2025-11-13T14:22:21+00:00 2024-12-31 990 2024-01-01 351814660 Indiana University Health West Hospital Inc INDI 3179634842 950 N MERIDIAN STREET 1200 INDIANAPOLIS IN 46204 Frank Runion VP & CFO 2025-11-13 2024 2025-03-06 01:10:19Z KENNETH D PUCKETT 950 N MERIDIAN STREET 1200 INDIANAPOLIS IN 46204 392757760 false X SEE SCHEDULE O X 1990 IN Lead the transformation of healthcare through quality, innovation & education, and make Indiana one of the nation's healthiest states. 8 8 1682 294 0 365849 329942 357337778 364439191 24444643 27338831 1240930 649796 383389200 392757760 140400 158362 0 105750790 114659665 0 0 195135237 198222831 301026427 313040858 82362773 79716902 720869351 793291616 25417433 18122793 695451918 775168823 Lead the transformation of healthcare through quality, innovation & education, and make Indiana one of the nation's healthiest states. false false 299422223 158362 362876936 IU HEALTH WEST HOSPITAL IS A 173-BED MULTIDISCIPLINARY HEALTHCARE FACILITY LOCATED IN AVON, IN. THE HOSPITAL OFFERS A FULL RANGE OF SERVICES, INCLUDING MATERNITY, ORTHOPEDICS AND CANCER CARE. BUILT WITH A SPECIFIC GOAL TO MEET THE NEEDS OF OUR PATIENTS, FAMILIES AND VISITORS. IU HEALTH WEST HOSPITAL INCLUDES FEATURES DESIGNED TO ENSURE PRIVACY AND CREATE A QUIET, SOOTHING ATMOSPHERE IN PATIENT SPACES. FROM ALL-PRIVATE ROOMS AND INTIMATE, COMFORTABLE FAMILY WAITING AREAS TO SEPARATE CORRIDORS AND ELEVATORS AWAY FROM PUBLIC SPACES FOR STAFF AND SUPPLY MOVEMENT, IU HEALTH WEST HOSPITAL DELIVERS ON OUR GOALS TO CREATE A HEALING SANCTUARY FOR PATIENTS. 773200 0 937059 IU HEALTH WEST HOSPITAL, INC. RECEIVES RENT FROM A RELATED EXEMPT ORGANIZATION, INDIANA UNIVERSITY HEALTH CARE ASSOCIATES, INC. FOR SPACE IN THEIR MEDICAL OFFICE BUILDING THAT'S CONNECTED TO THE HOSPITAL AND THE ORTHO, SPORT & SPINE CENTER. 515871 0 625196 IU Health West Hospital provides services, which include coordinated activities and polices, to related tax-exempt organizations designed to meet the mission of the Indiana University Health System. 300711294 true true false true false false false false false false true false false true 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 false false false true true true false false true 0 0 1682 true false false false false false false false false false false false false X 8 8 false false false false true true true true true false false false true true true true true true false false false false IN X CRAIG J JONES 3179634842 950 N MERIDIAN ST STE 800 INDIANAPOLIS IN 46204 KENNETH D PUCKETT DIRECTOR / PRESIDENT (ISR) 10.0 45.0 X X 0 1000489 194306 MARSHA A WURSTER Director/Chair (Part Year) 2.0 2.0 X X 0 0 0 MATT MURPHY Director/Vice-Chair (Part Year) 2.0 2.0 X X 0 7000 0 MICHELE M KAWIECKI Director/Chair (Part Year) 2.0 2.0 X X 0 12000 0 CHARLES E SCHALLIOL DIRECTOR (PART YEAR) 2.0 2.0 X 0 2000 0 CLAUDIA J SOMES MD DIRECTOR 2.0 2.0 X 0 7000 0 JAY L HESS MD DIRECTOR 2.0 10.0 X 0 46500 0 MEGAN CRITTENDON MD DIRECTOR 2.0 53.0 X 0 316442 39939 MICHAEL BECHER DIRECTOR (Part Year) 2.0 2.0 X 0 6000 0 MICHAEL TSANGARIS MD DIRECTOR (PART YEAR) 2.0 2.0 X 0 223735 20036 TONY PEARSON DIRECTOR (PART YEAR) 2.0 2.0 X 0 6000 0 CARA L BREIDSTER CFO (ISR) 10.0 45.0 X 0 351618 66113 JENNIFER GIROD Secretary 5.0 45.0 X 0 187201 17775 ATHANASIA S BANICH VP, COO (ISR) 10.0 45.0 X 0 347418 55603 CARRIE WING VP-CNO (ISR) 10.0 45.0 X 0 283501 35494 HARPREETINDER SINGH MD VP-CMO (ISR) 15.0 40.0 X 0 483240 74251 TAMARAH D BROWNLEE REGIONAL VP-HR (ISR) 10.0 45.0 X 0 285807 47003 ANNE K STEGEMOLLER DIRECTOR - PHARMACY 50.0 0 X 204465 0 30856 JAMES R BILLMAN PHARMACIST 50.0 0 X 225750 0 37062 JUAN GUZMAN VP COO (West) 55.0 0 X 373813 0 53949 KAPRI D AMES VP - CNO West 55.0 0 X 250281 0 53164 MARIA CAMACHO CLINICAL NURSE 50.0 0 X 192133 0 56534 ALLISON P EMHARDT Former Officer 5.0 45.0 X 0 214962 46329 ARTHUR VASQUEZ FORMER OFFICER & KEY EMPLOYEE 0.0 55.0 X 0 848653 170264 DEREK E EMPIE FORMER OFFICER 0.0 55.0 X 0 430208 77430 1246442 5059774 1076108 true true false 0 329942 329942 NET PATIENT SERVICE REVENUE 622110 362876936 362876936 SHARED SERVICES 541900 625196 625196 RENT FROM RELATED 501(C)(3) ORGS. 532000 937059 937059 0 0 0 0 364439191 27338831 27338831 577606 577606 0 577606 577606 0 0 All Other Revenue 900099 48858 48858 GIFT SHOP 453220 9693 9693 TELEPHONE 517000 13639 13639 0 0 0 0 72190 392757760 364439191 0 27988627 X 158362 158362 94603490 91413538 3189952 3100258 2995720 104538 10855075 10489051 366024 6100842 5895127 205715 45250 45250 16595 16595 78956827 73802979 5153848 0 340325 340325 1152245 1074895 77350 854406 427203 427203 4519047 4519047 57233 53391 3842 14267770 13595590 672180 1678281 1678281 Drugs and Medical Supplies 63146560 63146560 Bad Debt 10661345 10661345 Hospital Assessment Fee 21512777 21512777 Noncapitalized Equipment 755630 719415 36215 258540 246294 12246 0 313040858 300711294 12329564 0 522650843 0 40223772 44789960 0 0 0 0 7783613 7937969 748190 1422884 312533865 162597491 149462933 149936374 0 0 0 589204429 720869351 793291616 13145339 16102070 0 0 12272094 2020723 25417433 18122793 X 695451918 775168823 695451918 775168823 720869351 793291616 X 79716902 3 X false true true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 16595 16595 false Schedule C, Part II-B, Line 1 DETAILED DESCRIPTION OF THE LOBBYING ACTIVITY IU Health West Hospital paid institutional membership dues to the American Hospital Association ("AHA") and Indiana Hospital Association ("IHA") during 2024 in the amount of $44,373 and $20,336, respectively. Each membership organization notified IU Health West Hospital that a portion of the dues it paid were used for lobbying purposes. The AHA used 32.00%, or $14,199 of 2024 membership dues paid by IU Health West Hospital, for lobbying expenditures. The IHA used 11.78%, or $2,396 of the 2024 membership dues paid by IU Health West Hospital, for lobbying expenditures. The total membership dues paid to these organizations by IU Health West Hospital during 2024 that were attributable to lobbying expenditures was $16,595. 152137696 47983496 104154200 102960 102960 0 106802039 86105088 20696951 53491170 28405947 25085223 149936374 INTERCOMPANY RECEIVABLES (NET) 589204429 589204429 0 Federal Income Taxes 0 INTERCOMPANY PAYABLES (NET) 0 DUE TO THIRD-PARTY PAYERS 1759355 SELF-INSURANCE LIABILITIES 261368 2020723 X 0 0 0 0 0 0 0 0 0 0 0 0 Schedule D, Part X, Line 2 FIN 48 (ASC 740) footnote IU Health West Hospital is a subsidiary in IU Health's 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 which, as of December 31, 2024, and 2023, 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, 2024, and 2023, the Indiana University Health System had gross deferred tax assets of $110,705,348, and $141,386,173, respectively, relating to net operating loss carryovers. Indiana University Health West Hospital, Inc.'s portion of the December 31, 2024, and 2023 deferred tax assets is $0 and $0 respectively. Management determined that a full valuation allowance at December 31, 2024 and 2023 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 $30,681,000. At December 31, 2024, Indiana University Health System has available net operating loss carryforwards of $445,118,000, Indiana University Health West Hospital, Inc.'s portion is $0. Net operating losses generated from 2005 through 2017 will expire between 2025 and 2037. Net operating losses generated after 2017 do not expire. true true X true X 300 false 11129 7552239 7552239 0.02498 15956 63174627 45902030 17272597 0.05712 0 0.0 0 27085 70726866 45902030 24824836 0.08210 6 1667 1646184 1646184 0.00544 2 199 417886 417886 0.00138 1 496 1816993 933496 883497 0.00292 0 0.0 2 19260 354323 158362 195961 0.00065 11 21622 4235386 1091858 3143528 0.01040 11 48707 74962252 46993888 27968364 0.09249 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 1 1 1124 1124 0.00000 0 0.0 0 0.0 0 0.0 1 1 1124 0 1124 0.00000 false 1839082 44639327 54334481 -9695154 X true true 1 1 IU HEALTH WEST HOSPITAL 1111 N RONALD REAGAN PKWY AVON IN 46123 HTTPS://IUHEALTH.ORG/FIND-LOCATIONS/IU-HEALTH-WEST-HOSPITAL 23-003776-1 X X X X IU HEALTH WEST HOSPITAL 1 false false true X X X X X X X X X 24 true false false true X HTTPS://IUHEALTH.ORG/IN-THE-COMMUNITY/COMMUNITY-BENEFIT true 25 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'S 2024 COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) REPORTS INCLUDE PRIORITIZED DESCRIPTIONS OF SIGNIFICANT HEALTH NEEDS IN THE COMMUNITY. THE CHNA REPORTS IDENTIFIED THE FOLLOWING NEEDS TO BE ADDRESSED: - Access to healthcare services - Aging population and needs of older adults - Behavioral health (mental health and substance abuse) - Chronic disease prevention and management - Maternal and infant health and child well-being - Smoking, vaping and tobacco use - Social determinants of health (SDOH) Schedule H, Part V, Section B, Line 5 Facility , 1 Facility , 1 - IU Health West Hospital. In conducting each its most recent CHNA, IU Health West Hospital took into account input from persons who represent the broad interests of the communities it serves by hosting six community focus groups and three interviews. 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 West Hospital The defined community per the most recent CHNA is Hendricks and Marion Counties, Indiana. The hospital resides in Hendricks County. Hendricks County - Community Meetings and Interview Two community meetings were held in May 2021 to receive input from stakeholders regarding the health needs in Hendricks County. Secondary data was presented, and each group was asked to discuss their reactions to the data, needs identified from the data, thoughts regarding the causes of the needs, impacts of the COVID-19 pandemic and others. After this discussion, participants were given the opportunity to make additional comments before being asked to select what they believed were the most significant needs in the county. Participants focused discussion on the need for social associations, alcohol abuse and drunk driving, mental health and access to services, costs of care, teen suicide, child abuse and ACEs, housing, elderly needs, health insurance, obesity, physical inactivity, diabetes, transportation, sexual abuse and crisis services, domestic violence, isolation in Hispanic (or Latino) and non-English speaking communities and sex education and contraceptives. From this process, participants identified the following needs as most significant for Hendricks County: * Access to behavioral and mental health services * Substance abuse, including alcohol * Social isolation * Child abuse and teen suicide/self-harm * Obesity and related chronic diseases * Housing access and affordability * Transportation In discussing the impacts of the COVID-19 pandemic, residents identified issues regarding increasing violence and domestic violence, inability to access health and social services, increasing stress on caregivers, increased community togetherness, increasing telehealth services and food insecurity. A survey was also issued to internal providers at IU Health that serve Hendricks County, asking them to identify priority needs among the patients they serve. The following issues were identified as the most significant: * Substance abuse access to treatment * Mental health and access to mental health services * Obesity and education on healthy eating The survey also asked about the impacts of the COVID-19 pandemic. Issues most often selected as significant impacts include: * Social isolation and loneliness * Lack of access to healthcare services An additional interview was conducted with a representative of the local public health department to obtain subject-matter expertise into the health needs in Hendricks County. The following issues were discussed as significant: * Mental health is the greatest health need in Hendricks County, and access to mental health services and integration into primary care is needed for complete healthcare * Obesity is an issue, influenced by a lack of physical activity and places to exercise * Smoking and tobacco usage is still a need, including the use of e-cigarettes * Alcohol abuse is a significant concern * Access to affordable housing is difficult for many * Transportation is a barrier, with few public options * Insurance and costs of care are two of the largest barriers to accessing healthcare * Elderly needs are significant, particularly transportation to medical care from rural areas In regard to the COVID-19 pandemic, a wide array of impacts was noted, including: Alcohol abuse has likely increased Mental health needs have increased greatly due to stress and impacts of isolation Marion County - Community Meetings and Interviews In collaboration with other local health systems - Ascension St. Vincent and Community Health Network - four community meetings were held in May 2021 to receive input from stakeholders regarding the health needs in Marion County. 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 their reactions, additions to the proposed needs, thoughts regarding the causes of the needs, impacts of the COVID-19 pandemic and others. After this discussion, participants were given the opportunity to make additional comments before being asked to vote on what they believed were the most significant needs in the county. Participants were asked to choose three to five significant health needs via an online poll during and after the meeting. Preliminary needs identified include a wide-array of topics, including COVID-19, food insecurity, maternal and child health, racial and ethnic disparities, mental health and access to mental health providers, obesity and physical inactivity, poverty, educational achievement, housing, crime and community safety, public health funding and others. In addition to these topics, participants focused discussion around substance abuse and treatment, transportation barriers, culturally appropriate care and services (including language barriers), affordability of healthy food, smoking and tobacco use, access to and cost of primary care, health insurance, preventive health services, lack of providers within high-need areas, childcare, chronic conditions (including diabetes and hypertension), navigating existing resources, dental health needs, child health, job opportunities and trainings, technology barriers and digital-divide, post-incarceration resources and social connectedness. For those unable to attend community meetings, a separate survey was distributed to receive their input into the most significant needs. These findings were combined with those of the community meeting participants. From this process, participants identified the following needs as most significant for Marion County: * Racial and ethnic health disparities * Access to mental and behavioral healthcare services * Food insecurity and access to affordable, healthy food * Access to safe and affordable housing * Mental health * Poverty and associated community need A survey was also issued to internal providers at the Academic Medical Center, asking them to identify priority needs among the patients they serve. Among 12 responses, the following issues were identified as the most significant: * Food insecurity and nutrition * Health disparities, particularly for racial and ethnic minority populations * Mental health * Poverty and income inequality The survey also asked about the impacts of the COVID-19 pandemic. Issues most often selected as significant impacts include: * Social isolation and loneliness * Health disparities * Digital divide (lack of internet or device access) * Economic disparities * Housing (inability to stay sheltered, pay rent or mortgage) Two additional interviews were conducted with representatives of a local public health department and health equity organization to obtain subject-matter expertise into the health needs in Marion County. The following issues were discussed as significant: * Poverty is a significant issue and impacts almost all areas of wellbeing, including housing, accessing health services, nutrition, stress and mental health, chronic disease, transportation and others (the need for a living wage for all residents is significant) * Health disparities are significant, including large disparities in social determinants of health for racial and ethnic minority populations * Health insurance is a significant barrier to optimal health, with restrictions in coverage leading to a lack of preventive health * Mental health is a significant issue, with depression and anxiety both widespread (self-medication through substance abuse is common) * Obesity continues to be an issue, as well as diabetes, with rates increasing for adults * Infant and maternal mortality are significant issues, with social determinants of health impacting access to prenatal care and other needed services * HIV is still a concern, with some hope that the disease can be eradicated within the next decade through modern medicine and available tools such as PrEP (pre-exposure prophylaxis) * Tobacco and vaping are issues, with a low cigarette tax in Indiana perpetuating the issue Schedule H, Part V, Section B, Line 5 Facility , 2 Facility , 2 - IU Health West Hospital (Continued). * Environmental health - including old housing and air pollution - is leading to poor health, including lead poisoning, arsenic poisoning and pediatric asthma (the need for safe and stable housing is significant) * Health literacy is a need, particularly affecting Hispanic (or Latino) populations due to language barriers (education disparities around health are also leading to generational persistence of health disparities for racial and ethnic minority populations) * Food insecurity is significant and food pantries may have irregular hours and face huge demand * Education needs better funding, including adequate teacher compensation * More community collaboration is needed, with health systems and social service providers sitting at the same table to talk about community improvement and planned interventions In regard to the COVID-19 pandemic, a wide array of impacts were noted, including: * Testing was a large challenge throughout the beginning of the pandemic, due to inadequate federal resources and other limits * The pandemic highlighted the impact of social determinants of health, as homeless populations faced huge concerns due to inability to socially distance in shelters and access care (hotels were turned into isolation areas for patients with COVID-19) * Racial and ethnic disparities in testing, treatment and outcomes were highlighted by the pandemic (elderly Black residents were particularly affected) * Care was delayed for a lot of individuals due to fear of going to a provider and being exposed to the virus, leading to unmet needs and emergency situations * Community collaboration among providers led to a better response, including health systems offering testing and other aid to public health organizations (more collaboration and coordination will be needed in the future) * Vaccination disparities are evident, with Black populations disproportionately unable to access the vaccine if desired * The need for better health information sharing (including the identification of health disparities) between organizations Community meeting and survey participants Individuals from a wide variety of organizations and communities participated in the interview process, community meetings and surveys. Participants included representatives from the following organizations: * Allen Chapel AME Church * Anthem * Anthem Medicaid * Ascension St. Vincent * Aspire Indiana * Health Avon Education Foundation * Avon Community School Corporation * Broadway United Methodist Church * Brownsburg Education Foundation * Care to Change Counseling * Central Indiana Council on Aging (CICOA) * City of Indianapolis * City-County Council staff * City of Indianapolis, Division of Community Nutrition and Food Policy * Coalition for Our Immigrant Neighbors * Coburn Place * Community Action of Greater Indiana * Community Health Network * Concerned Clergy of Indianapolis * Connections IN Health, Indiana Clinical and Translational Sciences Institute (CTSI), Indiana University School of Medicine * Covering Kids & Families of Indiana * Crossroads AME Church/Common Grounds Institute * Cummins Behavioral Health Systems * First Baptist Church North Indianapolis * Gennesaret Free Clinic * Gleaners Food Bank of Indiana * Habitat for Humanity of Greater Indianapolis * Health by Design * Hendricks County Community Foundation * Hendricks County Economic Development Partnership * Hendricks County Health Department * Hendricks County Health Partnership * Hendricks County Senior Services * Hendricks County Trauma Resource Center * Hendricks Regional Health * HOPE Healthcare Services * Horizon House * Immigrant Welcome Center * Indiana Department of Health * Indiana Division of Mental Health and Addiction * Indiana Legal Services * Indiana Native American Indian Affairs Commission * Indiana Public Health Association * Indiana University Richard M. Fairbanks School of Public Health * Indianapolis City Council * Indianapolis Neighborhood Housing Partnership * Indianapolis Urban League * Indy Go * Indy Hunger Network * IU Health * IU Health Indy Suburban Region * IU Health Methodist Hospital * IU Health University Hospital * IU Health West Hospital * Jump IN for Healthy Kids * Managed Health Services (MHS) * Marion County Public Health Department * Marian University/College of Osteopathic Medicine * Mental Health America of Hendricks County * MSD of Wayne Township * Neighborhood Christian Legal Clinic * New Strength Counselling * Nine13sports * Nurse Family Partnership of Goodwill of Central and Southern Indiana * Pathway to Recovery * Plainfield Schools * Playworks * Prevail, Inc. * Prime Life Enrichment * Purdue Extension * Raphael Health Center, Inc. * Richard M. Fairbanks Foundation * Sheltering Wings * Susie's Place * The Julian Center * The Willow Center * United States Congress, Representative Andre Carson (staff) * University of Indianapolis * United Way of Central Indiana * Wayne Township Education Foundation * YMCA of Greater Indianapolis/Top 10 Coalition Schedule H, Part V, Section B, Line 11 Facility , 1 Facility , 1 - IU Health West Hospital. In April 2025, IU Health's board of directors approved the implementation strategy for IU Health West Hospital to respond to the needs identified in their 2024 CHNA. IU Health West Hospital will address these community health needs in 2025-2027: * Access to healthcare services * Aging population and needs of older adults * Behavioral health (mental health and substance use) * Chronic disease prevention and management * Maternal and infant health and child well-being * Smoking, vaping and tobacco use * Social determinants of health IU Health West Hospital will address all the community health needs identified in the 2024 CHNA. In 2024, IU Health West Hospital addressed needs identified in the 2021 CHNA using the 2022-2024 implementation strategy planned adopted in April 2022. The hospital, along with community partners, prioritized and determined which of the significant needs identified in the CHNA could be adequately addressed by current or future initiatives, programs, resources, and collaborations. The 2022-2024 implementation strategy outlines how IU Health West Hospital planned to address significant needs including initiatives, strategies, internal/external collaborators, anticipated impact, and hospital resources. Significant Needs Hospital Addressed Below was the progress of the implementation strategy by significant need and its respective initiative(s). The hospital addressed 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 * Provided operational funding to support HOPE Healthcare Services. In 2024, IU Health West Hospital provided assistance to HOPE Healthcare Services to support healthcare services for un- and under - insured patients in Hendricks County and the surrounding areas. HOPE Healthcare saw a total of 1,539 patients for services including medical, dental and mental health. 900 patients were from Hendricks County. They had a total of 363 new patients. * Provided free vaccines to vulnerable populations. In 2024, IU Health West administered 77 flu vaccines and 65 COVID-19 vaccines to the Hendricks County area through the execution of a vaccine clinic at the Senior Expo at the Hendricks County Senior Center in Danville. * Supported community members accessing healthcare services regardless of their ability to pay. The hospital provides financial assistance to patients each year that includes discounts, full charity and personal hardship reductions. IU Health Patient Financial Counselors were certified Indiana Navigators. They assisted patients and families with information and helped them with applications for various health coverage programs. In 2024, the counselors served 488 people at IU Health West Hospital. Aging Population and Needs of Seniors * Provided senior-focused programming in the community through a senior health fair. IU Health West Hospital participated in the Senior Expo at the Hendricks County Senior Center in Danville. The expo was a health fair that IU Health West Hospital attended and provided a variety of free services including vaccines, balance screenings, open enrollment information, blood pressure checks and stroke education. In 2024, there were 77 flu shots and 65 COVID-19 boosters administered, in addition, 32 A1c tests, 23 cholesterol tests and 20 balance screenings were conducted. Seven seniors were deemed a "fall risk were given follow up resources. Over 130 seniors attended the event. Behavioral Health * Provided funding to support the efforts of Sheltering Wings in their mission to provide resources and shelter to those affected by domestic violence and supported their educational outreach efforts within the community. In 2024, IU Health West Hospital provided funding to Sheltering Wings. With this support, Sheltering Wings were able to provide safe housing for 260 residents, answer 1,592 help line calls, and helped 94 victims through their mobile advocacy program. In 2024 the number of families who exited to safe housing jumped to 71%, up from 49% in 2023. 83 clients participated in life skills training that covered topics like domestic violence education, financial stability, employment readiness, parenting, conflict resolution, building supported systems, and housing readiness. * Provided funding to support counseling for Susie's Place clients. IU Health West Hospital provided support to Susie's Place, which in 2024 conducted 408 forensic interviews in Hendricks County. The funding primarily supported the family advocate role; the family advocate provides social services to victims and families throughout the process of abuse, investigation and aftermath. Specifically in Hendricks County, the Child & Family Advocate made 143 referrals for mental health services, provided internet safety information 153 times, assisted with 63 Victim Crime Compensation applications, and provided advocacy during prosecution 128 times. * Further implemented the emergency department (ED) virtual care program (provided patients virtual access to behavioral health services). Virtual Integrated Behavioral Health (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 cares, and ambulatory care locations. In 2024, there were over 10,000 visits of which 871 visits included patients seeking care in the emergency departments in the Indy Suburban Region (which included IU Health West Hospital). This program was financially supported by the parent hospital, IU Health Inc., but was offered to and impacts patients in this hospital's defined community. * Funded the SMART (Self-Management And Recovery Training) program. In 2024 addiction and recovery counselors at IU Health West Hospital continued hosting the SMART step program in the community. Once a week, community members who struggled with substance use disorder (SUD) attended the free program to gain the tools and support needed to achieve and maintain abstinence from drugs. Approximately 15 individuals attended the class each week. * Supported Mental Health America of Hendricks County (MHAHC) in their implementation of the Open-Door Social Club program. The Open-Door Social Club was a free program that provides peer support while teaching daily living activities, computer literacy and healthy coping skills. The Open-Door Social Club aimed to reduce hospitalizations, incarcerations and costly alternative treatments while improving mental and physical health along with social well-being. The club accepts veterans and patients receiving behavioral health treatment. In 2024, they had an average of 7.9 participants in their daily programming. Club members also had access to a computer lab, music and art expression areas, educational classes, a library, a food pantry and were also served a hot meal. Over 936 hot meals were served. 179 resource referrals were made and 1,862 direct to mental health consumer contact hours were recorded. Chronic Disease and Chronic Disease Management * Provided Hendricks County residents with a free 10-week program to improv their overall health through fitness and nutrition. In 2024, 29 Hendricks County community members completed the Fresh & Fit program. 86 percent of participants lowered their blood pressure and 57% lowered their triglycerides at completion of the program. 67% of participants with high A1c (greater than 6.5) levels lowered their number. In addition, a total of 186.4 pounds (an average of 7 pounds per person) was lost between pre-program and post-program. On post-program assessments, 100 percent of participants reported that they planned to further implement healthy habits by continuing a fitness and nutrition regimen into the future. Schedule H, Part V, Section B, Line 11 Facility , 2 Facility , 2 - IU Health West Hospital (Continued). * Further implemented IU Health Serves Days of Service (volunteer event that engaged IU Health team members in activities that benefit the community). IU Health West Hospital participated in the annual Days of Service with a total of five projects. These projects were a mixture of on-site, take-home and in the community. Projects for 2024 included team members removing invasive plants and shrubs at Williams Park in Brownsburg, assembling dental hygiene kits for Hope Healthcare, painting at Family Promise of Hendricks County, creating bookmarks for the annual Avon school supply drive and assembling meals for the Million Meals project that were donated to local food pantries. 212 team members put in a combined 446 hours of volunteer work during the Days of Service. * Continued support of the B&O trail expansion through Hendricks County. IU Health West Hospital continued its promise to support the state grant to fund the ten-mile trail expansion through Hendricks County. Once completed the trail would allow a bicyclist to ride from downtown Indianapolis through Hendricks County. Currently, over eight miles had been built. The end goal of the trail was to span 60 miles to the state line, including a wildlife corridor and incorporate equestrian trails. Maternal and Infant Health and Child Well-being * Provided free child safety seat education. IU Health West Hospital had funds set aside for child safety seat education. Currently, IU Health West Hospital offers childbirth education classes as part of the IU Health system. Smoking, Tobacco Use and Exposure to Secondhand Smoke * Supported the Hendricks County Health Partnership (HCHP) to expand outreach efforts and promote tobacco cessation resources in the community. In July 2024, the Hendricks County Health Partnership distributed approximately 50 tobacco cessation brochures to the community and throughout the entire year, distributed 400 community resource guide cards. In September, they launched and promoted CredibleMind - a mental health platform with resources related to tobacco use and mental health. They also distributed QuitNow and Live Vape Free referral cards at the Brownsburg Public Library's Community Day and the Hendricks County National Night Out events in September and October. In November they presented to three Plainfield High School classes on the science behind addiction and recovery, including nicotine and vaping products. * Further implemented the Centralized Tobacco Treatment Program (CTTP) (provided patients access to evidence-based tobacco treatment). The CTTP program was free to IU Health Primary Care patients. Once a patient's level of care was assessed, they were provided evidence-based tobacco cessation treatment with a trained Tobacco Treatment Specialist (TTSs). Patients had access to Ex, a new digital cessation app, and support from an Advance Practice Provider (APP) who evaluated and prescribed medication assisted therapy (MAT) for nicotine replacement. Education and support were provided to primary care practices which helped to expand services. Cross-functional teams worked together, including the West Central Region TTSs for case conferencing and training. One focus in 2024 was on improving access and patient experience with medication management. CTTP improved patient tobacco treatment medication supported by integrating systems and processes with a dedicated APP resource. They improved documentation to accurately report MAT, demonstrating 73% of patients used NRT/medication to quit. 362 medication management sessions were scheduled compared to 263 in 2023. 75% of patients completed their appointment with the APP. In 2024, the team had been trained to complete prior authorizations. The team focused on care continuation, care coordination (TTS/APP), scheduled patient follow-up appointments, and monitored adherence or complications. A focus on improving patient experience resulted in strong and consistent quit rates of 37% of active patients (increased from 33% in July 2024) and harm reduction (patients who reduced use of tobacco) of 61% (July 2022-December 2024). This was an increase from 56% in July. The team received frequent testimonials of lives changed and gratitude for a supportive, compassionate partner. There were 73 patients connected to Ex for additional nicotine cessation supported. In 2024, CTTP received 1,767 referrals which was an all-time high for the program, scheduled 47% of them and completed at least one session with 67% of those scheduled. Additionally, 70% of patients seen completed two or more sessions. Over the program's life, CTTP had received 3,921 patient referrals (this information cannot be separated by hospital or region at this time). Social Determinants of Health * Provided educational programming for children through Kindergarten Countdown (a summer program designed for kindergarteners in families with lower incomes to get them prepared for the fall semester). In 2024, IU Health West Hospital provided funding to Avon Community Schools to run their Kindergarten Countdown program. This program provided a three-week summer camp for students identified as academically low and needing additional support before starting kindergarten. The funding went towards teacher salaries, student meals, curriculum and books. New for 2024, students facing a transportation barrier were provided with a school bus to take them to and from school each day. 18 students completed the program. * Provided vouchers to residents to purchase healthy produce at Farmers Markets and funded local food pantries (food insecurity). Supported Women, Infants, and Children (WIC) and Supplemental Nutrition Assistance Program (SNAP) acceptance at all county farmers' markets funded Double Up Bucks program to increase the value of vouchers for participants. IU Health West Hospital funded the Double Up Bucks program in 2024 to provide more farmers market spendable dollars to those in need. Double Up checks were printed for $5 each and WIC participants each received 9 checks for a total of $45 per household. All 900 checks were distributed to 100 households. There were 467 checks that were deposited by produce market vendors. In turn, $2,335 was redeemed for local produce and free to the WIC participants. This year saw a significant increase in redemption rate from 2023; there were 250 more checks redeemed in 2024. Additionally, $649 of the total $3,883.66 budget was utilized on Sprouts Bucks, another nutrition incentive program at the Plainfield farmer's market. 100% of that funding was redeemed for produce, eggs, and honey. IU Health West Hospital provided a food pantry grant to the Hendricks County Food Pantry Coalition to help address the food disparity needs within the community. The funds were used to stock 18 local food pantries with food and hygiene items. IU Health West Hospital also partnered with the food pantries to provide free blood pressure screenings and monitors to pantry goers. * Provided transitional housing through IU Health's Community Impact Investment fund (CIIF). In 2023, IU Health's CIIF funded awarded Volunteers of America a grant to provide transitional housing and recovery support to pregnant women and young mothers who were suffering from substance use disorder. Focused on Hendricks and western Marion counties, the program would help to reduce addictions and help these women to find stable housing, income and improved their mental health and social relationships. Groundbreaking for the Legacy Recovery House occurred on June 25, 2024, and it would be located adjacent to Winding Way Townhomes, a new affordable housing community for families and individuals, which also broke ground on June 25. The Legacy Recovery House featured three, three-bedroom duplexes, for women recovering from substance use disorder. Moms would be able to stay with their children while continuing to receive wrap-around services during their recovery. The Winding Way community would feature 22, one- two- and three-bedroom units that would end homelessness for individuals and families in the community. Schedule H, Part V, Section B, Line 11 Facility , 3 Facility , 3 - IU Health West Hospital (Continued). Significant Needs Hospital Did Not Address IU Health West Hospital did not address the following significant needs between 2022 and 2024: Health Education and Navigation Health Education and Navigation refers to services and resources that were available in the community, but people did not know how to get connected to them (e.g., how to obtain health insurance, understanding insurance benefits, navigating the healthcare system, language barriers and health literacy). IU Health West Hospital perceived this health need as being addressed under many initiatives that fall under the significant needs that the hospital was currently addressing. IU Health West Hospital would monitor this need to see if there are changes or opportunities in the future to address it further. Schedule H, Part V, Section B, Line 13 Facility , 1 Facility , 1 - IU HEALTH WEST HOSPITAL. IN ADDITION TO FPG, IU HEALTH WEST HOSPITAL 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 WEST HOSPITAL. IU Health West Hospital takes into consideration several other factors in determining patient eligibility for financial assistance. These factors include the following: 1. Financial Assistance due to Financial Hardship A. To be eligible for Financial Assistance due to financial Hardship under this Policy, a patient or guarantor must: a. Submit a completed Financial Assistance Application with all supporting documentation and be approved in accordance with this Policy; b. Be an Indiana Resident as defined in this Policy; and B. If Uninsured, consult with a member of IU Health's Financial Counseling 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. C. Financial Assistance due to financial Hardship is only available for Qualifying Care, as defined in this Policy. D. 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 will treat the adult as a dependent for purposes of the FPL calculation. 2. Financial Assistance due to Personal Hardship A. In order to be eligible for Financial Assistance due to personal Hardship under this Policy, a patient or guarantor must: a. Submit a completed Financial Assistance Application with all supporting documentation and be approved in accordance with this Policy; b. Be an Indiana Resident as defined in this Policy; and c. If Uninsured, consult with a member of IU Health's Financial Counseling 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. B. An Uninsured or Underinsured patient or their guarantor may be eligible for Financial Assistance if the Household's outstanding Patient Responsibility exceeds 5% of the patient's or their guarantor's annual household income. C. If approved, the Household's balance will be reduced to 5% of the patient or guarantor's annual household income. 3. Eligibility Period A. If approved for Financial Assistance by IU Health under Sections IV.E-F, 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. B. As a condition of extending the ongoing Financial Assistance, the patient must comply with requests from IU Health to verify that the patient continues to meet the conditions for qualification. 4. Appeals and Assistance Granted By the Financial Assistance Committee A. 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 request must be submitted, along with any additional information or requested supporting documentation, if applicable. B. The Financial Assistance Committee will review requests for and may grant additional Financial Assistance, including but not limited to, the following: a. 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; b. Care approved by an IU Health Chief Medical Officer (CMO), Chief Executive Officer (CEO) or Chief Financial Off icer (CFO) of an IU Health facility or region, including medically necessary non-elective services for which no payment source can be identified; c. Care provided when it is known no payment source exists; d. Care provided, due to medical urgency, for which a payer denies payment; e. International humanitarian aid; and f. Other care identified by the Financial Assistance Committee that fulfills the IU Health Mission. C. All decisions of the Financial Assistance Committee are final. 5. Presumptive Eligibility A. A Financial Assistance Application is not required to receive Financial Assistance under this Presumptive Eligibility section. B. 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 the patient received Qualifying Care, as defined in this Policy. a. Medicaid (any state) b. Indiana Children's Special Health Care Services c. Healthy Indiana Plan d. Patients who are awarded Hospital Presumptive Eligibility (PE) e. Patients approved for the Eskenazi Health Advantage program f. A state and/or federal program that verifies the patient or guarantor's gross household income meets the FPL income threshold. C. 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. a. IU Health may also periodically conduct a similar review on patient balances not placed with a collection agency, and presumptively quality patients for Financial Assistance. D. 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. 6. Exhaustion of Alternate Sources of Assistance A. Patients may be required to exhaust all other state and federal healthcare coverage assistance programs prior to receiving Financial Assistance due to financial or personal Hardship under this Policy including, but not limited to, Medicaid. B. Patients who may be eligible for coverage under an applicable health insurance policy must exhaust all insurance benefits. a. This includes patients covered under their own policy and those who may be entitled to benefits from a third-party policy. b. IU Health may request patients show proof that such a claim was properly submitted to the appropriate insurance provider before awarding Financial Assistance. C. 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. D. 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. 7. Patient Assets A. 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. B. 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 V, Section B, Line 16 Facility , 1 Facility , 1 - IU HEALTH WEST HOSPITAL. IU Health West Hospital takes several other measures to 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. 4 IU HEALTH WEST CANCER CENTER 1111 N RONALD REAGAN PKWY B1600 AVON IN 46123 Specialty Care IU HEALTH WEST HOSPITAL REHABILITATION SERVICES 1115 N RONALD REAGAN PKWY SUITE MG1 00 AVON IN 46123 Rehabilitation Services IU HEALTH WEST RETAIL PHARMACY 1111 N RONALD REAGAN PKWY M105 AVON IN 46123 PHARMACY IU HEALTH WEST HOSPITAL LAB 1111 N RONALD REAGAN PKWY A1110 AVON IN 46123 LAB Schedule H, Part I, Line 6a C.B. REPORT PREPARED BY A RELATED ORG. IU HEALTH WEST HOSPITAL'S COMMUNITY BENEFIT AND OTHER INVESTMENTS, ENCOMPASSING ITS TOTAL COMMUNITY INVESTMENT, ARE INCLUDED IN THE IU HEALTH COMMUNITY BENEFIT REPORT WHICH IS PREPARED ON BEHALF OF AND INCLUDES IU HEALTH AND ITS RELATED HOSPITAL ENTITIES IN THE STATE OF INDIANA. THE IU HEALTH COMMUNITY BENEFIT REPORT IS MADE AVAILABLE TO THE PUBLIC ON IU HEALTH'S WEBSITE AT HTTPS://IUHEALTH.ORG/IN-THE-COMMUNITY/COMMUNITY-BENEFIT. THE IU HEALTH COMMUNITY BENEFIT REPORT IS ALSO DISTRIBUTED TO NUMEROUS KEY ORGANIZATIONS THROUGHOUT THE STATE OF INDIANA IN ORDER TO BROADLY SHARE THE IU HEALTH STATEWIDE SYSTEM'S COMMUNITY BENEFIT EFFORTS. IT IS ALSO AVAILABLE BY REQUEST THROUGH THE INDIANA STATE DEPARTMENT OF HEALTH OR IU HEALTH. Schedule H, Part I, Line 7f 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 $10,661,345. 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 24.79%. Schedule H, Part II PROMOTION OF HEALTH IN COMMUNITIES SERVED IU Health West 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 West Hospital and its related hospital entities across the state of Indiana ("IU Health Statewide System") investments include economic development efforts across the state, environmental improvement projects, workforce development opportunities, collaboration with like-minded organizations through coalitions that address key issues and advocating for improvements in the health status of vulnerable populations. Several initiatives meet the definition of community benefit and have been reported as such. Coalition Building: IU Health team members participate on the governing boards of nonprofit organizations that seek to increase access to healthcare services, health equity, and advancing public health such as Sheltering Wings and Susie's Place. Additionally, IU Health team members participate in local coalitions to share resources and information as well as improve community and partner capacity to address health needs and advance health equity in the community. Schedule H, Part I, Line 3c Eligibility criteria for free or discounted care IU Health West Hospital uses several factors other than federal poverty guidelines ("FPG") in determining eligibility for free care under its FAP. These factors include the following: 1. Financial Assistance due to Financial Hardship A. To be eligible for Financial Assistance due to financial Hardship under this Policy, a patient or guarantor must: a. Submit a completed Financial Assistance Application with all supporting documentation and be approved in accordance with this Policy; b. Be an Indiana Resident as defined in this Policy; and B. If Uninsured, consult with a member of IU Health's Financial Counseling 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. C. Financial Assistance due to financial Hardship is only available for Qualifying Care, as defined in this Policy. D. 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 will treat the adult as a dependent for purposes of the FPL calculation. 2. Financial Assistance due to Personal Hardship A. In order to be eligible for Financial Assistance due to personal Hardship under this Policy, a patient or guarantor must: a. Submit a completed Financial Assistance Application with all supporting documentation and be approved in accordance with this Policy; b. Be an Indiana Resident as defined in this Policy; and c. If Uninsured, consult with a member of IU Health's Financial Counseling 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. B. An Uninsured or Underinsured patient or their guarantor may be eligible for Financial Assistance if the Household's outstanding Patient Responsibility exceeds 5% of the patient's or their guarantor's annual household income. C. If approved, the Household's balance will be reduced to 5% of the patient or guarantor's annual household income. 3. Eligibility Period A. If approved for Financial Assistance by IU Health under Sections IV.E-F, 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. B. As a condition of extending the ongoing Financial Assistance, the patient must comply with requests from IU Health to verify that the patient continues to meet the conditions for qualification. 4. Appeals and Assistance Granted By the Financial Assistance Committee A. 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 request must be submitted, along with any additional information or requested supporting documentation, if applicable. B. The Financial Assistance Committee will review requests for and may grant additional Financial Assistance, including but not limited to, the following: a. 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; b. Care approved by an IU Health Chief Medical Officer (CMO), Chief Executive Officer (CEO) or Chief Financial Off icer (CFO) of an IU Health facility or region, including medically necessary non-elective services for which no payment source can be identified; c. Care provided when it is known no payment source exists; d. Care provided, due to medical urgency, for which a payer denies payment; e. International humanitarian aid; and f. Other care identified by the Financial Assistance Committee that fulfills the IU Health Mission. C. All decisions of the Financial Assistance Committee are final. 5. Presumptive Eligibility A. A Financial Assistance Application is not required to receive Financial Assistance under this Presumptive Eligibility section. B. 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 the patient received Qualifying Care, as defined in this Policy. a. Medicaid (any state) b. Indiana Children's Special Health Care Services c. Healthy Indiana Plan d. Patients who are awarded Hospital Presumptive Eligibility (PE) e. Patients approved for the Eskenazi Health Advantage program f. A state and/or federal program that verifies the patient or guarantor's gross household income meets the FPL income threshold. C. 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. a. IU Health may also periodically conduct a similar review on patient balances not placed with a collection agency, and presumptively quality patients for Financial Assistance. D. 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. 6. Exhaustion of Alternate Sources of Assistance A. Patients may be required to exhaust all other state and federal healthcare coverage assistance programs prior to receiving Financial Assistance due to financial or personal Hardship under this Policy including, but not limited to, Medicaid. B. Patients who may be eligible for coverage under an applicable health insurance policy must exhaust all insurance benefits. a. This includes patients covered under their own policy and those who may be entitled to benefits from a third-party policy. b. IU Health may request patients show proof that such a claim was properly submitted to the appropriate insurance provider before awarding Financial Assistance. C. 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. D. 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. 7. Patient Assets A. 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. B. 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 10661345 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 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 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. 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. 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 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 $201,699,000 and $95,909,000 in 2024 and 2023, 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 West Hospital Medicare Cost Report. "Allowable costs" for Medicare Cost Report purposes, however, are not reflective of all costs associated with IU Health West Hospital'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 West's participation in Medicare programs would significantly increase the Medicare shortfall reported on Schedule H, Part III, Line 7. IU Health West Hospital'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 West Hospital 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 West Hospital'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 WEST 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 WEST 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 WEST HOSPITAL: Line 16c URL: https://iuhealth.org/pay-a-bill/financial-assistance; Schedule H, Part VI, Line 2 Needs assessment Though IU Health West Hospital believes its CHNA process is comprehensive, the CHNA is done on a triennial basis. Between CHNA cycles, IU Health West 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 West Hospital 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 West Hospital has established a FAP to provide Financial Assistance to Uninsured Patients. IU Health West Hospital is committed to ensuring its patients are compliant with all provisions of the Patient Protection & Affordable Care Act. To that end, IU Health West Hospital 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 West Hospital 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 West Hospital is located in Hendricks County, Indiana, a county located in central Indiana. Based on the most recent Census Bureau statistics, Hendricks County's population is 190,629 persons with approximately 49.7% being female and 50.3% male. Schedule H, Part VI, Line 5 Promotion of community health IU Health West 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 West Hospital extends medical staff membership and clinical privileges to medical and allied health providers who meet the credentialing qualifications as well as any additional standards and rules set forth by its Board for medical staff appointment (in accordance with Indiana state law). Information on privileging and credentialing, including applying for membership, for IU Health West Hospital can be accessed on the IU Health website. A nondiscrimination clause is explicitly stated in IU Health West Hospital credentialing process. 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 2024, IU Health West Hospital's promotion of community health included the following highlights: In 2024, IU Health West Hospital maintained a strong presence across the Hendricks County area and supported numerous not-for-profit agencies including local parks departments, health partnerships, medical and dental clinics that provide care to the un- and under-insured, behavioral health agencies and organizations that provide health and social services to those who are in need. Schedule H, Part VI, Line 6 Affiliated health care system Indiana University Health West 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 15 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 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, conducted, and adopted its own community health needs assessment (CHNA) and implementation strategy. IU Health considered 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 received training in affiliate hospitals. Research conducted by IU School of Medicine faculty gave 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 partnered 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 identified and addressed significant needs unique to the communities they serve. However, some needs were common in communities served by multiple or all affiliate hospitals in the healthcare system and aligned with system priority areas, warranting a system-level strategy. The Community Health Division, along with additional internal partners such as the Office of Health Excellence Research and Engagement (HERE) and the IU Health Foundation, planed and provided technical assistance for system-level strategies that addressed these common needs including tobacco and nicotine cessation, infant and maternal health, hypertension, and social determinants of health. For example, the Community Health Division has launched a community health worker initiative throughout the system in outpatient and inpatient sites that did community outreach as part of the WeCare and iHEART initiatives. Each affiliate hospital collaborated with the Community Health Division to align and activate local resources to support local and system strategies. This benefits the community each affiliate hospital served and worked 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, sought to positively impact the health of communities IU Health affiliate hospitals serve and foster a culture of engagement and social responsibility. Each affiliate hospital coordinated the different initiatives of the program, including Days of Service. This was 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 addressed key social and environmental factors that impact different groups in the communities IU Health serves. Each affiliate hospital and its team members were eligible to pursue this grant opportunity with a community organization. Schedule H, Part VI, Line 7 State filing of community benefit report IN true Volunteers of America Ohio & Indiana 1780 East Broad St Columbus OH 43203 340861121 501(c)(3) 58362 FMV General Support Family Promise of Hendricks County 238 N Vine St Plainfield IN 46168 461733831 501(c)(3) 100000 Not Applicable Community Benefit 2 0 Schedule I, Part I, Line 2 Procedures for monitoring use of grant funds ALTHOUGH IU HEALTH WEST 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. X X X X false true false false false false false true false KENNETH D PUCKETT DIRECTOR / PRESIDENT (ISR) 0 631564 0 258569 0 110356 0 128220 0 66086 0 1194795 0 82802 MEGAN CRITTENDON MD DIRECTOR 0 276381 0 35819 0 4242 0 9436 0 30503 0 356381 0 0 MICHAEL TSANGARIS MD DIRECTOR (PART YEAR) 0 197761 0 20193 0 5781 0 8478 0 11558 0 243771 0 0 ALLISON P EMHARDT Former Officer 0 191788 0 22904 0 270 0 8917 0 37412 0 261291 0 0 DEREK E EMPIE FORMER OFFICER 0 373567 0 55399 0 1242 0 13800 0 63630 0 507638 0 0 CARA L BREIDSTER CFO (ISR) 0 309988 0 39308 0 2322 0 12104 0 54009 0 417731 0 0 JENNIFER GIROD Secretary 0 164135 0 16916 0 6150 0 7241 0 10534 0 204976 0 0 ARTHUR VASQUEZ FORMER OFFICER & KEY EMPLOYEE 0 591884 0 254900 0 1869 0 116832 0 53432 0 1018917 0 0 TAMARAH D BROWNLEE REGIONAL VP-HR (ISR) 0 254100 0 30897 0 810 0 11661 0 35342 0 332810 0 0 ATHANASIA S BANICH VP, COO (ISR) 0 311943 0 34935 0 540 0 12700 0 42903 0 403021 0 0 HARPREETINDER SINGH MD VP-CMO (ISR) 0 427677 0 51321 0 4242 0 13800 0 60451 0 557491 0 0 CARRIE WING VP-CNO (ISR) 0 242073 0 40250 0 1178 0 11456 0 24038 0 318995 0 0 KAPRI D AMES VP - CNO West 225216 0 24562 0 503 0 7086 0 46078 0 303445 0 0 0 JAMES R BILLMAN PHARMACIST 182978 0 30058 0 12714 0 7327 0 29735 0 262812 0 0 0 MARIA CAMACHO CLINICAL NURSE 154192 0 36082 0 1859 0 8046 0 48488 0 248667 0 0 0 JUAN GUZMAN VP COO (West) 267213 0 106168 0 432 0 13800 0 40149 0 427762 0 0 0 ANNE K STEGEMOLLER DIRECTOR - PHARMACY 188160 0 15855 0 450 0 8152 0 22704 0 235321 0 0 0 Schedule J, Part I, Line 3 Arrangement used to establish the top management official's compensation IU Health West Hospital's Regional President is employed by IU Health. IU Health, IU Health West Hospital, and other related entities have a process in place to determine the compensation for the other officers and key employees. IU Health human resources uses market data from multiple compensation experts/vendors who utilize a variety of methods and procedures to obtain compensation ranges for comparable officer and employee positions. This market data and multiple other factors (including market pay benchmarks, internal equity, candidate/employee qualifications & performance, and business needs) are used to recommend compensation ranges for its officers and other employees, which are then used as a guide for setting reasonable compensation by management. Please see schedule O for additional details. Schedule J, Part I, Line 4b Supplemental nonqualified retirement plan KENNETH D. PUCKETT AND ARTHUR VASQUEZ PARTICIPATE IN AN IU HEALTH 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 THIS EXECUTIVE LEAVES PRIOR TO RETIREMENT OR OTHER KEY DATES, THAT BENEFIT MAY BE FORFEITED OR REDUCED. THE EXECUTIVES LISTED ABOVE HAVE AN AMOUNT INCLUDED IN COLUMN C, DEFERRED COMPENSATION, REPRESENTING THE CURRENT YEAR UNVESTED CONTRIBUTIONS MADE UNDER THE SUPPLEMENTAL RETIREMENT PLAN. THESE AMOUNTS WERE NOT PAID TO THESE 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 THESUPPLEMENTAL EXECUTIVE RETIREMENT PLAN: - KENNETH D. PUCKETT: $100,855 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. LINE J - WEB SITE HTTPS://IUHEALTH.ORG/FIND-LOCATIONS/IU-HEALTH-WEST-HOSPITAL SECTION B, LINES 12, 13, 14, AND 16B - POLICIES IU HEALTH WEST HOSPITAL IS PART OF THE IU HEALTH SYSTEM. AS THE SOLE MEMBER AND CONTROLLING PARENT OF IU HEALTH WEST HOSPITAL, IU HEALTH AND ITS BOARD OF DIRECTORS HAVE MANDATED THAT CERTAIN POLICIES BE FOLLOWED TO ENSURE GREATER STANDARDIZATION THROUGHOUT THE SYSTEM. THUS, IU HEALTH WEST HOSPITAL'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 WEST HOSPITAL 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 OF THE IU HEALTH WEST HOSPITAL SHALL CONSIST OF UP TO FIFTEEN (15) VOTING MEMBERS ALL APPOINTED BY IU HEALTH, WHO SHALL INCLUDE REPRESENTATIVES FROM THE MEDICAL STAFFS OF IU HEALTH NORTH HOSPITAL AND IU HEALTH WEST HOSPITAL, AND THE PRESIDENT OF THE INDIANAPOLIS SUBURBAN REGION, WHO SHALL BE AN EX-OFFICIO, VOTING DIRECTOR OF THE BOARD. AT ALL TIMES, THE IU HEALTH NORTH HOSPITAL DIRECTORS SHALL CONSIST OF THE SAME INDIVIDUALS APPOINTED BY IU HEALTH TO SERVE AS DIRECTORS OF IU HEALTH NORTH HOSPITAL. Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders THE BOARD OF DIRECTORS SHALL NOT, WITHOUT THE PRIOR APPROVAL OF THE IU HEALTH: - ANY PROPOSED AMENDMENT TO THE CORPORATION'S ARTICLES OF INCORPORATION OR THESE BYLAWS; - ADOPTION OF THE CORPORATION'S ANNUAL CAPITAL AND OPERATING BUDGETS; - APPROVAL OF ANY UNBUDGETED OPERATING OR CAPITAL BUDGET ITEMS OR DEVIATIONS, INCLUDING ANY ISSUANCE OR GUARANTEE OF ANY UNBUDGETED DEBT; - APPROVAL OF ANY STRATEGIC PLAN FOR THE CORPORATION, INCLUDING ANY AMENDMENTS TO A STRATEGIC PLAN; - APPROVAL OF ANY ENCUMBRANCE, SALE OR CONVEYANCE OF ASSETS; - ANY MERGER, CONSOLIDATION, JOINT VENTURE OR AFFILIATION INVOLVING THE CORPORATION OR ANY OF ITS AFFILIATES AND ANY OTHER ENTITY; - APPOINTMENT AND REMOVAL OF THE CORPORATION'S PRESIDENT AND OTHER OFFICERS; - CONSTRUCTION, ACQUISITION OR LEASE OF HOSPITAL BUILDINGS; - APPROVE ANY MANAGEMENT AGREEMENT FOR THE MANAGEMENT OF ALL OR SUBSTANTIAL PART OF IU HEALTH WEST HOSPITAL'S OPERATIONS; - PROJECTS OR CONTRACTS THAT REQUIRE MEMBER APPROVAL IN ACCORDANCE WITH THE MEMBER'S RESOLUTION AND POLICY GOVERNING SYSTEM-WIDE CONTRACT EXECUTION AUTHORITY AND PAYMENT APPROVAL LIMITS; AND - THE DISSOLUTION OF THE CORPORATION OR ANY OF ITS AFFILIATES. Form 990, Part VI, Line 11b Review of form 990 by governing body THE CFO REVIEWED AND APPROVED THE FORM 990. FOLLOWING THE CFO'S REVIEW AND APPROVAL, A COMPLETE COPY OF THE FORM 990 WAS MADE AVAILABLE TO EACH BOARD MEMBER PRIOR TO ITS FILING. EACH MEMBER WAS ALSO INFORMED OF THE AVAILABILITY OF IU HEALTH'S TAX DEPARTMENT TO ANSWER ANY QUESTIONS. Form 990, Part VI, Line 12c Conflict of interest policy IU HEALTH WEST HOSPITAL 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 19 Required documents available to the public IU HEALTH WEST HOSPITAL'S ARTICLES OF INCORPORATION ARE AVAILABLE TO THE PUBLIC THROUGH THE INDIANA SECRETARY OF STATE'S WEBSITE. IU HEALTH WEST HOSPITAL'S CONFLICT OF INTEREST POLICY IS DESCRIBED ON FORM 990, SCHEDULE O. IU HEALTH WEST HOSPITAL IS A CONSOLIDATED SUBSIDIARY IN THE CONSOLIDATED FINANCIAL STATEMENTS FOR IU HEALTH. THE CONSOLIDATED FINANCIAL STATEMENTS FOR IU HEALTH ARE AVAILABLE TO THE PUBLIC THROUGH ITS BOND FILINGS AND AS AN ATTACHMENT TO THE FORM 990 AS WELL AS IU HEALTH WEST'S FORM 990. Form 990, Part IX, Line 11g Other Fees Professional fees - Total Expense: 345960, Program Service Expense: 322736, Management and General Expenses: 23224, Fundraising Expenses: ; Consulting - Total Expense: 249768, Program Service Expense: 233001, Management and General Expenses: 16767, Fundraising Expenses: ; Intercompany fees - Total Expense: 71544926, Program Service Expense: 66888637, Management and General Expenses: 4656289, Fundraising Expenses: ; Physician fees - Total Expense: 134193, Program Service Expense: 125185, Management and General Expenses: 9008, Fundraising Expenses: ; Contract service - Total Expense: 6569637, Program Service Expense: 6128619, Management and General Expenses: 441018, Fundraising Expenses: ; Other Fees - Total Expense: 112343, Program Service Expense: 104801, Management and General Expenses: 7542, Fundraising Expenses: ; Form 990, Part XI, Line 9 Other changes in net assets or fund balances Rounding - 3; Total - 3; INDIANA HEALTH INFO EXCHANGE INC 846 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