2023-11-14T15:21:06+00:00 2022-12-31 990 2022-01-01 351720796 Indiana University Health Bloomington Inc INDI 3179634842 950 N MERIDIAN STREET 1200 INDIANAPOLIS IN 46204 MICHAEL L CRAIG VP & CFO 2023-11-14 MICHAEL CRAIG 999009999 2022 2023-04-26 12:10:37Z BRIAN T SHOCKNEY 950 N MERIDIAN STREET 1200 INDIANAPOLIS IN 46204 757420575 false X SEE SCHEDULE O X 1988 IN Lead the transformation of healthcare through quality, innovation & education, and make Indiana one of the nation's healthiest states. 13 7 4504 142 300025 0 5697529 13509224 679731175 688682109 12566807 1561228 2348074 1365881 700343585 705118442 902232 1245061 0 349565766 355701115 0 0 311856975 393143861 662324973 750090037 38018612 -44971595 990966337 894799494 187495611 158170668 803470726 736628826 X Lead the transformation of healthcare through quality, innovation & education, and make Indiana one of the nation's healthiest states. false false 702789710 1245061 675034907 INDIANA UNIVERSITY HEALTH BLOOMINGTON, INC. ("IU HEALTH BLOOMINGTON") IS A 185-BED FULL SERVICE HOSPITAL THAT OFFERS A BROAD RANGE OF SERVICES TO CARE FOR ITS PATIENTS WITHOUT REGARD TO THEIR ABILITY TO PAY. BASED UPON THE VALUES OF TRUST, EXCELLENCE, ACCOUNTABILITY, AND MUTUAL RESPECT, IU HEALTH BLOOMINGTON ENHANCES THE HEALTH OF ITS PATIENTS AND COMMUNITY IN SOUTH-CENTRAL INDIANA BY ADVANCING THE ART AND SCIENCE OF MEDICINE THROUGH THE USE OF NEW TECHNOLOGIES, PROCEDURES, AND CARE. 9173172 0 8810902 IU Health Bloomington 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. 3631432 0 3488019 Our network of pharmacies offers the ease of "one-stop" shopping. With services designed to meet your needs, we will provide expert care and help patients make the best use of their medications. 1370517 0 1316392 Income (Loss) from Pass-Through Entities (900099) 33200 0 31889 Rent from Related 501(c)(3) Organization. 1403717 1348281 716998031 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 4504 true true true false false false false false false false false false false false X 13 7 false false false false true true true true true false false true true true true true true true true true true IN X CRAIG J JONES 3179634842 950 N MERIDIAN ST STE 800 INDIANAPOLIS IN 46204 BRIAN T SHOCKNEY DIRECTOR/REGIONAL PRESIDENT (SCR) 33.0 22.0 X X 0 966602 185247 DANIEL J PETERSON DIRECTOR/CHAIR 2.0 4.0 X X 0 0 0 JACK A KENWORTHY DIRECTOR/VICE CHAIR 2.0 4.0 X X 0 0 0 JOYCE B POLING DIRECTOR/SECRETARY 2.0 4.0 X X 0 0 0 BLAKE A DYE DIRECTOR (PART YEAR) 2.0 53.0 X 0 873979 50493 CORINNA REPETTO MD Director 51.0 4.0 X 403218 0 76496 HOJJAT M SHAMLOO MD DIRECTOR 53.0 2.0 X 654432 0 74496 JAMES J LAUGHLIN MD DIRECTOR 53.0 2.0 X 270773 0 22539 JAMES RIDGE MD DIRECTOR 2.0 14.0 X 0 48000 0 JANET FARLOW PERRY DIRECTOR 2.0 4.0 X 0 0 0 JULIE MINTON DIRECTOR 2.0 4.0 X 0 0 0 KEVIN B GEBKE MD DIRECTOR (PART YEAR) 2.0 53.0 X 0 488828 74122 LYNN H COYNE DIRECTOR 2.0 4.0 X 0 0 0 Mohan Shenoy MD Director 51.0 4.0 X 640491 0 61364 RICHARD G HENDRICKSON DIRECTOR 2.0 6.0 X 0 3600 0 VANESSA MCCLARY DIRECTOR 2.0 4.0 X 0 0 0 MICHAEL L CRAIG VP & CFO (SCR) 30.0 25.0 X 0 320370 58505 ALAN W BIGGS COO (SCR) 35.0 20.0 X 310622 0 50213 BRUCE R WADE VP - HUMAN RESOURCES (SCR) 35.0 20.0 X 0 233705 54391 CYNTHIA R HERRINGTON VP & CNO (SCR) 35.0 20.0 X 295235 0 49008 JOHN SPARZO MD VP-CMO (SCR) (Part Year) 10.0 20.0 X 190997 0 21858 PAUL M CALKINS MD VP & CMO (SCR)(Part Year) 10.0 45.0 X 0 550676 60276 BRET J SPIER MD PHYSICIAN 50.0 0 X 869554 0 40637 BRYAN JACOB WOHLFELD MD PHYSICIAN 50.0 0 X 912487 0 67302 FRED Y WU MD PHYSICIAN 50.0 0 X 842077 0 32700 JASON VOORHIES MD PHYSICIAN 50.0 0 X 896219 0 64282 TODD EADS MD PHYSICIAN 50.0 0 X 1119178 0 66770 DEREK B FIELDS FORMER KEY EMPLOYEE 50.0 0 X 218002 0 27157 LARRY R BAILEY FORMER KEY EMPLOYEE 0.0 50.0 X 0 277022 39671 WENDY S HERNANDEZ FORMER KEY EMPLOYEE 0.0 50.0 X 0 277950 66073 7623286 4040732 1243600 711 true true false 0 6438111 6975674 95439 13509224 NET PATIENT SERVICE REVENUE 622110 675034907 675034907 SHARED SERVICES 541900 8810902 8810902 PHARMACY 446110 3488019 3187994 300025 INCOME (LOSS) FROM PASS-THROUGH ENTITIES 900099 1316392 1316392 RENT FROM RELATED 501(C)(3) ORGS. 532000 31889 31889 0 0 0 0 688682109 5637547 5637547 727993 727993 0 727993 727993 48225813 52235385 66748 -4009572 -66748 -4076319 -4076319 EDUCATION 900099 37156 37156 600732 0 0 600732 637888 705118442 688382084 300025 2927109 X 1245061 1245061 3121742 3026021 95721 762509 739129 23380 292290969 283328578 8962391 10284666 9969312 315354 30340994 29410661 930333 18900235 18320705 579530 18566 18566 399460 399460 172622953 161659797 10963156 0 485265 485265 177734 166446 11288 21077369 21077369 373089 349394 23695 5595 5240 355 33204184 31364364 1839820 6019593 6019593 DRUGS AND MEDICAL SUPPLIES 108412254 108412254 BAD DEBT 14263822 14263822 Noncapitalized Equipment 3884168 1942084 1942084 Education and Research Support 502961 502961 31696848 31214833 482015 0 750090037 716998031 33092006 0 0 3141029 2712996 869967 3646693 70275757 66881733 0 0 0 0 2167586 2656607 13980782 11231299 10876337 12470612 800658522 240574967 565217674 560083555 233216822 212684570 0 1093144 1386238 6185521 5439473 83941718 15605718 990966337 894799494 158944475 121440173 1500000 0 0 0 27051136 36730495 187495611 158170668 803470726 736628826 0 803470726 736628826 990966337 894799494 -44971595 -21870305 0 X false true X true true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 18566 18566 false Schedule C, Part II-B, Line 1 DETAILED DESCRIPTION OF THE LOBBYING ACTIVITY IU Health Bloomington paid institutional membership dues to the American Hospital Association ("AHA"), Indiana Hospital Association ("IHA") and The Greater Bloomington Chamber of Commerce during 2022 in the amount of $55,755, $33,411 and $7,900, respectively. Each membership organization notified IU Health Bloomington that a portion of the dues it paid were used for lobbying purposes. The AHA used 26.47%, or $15,288 of the 2022 membership dues paid by IU Health Bloomington, for lobbying expenditures. The IHA used 8.63%, or $2,883 of the 2022 membership dues paid by IU Health Bloomington, for lobbying expenditures. The Greater Bloomington Chamber of Commerce used 5.00%, or $395 of the 2022 membership dues paid by IU Health Bloomington, for lobbying expenditures. The total membership dues paid to these organizations by IU Health Bloomington during 2022 that were attributable to lobbying expenditures was $18,566. 20192777 20192777 530908533 160480235 370428298 11508976 8944166 2564810 146051343 61274658 84776685 91996893 9875908 82120985 560083555 DUE TO THIRD-PARTY PAYERS 5822943 SELF-INSURANCE LIABILITIES 330435 ENVIRONMENTAL OBLIGATIONS 412602 ALL OTHER LIABILITIES 30147508 INTERCOMPANY PAYABLES 17007 36730495 X Schedule D, Part V, Line 4 Intended uses of endowment funds TEMPORARILY AND PERMANENTLY RESTRICTED NET ASSETS ARE GENERALLY RESTRICTED FOR INDIGENT AND OTHER PATIENT CARE SERVICES, MEDICAL EDUCATION AND RESEARCH PROGRAMS, AND MEDICAL SUPPLIES AND EQUIPMENT. Schedule D, Part X, Line 2 FIN 48 (ASC 740) footnote IU HEALTH BLOOMINGTON 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. 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AND OTHER OUTPATIENT 0.5 0.5 SOUTHERN INDIANA SURGERY CENTER LLC AMBULATORY SURGERY CENTER 0.5 0.5 1 1 IU HEALTH BLOOMINGTON HOSPITAL 2651 E Discovery Pkwy BLOOMINGTON IN 47408 HTTPS://IUHEALTH.ORG/FIND-LOCATIONS/IU-HEALTH-BLOOMINGTON-HOSPITAL 22-005047-1 X X X IU HEALTH BLOOMINGTON 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 Bloomington'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 Bloomington: 1. Access to Healthcare Services 2. Aging Population and Needs of Seniors 3. Behavioral Health 4. Chronic Disease and Chronic Disease Management 5. Maternal and Infant Health and Child Well-being 6. Smoking, Tobacco Use and Exposure to Secondhand Smoke 7. Social Determinants of Health Schedule H, Part V, Section B, Line 5 Facility , 1 Facility , 1 - IU HEALTH BLOOMINGTON HOSPITAL. In conducting each its most recent CHNA, IU Health Bloomington Hospital took into account input from persons who represent the broad interests of the communities it serves by hosting twelve 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 Bloomington Hospital The defined community per the most recent CHNA is Lawrence, Monroe, and Owen Counties, Indiana. The hospital resides in Monroe County. Lawrence County - Community Meetings In collaboration with Ascension St. Vincent, four community meetings were held in 2021 to receive input from stakeholders regarding the health needs in Lawrence County - two on April 14 and two on May 6. Secondary data and a preliminary list of community health need priorities was presented at all meetings. Each group was then asked questions about the preliminary list, including additions to the proposed needs, thoughts regarding the causes of each issue, which health services are difficult to access, populations that have disproportionate access issues, the impacts of the COVID-19 pandemic and others. From this process, participants from community meetings identified the following needs as significant for Lawrence County: * Substance abuse, including opioids and alcohol * Mental health and access to mental health services * Transportation as a barrier to health services and basic needs * Health insurance restrictions and uninsured populations * Technology barriers and the "digital divide" * Elderly needs including aging in place and cognitive issues * Homelessness * Health literacy and a cultural stigma against seeking preventive care In discussing the impacts of the COVID-19 pandemic on health, participants focused on the delaying of healthcare due to fears of seeing providers, mental health impacts and isolation, impacts on children due to learning delays and social isolation, food insecurity, divisions due to political and health beliefs and increasing obesity due to people staying home. An additional community survey was issued to stakeholders unable to attend community meetings, asking them to identify priority needs. Among eight responses, the following issues were identified as the most significant by respondents: * Education access and quality * Economic stability * Access to quality healthcare services * Disparities in health access for certain populations The survey also asked about the impacts of the COVID-19 pandemic. Issues selected as significant impacts by respondents include: * Social isolation and loneliness * Learning and development in children * Digital divide (lack of Internet or device access) Monroe County - Community Meetings Six community meetings were held throughout April and May 2021 to receive input from stakeholders regarding the health needs in Monroe County. Each group was asked questions regarding their definition of quality of life, barriers to having a high-quality life, the most important health needs in Monroe County, what they would like decision makers to know and the impacts of the COVID-19 pandemic. In regard to definitions of quality of life, participants focused discussion on access to basic needs (including food, housing and healthcare services), social connectivity, mental health quality, self-value, equal opportunities (regardless of income, race and others), preventative care, balancing life, community and personal safety, outdoor recreation and exercise, nutrition, affordable care and providers who are available and listen. Describing barriers to achieving a high-quality life, issues around income and work constraints, pollution, stress, adequate sleep, personal effort, stigma around mental health and substance abuse, COVID-19, limited transportation, housing shortages, technology barriers and digital divides, safe infrastructure, childcare, navigating a complicated healthcare system, language barriers and effects of trauma were all described. Through these discussions, participants identified the following needs as most significant for Monroe County: * Mental health and access to mental health providers and resources * Access to affordable housing and homelessness * Access to healthcare services broadly due to a variety of barriers * Substance abuse and addiction * Poverty and access disparities in healthcare and basic needs for low-income populations In regard to the COVID-19 pandemic and its impacts, residents described issues around mental health impacts from isolation and fear, impacts on children due to virtual school, physical inactivity due to staying home, burnout among workers, job losses and financial impacts, food insecurity, social service organizations unable to meet demand and technology barriers and a digital divide. In addition to community meetings held by IU Health, Community Voices for Health in Monroe County hosted small group discussions with more than 150 community members to enhance understanding of health concerns. The issues mentioned most frequently by participants included: * Health insurance access, coverage limits and challenges using insurance * Access to quality health services, including both availability and timeliness of services * Social and economic barriers, including: - Costs of healthcare - Navigating social services - Employment - Housing - Food insecurity - Transportation - Decision makers being aware of issues - Health education - Stigmas surrounding mental health - Inequity, discrimination and bias in health services - Community and public safety Schedule H, Part V, Section B, Line 5 Facility , 2 Facility , 2 - IU HEALTH BLOOMINGTON HOSPITAL. Owen County - Community Meetings Two community meetings were held in 2021 to receive input from stakeholders regarding the health needs in Owen County - May 25 and May 27. Each group was asked questions regarding their definition of quality of life, barriers to having a high-quality life, the most important health needs in Owen County, what they would like decision makers to know and impacts of the COVID-19 pandemic. In regard to definitions of quality of life, participants focused discussion on quality time outside of obligations, access to basic needs (including transportation, food and housing), inclusivity and equity, safety, health education, nutrition, connectivity and health in all aspects (physical, mental, emotional and financial). Describing barriers to achieving a high-quality life, issues around adverse childhood experiences (ACEs), technology barriers and a digital divide, transportation, lack of places to exercise, lack of education, lack of sense of community and distance from services were described. Through these discussions, participants identified the following needs as most significant for Owen County: * Elderly needs and an aging population * Housing shortages and affordability * Mental health and access to affordable mental healthcare * Education about and navigation of available community resources * Substance abuse Social connectivity * Support for caregivers In regard to the COVID-19 pandemic and its impacts, residents highlighted issues around mental health impacts from isolation and impacts on child learning and development due to virtual schooling. 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: * Alzheimer's and Dementia Community Resource Service * Amethyst House * Area 10 Agency on Aging * Ascension St. Vincent * Bedford Chamber of Commerce * Bedford Farmers Market * Bedford Public Library * Bloomington Economic Development Center * Bloomington Health Foundation * Boys and Girls Club of Bloomington * Center Stone Community Mental Health * City of Bedford Community Development * Community Justice and Meditation Center * Community Voices for Health in Monroe County * Cornerstone Information Systems * Habitat for Humanity * Health Net * Hoosier Uplands * Indiana University Bloomington * IU Health * IU Health Bloomington Hospital * IU Health Dementia Network * IU Health South Central Region * Lawrence County Health Department * Life Designs * Local Council of Women * Monroe County Health Department * Monroe County Public Health Clinic * Nurse Family Partnership * Owen County Community Foundation * Owen County Health Department * Owen County System of Care * Purdue Extension * Salvation Army * United Way of Monroe County * WIC Family Services * YMCA of Owen County Schedule H, Part V, Section B, Line 11 Facility , 1 Facility , 1 - IU HEALTH BLOOMINGTON HOSPITAL. Along with the CHNA, IU Health Bloomington Hospital's Board adopted an implementation strategy in April 2022 in response to the 2021 CHNA. IU Health Bloomington Hospital, 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 Bloomington Hospital 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; Aging Population and Needs of Seniors; Behavioral Health; Chronic Disease and Chronic Disease Management; 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 Support community members accessing healthcare services regardless of their ability to pay. o Launched Integrated Social Work Initiative in IU Health Obstetric offices in 2022. o IU Health Bloomington Hospital provides financial assistance to patients each year. Additionally, IU Health Patient Financial Counselors are certified Indiana Navigators. They can assist patients with information and help them with applications for various health coverage programs. Aging Population and Needs of Seniors Further implement the Alzheimer's and Dementia Resource Service (ADRS) program which provides support, resources and assistance to those with dementia and their families. o Provided blood pressure screenings for the aging population in 2022. Behavioral Health Develop access points for referral to behavioral health services. o Continued to develop access points for referral to behavioral health services in 2022. o Provided MOMs Heal together support group in 2022 for people who are pregnant and had a Substance Use Disorder. Chronic Disease and Chronic Disease Management Provide screening for chronic disease and linkage to care. o Provided wellness screenings with blood pressure, diabetes screening and cholesterol screening focusing on vulnerable populations throughout the community in 2022. Maternal and Infant Health and Child Well-being Connect first-time, high-risk moms to appropriate resources in the community. o Connected pregnant women to the appropriate resources in the community in 2022. o Performed Fetal Infant Mortality Reviews along with many community partners to identify reasons for fetal and infant deaths and developed workgroups to combat. o Offered Long-Acting Reversible Contraception at time of delivery to better support access to birth control and help with birth spacing in 2022. o Nurse Home Visitors helped first-time mothers with mother's health, child's health and economic self-sufficiency of the family by partnering with Nurse Family Partnerships. Smoking, Tobacco Use and Exposure to Secondhand Smoke Screen individuals for tobacco use and link to tobacco cessation resources and services. o Provided a Tobacco Treatment Specialist to the community in 2022 with a focus on policy change. o Referred smokers to provider Quitline. Further implement the Centralized Tobacco Treatment Program (CTTP) (provides patients access to evidence-based tobacco treatment). Between July 2021 to March 2022, training took place in all adult primary care clinics in the IU Health System on the CTTP program, including the availability of services and how to make referrals into the free program for patients. In 2022, for the South Central Region (including IU Health Bloomington Hospital), there were 369 referrals to the CTTP (67% of patients scheduled counseling with a TTS because of the referral; 40% of patients completed the session). A total of 449 patients, including 41 in the CTTP, enrolled in Clickotine. Social Determinants of Health All IU Health Bloomington Hospital Community Health Strategies will support social determinants of health. o Researched SDOH strategies in 2022 to launch a new SDOH screener in 2023. Significant Needs Hospital Will Not Address IU Health Bloomington Hospital will address 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 BLOOMINGTON HOSPITAL. IN ADDITION TO FPG, IU HEALTH BLOOMINGTON 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 BLOOMINGTON HOSPITAL. IU Health Bloomington 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 Bloomington will treat the adult as a dependent for purposes of the FPL calculation. IU Health Bloomington 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 Bloomington, 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 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 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 Bloomington 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 BLOOMINGTON HOSPITAL. IU Health Bloomington 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. 79 BLOOMINGTON ENDOSCOPY CENTER 550 LANDMARK AVE BLOOMINGTON IN 47403 SURGERY CENTER IU HEALTH BLOOMINGTON ANTICOAGULATOIN CLINIC 2651 E DISCOVERY PKWY BLOOMINGTON IN 47408 SPECIALTY CARE IU HEALTH BLOOMINGTON WOUND CENTER 2920 MCINTIRE DR SUITE 103 BLOOMINGTON IN 47403 SPECIALTY CARE IU HEALTH OBSTETRICS & GYNECOLOGY 1542 S BLOOMINGTON ST GREENCASTLE IN 46135 SPECIALTY CARE IU HEALTH ORTHOPEDICS & SPORTS MEDICINE 2605 E CREEK EDGE DR BLOOMINGTON IN 47401 SPECIALTY CARE IU HEALTH PLASTIC SURGERY 2605 E CREEK EDGE DR BLOOMINGTON IN 47401 SPECIALTY CARE IU HEALTH SOTHERN INDIANA PHYSICIANS UROLOGY 1520 S LIBERTY DRIVE BLOOMINGTON IN 47403 SPECIALTY CARE IU HEALTH SOTHERN INDIANA PHYSICIANS UROLOGY 2209 John R Wooden Dr MARTINSVILLE IN 46151 SPECIALTY CARE IU HEALTH SOTHERN INDIANA PHYSICIANS UROLOGY 2900 W 16TH ST BEDFORD IN 47421 SPECIALTY CARE IU HEALTH SOUTHERN INDIAINA PHYSICIANS ORTHOPEDICS & SPORTS MEDICINE 2900 W 16TH ST BEDFORD IN 47421 SPECIALTY CARE IU HEALTH SOUTHERN INDIANA PHYSICIANS EAR NOSE & THROAT 2209 John R Wooden Dr MARTINSVILLE IN 46151 SPECIALTY CARE IU HEALTH SOUTHERN INDIANA PHYSICIANS EAR NOSE & THROAT 2900 W 16TH ST BEDFORD IN 47421 SPECIALTY CARE IU HEALTH SOUTHERN INDIANA PHYSICIANS EAR NOSE & THROAT 2920 MCLNTIRE DR SUITE 350 BLOOMINGTON IN 47403 SPECIALTY CARE IU HEALTH SOUTHERN INDIANA PHYSICIANS FAMILY & INTERNAL MEDICINE 2900 W 16TH ST BEDFORD IN 47421 SPECIALTY CARE IU HEALTH SOUTHERN INDIANA PHYSICIANS FOOT & ANKLE 2900 W 16TH ST BEDFORD IN 47421 SPECIALTY CARE IU HEALTH SOUTHERN INDIANA PHYSICIANS GASTROENTEROLOGY 2900 W 16TH ST BEDFORD IN 47421 SPECIALTY CARE IU HEALTH SOUTHERN INDIANA PHYSICIANS GASTROENTEROLOGY 550 S LANDMARK AVE BLOOMINGTON IN 47403 SPECIALTY CARE IU HEALTH SOUTHERN INDIANA PHYSICIANS GASTROENTEROLOGY 2209 John R Wooden Dr MARTINSVILLE IN 46151 SPECIALTY CARE IU HEALTH SOUTHERN INDIANA PHYSICIANS INFECTIOUS DISEASE 2651 E DISCOVERY PKWY LEVEL 2 BLOOMINGTON IN 47408 SPECIALTY CARE IU HEALTH SOUTHERN INDIANA PHYSICIANS LONG TERM CARE 2900 W 16TH ST BEDFORD IN 47421 SPECIALTY CARE IU HEALTH SOUTHERN INDIANA PHYSICIANS MEDICAL OBSTETRICS & GYNECOLOGY 2651 E DISCOVERY PKWY BLOOMINGTON IN 47408 SPECIALTY CARE IU HEALTH SOUTHERN INDIANA PHYSICIANS MEDICAL ONCOLOGY - HEMATOLOGY 2651 E DISCOVERY PKWY LEVEL 2 BLOOMINGTON IN 47408 SPECIALTY CARE IU HEALTH SOUTHERN INDIANA PHYSICIANS MEDICAL ONCOLOGY - HEMATOLOGY 2900 W 16TH ST BEDFORD IN 47421 SPECIALTY CARE IU HEALTH SOUTHERN INDIANA PHYSICIANS NEPHROLOGY 2900 W 16TH ST BEDFORD IN 47421 SPECIALTY CARE IU HEALTH SOUTHERN INDIANA PHYSICIANS NEPHROLOGY 550 S LANDMARK AVE BLOOMINGTON IN 47403 SPECIALTY CARE IU HEALTH SOUTHERN INDIANA PHYSICIANS NEUROSURGERY 583 S CLARIZZ BLVD BLOOMINGTON IN 47401 SPECIALTY CARE IU HEALTH SOUTHERN INDIANA PHYSICIANS OBSTETRICS & GYNECOLOGY 2900 W 16TH ST BEDFORD IN 47421 SPECIALTY CARE IU HEALTH SOUTHERN INDIANA PHYSICIANS PALLIATIVE CARE 2651 E DISCOVERY PKWY BLOOMINGTON IN 47408 SPECIALTY CARE IU HEALTH SOUTHERN INDIANA PHYSICIANS PULMONOLOGY 2651 E DISCOVERY PKWY BLOOMINGTON IN 47408 SPECIALTY CARE IU HEALTH SOUTHERN INDIANA PHYSICIANS RADIATION ONCOLOGY 9149 STATE RD 37 BEDFORD IN 47421 SPECIALTY CARE IU HEALTH SOUTHERN INDIANA PHYSICIANS SURGERY 2900 W 16TH ST BEDFORD IN 47421 SPECIALTY CARE IU HEALTH SOUTHERN INDIANA PHYSICIANS VASCULAR SURGERY 2651 E DISCOVERY PKWY LEVEL 2 BLOOMINGTON IN 47408 SPECIALTY CARE IUH BLOOM ADDICTION TREATMENT AND & RECOVERY CENTER 727 W 2ND STREET SUITE 202 BLOOMINGTON IN 47403 SPECIALTY CARE SOUTHERN INDIANA PHYSICIANS CARDIOLOGY 1185 N 1000W SUITE A LINTON IN 47441 SPECIALTY CARE SOUTHERN INDIANA PHYSICIANS CARDIOLOGY 1302 S ROGERS ST BLOOMINGTON IN 47403 SPECIALTY CARE SOUTHERN INDIANA PHYSICIANS CARDIOLOGY 2651 E DISCOVERY PKWY LEVEL 2 BLOOMINGTON IN 47408 SPECIALTY CARE SOUTHERN INDIANA PHYSICIANS CARDIOLOGY 2900 W 16TH ST BEDFORD IN 47421 SPECIALTY CARE SOUTHERN INDIANA PHYSICIANS CARDIOLOGY 642 W HOSPITAL RD PAOLI IN 47454 SPECIALTY CARE SOUTHERN INDIANA PHYSICIANS CARDIOLOGY 926 IN-46 SUITE 100 SPENCER IN 47460 SPECIALTY CARE SOUTHERN INDIANA PHYSICIANS EAR NOSE & THROAT 1206 N 1000 W SUITE B LINTON IN 47441 SPECIALTY CARE SOUTHERN INDIANA PHYSICIANS ENDOCRINOLOGY 550 S LANDMARK AVE BLOOMINGTON IN 47403 SPECIALTY CARE SOUTHERN INDIANA PHYSICIANS FOOT & ANKLE 550 S LANDMARK AVE BLOOMINGTON IN 47403 SPECIALTY CARE SOUTHERN INDIANA PHYSICIANS FOOT & ANKLE 642 W HOSPITAL RD PAOLI IN 47454 SPECIALTY CARE SOUTHERN INDIANA PHYSICIANS GENERAL & TRAUMA SURGERY 550 S LANDMARK AVE BLOOMINGTON IN 47403 SPECIALTY CARE SOUTHERN INDIANA PHYSICIANS LONG TERM CARE 550 S LANDMARK AVE BLOOMINGTON IN 47403 SPECIALTY CARE SOUTHERN INDIANA PHYSICIANS MEDICAL ONCOLOGY & HEMATOLOGY 642 W HOSPITAL RD PAOLI IN 47454 SPECIALTY CARE SOUTHERN INDIANA PHYSICIANS NEPHROLOGY 926 IN-46 SUITE 100 SPENCER IN 47460 SPECIALTY CARE SOUTHERN INDIANA PHYSICIANS NEUROLOGY 583 S CLARIZZ BLVD BLOOMINGTON IN 47401 SPECIALTY CARE SOUTHERN INDIANA PHYSICIANS NUEROLOGY 583 S CLARIZZ BLVD BLOOMINGTON IN 47401 SPECIALTY CARE SOUTHERN INDIANA PHYSICIANS PALLIATIVE CARE 514 W 2ND STREET BLOOMINGTON IN 47403 SPECIALTY CARE SOUTHERN INDIANA PHYSICIANS PODIATRY 550 S LANDMARK AVE BLOOMINGTON IN 47403 SPECIALTY CARE SOUTHERN INDIANA PHYSICIANS RADIATION ONCOLOGY 2620 COTA DR BLOOMINGTON IN 47403 SPECIALTY CARE SOUTHERN INDIANA PHYSICIANS RHEUMATOLOGY 1000 W 1ST STREET BLOOMINGTON IN 47403 SPECIALTY CARE SOUTHERN INDIANA PHYSICIANS RHEUMATOLOGY 2605 EAST CREEKS EDGE DR BLOOMINGTON IN 47401 SPECIALTY CARE SOUTHERN INDIANA PHYSICIANS RILEY PHYSICIANS PEDIATRICS 350 S LANDMARK AVE BLOOMINGTON IN 47403 SPECIALTY CARE SOUTHERN INDIANA PHYSICIANS RILEY PHYSICIANS PEDIATRICS 651 S CLARIZZ BLVD BLOOMINGTON IN 47401 SPECIALTY CARE SOUTHERN INDIANA PHYSICIANS RILEY PHYSICIANS PEDIATRICS 2209 John R Wooden Dr MARTINSVILLE IN 46151 SPECIALTY CARE SOUTHERN INDIANA PHYSICIANS MEDICAL ONCOLOGY & HEMATOLOGY 2209 John R Wooden Dr MARTINSVILLE IN 46151 SPECIALTY CARE SOUTHERN INDIANA PHYSICIANS CARDIOLOGY 2209 John R Wooden Dr MARTINSVILLE IN 46151 SPECIALTY CARE IU HEALTH SOUTHERN INDIANA PHYSICIANS - ELLETTSVILLE 5921 W STATE RD 46 BLOOMINGTON IN 47404 PRIMARY CARE SOUTHERN INDIANA PHYSICIANS FAMILY & INTERNAL MEDICINE 103 W WILLOW ST SUITE A NASHVILLE IN 47448 PRIMARY CARE SOUTHERN INDIANA PHYSICIANS FAMILY & INTERNAL MEDICINE 105 TEKE BURTON DR MITCHELL IN 47446 PRIMARY CARE SOUTHERN INDIANA PHYSICIANS FAMILY & INTERNAL MEDICINE 1302 S ROGERS STREET BLOOMINGTON IN 47403 PRIMARY CARE SOUTHERN INDIANA PHYSICIANS FAMILY & INTERNAL MEDICINE 1520 S LIBERTY DRIVE BLOOMINGTON IN 47403 PRIMARY CARE SOUTHERN INDIANA PHYSICIANS FAMILY & INTERNAL MEDICINE 550 S LANDMARK AVE BLOOMINGTON IN 47403 PRIMARY CARE SOUTHERN INDIANA PHYSICIANS FAMILY & INTERNAL MEDICINE 8695 W JACK CARNES WAY FRANCH LICK IN 47432 PRIMARY CARE SOUTHERN INDIANA PHYSICIANS FAMILY & INTERNAL MEDICINE 926 IN-46 SPENCER IN 47460 PRIMARY CARE SOUTHERN INDIANA PHYSICIANS FAMILY & INTERNAL MEDICINE 995 S CLARIZZ BLVD BLOOMINGTON IN 47401 PRIMARY CARE SOUTHERN INDIANA PHYSICIANS FAMILY & INTERNAL MEDICINE 2209 John R Wooden Dr MARTINSVILLE IN 46151 PRIMARY CARE SOUTHERN INDIANA PHYSICIANS FAMILY & INTERNAL MEDICINE 3 E MAIN ST GOSPORT IN 47433 PRIMARY CARE SOUTHERN INDIANA PHYSICIANS FAMILY & INTERNAL MEDICINE 2900 W 16TH ST BEDFORD IN 47421 PRIMARY CARE SOUTHERN INDIANA PHYSICIANS RILEY PHYSICIANS PEDIATRICS 1614 25TH ST BEDFORD IN 47421 PRIMARY CARE SOUTHERN INDIANA PHYSICIANS RILEY PHYSICIANS PEDIATRICS 4935 W ARLINGTON ROAD BLOOMINGTON IN 47403 PRIMARY CARE IU HEALTH SOUTHERN INDIANA PHYSICIANS BEDFORD LAB 2900 W 16TH ST BEDFORD IN 47421 LAB IU HEALTH BLOOMINGTON HOSPITAL MAIN CAMPUS LAB 2651 E DISCOVERY PKWY 1ST FLOOR BLOOMINGTON IN 47408 LAB SOUTHERN INDIANA PHYSICIANS MITCHELL CLINIC 105 TEKE BURTON DR MITCHELL IN 47446 LAB IU HEALTH BLOOMINGTON RETAIL PHARMACY 2651 E DISCOVERY PKWY SUITE A2032 BLOOMINGTON IN 47408 PHARMACY SOUTHERN INDIANA RADIOLOGICAL ASSOCIATES 429 S LANDMARK AVE BLOOMINGTON IN 47403 RADIOLOGY IU HEALTH BLOOMINGTON BEHAVIORAL HEALTH SERVICES 727 W 2ND STREET BLOOMINGTON IN 47403 BEHAVIORAL HEALTH Schedule H, Part I, Line 6a C.B. REPORT PREPARED BY A RELATED ORG. IU HEALTH BLOOMINGTON'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 7c TOTAL COMMUNITY BENEFIT EXPENSE SCHEDULE H, PART I, LINE 7, COLUMN (F), PERCENT OF TOTAL EXPENSE, IS BASED ON COLUMN (E) NET COMMUNITY BENEFIT EXPENSE. THE PERCENT OF TOTAL EXPENSE BASED ON COLUMN (C) TOTAL COMMUNITY BENEFIT EXPENSE, WHICH EXCLUDES DIRECT OFFSETTING REVENUE, IS 35.37%. 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 $14,263,822. Schedule H, Part II PROMOTION OF HEALTH IN COMMUNITIES SERVED IU Health Bloomington Hospital 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 Bloomington Hospital 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, collaboration with like-minded organizations through coalitions that address key issues, and advocacy for improvements in the health status of vulnerable populations. There were no reported community building activities in 2022 potentially due to a new software platform which created a barrier to reporting. We would expect to see an increase in reporting in the coming year. Schedule H, Part I, Line 7g DESCRIBE SUBSIDIZED HEALTH SERVICE COSTS FROM PHYSICIAN CLINIC IU HEALTH BLOOMINGTON 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 BLOOMINGTON 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 BLOOMINGTON WILL TREAT THE ADULT AS A DEPENDENT FOR PURPOSES OF THE FPL CALCULATION. IU HEALTH BLOOMINGTON 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 BLOOMINGTON, 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 BLOOMINGTON 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 BLOOMINGTON 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 BLOOMINGTON 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 BLOOMINGTON 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 BLOOMINGTON 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 14263822 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 Bloomington 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 Bloomington 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 Bloomington 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 Bloomington Medicare Cost Report. "Allowable costs" for Medicare Cost Report purposes, however, are not reflective of all costs associated with IU Health Bloomington'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 Bloomington's participation in Medicare programs would significantly increase the Medicare shortfall reported on Schedule H, Part III, Line 7. IU Health Bloomington's Medicare shortfall is attributable to reimbursements that are less than the cost of providing patient care and services to Medicare beneficiaries and does not include any amounts that result from inefficiencies or poor management. IU Health Bloomington 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 Bloomington'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 BLOOMINGTON 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 BLOOMINGTON 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 BLOOMINGTON HOSPITAL: Line 16c URL: HTTPS://IUHEALTH.ORG/PAY-A-BILL/FINANCIAL-ASSISTANCE; Schedule H, Part VI, Line 2 Needs assessment Though IU Health Bloomington Hospital believes its CHNA process is comprehensive, the CHNA is done on a triennial basis. Between CHNA cycles, IU Health Bloomington Hospital 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 Bloomington 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 BLOOMINGTON HOSPITAL IS LOCATED IN MONROE COUNTY, A COUNTY LOCATED IN SOUTH CENTRAL INDIANA. MONROE COUNTY INCLUDES ZIP CODES WITHIN THE TOWNS OF BLOOMINGTON, ELLETTSVILLE AND UNIONVILLE. BASED ON THE MOST RECENT CENSUS BUREAU (2022) STATISTICS, MONROE COUNTY'S POPULATION IS 139,745 AND APPROXIMATELY 50.2% WERE FEMALE AND 49.8% MALE. THE COUNTY'S POPULATION ESTIMATES BY RACE ARE 82.5% WHITE, 3.9% BLACK, 6.9% ASIAN, 0.3% AMERICAN INDIAN OR ALASKA NATIVE AND 2.9% PERSONS REPORTING TWO OR MORE RACES. IN THE COUNTY, IN ADDITION TO THE ABOVE CATEGORIZATIONS, 4.1% REPORTED HISPANIC OR LATINO HERITAGE. MONROE COUNTY HAS RELATIVELY HIGH LEVELS OF EDUCATIONAL ATTAINMENT, AS COMPARED TO OTHER INDIANA COUNTIES. ALMOST HALF (47.4%) OF THE POPULATION HAS A BACHELOR'S DEGREE OR GRADUATE/PROFESSIONAL DEGREE, WHILE 93.9% OF THE POPULATION HAS OBTAINED A HIGH SCHOOL DEGREE. Schedule H, Part VI, Line 5 Promotion of community health IU Health Bloomington Hospital 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 Bloomington Hospital, extends medical privileges to all physicians who meet the credentialing qualifications necessary for appointments 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. During 2022, IU Health Bloomington Hospital's promotion of community health included the following highlights: IU Health Bloomington Hospital Community Health offered a wide variety of programs and services to the community. - IU Health Bloomington Hospital has a permanent fitting station, as designated by the state, for car seat safety inspections and has four certified CPSTs (child passenger safety technician). Ten hours per month are devoted to inspection appointments, available for free to parents and caregivers. Technicians inspect, educate, and assist those community members with their car seat questions and problems. The department also can also replace or give out a car seat if needed once inspection and education are completed. The car seats available range from newborn to booster seats to cover all children that are required by Indiana law to be in an appropriate car seat. - Our community health program provides safe sleep education and distributes safe sleep kits. The safe sleep kits are given to those who complete a short educational presentation and include a pack and play crib, crib sheet, sleep sac, and additional educational materials for the parents or caregivers. This service is also available to anyone caring for an infant who needs a bed. - Coordinated School Health is a program in Monroe County. A school health coordinator works with all of the county schools to improve the health and wellness of students and staff. The coordinator worked with teachers on mental health and suicide prevention, preparing to be better equipped to handle school issues post pandemic. The coordinator also assisted the school with sexual education, healthy eating, and increasing student physical activity. Schedule H, Part VI, Line 6 Affiliated health care system Indiana University Health Bloomington Hospital 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 CENTERSTONE 645 S Rogers St Bloomington IN 47403 351147323 501(c)(3) 630000 MENTAL HEALTH PROGRAMS New Hope Family Shelter PO Box 154 Bloomington IN 47402 275077191 501(c)(3) 386490 COMMUNITY PROGRAMS Lawrence county economic growth council PO BOX 1235 Bedford IN 47421 351889139 501(c)(3) 172000 COMMUNITY PROGRAMS Greater Bloomington Chamber of Commerce PO BOX 1302 Bloomington IN 47402 350183215 501(c)(6) 19490 COMMUNITY PROGRAMS Indiana University Auditorium PO Box 500 Bloomington IN 47402 356018940 501(c)(3) 6000 COMMUNITY PROGRAMS Cancer Support Community 5150 W 71ST Street Indianapolis IN 46268 351902427 501(c)(3) 5046 COMMUNITY PROGRAMS Morgan County Economic Development 4 E Harrison St Mooresville IN 46158 351803277 501(c)(6) 5000 COMMUNITY PROGRAMS 5 2 Schedule I, Part I, Line 2 Procedures for monitoring use of grant funds. ALTHOUGH IU HEALTH BLOOMINGTON 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 BRIAN T SHOCKNEY DIRECTOR/REGIONAL PRESIDENT (SCR) 0 623428 0 317043 0 26131 0 127403 0 57844 0 1151850 0 0 JAMES J LAUGHLIN MD DIRECTOR 222806 0 44117 0 3851 0 10677 0 11862 0 293311 0 0 0 HOJJAT M SHAMLOO MD DIRECTOR 412475 0 217894 0 24064 0 12200 0 62296 0 728929 0 0 0 BLAKE A DYE DIRECTOR (PART YEAR) 0 302453 0 223938 0 347589 0 12200 0 38293 0 924472 0 0 CORINNA REPETTO MD Director 323009 0 56145 0 24064 0 12200 0 64296 0 479715 0 0 0 Mohan Shenoy MD Director 468260 0 92185 0 80045 0 12200 0 49164 0 701855 0 0 0 KEVIN B GEBKE MD DIRECTOR (PART YEAR) 0 425073 0 61659 0 2096 0 47122 0 27000 0 562951 0 0 MICHAEL L CRAIG VP & CFO (SCR) 0 289062 0 27744 0 3564 0 12150 0 46355 0 378875 0 0 LARRY R BAILEY FORMER KEY EMPLOYEE 0 241490 0 24168 0 11364 0 11270 0 28401 0 316692 0 0 DEREK B FIELDS FORMER KEY EMPLOYEE 192082 0 19861 0 6059 0 9159 0 17999 0 245159 0 0 0 WENDY S HERNANDEZ FORMER KEY EMPLOYEE 0 245502 0 31206 0 1242 0 12790 0 53283 0 344023 0 0 CYNTHIA R HERRINGTON VP & CNO (SCR) 249185 0 25372 0 20678 0 11646 0 37361 0 344243 0 0 0 PAUL M CALKINS MD VP & CMO (SCR)(Part Year) 0 471446 0 42413 0 36818 0 12200 0 48076 0 610952 0 0 BRUCE R WADE VP - HUMAN RESOURCES (SCR) 0 189323 0 20771 0 23611 0 9537 0 44854 0 288096 0 0 ALAN W BIGGS COO (SCR) 269604 0 36076 0 4942 0 12903 0 37310 0 360835 0 0 0 JOHN SPARZO MD VP-CMO (SCR) (Part Year) 148132 0 35000 0 7865 0 7862 0 13996 0 212855 0 0 0 BRET J SPIER MD PHYSICIAN 574207 0 275037 0 20310 0 12200 0 28437 0 910191 0 0 0 FRED Y WU MD PHYSICIAN 498000 0 344077 0 0 0 12200 0 20500 0 874777 0 0 0 TODD EADS MD PHYSICIAN 569456 0 526682 0 23040 0 12200 0 54570 0 1185947 0 0 0 JASON VOORHIES MD PHYSICIAN 851349 0 23830 0 21040 0 12200 0 52082 0 960501 0 0 0 BRYAN JACOB WOHLFELD MD PHYSICIAN 847333 0 27884 0 37269 0 12200 0 55102 0 979789 0 0 0 Schedule J, Part I, Line 3 Arrangement used to establish the top management official's compensation IU HEALTH'S BLOOMINGTON'S REGIONAL PRESIDENT IS EMPLOYED BY IU HEALTH. IU HEALTH AND OTHER RELATED ORGANIZATIONS HAVE A PROCESS IN PLACE TO DETERMINE THE COMPENSATION FOR ITS 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 OFFICERS 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 BLAKE DYE ENTERED INTO A SEVERANCE AGREEMENT WITH IU HEALTH, INC. DURING 2022. SEVERANCE OF $284,138 THAT WAS RECEIVED DURING 2022 IS INCLUDED IN COLUMN B(III), OTHER REPORTABLE COMPENSATION. Schedule J, Part I, Line 4b Supplemental nonqualified retirement plan BRIAN T. SHOCKNEY, Kevin Gebke and Blake A. Dye PARTICIPATE IN A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN, PROVISIONS OF WHICH ARE DESIGNED TO RETAIN THESE 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. BRIAN T. SHOCKNEY and Kevin Gebke Have 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 THIS EXECUTIVE DURING THE YEAR. THE FOLLOWING EXECUTIVE HAS AN AMOUNT INCLUDED IN COLUMN B (III), OTHER REPORTABLE COMPENSATION, REPRESENTING THE CURRENT YEAR VESTED AMOUNTS RECEIVED UNDER THE SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN: - BLAKE DYE $55,819 Schedule J, Part I, Line 7 Non-fixed payments AMOUNTS DISCLOSED IN COLUMN (II) INCLUDE INCENTIVES FOR CERTAIN EXECUTIVES. AS PART OF IU HEALTH BLOOMINGTON'S EXECUTIVE COMPENSATION PLAN, ANNUAL GOALS ARE SET FOR EACH MEMBER OF THE SENIOR LEADERSHIP GROUP WITH EACH MEMBERS' ANNUAL INCENTIVE DETERMINED UPON THE DEGREE OF SUCCESSFUL COMPLETION OF HIS OR HER SET GOALS. ANY INCENTIVE PAYOUTS ARE MADE IN THE FORM OF A LUMP SUM PAYMENT AND DO NOT AFFECT THE EXECUTIVE'S BASE PAY. ALTERNATIVELY, THE EXECUTIVE MAY ELECT TO DEFER ANY OR ALL OF THE INCENTIVE COMPENSATION THROUGH IU HEALTH BLOOMINGTON'S 457(F) PLAN, SUBJECT TO ANY PLAN RESTRICTIONS. ANY INCENTIVE AMOUNTS FOR THE PRESIDENT MUST RECEIVE APPROVAL FROM THE COMPENSATION COMMITTEE. ALL OTHER INCENTIVE AMOUNTS MUST RECEIVE APPROVAL FROM THE PRESIDENT AND THE COMPENSATION COMMITTEE. Form 990, Part III, Line 4d Description of other program services (Expenses $ 1,370,517 including grants of $ 0)(Revenue $ 1,316,392) Income (Loss) from Pass-Through Entities (900099) Form 990, Part III, Line 4d Description of other program services (Expenses $ 33,200 including grants of $ 0)(Revenue $ 31,889) Rent from Related 501(c)(3) Organization. Form 990, Part VI, Line 13 PART VI, SECTION B, LINES 12, 13, 14, AND 16B - POLICIES IU HEALTH BLOOMINGTON IS PART OF THE IU HEALTH SYSTEM. AS THE SOLE MEMBER AND CONTROLLING PARENT OF IU HEALTH BLOOMINGTON, IU HEALTH AND ITS BOARD OF DIRECTORS HAVE MANDATED THAT CERTAIN POLICIES BE FOLLOWED TO ENSURE GREATER STANDARDIZATION THROUGHOUT THE SYSTEM. THUS, IU HEALTH BLOOMINGTON'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 BLOOMINGTON IS IU HEALTH, A 501(C)(3) TAX-EXEMPT ORGANIZATION. Form 990, Part VI, Line 7a Members or stockholders electing members of governing body THE BOARD OF DIRECTORS SHALL CONSIST OF THIRTEEN (13) MEMBERS. TO BE ELIGIBLE FOR BOARD MEMBERSHIP, A DIRECTOR CANDIDATE SHALL SATISFY THE SELECTION CRITERIA AND PERSONAL CHARACTERISTICS AS MAY BE ESTABLISHED BY IU HEALTH FROM TIME TO TIME. IT IS PREFERRED THAT AT LEAST THREE (3) OF THE DIRECTORS ARE PHYSICIAN MEMBERS, BUT IT IS NOT REQUIRED. THE COMPOSITION OF THE BOARD OF DIRECTORS SHALL BE CONSISTENT WITH THE FOLLOWING CRITERIA: I. TWO (2) MEMBERS SHALL BE REPRESENTATIVES OF INDIANA UNIVERSITY HEALTH BEDFORD, INC.; II. TWO (2) MEMBERS SHALL BE REPRESENTATIVES OF INDIANA UNIVERSITY HEALTH PAOLI, INC.; III. TWO (2) MEMBERS SHALL BE REPRESENTATIVES OF INDIANA UNIVERSITY HEALTH MORGAN, INC.; IV. FIVE (5) MEMBERS SHALL BE REPRESENTATIVES OF INDIANA UNIVERSITY HEALTH BLOOMINGTON, INC.; AND V. TWO (2) MEMBERS SHALL BE THE PRESIDENT OF THE IU HEALTH SOUTH CENTRAL REGION AND AN IU HEALTH EXECUTIVE LEADERSHIP REPRESENTATIVE Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders THE FOLLOWING MATTERS REQUIRE THE APPROVAL OF IU HEALTH, AS THE MEMBER, BEFORE BECOMING EFFECTIVE: (A) AUTHORIZE THE ESTABLISHMENT OR ACQUISITION OF ANY SUBSIDIARIES, AFFILIATES OR JOINT VENTURE ARRANGEMENTS OR ACQUISITIONS OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF ANY OTHER BUSINESS OR ENTITY; (B) RECOMMEND AND RATIFY OR AMEND AND OPERATING AND CAPITAL BUDGETS OF THE CORPORATION; (C) AUTHORIZE ANY UNBUDGETED OPERATING OR CAPITAL BUDGET ITEMS OR DEVIATIONS, INCLUDING ANY ISSUANCE OR GUARANTEE OF ANY UNBUDGETED DEBT, GREATER THAN THE BUDGETED AMOUNT OF $100,000 FOR ANY INDIVIDUAL ITEM OR $300,000 PER FISCAL YEAR IN THE AGGREGATE; (D) AUTHORIZE THE INCURRENCE OF DEBT BY THE CORPORATION IN ACCORDANCE WITH POLICIES AND PROCEDURES ISSUED BY IU HEALTH, INCLUDING TO SERVE AS A GUARANTOR, SURETY OR CO-OBLIGOR; (E) AUTHORIZE ANY MERGER, CONSOLIDATION, REORGANIZATION, SALE OR TRANSFER OF ALL OR SUBSTANTIALLY ALL OF THE CORPORATION'S ASSETS OR A SUBSIDIARY ORGANIZATION OF THE CORPORATION; (F) AUTHORIZE ANY VOLUNTARY DECLARATION OF BANKRUPTCY, PLAN OF DISSOLUTION, ANY LIQUIDATING DISTRIBUTION OF ASSETS OR OTHER ACTION RELATED TO THE DISSOLUTION OR LIQUIDATION OF THE CORPORATION OR A SUBSIDIARY ORGANIZATION OF THE CORPORATION; (G) APPROVE ANY MANAGEMENT AGREEMENT FOR THE MANAGEMENT OF ALL OR A SUBSTANTIAL PART OF THE CORPORATION'S OPERATIONS; (H) APPROVE, UPON RECOMMENDATION OF THE NOMINATING COMMITTEE, THE MEMBERS OF THE BOARD OF DIRECTORS OF THE CORPORATION; (I) RECOMMEND AND RATIFY ANY STRATEGIC PLANS AND AMENDMENTS THERETO, WHICH WILL BE ALIGNED WITH IU HEALTH; (J) APPROVE ANY ACTION TO TERMINATE ACUTE CARE SERVICES OR CLOSE THE HOSPITAL OPERATED BY THE CORPORATION (THE "HOSPITAL"); AND (K) APPROVE ANY AMENDMENTS TO THE ARTICLES OF INCORPORATION AND BYLAWS OF THE CORPORATION OR A SUBSIDIARY ORGANIZATION OF THE CORPORATION. Form 990, Part VI, Line 11b Review of form 990 by governing body THE VP & CFO REVIEWED AND APPROVED THE FORM 990. 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 Bloomington 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 15a Process to establish compensation of top management official THE PRESIDENT OF IU HEALTH BLOOMINGTON, WHO IS ALSO THE 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 PAY AND BENEFITS (COLLECTIVELY REFERRED TO AS "COMPENSATION") ON AN ANNUAL BASIS IN APRIL. 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 SULLIVANCOTTER. 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 SULLIVANCOTTER'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 SULLIVANCOTTER. 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 SULLIVANCOTTER 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. Form 990, Part VI, Line 15b Process to establish compensation of other employees IU HEALTH, IU HEALTH BLOOMINGTON 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 BLOOMINGTON'S ARTICLES OF INCORPORATION ARE AVAILABLE FOR PUBLIC INSPECTION THROUGH THE INDIANA SECRETARY OF STATE'S WEBSITE. IU HEALTH BLOOMINGTON'S CONFLICT OF INTEREST PROCEDURES ARE DESCRIBED ON FORM 990, SCHEDULE O. IU HEALTH BLOOMINGTON 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 BLOOMINGTON'S FORM 990. Form 990, Part VIII, Line 11d Other Miscellaneous Revenue All Other Revenue - Total Revenue: 600732, Related or Exempt Function Revenue: , Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: 600732; Form 990, Part IX, Line 11g Other Fees Professional fees - Total Expense: 2190194, Program Service Expense: 2051096, Management and General Expenses: 139098, Fundraising Expenses: ; Fees-Other Services - Total Expense: 298803, Program Service Expense: 279826, Management and General Expenses: 18977, Fundraising Expenses: ; Consulting - Total Expense: 3116308, Program Service Expense: 2918394, Management and General Expenses: 197914, Fundraising Expenses: ; Intercompany fees - Total Expense: XXX-XX-XXXX, Program Service Expense: XXX-XX-XXXX, Management and General Expenses: 6853007, Fundraising Expenses: ; Physician fees - Total Expense: 3587922, Program Service Expense: 3360057, Management and General Expenses: 227865, Fundraising Expenses: ; Contract Labor Expense - Total Expense: 43785341, Program Service Expense: 41004566, Management and General Expenses: 2780775, Fundraising Expenses: ; Contract service - Total Expense: 11738754, Program Service Expense: 10993234, Management and General Expenses: 745520, Fundraising Expenses: ; BLOOMINGTON ENDOSCOPY CENTER LLC 950 N MERIDIAN ST STE 800 INDIANAPOLIS IN 46204 352117943 HEALTHCARE IN 6430531 9236398 IUHB IU HEALTH SOUTHERN INDIANA PHYSICIANS LLC 951 N MERIDIAN ST STE 800 INDIANAPOLIS IN 46204 351913875 HEALTHCARE IN 150832713 -139073185 IUHB ORTHOPEDICS OF SOUTH CENTRAL INDIANA LL 952 N MERIDIAN ST STE 800 INDIANAPOLIS IN 46204 753089189 HEALTHCARE IN 0 0 IUHSIP SOUTHERN INDIANA PEDIATRICS LLC 955 N MERIDIAN ST STE 800 INDIANAPOLIS IN 46204 351948555 HEALTHCARE IN 0 0 IUHSIP 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 950 N MERIDIAN STREET Suite 300 INDIANAPOLIS IN 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