FACTORS AND GOALS, ALL DISCRETIONARY INCENTIVE PLANS MUST BE APPROVED BY THE BOARD OF DIRECTORS PRIOR TO ANY INCENTIVE PAYOUT. LINE J - WEB SITE HTTPS://IUHEALTH.ORG/FIND-LOCATIONS/IU-HEALTH-ARNETT-HOSPITAL Form 990, Part III, Line 4d Description of other program services (Expenses $ 505,924 including grants of $ 0)(Revenue $ 521,033) INCOME (LOSS) FROM PASS-THROUGH ENTITIES Form 990, Part III, Line 4d Description of other program services (Expenses $ 35,053 including grants of $ 0)(Revenue $ 36,100) Clinical Research Form 990, Part III, Line 4d Description of other program services (Expenses $ 11,330 including grants of $ 0)(Revenue $ 11,668) RENT FROM RELATED 501(C)(3) ORGANIZATIONS Form 990, Part IV, Line 13 SECTION B, LINES 12, 13, 14, AND 16B - POLICIES IU HEALTH ARNETT IS PART OF THE 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. Form 990, Part VI, Line 6 Classes of members or stockholders THE SOLE MEMBER OF IU HEALTH ARNETT IS IU HEALTH, A 501(C)(3) TAX-EXEMPT HOSPITAL. Form 990, Part VI, Line 7a Members or stockholders electing members of governing body THE CONTROL AND MANAGEMENT OF THE AFFAIRS OF IU HEALTH ARNETT IS VESTED IN A BOARD OF UP TO FOURTEEN (14) VOTING DIRECTORS WHOM ARE APPOINTED BY IU HEALTH, AS THE SOLE MEMBER OF THE ORGANIZATION. FOUR (4) OF THE VOTING DIRECTORS WILL BE PHYSICIAN REPRESENTATIVES FROM THE WEST CENTRAL REGION. THE PHYSICIAN DIRECTORS WILL BE IDENTIFIED THROUGH A NOMINATION PROCESS DEVELOPED BY THE WEST CENTRAL REGION AND SUBMITTED TO IU HEALTH FOR CONSIDERATION AND APPROVAL Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders 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: -ANY PROPOSED AMENDMENT TO THE CORPORATION'S ARTICLES OF INCORPORATION OR THESE BYLAWS; -ADOPTION OF THE CORPORATION'S ANNUAL CAPITAL AND OPERATING BUDGETS; -APPROVAL OF ANY UNBUDGETED OPERATING OR CAPITAL BUDGET ITEMS OR DEVIATIONS, INCLUDING ANY ISSUANCE OR GUARANTEE OF ANY UNBUDGETED DEBT; -APPROVAL OF ANY STRATEGIC PLAN FOR THE CORPORATION, INCLUDING ANY AMENDMENTS TO A STRATEGIC PLAN; -APPROVAL OF ANY ENCUMBRANCE, SALE OR CONVEYANCE OF ASSETS; -ANY MERGER, CONSOLIDATION, JOINT VENTURE OR AFFILIATION INVOLVING THE CORPORATION OR ANY OF ITS AFFILIATES AND ANY OTHER ENTITY; -APPOINTMENT AND REMOVAL OF THE CORPORATION'S PRESIDENT AND OTHER OFFICERS; -CONSTRUCTION, ACQUISITION OR LEASE OF HOSPITAL BUILDINGS; -PROJECTS OR CONTRACTS THAT REQUIRE MEMBER APPROVAL IN ACCORDANCE WITH THE MEMBER'S RESOLUTION AND POLICY GOVERNING SYSTEM-WIDE CONTRACT EXECUTION AUTHORITY AND PAYMENT APPROVAL LIMITS; AND -THE DISSOLUTION OF THE CORPORATION OR ANY OF ITS AFFILIATES. Form 990, Part VI, Line 11b Review of form 990 by governing body THE CFO REVIEWED AND APPROVED THE FORM 990. FOLLOWING THE CFO'S REVIEW AND APPROVAL, A COMPLETE COPY OF THE FORM 990 WAS MADE AVAILABLE TO EACH BOARD MEMBER PRIOR TO ITS FILING. EACH MEMBER WAS ALSO INFORMED OF THE AVAILABILITY OF IU HEALTH'S TAX DEPARTMENT TO ANSWER ANY QUESTIONS. Form 990, Part VI, Line 12c Conflict of interest policy IU HEALTH Arnett FOLLOWS IU HEALTH'S CONFLICT OF INTEREST POLICY. IU HEALTH'S CONFLICT OF INTEREST POLICY INCLUDES THE FOLLOWING PROVISIONS: ALL IU HEALTH EMPLOYEES, ASSOCIATES, COLLEAGUES AND CONTRACTED PERSONNEL, INCLUDING EMPLOYED PHYSICIANS AND PAID MEDICAL DIRECTORS ("IU HEALTH REPRESENTATIVES") ARE COVERED BY AND SUBJECT TO ITS CONFLICT OF INTEREST POLICY. IU HEALTH REGULARLY AND CONSISTENTLY MONITORS AND ENFORCES COMPLIANCE WITH THE POLICY THROUGH THE FOLLOWING PROCEDURES: (A) ON AN ANNUAL BASIS, EACH IU HEALTH REPRESENTATIVE AT THE LEVEL OF MANAGER OR ABOVE, TOGETHER WITH EVERY OTHER PERSON DESIGNATED BY THE CORPORATE COMPLIANCE DEPARTMENT ("DEPARTMENT"), MUST COMPLETE, SIGN AND SUBMIT A CONFLICT OF INTEREST QUESTIONNAIRE ("QUESTIONNAIRE") TO THE DEPARTMENT. GOVERNING BOARD MEMBERS, COMMITTEE MEMBERS, CORPORATE OFFICERS, MEDICAL STAFF AND RESEARCHERS MUST COMPLY WITH THE ADMINISTRATIVE REQUIREMENTS NOTED IN THE RESPECTIVE POLICIES AND PROCEDURES RELATIVE TO THOSE AREAS. (B) AN IU HEALTH REPRESENTATIVE MUST SUPPLEMENT A QUESTIONNAIRE IN WRITING, IF AFTER COMPLETION OF THE ORIGINAL QUESTIONNAIRE, A SITUATION ARISES, OR MAY REASONABLY BE EXPECTED TO ARISE, THAT WOULD CHANGE ANY ANSWER OR INFORMATION ON THE ORIGINAL QUESTIONNAIRE IF THE SITUATION HAD EXISTED OR BEEN ANTICIPATED AT THE TIME OF COMPLETION OF THE ORIGINAL QUESTIONNAIRE. (C) IF A FULLY AND PROPERLY COMPLETED QUESTIONNAIRE REVEALS FACTS OR OTHER INFORMATION THAT MIGHT REASONABLY INDICATE A CONFLICT OF INTEREST OR VIOLATION OF THE POLICY, THE IU HEALTH REPRESENTATIVE COMPLETING THE QUESTIONNAIRE MUST SECURE APPROVAL BY HIS/HER SUPERVISOR, EVIDENCED IN WRITING. (D) THE DEPARTMENT WILL REVIEW EACH QUESTIONNAIRE AND DETERMINE WHETHER A CONFLICT OF INTEREST EXISTS AND, IF SO, WHETHER AND HOW IT SHOULD OR MAY BE ELIMINATED, AVOIDED OR MANAGED IN ORDER TO COMPLY WITH THE SPIRIT OF THE POLICY AND WITH THE BEST INTERESTS OF IU HEALTH AND ITS PATIENTS. IN MAKING THE DETERMINATION, THE CORPORATE COMPLIANCE DEPARTMENT MAY CONSULT WITH THE IU HEALTH REPRESENTATIVE'S SUPERVISOR AND OTHER APPROPRIATE INDIVIDUALS AND GROUPS. (E) THE SCOPE OF THE POLICY IS NOT LIMITED TO THOSE WHO ARE REQUIRED TO COMPLETE QUESTIONNAIRES. IF AN IU HEALTH REPRESENTATIVE IS INVOLVED IN A SITUATION OR RELATIONSHIP THAT WOULD CONSTITUTE A VIOLATION OF THE POLICY IN THE ABSENCE OF DISCLOSURE AND APPROVAL AS DESCRIBED ABOVE, THEN THE IU HEALTH REPRESENTATIVE MUST DISCLOSE THE MATTER TO HIS/HER SUPERVISOR, SECURE HIS/HER SUPERVISOR'S APPROVAL IN WRITING, AND DISCLOSE THE MATTER TO THE DEPARTMENT. OTHERWISE, THE IU HEALTH REPRESENTATIVE IS IN VIOLATION OF THE POLICY AND SUBJECT TO CORRECTIVE ACTION, UP TO AND INCLUDING TERMINATION. (F) THE CHIEF COMPLIANCE OFFICER, IN CONSULTATION WITH ONSITE COMPLIANCE PERSONNEL, MAY FROM TIME TO TIME APPOINT STANDING OR AD HOC COMMITTEES TO ASSIST IN RESOLVING ISSUES THAT ARISE UNDER PROVISIONS OF THE POLICY. Form 990, Part VI, Line 15b Process to establish compensation of other employees IU HEALTH ARNETT'S REGIONAL PRESIDENT IS EMPLOYED BY IU HEALTH. IU HEALTH'S PROCESS FOR DETERMINING COMPENSATION IS AS FOLLOWS: (1) THE BOARD OF DIRECTORS ("BOARD") HAS ESTABLISHED A TALENT MANAGEMENT AND EXECUTIVE COMPENSATION COMMITTEE ("TMECC"), THE PURPOSE OF WHICH INCLUDES REVIEWING AND MAKING RECOMMENDATIONS REGARDING EXECUTIVE (SENIOR VICE PRESIDENTS AND ABOVE) PAY AND BENEFITS (COLLECTIVELY REFERRED TO AS "COMPENSATION") ON AN ANNUAL BASIS. THE TMECC IS MADE UP OF MEMBERS OF THE BOARD THAT ARE NEITHER PHYSICIANS NOR EMPLOYEES AND DO NOT OTHERWISE HAVE A CONFLICT OF INTEREST REGARDING ANY OF IU HEALTH'S COMPENSATION ARRANGEMENTS. THE TMECC REVIEWS AN EXECUTIVE'S ENTIRE COMPENSATION PACKAGE INCLUDING BASE SALARY, SHORT-TERM AND LONG-TERM INCENTIVES, HEALTH AND WELFARE BENEFITS, QUALIFIED AND NONQUALIFIED RETIREMENT PLANS, AS WELL AS ANY ADDITIONAL FRINGE BENEFITS. AS DEEMED APPROPRIATE, THE COMMITTEE ON FINANCE, WHICH IS ALSO MADE UP OF MEMBERS OF THE BOARD, MAY ALSO REVIEW EXECUTIVE COMPENSATION AND BENEFITS. (2) THE TMECC ENGAGES AN INDEPENDENT COMPENSATION CONSULTING FIRM ON AN ANNUAL BASIS TO CONDUCT A COMPENSATION ANALYSIS FOR ITS EXECUTIVE GROUP, WHICH CONSISTS OF EMPLOYEES AT THE LEVEL OF SENIOR VICE PRESIDENT AND ABOVE. THE CURRENT COMPENSATION ADVISOR IS SULLIVAN COTTER. SULLIVANCOTTER PERFORMS ITS ANALYSIS IN THE FORM OF A COMPENSATION SURVEY ("SURVEY") THAT INCLUDES RELEVANT COMPARABILITY DATA FOR COMPENSATION 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. SULLIVANCOTTER THEN PREPARES A SURVEY REPORT AND PROVIDES RECOMMENDATIONS TO THE TMECC, IF DEEMED APPROPRIATE, ON CHANGES IN EXECUTIVE COMPENSATION. A SEPARATE ANALYSIS USING THE SAME METHODOLOGY IS DONE FOR THE PRESIDENT AND CHIEF EXECUTIVE OFFICER. (3) THE TMECC THEN REVIEWS SULLIVAN COTTER'S REPORT AND RECOMMENDATIONS AND, IF APPROPRIATE, VOTES ON WHETHER TO RECOMMEND ANY CHANGES IN EXECUTIVE COMPENSATION TO THE BOARD. THE TMECC WILL ONLY RECOMMEND CHANGES TO THE BOARD IF THEY ARE CONSISTENT WITH THE BOARD'S PHILOSOPHY ON COMPENSATION MATTERS AND ARE DEEMED REASONABLE BASED UPON THE INDEPENDENT ANALYSIS PROVIDED BY SULLIVAN COTTER. THE TMECC'S REVIEW, DISCUSSION AND VOTE ARE DOCUMENTED IN THE MINUTES FOR THE MEETING. THERE ARE NO EXECUTIVES PRESENT DURING THE FINAL DISCUSSION AND APPROVAL. (4) THE BOARD THEN REVIEWS THE REPORT PREPARED BY SULLIVAN COTTER AS WELL AS THE RECOMMENDATIONS OF THE TMECC AS TO ANY CHANGES IN EXECUTIVE COMPENSATION. AS DEEMED APPROPRIATE, THE COMMITTEE ON FINANCE MAY ALSO PROVIDE ITS REVIEW OF THE TMECC'S RECOMMENDATIONS ON ANY CHANGES IN EXECUTIVE COMPENSATION. THIS REVIEW AND DISCUSSION ARE DOCUMENTED IN THE MINUTES. (5) THE BOARD THEN VOTES ON WHETHER TO ACCEPT THE TMECC'S RECOMMENDATIONS ON ANY CHANGES IN EXECUTIVE COMPENSATION. CHANGES IN EXECUTIVE COMPENSATION ARE MADE IF APPROVED BY THE TMECC AND BOARD ON AN ANNUAL BASIS, OR AS NECESSARY THROUGHOUT THE YEAR. THE DISCUSSION AND APPROVAL ARE DOCUMENTED IN THE MINUTES OF THE MEETING. THERE ARE NO EXECUTIVES PRESENT DURING THE FINAL DISCUSSION AND APPROVAL. IU HEALTH'S GENERAL COUNSEL ALSO PREPARES A FORMAL WRITTEN OPINION REVIEWING THE EXECUTIVE COMPENSATION APPROVAL PROCESS, COMPARING IT TO THE INTERMEDIATE SANCTIONS TEST OF IRC SECTION 4958. IF WARRANTED, IU HEALTH'S GENERAL COUNSEL MAY ALSO PROVIDE COMMENTS REGARDING THE EXECUTIVE COMPENSATION APPROVAL PROCESS AS IT 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 TMECC AND BOARD ALSO REVIEW THE ACHIEVEMENTS OF THE EXECUTIVE GROUP AS IT RELATES TO THE LONG-TERM AND SHORT-TERM SHARED AND INDIVIDUAL GOALS DEVELOPED BY THE EXECUTIVES AND THE BOARD. THESE ACHIEVEMENTS MAY ALSO BE REVIEWED WITH THE COMMITTEE ON FINANCE. THE BOARD, AT ITS DISCRETION, MAY APPROVE BONUS PAYMENTS BASED UPON THE ACHIEVEMENT OF THE GOALS. THE DISCUSSION AND VOTE OF THE TMECC 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 TMECC AND AUDIT COMMITTEE ALSO REVIEW FORM 990 DISCLOSURES RELATED TO EXECUTIVE COMPENSATION AS WELL AS THE ORGANIZATION'S PRACTICES AND APPROVAL PROCESSES PRIOR TO THE FILING OF THE FORM 990 RETURN WITH THE INTERNAL REVENUE SERVICE. IU HEALTH ARNETT AND OTHER RELATED ENTITIES HAVE A PROCESS IN PLACE TO DETERMINE THE COMPENSATION FOR THE OTHER OFFICERS AND KEY EMPLOYEES. IU HEALTH HUMAN RESOURCES USES MARKET DATA FROM MULTIPLE COMPENSATION EXPERTS/VENDORS WHO UTILIZE A VARIETY OF METHODS AND PROCEDURES TO OBTAIN COMPENSATION RANGES FOR COMPARABLE OFFICER AND EMPLOYEE POSITIONS. THIS MARKET DATA AND MULTIPLE OTHER FACTORS (INCLUDING MARKET PAY BENCHMARKS, INTERNAL EQUITY, CANDIDATE/EMPLOYEE QUALIFICATIONS & PERFORMANCE, AND BUSINESS NEEDS) ARE USED TO RECOMMEND COMPENSATION RANGES FOR ITS OFFICERS AND OTHER EMPLOYEES, WHICH ARE THEN USED AS A GUIDE FOR SETTING REASONABLE COMPENSATION BY MANAGEMENT. Form 990, Part VI, Line 19 Required documents available to the public IU HEALTH ARNETT'S ARTICLES OF INCORPORATION ARE AVAILABLE FOR PUBLIC INSPECTION THROUGH THE INDIANA SECRETARY OF STATE'S WEBSITE. IU HEALTH ARNETT'S CONFLICT OF INTEREST PROCEDURES ARE DISCLOSED ON THE FORM 990, SCHEDULE O. IU HEALTH ARNETT IS A SUBSIDIARY IN IU HEALTH'S CONSOLIDATED AUDITED FINANCIAL STATEMENTS. IU HEALTH'S CONSOLIDATED AUDITED FINANCIAL STATEMENTS ARE AVAILABLE FOR PUBLIC INSPECTION THROUGH ITS BOND FILINGS AND AS AN ATTACHMENT TO IU HEALTH'S FORM 990 AS WELL AS IU HEALTH ARNETT'S FORM 990. Form 990, Part VIII, Line 2f Other Program Service Revenue Clinical Research - Total Revenue: 36100, Related or Exempt Function Revenue: 36100, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ; Form 990, Part VIII, Line 11d Other Miscellaneous Revenue OTHER OPERATING REVENUE - Total Revenue: 870441, Related or Exempt Function Revenue: 818323, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: 52118; Form 990, Part IX, Line 11g Other Fees Professional fees - Total Expense: 1645839, Program Service Expense: 1512900, Management and General Expenses: 132939, Fundraising Expenses: ; Fees-Other Services - Total Expense: 377031, Program Service Expense: 346577, Management and General Expenses: 30454, Fundraising Expenses: ; Consulting - Total Expense: 875036, Program Service Expense: 804357, Management and General Expenses: 70679, Fundraising Expenses: ; Intercompany fees - Total Expense: 90503728, Program Service Expense: 83193465, Management and General Expenses: 7310263, Fundraising Expenses: ; Physician fees - Total Expense: 404346, Program Service Expense: 371686, Management and General Expenses: 32660, Fundraising Expenses: ; Other Expense - Total Expense: 6055808, Program Service Expense: 5566661, Management and General Expenses: 489147, Fundraising Expenses: ; Contract service - Total Expense: 4451235, Program Service Expense: 4091695, Management and General Expenses: 359540, Fundraising Expenses: ; ARNETT CLINIC LLC 950 N MERIDIAN ST STE 800 INDIANAPOLIS IN 46204 352030653 HEALTHCARE IN 140014968 -70789270 IUHA CAH PHYSICIANS LLC 950 N MERIDIAN ST STE 800 INDIANAPOLIS IN 46204 262769447 HEALTHCARE IN 0 0 IUHA CLARIAN-ARNETT OCCUP HEALTH CTRS LLC 950 N MERIDIAN ST STE 800 INDIANAPOLIS IN 46204 271973115 HEALTHCARE IN 0 0 IUHA INDIANA HEALTH INFO EXCHANGE INC 846 N SENATE AVE INDIANAPOLIS IN 46202 364550324 HEALTHCARE IN 501(c)(3) Type I N/A false IU HEALTH BALL MEMORIAL PHYSICIANS INC 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