2024-11-12T13:58:59+00:00 2023-12-31 990 2023-01-01 352090919 Indiana University Health Paoli Inc INDI 3179634842 950 N MERIDIAN STREET 1200 INDIANAPOLIS IN 46204 MICHAEL L CRAIG VP & CFO 2024-11-12 2023 2024-10-15 13:58:12Z BRIAN SHOCKNEY 950 N MERIDIAN STREET 1200 INDIANAPOLIS IN 46204 40745623 false X HTTPS://IUHEALTH.ORG/FIND-LOCATIONS/IU-HEALTH-PAOLI-HOSPITAL X 1999 IN Lead the transformation of healthcare through quality, innovation & education, and make Indiana one of the nation's healthiest states. 13 7 196 33 0 0 355482 49090 36070080 35607751 211635 1656179 9392 23943 36646589 37336963 0 0 14958331 15065772 0 0 19218639 21256677 34176970 36322449 2469619 1014514 47092675 49878050 7032879 7963373 40059796 41914677 X Lead the transformation of healthcare through quality, innovation & education, and make Indiana one of the nation's healthiest states. false false 24410938 0 25043294 INDIANA UNIVERSITY HEALTH PAOLI, INC. ("IU HEALTH PAOLI") IS A 24-BED CRITICAL ACCESS HOSPITAL THAT OFFERS A BROAD RANGE OF MEDICAL SPECIALTIES AND SERVICES TO CARE FOR ITS PATIENTS WITHOUT REGARD TO THEIR ABILITY TO PAY. IU HEALTH PAOLI SPECIALIZES IN RURAL, COMMUNITY-BASED SERVICES TO SERVE SOUTH CENTRAL INDIANA THROUGH ITS 24-HOUR EMERGENCY ROOM WITH AIR TRANSPORT AVAILABILITY, OB SERVICES, COMMUNITY OUTREACH PROGRAMS AND VISITING SPECIALIST SERVICES. 9688014 0 9938978 The laboratories of IU Health offer some of the most comprehensive laboratory services in Indiana 577384 0 592341 OUR NETWORK OF PHARMACIES OFFERS THE CONVENIENCE OF ONE-STOP SHOPPING. WE PROVIDE EXPERT CARE AND HELP PATIENTS MAKE THE BEST USE OF THEIR MEDICATIONS 27907 0 28630 Rent from Related 501(c)(3) Organizations 4394 0 4508 IU HEALTH PAOLI RECEIVES "SHARED SERVICES" REVENUE BY SHARING/PROVIDING SERVICES WITH IU Health Bloomington and INDIANA UNIVERSITY HEALTH CARE ASSOCIATES, INC. ("IU HEALTH PHYSICIANS") 32301 33138 34708637 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 false false true false false false false false false false false false false false false false true true true false false true 0 0 196 true false 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 false IN X CRAIG J JONES 3179634842 950 N MERIDIAN STREET SUITE 800 INDIANAPOLIS IN 46204 BRIAN T SHOCKNEY PRESIDENT (SCR) (Part Year)/SVP System Regional Operations 10.0 45.0 X X 0 1036225 211047 JACK A KENWORTHY DIRECTOR/CHAIR 2.0 4.0 X X 0 7500 0 JOHN SPARZO MD Director (Part Year)/President (Part Year)/VP-CMO (SCR) 10.0 45.0 X X 0 473018 65730 JOYCE B POLING DIRECTOR/SECRETARY 2.0 4.0 X X 0 3000 0 JULIE MINTON DIRECTOR/Treasurer 2.0 4.0 X X 0 5000 0 RICHARD G HENDRICKSON DIRECTOR/Vice Chair 2.0 6.0 X X 0 3600 0 CORINNA REPETTO MD Director 2.0 53.0 X 0 380967 79171 DANIEL J PETERSON DIRECTOR 2.0 4.0 X 0 0 0 HOJJAT M SHAMLOO MD DIRECTOR 1.0 54.0 X 0 649685 79767 JAMES J LAUGHLIN MD DIRECTOR 1.0 54.0 X 0 203139 16251 JAMES RIDGE MD DIRECTOR 2.0 14.0 X 0 48000 0 JANET FARLOW PERRY DIRECTOR 2.0 4.0 X 0 0 0 KEVIN B GEBKE MD DIRECTOR 1.0 54.0 X 0 653475 144075 LYNN H COYNE DIRECTOR 2.0 4.0 X 0 0 0 Mohan Shenoy MD Director 2.0 53.0 X 0 794400 69793 VANESSA MCCLARY DIRECTOR 2.0 4.0 X 0 0 0 MICHAEL L CRAIG VP & CFO (SCR) 10.0 45.0 X 0 333908 66441 ALAN W BIGGS VP & COO (SCR) 10.0 45.0 X 0 314970 52742 Brechin Newby MD Chief Physician Executive (SCR) 35.0 20.0 X 0 442811 26086 BRUCE R WADE VP - HUMAN RESOURCES (SCR) 10.0 45.0 X 0 245476 67879 CYNTHIA R HERRINGTON VP & CNO (SCR) 10.0 45.0 X 0 309541 47047 ANGELA M (CONKLIN) HIGGS ANESTHETIST 50.0 0 X 195366 0 28186 FRANKLIN R FRAZIER ANESTHETIST 50.0 0 X 193666 0 8808 Jerome B Sneed MD Physician 25.0 25.0 X 153754 149256 79941 JULIE A MAUDLIN Nurse Practitioner 50.0 2.0 X 192217 12446 64016 MICHELE RIDGE CNO 50.0 0 X 232520 0 57409 LARRY R BAILEY FORMER Officer 0.0 50.0 X 0 290094 66171 PAUL M CALKINS MD FORMER KEY EMPLOYEE 10.0 45.0 X 0 571987 62470 967522 6928499 1293027 24 true true false 0 49090 49090 NET PATIENT SERVICE REVENUE 622110 25043294 25043294 RENT FROM RELATED 501(C)(3) ORGS. 532000 28630 28630 SHARED SERVICES 541900 4508 4508 PHARMACY 446110 592341 592341 LABORATORY 621500 9938978 9938978 0 0 0 0 35607751 1383023 1383023 12718 12718 0 12718 12718 3681816 3408660 273156 0 273156 273156 All Other Revenue 900099 11225 11225 0 0 0 0 11225 37336963 35607751 0 1680122 X 12221446 11809349 412097 418726 404607 14119 1667993 1611750 56243 757607 732061 25546 1563 1563 13659 13659 11136007 10388449 747558 0 580 580 49635 46303 3332 71796 35898 35898 960528 960528 9381 8751 630 1320907 1258677 62230 206219 206219 Drugs and Medical Supplies 3064168 3064168 Bad Debt 2552239 2552239 Hospital Assessment Fee 1423620 1423620 Repairs and Maintenance 321408 299832 21576 124967 112405 12562 0 36322449 34708637 1613812 0 20830896 23589509 230642 718 3459576 3427764 0 0 0 0 8625 0 599356 676861 92844 109125 26738472 15803594 11604385 10934878 10266351 11139195 0 0 0 0 47092675 49878050 6234355 6040968 0 0 798524 1922405 7032879 7963373 X 40059797 41914677 40059797 41914677 47092676 49878050 1014514 840366 0 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 1563 1563 false Schedule C, Part II-B, Line 1 DETAILED DESCRIPTION OF THE LOBBYING ACTIVITY IU Health Paoli paid institutional membership dues to the American Hospital Association ("AHA") and the Indiana Hospital Association ("IHA") during 2023 in the amount of $4,378 and $3,748. Each membership organization notified IU Health Paoli that a portion of the dues it paid were used for lobbying purposes. The AHA used 26.47%, or $1,159 of 2023 membership dues paid by IU Health Paoli, for lobbying expenditures. The IHA used 10.78%, or $404 of the 2023 membership dues paid by IU Health Paoli, for lobbying expenditures. The total membership dues paid to these organizations by IU Health Paoli during 2023 that were attributable to lobbying expenditures was $1,563. 183505 183505 8531552 4006497 4525055 791602 791602 0 13222081 9624073 3598008 4009732 1381422 2628310 10934878 DUE TO THIRD-PARTY PAYERS INTERCOMPANY PAYABLES (NET) SELF-INSURANCE LIABILITIES Operating Lease Liabilities Intercompany Payables (Net) 1863040 Self-Insurance Liabilities 59365 Operating Lease Liabilities 0 1922405 X Schedule D, Part X, Line 2 FIN 48 (ASC 740) footnote IU HEALTH PAOLI IS A SUBSIDIARY IN INDIANA UNIVERSITY HEALTH, INC.'S ("IU HEALTH") CONSOLIDATED AUDITED FINANCIAL STATEMENTS. THE INTERNAL REVENUE SERVICE (IRS) 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 WHICH, AS OF DECEMBER 31, 2023 AND 2022, 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, 2023 AND 2022, THE INDIANA UNIVERSITY HEALTH SYSTEM HAD GROSS DEFERRED TAX ASSETS OF $141,386,000 AND $145,194,000, RESPECTIVELY, RELATING TO NET OPERATING LOSS CARRYOVERS. MANAGEMENT DETERMINED THAT A FULL VALUATION ALLOWANCE AT DECEMBER 31, 2023 AND 2022 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. THE DECREASE IN THE GROSS DEFERRED TAX ASSET AND THE VALUATION ALLOWANCE FOR THE CURRENT YEAR IS $3,009,000. AT DECEMBER 31, 2023, INDIANA UNIVERSITY HEALTH SYSTEM HAS AVAILABLE NET OPERATING LOSS CARRYFORWARDS OF $571,690,000, NET OPERATING LOSSES GENERATED FROM 2004 THROUGH 2017 EXPIRE BETWEEN 2024 AND 2037. NET OPERATING LOSSES GENERATED AFTER 2017 DO NOT EXPIRE. true true X true X 300 false true true true false true true 0 1325 306455 0 306455 0.0091 0 5471 9841921 9220029 621892 0.0184 0 0 0 0 0 0.0 0 6796 10148376 9220029 928347 0.0275 1 131 387516 0 387516 0.0115 2 21 15994 0 15994 0.0005 1 211 3079455 2730306 349149 0.0103 0 0 0 0 0 0.0 1 5 148 0 148 0.0000 5 368 3483113 2730306 752807 0.0223 5 7164 13631489 11950335 1681154 0.0498 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0 0 0 0 0.0 false 795278 7613001 7744337 -131336 X true true 1 1 INDIANA UNIVERSITY HEALTH PAOLI INC 560 W Longest Street PAOLI IN 47454 HTTPS://IUHEALTH.ORG/FIND-LOCATIONS/IU-HEALTH-PAOLI-HOSPITAL 22-005065-1 X X X X INDIANA UNIVERSITY HEALTH PAOLI INC 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 Paoli'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 Paoli: 1. Access to Healthcare Services 2. Behavioral Health 3. Chronic Disease and Chronic Disease Management 4. Maternal and Infant Health and Child Well-being 5. Smoking, Tobacco Use and Exposure to Secondhand Smoke 6. Social Determinants of Health Schedule H, Part V, Section B, Line 5 Facility , 1 Facility , 1 - INDIANA UNIVERSITY HEALTH PAOLI, INC.. In conducting each its most recent CHNA, IU Health Paoli Hospital took into account input from persons who represent the broad interests of the communities it serves by hosting two 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 Paoli Hospital The defined community per the most recent CHNA is Orange County, Indiana, where the hospital resides. Orange County - Community Meetings IU Health Paoli Hospital obtained community input through focus groups of community stakeholders. Two community meetings were held in 2021 to receive input from stakeholders regarding the health needs in Orange County - April 20 and May 4. 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 Orange 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 timely access to care, providing for children, knowing available resources, good mental and physical health, access to all basic necessities (food, housing, etc.), transportation, areas to recreate, community events and relationships and educational opportunities throughout life. Describing barriers to achieving a high-quality life, issues around technology and internet barriers, lack of transportation, isolation, lack of sense of community and connections, poverty, unemployment, lack of childcare, in flexible education opportunities and stress were discussed. Through these discussions, participants identified the following needs as most significant for Orange County: * Mental health, including a lack of providers and stigma * Substance abuse, including drugs, alcohol and tobacco * Transportation * Obesity and chronic disease * Social determinants of health, including poverty, housing and food insecurity * Access to healthcare, including telehealth In regard to the COVID-19 pandemic and its impacts, residents highlighted issues around the pandemic impacting already limited transportation options, isolation and limiting social connections and difficulties accessing online resources. Community meeting and survey participants Individuals from a wide variety of organizations and communities participated in community meetings and surveys. Participants included representatives from the following organizations: * Anthem Care Source * French Lick Resort * Hoosier Uplands * IU Health * IU Health Paoli Hospital * IU Health South Central Region * LifeStream Services * Nurse Family Partnership * OB Med-Surgeon Health Specialties * Orange County Health Department * Positive Link * Purdue Extension * United Way of Orange County * WIC Family Services * YMCA of Orange County Schedule H, Part V, Section B, Line 11 Facility , 1 Facility , 1 - INDIANA UNIVERSITY HEALTH PAOLI, INC.. Along with the CHNA, IU Health Paoli Hospital's Board adopted an implementation strategy in April 2022 in response to the 2021 CHNA. IU Health Paoli 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 Paoli 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; 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. IU Health Paoli partnered with IU School of Nursing to offer free Health Screenings in Orange County during 2023. The hospital provides financial assistance to patients each year that includes discounts, full charity, and personal hardship reductions. IU Health Patient Financial Counselors are certified Indiana Navigators. They can assist patients and families with information and help them with applications for various health coverage programs. In 2023, the counselors served 131 people at IU Health Paoli Hospital. Behavioral Health During 2023, IU Health Paoli partnered with Paoli Jr./Sr. High Health Class students to provide behavioral health education regarding stress management. Develop access points for referral to behavioral health care. Offered virtual behavioral health appointments in Orange County schools in 2023 to support students with access to mental health support. Further implement the Virtual Care Peer Recovery Coaching Program (provides patients who have substance use concerns with virtual behavioral health services). The Virtual Peer Recovery Coach program was discontinued in February 2023 as IU Health continues to assess and evolve its behavioral health services based on the needs of patients and the communities it serves. Since 2018, this program had served 15 IU Health and two non-IU Health emergency department patients struggling with substance use disorder through support to aid in recovery. IU Health continues to serve patients with a need for this service through the Virtual Behavioral Health team. Further implement emergency department (ED) virtual care program (provides patients virtual access to behavioral health services). Virtual Integrated Behavioral Health (VIBH) expanded behavioral health access to patients and providers across the state. VIBH provided urgent psychiatric assessment for patients experiencing behavioral health crises, such as suicidal ideation, homicidal ideation, psychosis, and substance abuse disorders. A team of behavioral health professionals provided consultation through iPad carts located in emergency departments, urgent care, and ambulatory care locations. In 2023, there were over 11,000 visits of which 1,942 visits included patients seeking care in the South Central Region (which includes IU Health Paoli Hospital). VIBH also provided brief behavioral health therapy and consultation for medication management to primary care patients aged 18 and older experiencing depression, anxiety, and other mood disorders. A team of behavioral health professionals provided problem solving treatment, cognitive behavioral therapy, and other evidence-based interventions. In 2023, there were over 6,000 visits of which 2,248 were provided to patients seeking help through IU Health Physicians ambulatory clinics. Chronic Disease and Chronic Disease Management Provide screening for chronic disease and linkage to care. Provided blood pressure screenings to the community in 2023. Maternal and Infant Health and Child Well-being Connect pregnant women to the appropriate resources in the community. In 2023, provided numerous resources and education during a Community Baby Shower sponsored by IU Health Paoli. Performed Fetal Infant Mortality Reviews along with many community partners to identify reasons for fetal and infant deaths and developed workgroups to combat in 2023. Offered Long-Acting Reversible Contraception at time of delivery to better support access to birth control and help with birth spacing. 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 in 2023. Smoking, Tobacco Use and Exposure to Secondhand Smoke Screen individuals for tobacco use and link to tobacco cessation resources and services. Provided a Tobacco Coordinator to the community in 2023 with a focus on policy change. Referred tobacco users to provider Quitline. Worked with Orange County Schools to develop strategies to prevent vaping and support students in need of cessation. Further implement the Centralized Tobacco Treatment Program (CTTP) (provides patients access to evidence-based tobacco treatment). The CTTP program is free to IU Health Primary Care patients. Once a patient's level of care is assessed, they are provided evidence-based tobacco cessation treatment with a trained Tobacco Treatment Specialist (TTSs). Patients had access to Clickotine, a digital cessation app, and support from an Advance Practice Provider (APP) to evaluate and prescribe medication assisted therapy (MAT) for nicotine replacement. Education and support were provided to PCP offices which helped to expand services. Cross-functional teams worked together including the West Central Region TTSs for case conferencing and training. The goal to increase access to Specialty Care patients is on hold until budget allows for additional staffing. The 2023 focus was on improving internal efficiencies to maximize resources and improve patient experience including data collection and reporting enhancements. An additional focus was on improving access and patient experience with medication management. CTTP improved patient tobacco treatment medication support by integrating systems and processes with a dedicated APP resource. They improved documentation to accurately report MAT, demonstrating 70% of patients used NRT/medication to quit. There was a 30% increase in scheduled medication management appointments compared to 2022. The team focused on care continuation, care coordination (TTS/APP), scheduling patient follow-up appointments, and monitoring adherence or complications. These tactics also improved the engagement rate - 78% of scheduled medication management appointments were completed. The above focus on improving patient experience resulted in strong and consistent quit rates of 31% of active patients and harm reduction (patients who reduced use of tobacco) of 54% (July 2022-December 2023). The team received frequent testimonials of lives changed and gratitude for a supportive, compassionate partner. In 2023, CTTP received 1,149 referrals, scheduled 75% of them and completed at least one session with 82% of those scheduled. Additionally, 44% of patients seen completed 2 or more sessions. Over the program's life, CTTP has received 2,678 patient referrals. This program is financially supported by the parent hospital, IU Health Inc., but is offered to and impacts patients in this hospital's defined community. Offered Tobacco Prevention and Cessation outreach and education at local schools, festivals, fairs and other community events in 2023. Social Determinants of Health All Community Health Strategies will support social determinants of health. IUHealth.findhelp.org was promoted at community events. Increased findhelp utilization in the community by 25% Significant Needs Hospital Will Not Address IU Health Paoli Hospital addressed all the significant health needs identified in the 2022 Community Health Needs Assessment. Schedule H, Part V, Section B, Line 13 Facility , 1 Facility , 1 - INDIANA UNIVERSITY HEALTH PAOLI, INC.. IN ADDITION TO FPG, IU HEALTH PAOLI 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 - INDIANA UNIVERSITY HEALTH PAOLI, INC.. IU Health Paoli 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 Paoli will treat the adult as a dependent for purposes of the FPL calculation. IU Health Paoli 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 Paoli, 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 Paoli 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 Paoli 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 Paoli 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 Paoli 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 - INDIANA UNIVERSITY HEALTH PAOLI, INC.. IU Health Paoli 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. 8 IU HEALTH PAOLI HOSPITAL SURGERY DEPT 642 W HOSPITAL RD PAOLI IN 47454 SPECIALTY CARE IU HEALTH PAOLI MULTI-SPECIALITY 642 W HOSPITAL RD PAOLI IN 47454 SPECIALTY CARE IU HEALTH PAOLI WALK-IN 560 W LONGEST ST PAOLI IN 47454 PRIMARY CARE IU HEALTH PRIMARY CARE - PAOLI 560 W LONGEST ST PAOLI IN 47454 PRIMARY CARE IU HEALTH PAOLI HOSPITAL REHABILITATION 642 W HOSPITAL RD PAOLI IN 47454 REHABILITATION SERVICES IU HEALTH PAOLI RADIOLOGY 642 W HOSPITAL RD PAOLI IN 47454 RADIOLOGY IU HEALTH PAOLI HOSPITAL LAB 642 W HOSPITAL RD PAOLI IN 47454 LAB IU HEALTH PAOLI INFUSION 642 W HOSPITAL RD PAOLI IN 47454 OUTPATIENT Schedule H, Part I, Line 6a C.B. REPORT PREPARED BY A RELATED ORG. IU Health Paoli'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. The IU Health Community Benefit Report is also distributed to numerous key organizations throughout the State of Indiana in order to broadly share the IU Health Statewide System's community benefit efforts. It is also available by request through the Indiana State Department of Health or IU Health. Schedule H, Part I, Line 7f BAD DEBT EXPENSE THE AMOUNT OF BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE OF TOTAL EXPENSE ON LINE 7, COLUMN (F) IS $2,552,239. Schedule H, Part I, Line 7 TOTAL COMMUNITY BENEFIT EXPENSE SCHEDULE H, PART I, LINE 7, COLUMN (F), PERCENT OF TOTAL EXPENSE, IS BASED ON COLUMN (E) NET COMMUNITY BENEFIT EXPENSE. THE PERCENT OF TOTAL EXPENSE BASED ON COLUMN (C) TOTAL COMMUNITY BENEFIT EXPENSE, WHICH DOES NOT INCLUDE DIRECT OFFSETTING REVENUE, IS 40.37%. Schedule H, Part II PROMOTION OF HEALTH IN COMMUNITIES SERVED IU Health Paoli 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 Paoli 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, collaborate with community partners such as: Love Never Fails Church Veterans Outreach event; Safe Haven Summer of Recovery event; Orange County Tobacco Prevention and Cessation Coalition; Hoosier Uplands Head Start tobacco prevention activities; Paoli Food Pantry blood pressure screenings; IU Health School of Nursing free health screenings; Qsource education and outreach. Schedule H, Part I, Line 7g DESCRIBE SUBSIDIZED HEALTH SERVICE COSTS FROM PHYSICIAN CLINIC IU HEALTH PAOLI 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 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 NORTH WILL TREAT THE ADULT AS A DEPENDENT FOR PURPOSES OF THE FPL CALCULATION. IU HEALTH 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, 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 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 2552239 Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount THE BAD DEBT EXPENSE REPORTED ON SCHEDULE H, PART III, LINE 2 IS REPORTED AT COST, AS CALCULATED USING THE COST TO CHARGE RATIO METHODOLOGY. Schedule H, Part III, Line 3 Bad Debt Expense Methodology IU Health Paoli 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 Paoli 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 Paoli 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 a patient applies for financial assistance due to financial hardship. In determining the level of financial assistance based on household makeup, single person 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. Qualifying 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 5% of annual household income or Amounts Generally Billed, whichever is less. 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 $95,909,000 and $88,213,000 in 2023 and 2022, 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 Paoli Medicare Cost Report. "Allowable costs" for Medicare Cost Report purposes, however, are not reflective of all costs associated with IU Health Paoli'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 Paoli's participation in Medicare programs would significantly increase the Medicare shortfall reported on Schedule H, Part III, Line 7. IU Health Paoli'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 Paoli 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 PAOLI'S FAP and written debt collection policy describe the collection practices applicable to patients, including those who may qualify for financial assistance. Schedule H, Part V, Section B, Line 16a FAP website - INDIANA UNIVERSITY HEALTH PAOLI, INC.: Line 16a URL: HTTPS://IUHEALTH.ORG/PAY-A-BILL/FINANCIAL-ASSISTANCE; Schedule H, Part V, Section B, Line 16b FAP Application website - INDIANA UNIVERSITY HEALTH PAOLI, INC.: Line 16b URL: HTTPS://IUHEALTH.ORG/PAY-A-BILL/FINANCIAL-ASSISTANCE; Schedule H, Part V, Section B, Line 16c FAP plain language summary website - INDIANA UNIVERSITY HEALTH PAOLI, INC.: Line 16c URL: HTTPS://IUHEALTH.ORG/PAY-A-BILL/FINANCIAL-ASSISTANCE; Schedule H, Part VI, Line 2 Needs assessment Though IU Health Paoli Hospital believes its CHNA process is comprehensive, the CHNA is done on a triennial basis. Between CHNA cycles, IU Health Paoli 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 Paoli is committed to serving the healthcare needs of all of its patients regardless of their ability to pay for such services. To assist in meeting those needs, IU Health Paoli has established a FAP to provide Financial Assistance to Uninsured Patients. IU Health Paoli is committed to ensuring its patients are compliant with all provisions of the Patient Protection & Affordable Care Act. To that end, IU Health Paoli will make a good faith effort to locate and obtain health insurance coverage for patients prior to considering patients for coverage under the FAP. IU Health Paoli 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 PAOLI IS LOCATED IN ORANGE COUNTY, INDIANA, A COUNTY LOCATED IN SOUTH CENTRAL INDIANA. ORANGE COUNTY INCLUDES ZIP CODES WITHIN THE TOWNS OF FRENCH LICK, ORLEANS, PAOLI, AND WEST BADEN SPRINGS. BASED ON THE MOST RECENT CENSUS BUREAU (2023) STATISTICS, ORANGE COUNTY'S POPULATION IS 19,638 PERSONS WITH APPROXIMATELY 49.7% BEING FEMALE AND 50.3% MALE. THE COUNTY'S POPULATION ESTIMATES BY RACE ARE 94.3% WHITE, 1.7% BLACK, 1.98% HISPANIC OR LATINO, 0.4% ASIAN, 0.5% AMERICAN INDIAN OR ALASKA NATIVE, AND 1.6% PERSONS REPORTING TWO OR MORE RACES. ORANGE COUNTY HAS RELATIVELY LOW LEVELS OF EDUCATIONAL ATTAINMENT AS COMPARED TO OTHER INDIANA COUNTIES. ROUGHLY, 13.9% OF THE POPULATION HAS A BACHELOR'S DEGREE OR GRADUATE/PROFESSIONAL DEGREE, WHILE 85.3% OF THE POPULATION HAS OBTAINED A HIGH SCHOOL DEGREE. Schedule H, Part VI, Line 5 Promotion of community health IU Health Paoli 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 Paoli 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 2023, IU Health Paoli Hospital's promotion of community health included the following highlights: IU Health Paoli Hospital partners with the local school systems and community partners to provide preventive health educational programs. - IU Health Paoli Hospital has a permanent fitting station, as designated by the state, for car seat safety inspections and has two 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. Monthly community car seat inspections ensure children in our community are safely traveling in vehicles. 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. - In 2022, IU Health Community Health started Coordinated School Health in Orange County. A school health coordinator was hired to work with all of the county schools to improve the health and wellness of students and staff. In 2022-2023, 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. The coordinator also provided CPR training for staff. Schedule H, Part VI, Line 6 Affiliated health care system Indiana University Health Paoli 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 six 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 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 partners, 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 initiatives as well as system level strategies. 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 (IU Health Arnett and IU Health Ball) 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 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. However, some needs are common in communities served by multiple or all 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 partners such as the Office of Health Equity Research and Evaluation (HERE) and the IU Health Foundation, plans and provides technical assistance for system-level strategies that address these common needs including health equity, tobacco and nicotine cessation, behavioral and substance use disorders, infant and maternal health, hypertension, and social determinants of health. For example, the Community Health Division is coordinating efforts to select and train community health workers who are placed throughout the system in outpatient and inpatient sites and do outreach through the WeCare and iHEART initiatives. These valued team members are from the communities being served by IU Health and have an intimate understanding of the needs of residents. Each affiliate hospital works collaboratively with the Community Health Division to align and activate local resources to support local and system 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, the Community Outreach and Engagement Program's IU Health Serves initiative, 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 $200 million Community Impact and Investment (CII) Fund was established in 2018 by IU Health to financially support high-impact community investing. The focus of these efforts will address key social and environmental factors that impact historically 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. Schedule H, Part VI, Line 7 State filing of community benefit report IN false true false false false false false true false BRIAN T SHOCKNEY PRESIDENT (SCR) (Part Year)/SVP System Regional Operations 0 721623 0 270916 0 43686 0 145015 0 66031 0 1247272 0 0 JOHN SPARZO MD Director (Part Year)/President (Part Year)/VP-CMO (SCR) 0 411709 0 59165 0 2143 0 13671 0 52059 0 538748 0 0 JAMES J LAUGHLIN MD DIRECTOR 0 188230 0 14910 0 0 0 8126 0 8126 0 219391 0 0 HOJJAT M SHAMLOO MD DIRECTOR 0 544059 0 102062 0 3564 0 14555 0 65211 0 729452 0 0 KEVIN B GEBKE MD DIRECTOR 0 576771 0 73353 0 3351 0 114073 0 30002 0 797550 0 0 CORINNA REPETTO MD Director 0 342524 0 34879 0 3564 0 13200 0 65971 0 460138 0 0 Mohan Shenoy MD Director 0 516917 0 256519 0 20964 0 13200 0 56593 0 864193 0 0 LARRY R BAILEY FORMER Officer 0 251745 0 34785 0 3564 0 11825 0 54345 0 356264 0 0 MICHAEL L CRAIG VP & CFO (SCR) 0 291606 0 38738 0 3564 0 13200 0 53241 0 400348 0 0 PAUL M CALKINS MD FORMER KEY EMPLOYEE 0 511890 0 53240 0 6858 0 13200 0 49270 0 634457 0 0 CYNTHIA R HERRINGTON VP & CNO (SCR) 0 271014 0 36206 0 2322 0 6897 0 40150 0 356588 0 0 BRUCE R WADE VP - HUMAN RESOURCES (SCR) 0 211265 0 31042 0 3169 0 9856 0 58023 0 313355 0 0 ALAN W BIGGS VP & COO (SCR) 0 276239 0 36409 0 2322 0 12686 0 40056 0 367712 0 0 Brechin Newby MD Chief Physician Executive (SCR) 0 408104 0 34167 0 540 0 13043 0 13043 0 468897 0 0 ANGELA M (CONKLIN) HIGGS ANESTHETIST 194746 0 500 0 120 0 5682 0 22504 0 223552 0 0 0 FRANKLIN R FRAZIER ANESTHETIST 192986 0 500 0 180 0 6542 0 2266 0 202474 0 0 0 MICHELE RIDGE CNO 202532 0 28080 0 1908 0 9476 0 47933 0 289929 0 0 0 JULIE A MAUDLIN Nurse Practitioner 122592 8234 65870 3985 3755 227 5924 358 54440 3293 252581 16098 0 0 Jerome B Sneed MD Physician 144982 139691 8177 8918 594 648 5902 6436 32337 35265 191993 190957 0 0 Schedule J, Part I, Line 3 Arrangement used to establish the top management official's compensation IU HEALTH PAOLI'S REGIONAL PRESIDENT IS EMPLOYED BY INDIANA UNIVERSITY HEALTH, INC. IU HEALTH, IU HEALTH PAOLI, 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 4b Supplemental nonqualified retirement plan BRIAN T. SHOCKNEY AND KEVIN GEBKE 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. EACH OF THE EXECUTIVES LISTED ABOVE HAVE AN AMOUNT INCLUDED IN COLUMN C, DEFERRED COMPENSATION, REPRESENTING THE CURRENT YEAR UNVESTED CONTRIBUTIONS MADE UNDER THE SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN. THESE AMOUNTS WERE NOT PAID TO THE EXECUTIVES 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: - BRIAN SHOCKNEY: $38,055 Schedule J, Part I, Line 7 Non-fixed payments AMOUNTS DISCLOSED IN COLUMN B(II) INCLUDE A LONG TERM INCENTIVE FOR CERTAIN EXECUTIVES. ALTHOUGH THESE PLANS ARE BASED ON A FIXED FORMULA THAT HAS BEEN APPROVED BY THE BOARD OF DIRECTORS BASED UPON CERTAIN QUALITATIVE AND QUANTITATIVE FACTORS AND GOALS, ALL DISCRETIONARY INCENTIVE PLANS MUST BE APPROVED BY THE BOARD OF DIRECTORS PRIOR TO ANY INCENTIVE PAYOUT. Form 990, Part III, Line 4d Description of other program services (Expenses $ 27,907 including grants of $ 0)(Revenue $ 28,630) Rent from Related 501(c)(3) Organizations Form 990, Part III, Line 4d Description of other program services (Expenses $ 4,394 including grants of $ 0)(Revenue $ 4,508) IU HEALTH PAOLI RECEIVES "SHARED SERVICES" REVENUE BY SHARING/PROVIDING SERVICES WITH IU Health Bloomington and INDIANA UNIVERSITY HEALTH CARE ASSOCIATES, INC. ("IU HEALTH PHYSICIANS") Form 990, Part VI, Line 13 PART VI, LINES 12, 13, 14, AND 16B - POLICIES IU HEALTH PAOLI IS PART OF THE IU HEALTH SYSTEM. AS THE SOLE MEMBER AND CONTROLLING PARENT OF IU HEALTH PAOLI, IU HEALTH AND ITS BOARD OF DIRECTORS HAVE MANDATED THAT CERTAIN POLICIES BE FOLLOWED TO ENSURE GREATER STANDARDIZATION THROUGHOUT THE SYSTEM. THUS, IU HEALTH PAOLI'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 PAOLI IS IU HEALTH, INC., 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 FROM NINE (9) TO 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 THE MEMBER AND IU HEALTH FROM TIME TO TIME. IT IS PREFERRED THAT AT LEAST THREE (3) OF THE DIRECTORS ARE PHYSICIAN MEMBERS, BUT IS NOT REQUIRED. THE COMPOSITION OF THE BOARD OF DIRECTORS SHALL BE CONSISTENT WITH THE FOLLOWING CRITERIA: I. TWO (2) MEMBER 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. FOUR (4) 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. VI. ONE (1) MEMBER DIRECTLY APPOINTED BY THE LOCAL COUNCIL OF WOMEN, INC. ("COUNCIL DIRECTOR") Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders ALL ACTION OF THE HOSPITAL SHALL BE BY ITS BOARD, SUBJECT TO THE FOLLOWING MATTERS WHICH ARE RESERVED TO AND REQUIRE THE APPROVAL OF IU HEALTH, AS THE MEMBER: A) AUTHORIZE THE ESTABLISHMENT OR ACQUISITION OF ANY SUBSIDIARIES, AFFILIATES OR JOINT VENTURE ARRANGEMENTS OR ACQUISITION OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF ANY OTHER BUSINESS OR ENTITY; B) APPROVE OR AMEND ANY OPERATING OR CAPITAL BUDGET (PROVIDED THAT THE APPROVAL OR AMENDMENT OF ANY OPERATING OR CAPITAL BUDGET, OR ANY OTHER ACTION, THAT WOULD ELIMINATE A CORE SERVICE (AS THAT TERM IS DEFINED IN THAT CERTAIN INTEGRATION DEFINITIVE AGREEMENT BETWEEN IU HEALTH BLOOMINGTON HOSPITAL, FOUNDATION AND IU HEALTH, DATED MARCH 5, 2009 (THE "DEFINITIVE AGREEMENT")). THE ELIMINATION OF A CORE SERVICE MUST ALSO BE APPROVED BY A MAJORITY VOTE OF THE BOARD; 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 BY $100,000 FOR ANY INDIVIDUAL ITEM OR $300,000 PER FISCAL YEAR IN THE AGGREGATE; D) AUTHORIZE THE INCURRENCE OF DEBT BY THE HOSPITAL IN ACCORDANCE WITH POLICIES AND PROCEDURES ISSUED BY IU HEALTH (THE "SYSTEM POLICIES"), INCLUDING TO SERVE AS A GUARANTOR, SURETY OR CO-OBLIGER; E) APPROVE ANY STRATEGIC PLANS AND AMENDMENTS THERETO; F) AMEND OR REPEAL THE HOSPITAL'S ARTICLES OF INCORPORATION OR THESE BY-LAWS (OR OTHER CORRESPONDING ORGANIZATIONAL DOCUMENTS IF AN AFFILIATE IS NOT A CORPORATION) IN ANY MANNER, INCLUDING WITHOUT LIMITATION ANY CHANGE RELATING TO THE NONPROFIT PURPOSES OF HOSPITAL; G) AUTHORIZE ANY MERGER, CONSOLIDATION, REORGANIZATION, SALE OR TRANSFER OF ALL OR SUBSTANTIALLY ALL OF THE HOSPITAL'S ASSETS OR A SUBSIDIARY ORGANIZATION OF THE HOSPITAL; H) AUTHORIZE ANY VOLUNTARY DECLARATION OF BANKRUPTCY, PLAN OF DISSOLUTION, LIQUIDATING DISTRIBUTION OF ASSETS OR OTHER ACTION RELATED TO ITS DISSOLUTION OR LIQUIDATION OF THE HOSPITAL; I) APPROVE, UPON RECOMMENDATION OF THE NOMINATING COMMITTEE AS PROVIDED IN THESE BYLAWS, THE MEMBERS OF THE BOARD OF DIRECTORS OF HOSPITAL; J) APPROVE ANY MANAGEMENT AGREEMENT FOR THE MANAGEMENT OF ALL OR A SUBSTANTIAL PART OF HOSPITAL'S OR ANY OF ITS AFFILIATE'S OPERATIONS; AND K) APPROVE ANY ACTION TO TERMINATE ACUTE CARE SERVICES OR TO CLOSE THE HOSPITAL OWNED BY THE SOLE MEMBER. Form 990, Part VI, Line 11b Review of form 990 by governing body THE VP & CFO REVIEWED AND APPROVED THE FORM 990. FOLLOWING THE VP & CFO'S REVIEW AND APPROVAL, A COMPLETE COPY OF THE FORM 990 WAS MADE AVAILABLE TO EACH BOARD MEMBER PRIOR TO ITS FILING. EACH MEMBER WAS ALSO INFORMED OF THE AVAILABILITY OF IU HEALTH'S TAX DEPARTMENT TO ANSWER ANY QUESTIONS. Form 990, Part VI, Line 12c Conflict of interest policy IU HEALTH PAOLI 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 IU HEALTH PAOLI'S REGIONAL PRESIDENT IS EMPLOYED BY IU HEALTH. IU HEALTH'S PROCESS FOR DETERMINING COMPENSATION IS AS FOLLOWS: (1) THE BOARD OF DIRECTORS ("BOARD") HAS ESTABLISHED A TALENT MANAGEMENT AND EXECUTIVE COMPENSATION COMMITTEE ("TMECC"), THE PURPOSE OF WHICH INCLUDES REVIEWING AND MAKING RECOMMENDATIONS REGARDING EXECUTIVE 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 SULLIVAN COTTER. SULLIVAN COTTER 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. SULLIVAN COTTER THEN PREPARES A SURVEY REPORT AND PROVIDES RECOMMENDATIONS TO THE TMECC, IF DEEMED APPROPRIATE, ON CHANGES IN EXECUTIVE COMPENSATION. A SEPARATE ANALYSIS USING THE SAME METHODOLOGY IS DONE FOR THE PRESIDENT AND CHIEF EXECUTIVE OFFICER. (3) THE TMECC THEN REVIEWS SULLIVAN COTTER'S REPORT AND RECOMMENDATIONS AND, IF APPROPRIATE, VOTES ON WHETHER TO RECOMMEND ANY CHANGES IN EXECUTIVE COMPENSATION TO THE BOARD. THE TMECC WILL ONLY RECOMMEND CHANGES TO THE BOARD IF THEY ARE CONSISTENT WITH THE BOARD'S PHILOSOPHY ON COMPENSATION MATTERS AND ARE DEEMED REASONABLE BASED UPON THE INDEPENDENT ANALYSIS PROVIDED BY SULLIVAN COTTER. THE TMECC'S REVIEW, DISCUSSION AND VOTE ARE DOCUMENTED IN THE MINUTES FOR THE MEETING. THERE ARE NO EXECUTIVES PRESENT DURING THE FINAL DISCUSSION AND APPROVAL. (4) THE BOARD THEN REVIEWS THE REPORT PREPARED BY SULLIVAN COTTER AS WELL AS THE RECOMMENDATIONS OF THE TMECC AS TO ANY CHANGES IN EXECUTIVE COMPENSATION. AS DEEMED APPROPRIATE, THE COMMITTEE ON FINANCE MAY ALSO PROVIDE ITS REVIEW OF THE TMECC'S RECOMMENDATIONS ON ANY CHANGES IN EXECUTIVE COMPENSATION. THIS REVIEW AND DISCUSSION ARE DOCUMENTED IN THE MINUTES. (5) THE BOARD THEN VOTES ON WHETHER TO ACCEPT THE TMECC'S RECOMMENDATIONS ON ANY CHANGES IN EXECUTIVE COMPENSATION. CHANGES IN EXECUTIVE COMPENSATION ARE MADE IF APPROVED BY THE TMECC AND BOARD ON AN ANNUAL BASIS, OR AS NECESSARY THROUGHOUT THE YEAR. THE DISCUSSION AND APPROVAL ARE DOCUMENTED IN THE MINUTES OF THE MEETING. THERE ARE NO EXECUTIVES PRESENT DURING THE FINAL DISCUSSION AND APPROVAL. IU HEALTH'S GENERAL COUNSEL ALSO PREPARES A FORMAL WRITTEN OPINION REVIEWING THE EXECUTIVE COMPENSATION APPROVAL PROCESS, COMPARING IT TO THE INTERMEDIATE SANCTIONS TEST OF IRC SECTION 4958. IF WARRANTED, IU HEALTH'S GENERAL COUNSEL MAY ALSO PROVIDE COMMENTS REGARDING THE EXECUTIVE COMPENSATION APPROVAL PROCESS AS IT RELATES TO MEETING THE REQUIREMENTS FOR A REBUTTABLE PRESUMPTION OF REASONABLENESS AS PROVIDED IN THE INTERMEDIATE SANCTIONS TEST. (6) AFTER THE END OF EACH YEAR, THE TMECC AND BOARD ALSO REVIEW THE ACHIEVEMENTS OF THE EXECUTIVE GROUP AS IT RELATES TO THE LONG-TERM AND SHORT-TERM SHARED AND INDIVIDUAL GOALS DEVELOPED BY THE EXECUTIVES AND THE BOARD. THESE ACHIEVEMENTS MAY ALSO BE REVIEWED WITH THE COMMITTEE ON FINANCE. THE BOARD, AT ITS DISCRETION, MAY APPROVE BONUS PAYMENTS BASED UPON THE ACHIEVEMENT OF THE GOALS. THE DISCUSSION AND VOTE OF THE TMECC AND BOARD IS DOCUMENTED IN THE MINUTES FOR EACH SUCH MEETING. THE BONUSES ARE NOT PAID UNTIL APPROVAL IS MADE BY THE BOARD. (7) THE TMECC AND AUDIT COMMITTEE ALSO REVIEW FORM 990 DISCLOSURES RELATED TO EXECUTIVE COMPENSATION AS WELL AS THE ORGANIZATION'S PRACTICES AND APPROVAL PROCESSES PRIOR TO THE FILING OF THE FORM 990 RETURN WITH THE INTERNAL REVENUE SERVICE. Form 990, Part VI, Line 15b Process to establish compensation of other employees IU Health Paoli, and other related entities have a process in place to determine the compensation for the officers and key employees. IU Health Human resources use 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 ranged 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 PAOLI'S ARTICLES OF INCORPORATION ARE AVAILABLE FOR PUBLIC INSPECTION THROUGH THE INDIANA SECRETARY OF STATE'S WEBSITE. IU HEALTH PAOLI'S CONFLICT OF INTEREST PROCEDURES ARE DESCRIBED ON FORM 990, SCHEDULE O. IU HEALTH PAOLI 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 PAOLI'S FORM 990. Form 990, Part IX, Line 11g Other Fees Professional fees - Total Expense: 256935, Program Service Expense: 239687, Management and General Expenses: 17248, Fundraising Expenses: ; Other Fees - Total Expense: 53652, Program Service Expense: 50050, Management and General Expenses: 3602, Fundraising Expenses: ; Consulting - Total Expense: 69936, Program Service Expense: 65241, Management and General Expenses: 4695, Fundraising Expenses: ; Intercompany fees - Total Expense: 9684596, Program Service Expense: 9034471, Management and General Expenses: 650125, Fundraising Expenses: ; Contract service - Total Expense: 1045768, Program Service Expense: 975566, Management and General Expenses: 70202, Fundraising Expenses: ; Physician Fees - Total Expense: 25120, Program Service Expense: 23434, Management and General Expenses: 1686, Fundraising Expenses: ; INDIANA HEALTH INFO EXCHANGE INC 846 N SENATE AVE INDIANAPOLIS IN 46202 364550324 HEALTHCARE IN 501(c)(3) Type I na false INDIANA UNIVERSITY 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