2025-11-13T14:19:33+00:00 2024-12-31 990 2024-01-01 822736786 Indiana University Health Jay Inc INDI 3179634842 950 N MERIDIAN STREET 1200 INDIANAPOLIS IN 46204 Michael L Craig VP & CFO 8123539171 2025-11-13 2024 2025-03-06 01:10:19Z JEFFREY C BIRD 950 N MERIDIAN STREET 1200 INDIANAPOLIS IN 46204 45014314 false X SEE SCHEDULE O X 2017 IN Lead the transformation of healthcare through quality, innovation & education, and make Indiana one of the nation's healthiest states. 16 12 230 93 0 215326 448364 39213833 44523214 -358298 -81855 68235 42736 39139096 44932459 1454 0 0 15829624 18897011 0 0 29111728 27742191 44942806 46639202 -5803710 -1706743 23735523 23936360 20498176 22405755 3237347 1530605 Lead the transformation of healthcare through quality, innovation & education, and make Indiana one of the nation's healthiest states. false false 44607192 0 44493226 INDIANA UNIVERSITY HEALTH JAY IS A 25-BED CRITICAL ACCESS HOSPITAL THAT OFFERS A COMPREHENSIVE RANGE OF SERVICES TO CARE FOR ITS PATIENTS WITHOUT REGARD TO THEIR ABILITY TO PAY. IU HEALTH JAY IS PART OF THE INDIANA UNIVERSITY HEALTH SYSTEM, INDIANA'S LARGEST COMPREHENSIVE HEALTH SYSTEM. IU HEALTH IS DEDICATED TO PROVIDING LEADING-EDGE CARE. OUR UNIQUE PARTNERSHIP WITH THE INDIANA UNIVERSITY SCHOOL OF MEDICINE GIVES OUR HIGHLY SKILLED PHYSICIANS ACCESS TO INNOVATIVE TREATMENTS USING THE LATEST RESEARCH AND TECHNOLOGY. 30065 0 29988 IU HEALTH JAY LEASES PHYSICIAN AND CLINIC SPACE TO RELATED TAX-EXEMPT ORGANIZATIONS. 44637257 true true false true false false false false false false true false false false true true false true false false false false false false false false true true false false true false false false false false false false false false false false false false false false true true true false false true 0 0 230 true false false false false false false false false false false false false X 16 12 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 DANIEL E BORGENHEIMER DIRECTOR/CHAIR 2.0 4.0 X X 0 0 0 J STEVEN RHEA Director/Secretary/Treasurer 2.0 4.0 X X 0 0 0 JEFFREY C BIRD MD DIRECTOR/PRESIDENT (ECR) 10.0 45.0 X X 0 1005128 176317 PETER M VOSS MD DIRECTOR/VICE CHAIR 10.0 45.0 X X 0 544772 67799 WILBUR R DAVIS Director/ Vice Chair 2.0 4.0 X X 0 3000 0 CHARLES R ROUTH MD DIRECTOR 2.0 53.0 X 0 296767 62572 DEA BELL DIRECTOR 2.0 4.0 X 0 6000 0 DERRON L BISHOP PHD DIRECTOR 2.0 4.0 X 0 2000 0 DONALD J ENGEL DIRECTOR (PART YEAR) 2.0 4.0 X 0 0 0 GEOFFREY S MEARNS Director 2.0 4.0 X 0 0 0 JOAN V CASTOR DIRECTOR 2.0 53.0 X 0 644641 136828 KEVIN D WOODGETT DIRECTOR (PART YEAR) 2.0 4.0 X 0 4000 0 MICHAEL J FISHER DIRECTOR 2.0 7.0 X 0 0 0 PATRICK A CLEARY MD DIRECTOR 2.0 4.0 X 0 4000 0 TERRY W BAILEY DIRECTOR 2.0 4.0 X 0 6000 0 WILLIAM W HINKLE DIRECTOR 2.0 4.0 X 0 6000 0 JONATHAN W VANATOR CFO (ECR) (PART YEAR) 10.0 45.0 X 0 468222 65683 MICHAEL L CRAIG CFO (Part Year) 5.0 50.0 X 0 375821 65857 MICHELLE R ALTOBELLA VP-General Counsel, Asst Secretary (ECR) 0.0 57.0 X 0 274361 53284 BRIAN REED VP-HUMAN RESOURCES (ECR) 10.0 45.0 X 0 211282 63512 KREIGH COOK COO (ECR) 15.0 35.0 X 0 307676 43866 MELISSA R HICKS VP & CNO (ECR) 20.0 35.0 X 0 275836 46483 RYAN M JOHNSTON MD VP & CMO (ECR) 10.0 45.0 X 0 446201 79162 CHANTEL S WILLMANN NURSE PRACTITIONER 50.0 0 X 138655 0 23986 CHERI L KNAPKE Manager-Pharmacy 50.0 0 X 159147 0 38267 CHRISTINA SCHEMENAUR VP - CNO - JAY 50.0 0 X 191944 0 30702 DIANE R ROESSNER Pharmacist 50.0 0 X 141436 0 36239 ZINA SPAHR CLINICAL NURSE 50.0 0 X 125396 0 35052 756578 4881707 1025609 true true false 397373 50991 448364 Net Patient Service Revenue 622110 44493226 44493226 Rent from Related 501(c)(3) Orgs. 532000 29988 29988 0 0 0 0 44523214 39724 39724 0 39724 39724 81855 0 -81855 -81855 -81855 All Other Revenue 900099 3012 3012 0 0 0 0 3012 44932459 44523214 0 -39119 X 0 0 0 0 0 0 14227561 13747819 479742 541254 523003 18251 3087125 2983030 104095 1041071 1005967 35104 2348 2348 5836 5836 15303626 14414653 888973 0 16825 16825 144782 135064 9718 108383 54192 54191 2364208 2364208 11261 10505 756 643410 643410 2300193 2191827 108366 270822 270822 Drugs and Medical Supplies 4128162 4128162 Hospital Assessment Fee 2279414 2279414 Other Expenses 144347 137429 6918 Bad Debt 17813 17813 761 761 0 0 46639202 44637257 2001945 0 2658054 2498081 0 761 3082541 4732689 0 0 0 0 409205 366855 78689 137338 34205679 18005043 17507034 16200636 0 0 0 0 23735523 23936360 1682416 1087352 0 0 18815760 21318403 20498176 22405755 X 3237349 1530605 3237349 1530605 23735525 23936360 X -1706743 -1 X false true true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 2348 2348 false Schedule C, Part II-B, Line 1 DETAILED DESCRIPTION OF THE LOBBYING ACTIVITY IU Health Jay, Inc. paid institutional membership dues to the American Hospital Association ("AHA") and Indiana Hospital Association ("IHA") during 2024 in the amount of $6,137 and $3,262, respectively. Each membership organization notified IU Health Jay that a portion of the dues it paid were used for lobbying purposes. The AHA used 32.00%, or $1,964 of 2024 membership dues paid by IU Health Jay for lobbying expenditures. The IHA used 11.78%, or $384 of the 2024 membership dues paid by IU Health Jay, for lobbying expenditures. The total membership dues paid to these organizations by IU Health Jay during 2024 that were attributable to lobbying expenditures was $2,348. 972048 972048 18888952 8665957 10222995 11708252 8960660 2747592 2636427 378426 2258001 16200636 0 Federal Income Taxes 0 Intercompany Payables (Net) 17942266 Due to Third-Party Payers 3376137 21318403 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 Jay 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 Jay, 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 Jay, 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 3349 2272578 2272578 0.04875 5254 11126557 6988261 4138296 0.08876 0 0.0 0 8603 13399135 6988261 6410874 0.13751 8 7478 616560 80266 536294 0.01150 3 240 69070 5000 64070 0.00137 1 2438 1115933 905827 210106 0.00451 0 0 0 0 0 0.0 2 1213 2220 0 2220 0.00005 14 11369 1803783 991093 812690 0.01743 14 19972 15202918 7979354 7223564 0.15494 0 0.0 1 149 1081 1081 0.00002 1 705 15869 15869 0.00034 1 7633 7633 0.00016 0 0.0 1 132 945 945 0.00002 1 232 4351 4351 0.00009 0 0.0 0 0.0 5 1218 29879 0 29879 0.00064 false 6781 10611264 10417443 193821 X true true 1 1 IU HEALTH JAY 500 W VOTAW ST PORTLAND IN 47371 https://iuhealth.org/find-locations/iu-health-jay-hospital 23-005029-1 X X X X IU HEALTH JAY 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 JAY'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 Jay Hospital. IU Health Jay The defined community per the most recent CHNA conducted in the current tax year (i.e., 2024) is Jay County, Indiana, where the hospital resides. This CHNA relies on multiple data sources and community input gathered in January through June of 2024. The CHNA process was completed when the CHNA was made widely available to the public on December 19, 2024. Primary data summary IU Health Jay obtained the insight and views of those who live and service the county through community meetings (including those having public health expertise) and a key informant interview. People and organizations representing a broad range of sectors, services and groups in the community were invited to attend. See Appendix C for a list of the organizations and community members that participated in the community input process. Community meetings In May, IU Health held two community meetings in Jay County to gather input on local health needs. A total of 17 people attended. Participants reviewed secondary data and a draft list of health priorities. They shared reactions, suggested additions, and discussed possible causes of health issues. Key discussion highlights from 2024 include: - Unaddressed trauma is affecting residents' health - Access to primary and specialty care is limited - Access to mental health and substance use treatment is hard due to discomfort with virtual care, providers shortages and limited services - Access to healthcare services is hard due to provider shortages, long wait times, health literacy, broadband gaps, and understanding insurance coverage - Changes in the population and its impact on accessing care - More support for older adults to age in place or seeking assisted living - Challenges recruiting and maintaining skilled maternal healthcare providers - Teen births are common - Accessing dental care is challenging due to provider shortages and lack of insurance coverage - Chronic disease risk factors are widespread in the community - Social determinants of health including no transportation; affordable, healthy food; limited housing options and poverty impact health - A local employer increased services for employees and families, which is positive - There are parks, trails and fitness centers in the community - Partners such as The Jay County Drug Prevention Coalition (JCDPC) help advocate for services and the needs of residents - Programs like Healthy Beginnings and Healthy Families are good for mothers, infants and families - Healthcare staff are appreciated in the community Participants from the community meetings identified the following needs as most significant in Jay County, which are not listed in any order: - Access to healthcare services (especially health literacy, more information on services and programs and language barriers) - Access to mental health and substance use treatment - Maternal and infant health - Smoking - Social determinant of health (especially children living in poverty and the food environment) A representative from the local public health department was interviewed to learn more about the health and well-being of residents in Jay County. The following issues were discussed as significant: - The health status of the community has not changed - There's a need for more healthcare, mental health and substance use services - Dental health in the community is poor - Smoking - Social determinants of health including food insecurity, cost of housing and transportation - A need for good maternal and infant health services - Certain groups face worse health outcomes than the general population. - Purdue Extension, community advocates, faith-based organizations and a mobile market are good community resources Community meeting and survey participants Individuals from organizations representing different sectors and groups within the local community participated in the community input process. Participants included community members and representatives from the following organizations: - Community and Family Services, WIC - FCC Indiana - IU Health - IU Health Jay - Jay Community Center - Jay County Chamber of Commerce - Jay County Commissioners - Jay County Development Corporation - Jay County Drug Prevention Coalition, Inc. - Jay County Emergency Management - Jay County Purdue Extension - JRDS - Pennville Custom Cabinetry - Portland Fire Department - Toddlertown Early Learning Center - Tyson Foods Schedule H, Part V, Section B, Line 11 Facility , 1 Facility , 1 - IU HEALTH JAY HOSPITAL. In April 2025, IU Health's board of directors approved the implementation strategy for IU Health Jay to respond to the needs identified in their 2024 CHNA. IU Health Jay 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 Jay will address all the community health needs identified in the 2024 CHNA. In 2024, IU Health Jay addressed needs identified in the 2021 CHNA using the 2022-2024 implementation strategy plan 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 Jay 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; Smoking, Tobacco Use and Exposure to Secondhand Smoke; and Social Determinants of Health. Access to Healthcare Services * Supported community members accessing healthcare services regardless of their ability to pay. The hospital provided financial assistance to patients each year that included 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 107 people at IU Health Jay. * Implemented Medical provider recruitment plans to address areas experiencing a shortage of primary and specialty care services. In 2024, 26 new physicians were added to the region representing multiple specialties including Neurology, Podiatry, Hematology, Family Medicine, Primary Care, Anesthesiology, Cardiovascular Surgery, Infectious Disease, Hematology/Oncology, Orthopedic Surgery, and Sports Medicine. * Further implemented Healthy Beginnings Program. The Healthy Beginnings navigation program began in the first trimester of pregnancy and continued through the first year of life. Navigators attended appointments with clients and connected them to community resources that addressed social determinants of health. Once the baby was born, navigators continued to engage with families to ensure that postpartum and infant needs were met. The program was open to Jay and Blackford County families. In 2024, the overall HB impact in Blackford County increased enrollments by 106%. 150 families were enrolled in postpartum in 2024. Maternal Navigator cared for 107 patients in 2024 with 718 patient encounters. Infant Navigators had 1,439 encounters in 2024. This included referrals to WIC, childbirth classes, car seat fitting, safe sleep classes, healthy families, tobacco cessation, government assistance programs, family resource center/community partnered and food pantries. Multiple family programs such as diaper events, childhood vaccination event, park health and safety program, and mental health series. 89% of families in the Healthy Beginnings Program adhered to the well-baby appointments and vaccination schedules. * Implemented Mobile Integrated Health Care - Paramedicine. This program was operational in the IU Health East Central Region and included an 80-hour paramedicine training program for Paramedic, EMS and Fire Department personnel; IU Health Paramedic and affiliate EMS organizations deployed at hospital or physician point of care to establish post-discharge care in a six-county area. This team had a total of 781 home visited in 2024 and supported 602 patients enrolled in the Heart/Lung Center, CV Surgery, IMRC, FMRC, Cardiology, and Pulmonology that held a 3.7% overall readmission rate for the year. * Further implemented Infant and Maternal Health Programs, in 2024 a Maternal Navigator served to connect community resources to mothers-to-be; worked with provider teams to optimize prenatal visits, and recognize early maternal warning signs, such as blood pressure and mental health; and further assisted with navigating healthcare, appointments and services. 360 people served. Aging Population and Needs of Seniors * Supported senior-focused programs at local events in the community. In 2024, IU Health partnered with Purdue Extension and the Blackford Community Foundation to purchase equipment for the Blackford Senior Center that provided access to virtual visits and a patient portal for the senior residents of Blackford County. Education on utilizing the new equipment and services was also provided for Blackford residents. Additionally, IU Health teams engaged in support of a community senior health fair organized in Delaware County, and a partnership with Purdue Extension and the Health Department in Jay County to offer hypertension screenings and provide information on health topics for seniors at local food distribution events and community education classes. Many of these connections were made in conjunction with Healthy Community Alliance partnered and resources. Behavioral Health * Further implemented Comprehensive Outpatient Addiction Treatment in Jay County. IU Health Jay Advanced Practice Provider provided services to 300 unique individuals in 2023. These were both SUD and BH patients. This service was available 4 days per week. The primary SUD therapist completed 91 intake sessions, 817 individual therapy sessions, and served 148 individual patients. There were 448 peer recovery sessions completed. In 2024, Naloxone education was completed for multiple departments in IUH, including SPA, Leadership, and multiple Primary Care locations throughout the region. They also provided Narcan training to Core- ECI community group and distributed it at Hope Fest. They have provided Narcan training to additional multiple sites throughout the region including in Delaware and Blackford Counties. A Peer led Compassion Connections support group was held every Tuesday at noon and a SMART Recovery group was started for individuals with substance use disorder. These groups had 346 sessions attended by individuals. They also hosted and co-facilitated a family education and support group using the CRAFT model which hosted 64 sessions attended by individuals. In addition, hosted a Positive Link that tested for HIV and Hep-C in clinics monthly. They assisted with CIT training, Stigma Training for Core-ECI group, Stigma training for local police department, and Stigma presentation at the A Better Life Brianna's Hope 10-year Celebration. In addition, three team members were part of the local CISM team. They serve on the Jay County Drug Prevention Coalition Board, Suicide and Overdose Fatality Review Committee, Child Protection Team, Core-ECI community group, and Systems of Care team all who have a mission to support those with substance use disorder as well as mental health issues. Schedule H, Part V, Section B, Line 11 Facility , 2 Facility , 2 - IU HEALTH JAY HOSPITAL (CONTINUED). * Further implemented the Virtual Care Peer Recovery Coaching Program (provided patients who have substance use concerns with virtual behavioral health services). The Virtual Peer Recovery Coach program was discontinued in February 2023 as IU Health continued to assess and evolve its behavioral health services based on the needs of patients and the communities it served. Since 2018, this program had served 15 IU Health and two non-IU Health emergency department patients who struggled with substance use disorder through support to aid in recovery. IU Health continued to serve patients with a need for this service through the Virtual Behavioral Health team. * Supported the Consortium for Opioids Response and Engagement-East Central Indiana (CORE-ECI). IU Health Jay was part of the Consortium for Opioids Response Engagement which was created to build sustainable consortium of stakeholders to combat the opioid crisis in Blackford and Jay Counties. In 2024, meetings were held to decide the focus of the consortium moving forward, and three project workgroups were created to include: Crisis Intervention Team (40-hour training completed in January 2024), Youth Programming & Intervention and Education/Stigma. Participating organizations included: Purdue University, Jay County Drug Prevention Coalition, Blackford County Community Corrections, Hester Hollis Concern Center and A Better Life Brianna's Hope. Chronic Disease and Chronic Disease Management * Supported the Healthy Community Alliance of East Central Indiana (HCA). Four community workgroups related to increased physical activity, improved nutrition and tobacco prevention and cessation were facilitated by IU Health Community Outreach personnel in a three-county area. Four new community Partners joined the HCA in 2024. Coalition partners collaborated to design a new 1-800 QUIT NOW tobacco cessation toolkit and over 200 were distributed to HCA partners and community members. HCA partners continued to engage with senior, resource limited, minority and faith-based organizations by offering multiple community-based heart health, healthy eating, vaping education, access to care, screening events, healthy eating and food access programs to East Central Indiana in 2024. * Provided outpatient nutrition counseling. No-cost nutrition counselling offered by IU Health Jay team members was promoted utilizing multiple outreach activities and community events during 2024. 213 participants participated in counseling in 2024 in Jay and Blackford Counties. Bariatric and Medical Weight Loss Support Groups were offered 1-2 times per month with 22 participants in 2024. * Further implemented IU Health Days of Service (volunteered at an event engaging IU Health team members in activities that benefit the community). 2024 Day of Service efforts by IU Health Jay team members targeted improvements at the Jay County Drug Prevention Coalition Recovery House. Improvements included painting doors & shutters, power washing, mulching, trimming bushes, constructing a picnic table, flower beds and herb garden. Team members also assembled dignity bags which were distributed to local organizations such as the jail and Youth Service Bureau. Smoking, Tobacco Use and Exposure to Secondhand Smoke * Promoted the use of Quit Now Indiana (1-800 Quit Now). Quit-Now Tobacco toolkits were distributed to community members at health fairs, special events and speaking opportunities in 2024. The Indiana Tobacco Quitline received referrals as follows in 2024: Blackford County, 25 referrals; Delaware County, 136 referrals; Jay County 21 referrals. * 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 support 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 has 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 support. In 2024, CTTP received 1,767 referrals which were 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 has received 3,921 patient referrals (this information cannot be separated by hospital or region at this time). Social Determinants of Health * Advanced community collaborations and interventions with support from the Community Impact and Investment Fund (CII). Information about the 2024 CII funding opportunity was widely shared in the East Central Region. CII funding in the amount of $365,000 was approved to support Nextech for their "Muncie Catapult" proposal which will provide a collaboration between Nextech & TeenWorks to empower underserved teens for postsecondary & career success. * Supported Farmers Market Education Program. Families were engaged at local farmers markets and farmstands in the East Central Region with educational programming related to the nutritional value of fresh produce, selection, reading food labels, and maintaining active lifestyles. Programming also included cooking demonstrations and implementation of IU Health Bucks to encourage increased usage of fresh produce in family meal planning and to incentivize participants to visit a local farmers market. Community partners serving high-needs audiences promoted the program and recruited participants. Nearly 100 families signed up to participate in 2024, and 100% of participating families reported increased knowledge about healthy eating. More than $3,000 of IU Health Bucks were distributed and redeemed for fresh produce through this program. * Assisted community members with accessing health services. Dual language handouts were acquired/developed/utilized in 2024 to promote community events and provide health and wellness information. Significant Needs Hospital Did Not Address IU Health Jay addressed all the significant health needs identified in the 2021 Community Health Needs Assessment. Schedule H, Part V, Section B, Line 13 Facility , 1 Facility , 1 - IU HEALTH JAY. INCOME LEVEL OTHER THAN FPG IN ADDITION TO FPG, IU HEALTH JAY 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 JAY. IU Health Jay 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 Jay 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. 12 IU HEALTH JAY GENERAL SURGERY 510 W VOTAW ST SUITE B PORTLAND IN 47371 SPECIALTY CARE IU HEALTH JAY MULTI-SPECIALTY 510 W VOTAW ST ENTRANCE C PORTLAND IN 47371 SPECIALTY CARE IU HEALTH BALL MEMORIAL CANCER CENTER AT JAY COUNTY 510 W VOTAW ST PORTLAND IN 47371 SPECIALTY CARE IU HEALTH SLEEP DISORDERS CENTER 510 W VOTAW ST PORTLAND IN 47371 SPECIALTY CARE IU HEALTH JAY FAMILY FIRST 500 WEST VOTAW ST ENTRANCE B PORTLAND IN 47371 PRIMARY CARE IU HEALTH JAY FAMILY MEDICINE 430 WEST VOTAW ST PORTLAND IN 47371 PRIMARY CARE IU HEALTH JAY FAMILY PRACTICE 428 WEST VOTAW STREET ENTRANCE 1 PORTLAND IN 47371 PRIMARY CARE IU HEALTH JAY REHABILITATION 500 WEST VOTAW ST PORTLAND IN 47371 REHABILITATION SERVICES IU HEALTH JAY RADIOLOGY 500 WEST VOTAW ST ENTRANCE 1 PORTLAND IN 47371 RADIOLOGY IU HEALTH JAY HOSPITAL OUTPATIENT LAB 500 WEST VOTAW ST PORTLAND IN 47371 LAB IU HEALTH JAY HOSPITAL BEHAVIORAL HEALTH OUTPATIENT SERVICES 1758 W 100 S PORTLAND IN 47371 BEHAVIORAL HEALTH IU HEALTH ADDICTION TREATMENT & RECOVERY CENTER 510 W VOTAW ST ENTRANCE C PORTLAND IN 47371 BEHAVIORAL HEALTH Schedule H, Part I, Line 6a C.B. REPORT PREPARED BY A RELATED ORG. IU HEALTH JAY 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 ("IU HEALTH STATEWIDE SYSTEM"). 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 PERCENTAGE OF TOTAL EXPENSE The amount of bad debt expense included on Form 990, Part IX, Line 25, column (A), but subtracted for purposes of calculating the percentage of total expense on Line 7, column (f) is $17,813. Bad debt expense is reported at cost based on the cost-to-charge ratio. Delivered from worksheet 2, ratio of patient care cost-to-charges. Schedule H, Part I, Line 7c TOTAL COMMUNITY BENEFIT EXPENSE Schedule H, Part I, Line 7, Column (f), Percent of Total Expense, is based on column (e) Net Community Benefit Expense. The percent of total expense based on column (c) Total Community Benefit Expense, which does not include direct offsetting revenue, is 32.61%. Schedule H, Part II PROMOTION OF HEALTH IN COMMUNITIES SERVED IU Health Jay is a subsidiary of IU Health, IU Health participates in a variety of community-building activities that address the social determinants of health in communities it serves. IU Health and its related hospital entities across the State of Indiana ("IU Health Statewide System") investments include economic development efforts across the state, collaborate with like-minded organizations through coalitions that address key issues, and advocate for improvements in the health status of vulnerable populations. This includes making contributions to community-building activities by providing investments and resources to local community initiatives that addressed economic development, community support and workforce development. Several examples include IU Health's support numerous organizations and initiatives that focus on some of the root causes of health issues, such as lack of education, employment and poverty. IU Health Jay is a supporting member of a three-county health coalition focused on obesity prevention and tobacco cessation as a means to reduce the impact of chronic disease including cancer and heart disease. More than 150 organizations are partners in the "Healthy Community Alliance of East Central Indiana" coalition and each pledge to influence audiences to make positive choices regarding improved nutrition, increased physical activity or tobacco cessation. Coalition partners report a collective total audience size of more than 50,000 people. IU Health Jay President Advisory council continues to meet to engage community partners in discussions around community healthcare topics such as the Community Heath Needs Assessment, Hospital Quality Outcomes, IU Health Foundation, Medical Staff business, Physician recruitment, Team Member Engagement, and Hospital Finances. Participating organizations include: Vista Cleaning LLC, Hinkle, Racster & Schemenaur, First Merchants Bank, The Portland Foundation, and retired community members. The group meets for discussion on a bi-monthly basis. IU Health Jay is part of the Consortium for Opioids Response Engagement which was created to build sustainable consortium of stakeholders to combat the opioid crisis. Early intervention of children, adolescents and families with a focus on the individual, interpersonal, community, and societal influences that produce health disparities, stigma and bias and cultural insensitivities. Embed evidence-based prevention, treatment and recovery services into a seamless community-based system of care for both counties through process design and improvement. Increase access to medication-assisted treatment (MAT) for opioid addiction. Participating organizations include: Purdue University, Jay County Drug Prevention Coalition, Blackford County Community Corrections, Hester Hollis Concern Center and A Better Life Brianna's Hope. IU Health Jay manager sits on the Shafer Leadership Academy Board of Directors. IU Health Jay manager is a member of the Jay Community Center Board of Directors. IU Health Jay COO is a member of the Jay County Health Department Board of Directors. Two Healthy Beginnings team members sit on the Maternal Health Community Advisory Board. Three Healthy Beginnings team members sit on the Critical Incident Scene Management team. IU Health Jay nurses and behavioral health team members are part of the Suicide Overdose Fatality Review team. IU Health Jay managers sit on the Hope Fest Health Fair planning committee. Schedule H, Part I, Line 7g DESCRIBE SUBSIDIZED HEALTH SERVICE COSTS FROM PHYSICIAN CLINIC IU HEALTH JAY INCLUDES COSTS ASSOCIATED WITH PHYSICIAN CLINICS AS SUBSIDIZED HEALTH SERVICES BUT IS NOT ABLE TO SEGREGATE THE COSTS ASSOCIATED WITH PHYSICIAN CLINICS. Schedule H, Part I, Line 3c Eligibility criteria for free or discounted care IU HEALTH JAY 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 17813 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. Financial Assistance may additionally be granted in the following circumstances: a) If the patient or their guarantor is found to have filed a petition for bankruptcy. b) If the patient is deceased and found to have no estate. c) If the patient is deceased and was under 21 years of age at the time of death. Due to this comprehensive methodology, IU Health does not believe any amount of bad debt is attributable to patients who may be eligible under the financial assistance policy and no portion of bad debt is included as community benefit. Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote IU HEALTH'S CONSOLIDATED FINANCIAL STATEMENTS, FOOTNOTE 5, ADDRESSES BAD DEBT EXPENSE AS FOLLOWS: The Indiana University Health System does not require collateral or other security from its patients, substantially all of whom are residents of the State, for the delivery of health care services. However, consistent with industry practice, the Indiana University Health System routinely obtains assignment of (or is otherwise entitled to receive) patients' benefits payable under their health insurance programs, plans, or policies (e.g., Medicare, Medicaid, managed care payers, and commercial insurance policies). The Indiana University Health System uses a portfolio approach to account for categories of patient contracts as a collective group, rather than recognizing revenue on an individual contract basis. The portfolios consist of major payer classes for inpatient revenue and outpatient revenue. Based on the historical collection trends and other analysis, the Indiana University Health System believes that revenue recognized by utilizing the portfolio approach approximates the revenue that would have been recognized if an individual contract approach were used. In support of its mission, the Indiana University Health System provides care to uninsured and underinsured patients. The Indiana University Health System provides charity care to patients who lack the financial resources to pay for their medical care. Financial assistance is available to qualifying uninsured and underinsured patients receiving care at an Indiana University Health System hospital location. Under its financial assistance policy, the Indiana University Health System provides medically necessary care to uninsured patients. Financial assistance up to the full amount of patient financial responsibility is available for uninsured and underinsured patients receiving care via the emergency department, direct admission from a physician's office, or transfer from another hospital. The federal poverty level (FPL) thresholds are used when determining the level of financial assistance based on household makeup. Households without dependents are eligible for assistance if household income is less than or equal to 200% FPL, two adults and at least one dependent are eligible if household income is less than or equal to 250% FPL, and households with one adult and at least one dependent are eligible if household income is less than or equal to 300% FPL. 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 IU Health Jay did not have a Medicare shortfall for 2024. IU Health Jay's Medicare reimbursements, however, are normally less than the cost of providing patient care and services to Medicare beneficiaries and do not include any amounts that result from inefficiencies or poor management. IU Health Jay 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. 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 Medicare Cost Report. "Allowable costs" for Medicare Cost Report purposes, however, are not reflective of all costs associated with IU Health'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 Blackford Hospital's participation in Medicare programs would significantly reduce the Medicare surplus reported on Schedule H, Part III, Line 7. Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance IU Health Jay'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 JAY: Line 16a URL: https://iuhealth.org/pay-a-bill/financial-assistance; Schedule H, Part V, Section B, Line 16b FAP Application website - IU HEALTH JAY: 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 JAY: Line 16c URL: https://iuhealth.org/pay-a-bill/financial-assistance; Schedule H, Part VI, Line 2 Needs assessment Though IU Health Jay believes its CHNA process is comprehensive, the CHNA is done on a triennial basis. Between CHNA cycles, IU Health Jay 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 Jay 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 Jay has established a FAP to provide Financial Assistance to Uninsured Patients. IU Health Jay is committed to ensuring its patients are compliant with all provisions of the Patient Protection & Affordable Care Act. To that end, IU Health Jay 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 Jay 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 Jay is located in Jay County, Indiana, a county located in east-central Indiana. Jay County includes ZIP codes within the towns of Portland, Dunkirk, Bryant, Redkey, Pennville, and Salamonia. Based on the most recent Census Bureau statistics, Jay County's population is 20,164 persons with approximately 49.2% being female and 50.8% male. Schedule H, Part VI, Line 5 Promotion of community health IU Health Jay is governed by a Board of Directors, comprised of persons who reside within the organization's service area and surrounding areas, and who are neither employees nor independent contractors of the organization. IU Health Jay 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 Jay can be accessed on the IU Health website. A nondiscrimination clause is explicitly stated in IU Health Jay 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. IU Health Jay participates in other initiatives and collaborations throughout the year to promote health and wellness in the community. Some of these include: - Reduced priced blood test screenings such as cholesterol, glucose and A1C are offered on a walk-in basis year-round for the entire community. - Lung cancer screenings using low dose CT imaging offered at reduced cost to community members meeting requirements set out by the National Comprehensive Cancer Network. In November, a free lung cancer screening event as held at IU Health Jay. The free screenings were funded by the American Cancer Society. - Reduced price heart scans are available to the community all year. - A Hispanic Health fair was held in September which offered free heart scans, lung cancer screenings, mammogram screenings and blood draws for attendees. Funding was provided by the IU Health Foundation. - IU Health Jay participated in the Hope Fest Health Fair in conjunction with multiple community partners. The event focused on substance abuse awareness and services available. IU Health team members provided information on general health and wellness at the event. - IU Health Jay team member annual campaign to raise donations for the local United Way. - Ostomy Support Group meetings held monthly to provide information, advocacy and service to the intestinal and urinary diversion community. - Education for students in the healthcare field such as nursing, pharmacy and radiology. Students job shadowed nurses at IU Health Jay to learn and experience the healthcare field. - Additionally, team members at IU Health Jay participated in the IU Health Statewide System's team member community benefit service program, "IU Health Serves", team members across the state make a difference in the lives of thousands of Hoosiers every year. Schedule H, Part VI, Line 6 Affiliated health care system Indiana University Health Jay 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 X X X X false true false false false false false true false JEFFREY C BIRD MD DIRECTOR/PRESIDENT (ECR) 0 615805 0 259543 0 129780 0 123960 0 52357 0 1181445 0 103503 PETER M VOSS MD DIRECTOR/VICE CHAIR 0 448576 0 92632 0 3564 0 15124 0 52675 0 612571 0 0 JOAN V CASTOR DIRECTOR 0 383981 0 200279 0 60381 0 82880 0 53948 0 781469 0 0 CHARLES R ROUTH MD DIRECTOR 0 177352 0 112557 0 6858 0 11923 0 50649 0 359339 0 0 MICHELLE R ALTOBELLA VP-General Counsel, Asst Secretary (ECR) 0 237733 0 35399 0 1229 0 11328 0 41956 0 327645 0 0 MICHAEL L CRAIG CFO (Part Year) 0 329178 0 43079 0 3564 0 13500 0 52357 0 441678 0 0 JONATHAN W VANATOR CFO (ECR) (PART YEAR) 0 335594 0 131818 0 810 0 11803 0 53880 0 533905 0 0 KREIGH COOK COO (ECR) 0 279864 0 27326 0 486 0 12505 0 31361 0 351542 0 0 MELISSA R HICKS VP & CNO (ECR) 0 243839 0 31515 0 482 0 11225 0 35258 0 322319 0 0 RYAN M JOHNSTON MD VP & CMO (ECR) 0 392288 0 52671 0 1242 0 13800 0 65362 0 525363 0 0 BRIAN REED VP-HUMAN RESOURCES (ECR) 0 183135 0 27779 0 368 0 8888 0 54624 0 274794 0 0 CHERI L KNAPKE Manager-Pharmacy 151116 0 7911 0 120 0 6801 0 31466 0 197414 0 0 0 DIANE R ROESSNER Pharmacist 140276 0 1040 0 120 0 5889 0 30350 0 177675 0 0 0 CHRISTINA SCHEMENAUR VP - CNO - JAY 171348 0 20067 0 529 0 7659 0 23043 0 222646 0 0 0 ZINA SPAHR CLINICAL NURSE 123904 0 714 0 778 0 5178 0 29874 0 160448 0 0 0 CHANTEL S WILLMANN NURSE PRACTITIONER 131973 0 5890 0 792 0 5048 0 18938 0 162641 0 0 0 Schedule J, Part I, Line 3 Arrangement used to establish the top management official's compensation IU HEALTH'S JAY'S REGIONAL PRESIDENT AND PRESIDENT ARE EMPLOYED BY INDIANA UNIVERSITY HEALTH, INC. IU HEALTH, IU HEALTH BALL MEMORIAL HOSPITAL, IU HEALTH JAY, AND OTHER RELATED ORGANIZATIONS HAVE A PROCESS IN PLACE TO DETERMINE THE COMPENSATION FOR ITS OFFICERS AND KEY EMPLOYEES. IU HEALTH HUMAN RESOURCES USES MARKET DATA FROM MULTIPLE COMPENSATION EXPERTS/VENDORS WHO UTILIZE A VARIETY OF METHODS AND PROCEDURES TO OBTAIN COMPENSATION RANGES FOR COMPARABLE OFFICERS AND EMPLOYEE POSITIONS. THIS MARKET DATA AND MULTIPLE OTHER FACTORS (INCLUDING MARKET PAY BENCHMARKS, INTERNAL EQUITY, CANDIDATE/EMPLOYEE QUALIFICATIONS & PERFORMANCE, AND BUSINESS NEEDS) ARE USED TO RECOMMEND COMPENSATION RANGES FOR ITS OFFICERS AND OTHER EMPLOYEES, WHICH ARE THEN USED AS A GUIDE FOR SETTING REASONABLE COMPENSATION BY MANAGEMENT. PLEASE SEE SCHEDULE O FOR ADDITIONAL DETAILS. Schedule J, Part I, Line 4b Supplemental nonqualified retirement plan JOAN V. CASTOR PARTICIPATE IN AN IU HEALTH SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN. PROVISIONS OF WHICH ARE DESIGNED TO RETAIN ITS CRITICAL EMPLOYEES. THE PLAN PROVIDES FOR AN ADDITIONAL RETIREMENT BENEFIT FOR SERVICES THROUGH NORMAL RETIREMENT OR OTHER KEY DATES. IF THE EXECUTIVE LEAVES PRIOR TO RETIREMENT OR OTHER KEY DATES, THE BENEFIT MAY BE FORFEITED OR REDUCED. EACH OF THE EXECUTIVES LISTED ABOVE HAVE AN AMOUNT INCLUDED IN COLUMN C, DEFERRED COMPENSATION, REPRESENTING THE CURRENT YEAR UNVESTED CONTRIBUTIONS MADE UNDER THE SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN. THESE AMOUNTS WERE NOT PAID TO THE EXECUTIVES DURING THE YEAR. THE FOLLOWING EXECUTIVES HAVE AN AMOUNT INCLUDED IN COLUMN B (III), OTHER REPORTABLE COMPENSATION, REPRESENTING THE CURRENT YEAR VESTED AMOUNTS RECEIVED UNDER THE SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN: -JOAN V. CASTOR: $56,550 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 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-JAY-HOSPITAL SECTION B, LINES 12, 13, 14, AND 16B - POLICIES IU HEALTH JAY IS PART OF THE IU HEALTH SYSTEM. AS THE SOLE MEMBER AND CONTROLLING PARENT OF IU HEALTH JAY, IU HEALTH AND ITS BOARD OF DIRECTORS HAVE MANDATED THAT CERTAIN POLICIES BE FOLLOWED TO ENSURE GREATER STANDARDIZATION THROUGHOUT THE SYSTEM. THUS, IU HEALTH JAY'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 IU HEALTH JAY HAS ONE CLASS OF MEMBERSHIP AND THE SOLE MEMBER IS IU HEALTH. Form 990, Part VI, Line 7a Members or stockholders electing members of governing body THE BOARD OF DIRECTORS SHALL INITIALLY CONSIST OF ELEVEN (11) MEMBERS, INCLUDING THE LEGACY DIRECTORS AND FOUR (4) ADDITIONAL DIRECTORS APPOINTED BY IU HEALTH. UPON THE EXPIRATION OF THE TRANSITION PERIOD AND AT ALL TIMES THEREAFTER, THE BOARD OF DIRECTORS SHALL CONSIST OF THE SAME INDIVIDUALS APPOINTED BY IU HEALTH TO SERVE AS DIRECTORS OF EACH OTHER EAST CENTRAL REGION HOSPITAL. Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders NOTWITHSTANDING ANY OTHER PROVISIONS OF THE BYLAWS, THE FOLLOWING MATTERS REQUIRE THE WRITTEN APPROVAL OF IU HEALTH PRIOR TO IMPLEMENTATION: - APPOINT AND REMOVE GOVERNING BOARD MEMBERS; - WITH NOTICE TO THE CORPORATION'S BOARD OR THE APPLICABLE AFFILIATE'S GOVERNING BOARD, APPOINT AND REMOVE THE PRESIDENT AND OTHER OFFICERS; - APPROVE ANY PROPOSED AMENDMENT TO THE CORPORATION'S ARTICLES OF INCORPORATION OR THESE BYLAWS OR AN AFFILIATE'S ORGANIZATIONAL DOCUMENTS; - APPROVE ANY ANNUAL CAPITAL OR OPERATING BUDGETS; - APPROVE ANY UNBUDGETED OPERATING OR CAPITAL BUDGET ITEMS OR DEVIATIONS, INCLUDING ANY ISSUANCE OR GUARANTEE OF ANY UNBUDGETED DEBT, PROVIDED THAT THE BUDGET(S) FOR ITEMS TO BE FUNDED THROUGH THE CAPITAL IMPROVEMENT FUND, AS DEFINED IN THE DEFINITIVE AGREEMENT, WILL BE APPROVED PURSUANT TO THE STRATEGIC PLANNING PROCESS APPROVE STRATEGIC PLANS AND AMENDMENTS, WHICH WILL BE INTEGRATED WITH THE MEMBER'S STRATEGIC PLAN; - APPROVE ANY ENCUMBRANCE, SALE OR CONVEYANCE OF ASSETS OTHER THAN IN THE ORDINARY COURSE OF BUSINESS; - MONITOR STRATEGIC PLANNING PERFORMANCE AND ACCOUNTABILITY, AND APPROVE/IMPLEMENT RELATED ACTIONS PLANS TO ADDRESS ANY DEFICIENCIES; - APPROVE ANY AFFILIATIONS OR JOINT VENTURES; - AUTHORIZE THE ESTABLISHMENT OR ACQUISITION OF ANY SUBSIDIARIES, AFFILIATES OR JOINT VENTURE ARRANGEMENTS OR ACQUISITION OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF ANY OTHER BUSINESS OR ENTITY; - APPROVE ANY AGREEMENT TO ACT AS PRIMARY OBLIGOR, OR TO SERVE AS A GUARANTOR, SURETY OR CO-OBLIGOR WITH RESPECT TO THE INDEBTEDNESS OF ANY OTHER PARTY, TO BORROW AMOUNTS FROM THIRD-PARTY LENDERS OR TO LOAN MONEY TO ANY INDIVIDUAL OR ENTITY; - AUTHORIZE ANY MERGER, CONSOLIDATION, REORGANIZATION, SALE OR TRANSFER OF ALL OR SUBSTANTIALLY ALL OF ITS ASSETS; - AUTHORIZE ANY VOLUNTARY DECLARATION OF BANKRUPTCY, PLAN OF DISSOLUTION, LIQUIDATING DISTRIBUTION OF ASSETS OR OTHER ACTION RELATED TO ITS DISSOLUTION OR LIQUIDATION; - APPROVE ANY MANAGEMENT AGREEMENT FOR THE MANAGEMENT OF ALL OR PART OF THE CORPORATION'S OR AN AFFILIATE'S OPERATIONS; OR - APPROVE PROJECTS OR CONTRACTS THAT REQUIRE IU HEALTH APPROVAL IN ACCORDANCE WITH IU HEALTH'S RESOLUTION AND POLICY GOVERNING SYSTEM-WIDE CONTRACT EXECUTION AUTHORITY AND PAYMENT APPROVAL LIMITS, AS AMENDED FROM TIME TO TIME. 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 JAY 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 JAY'S ARTICLES OF INCORPORATION ARE AVAILABLE FOR PUBLIC INSPECTION THROUGH THE INDIANA SECRETARY OF STATE'S WEBSITE. IU HEALTH JAY'S CONFLICT OF INTEREST PROCEDURES ARE DISCLOSED ON THE FORM 990, SCHEDULE O. IU HEALTH JAY IS A SUBSIDIARY IN IU HEALTH'S CONSOLIDATED AUDITED FINANCIAL STATEMENTS. IU HEALTH'S CONSOLIDATED AUDITED FINANCIAL STATEMENTS ARE AVAILABLE FOR PUBLIC INSPECTION THROUGH ITS BOND FILINGS AND AS AN ATTACHMENT TO IU HEALTH'S FORM 990. Form 990, Part IX, Line 11g Other Fees Intercompany fees - Total Expense: 13303275, Program Service Expense: 12527486, Management and General Expenses: 775789, Fundraising Expenses: ; Contract service - Total Expense: 781345, Program Service Expense: 728893, Management and General Expenses: 52452, Fundraising Expenses: ; Physician fees - Total Expense: 314317, Program Service Expense: 314317, Management and General Expenses: , Fundraising Expenses: ; Other Fees - Total Expense: 25422, Program Service Expense: 23715, Management and General Expenses: 1707, Fundraising Expenses: ; Consulting - Total Expense: 120093, Program Service Expense: 112031, Management and General Expenses: 8062, Fundraising Expenses: ; Professional Fees - Total Expense: 759174, Program Service Expense: 708211, Management and General Expenses: 50963, Fundraising Expenses: ; Form 990, Part XI, Line 9 Other changes in net assets or fund balances Rounding - -1; Total - -1; INDIANA HEALTH INFO EXCHANGE INC 846 N SENATE 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