2025-11-13T14:20:21+00:00 2024-12-31 990 2024-01-01 352090919 Indiana University Health Paoli Inc INDI 3179634842 950 N MERIDIAN STREET 1200 INDIANAPOLIS IN 46204 MICHAEL L CRAIG VP & CFO 2025-11-13 2024 2025-03-06 01:10:19Z BRIAN SHOCKNEY 950 N MERIDIAN STREET 1200 INDIANAPOLIS IN 46204 41246133 false X SEE SCHEDULE O X 1999 IN Lead the transformation of healthcare through quality, innovation & education, and make Indiana one of the nation's healthiest states. 13 7 197 24 0 49090 30577 35607751 36612785 1656179 1813577 23943 511654 37336963 38968593 0 0 15065772 15562066 0 0 21256677 20223350 36322449 35785416 1014514 3183177 49878050 50030715 7963373 4234988 41914677 45795727 X Lead the transformation of healthcare through quality, innovation & education, and make Indiana one of the nation's healthiest states. false false 33597385 0 36023436 INDIANA UNIVERSITY HEALTH PAOLI, INC. ("IU HEALTH PAOLI") IS A 24-BED CRITICAL ACCESS HOSPITAL THAT OFFERS A BROAD RANGE OF MEDICAL SPECIALTIES AND SERVICES TO CARE FOR ITS PATIENTS WITHOUT REGARD TO THEIR ABILITY TO PAY. IU HEALTH PAOLI SPECIALIZES IN RURAL, COMMUNITY-BASED SERVICES TO SERVE SOUTH CENTRAL INDIANA THROUGH ITS 24-HOUR EMERGENCY ROOM WITH AIR TRANSPORT AVAILABILITY, OB SERVICES, COMMUNITY OUTREACH PROGRAMS AND VISITING SPECIALIST SERVICES. 518218 0 555638 OUR NETWORK OF PHARMACIES OFFERS THE CONVENIENCE OF ONE-STOP SHOPPING. WE PROVIDE EXPERT CARE AND HELP PATIENTS MAKE THE BEST USE OF THEIR MEDICATIONS 27236 0 29203 Rent from Related 501(c)(3) Organizations 4204 0 4508 IU HEALTH PAOLI RECEIVES "SHARED SERVICES" REVENUE BY SHARING/PROVIDING SERVICES WITH IU Health Bloomington and INDIANA UNIVERSITY HEALTH CARE ASSOCIATES, INC. ("IU HEALTH PHYSICIANS") 4204 4508 34147043 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 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 0 197 true false false false false false false false false false false false false X 13 7 false false false false true true true true true false false false true true true true true true false false false false IN X CRAIG J JONES 3179634842 950 N MERIDIAN STREET SUITE 800 INDIANAPOLIS IN 46204 DENZIL ROSS MD Director/President (SCR) (Part Year) 15.0 35.0 X X 0 660820 141155 JACK A KENWORTHY DIRECTOR/CHAIR 2.0 4.0 X X 0 9000 0 JOHN SPARZO MD Director/President (Part Year)/CMO (SCR) (Part Year) 10.0 45.0 X X 0 521174 63820 JOYCE B POLING DIRECTOR/SECRETARY 2.0 4.0 X X 0 8000 0 JULIE MINTON DIRECTOR/Treasurer 2.0 4.0 X X 0 5000 0 RICHARD G HENDRICKSON MD DIRECTOR/Vice Chair 2.0 6.0 X X 0 3600 0 BRYAN HOFF MD DIRECTOR 2.0 4.0 X 0 658320 82816 CORINNA REPETTO MD Director 2.0 53.0 X 0 335475 80504 DANIEL J PETERSON DIRECTOR 2.0 4.0 X 0 0 0 HOJJAT M SHAMLOO MD DIRECTOR 1.0 54.0 X 0 696410 66383 JAMES J LAUGHLIN MD DIRECTOR 1.0 54.0 X 0 20415 456 JANET F PERRY DIRECTOR 2.0 4.0 X 0 0 0 KEVIN B GEBKE MD DIRECTOR 1.0 54.0 X 0 971536 151102 LYNN H COYNE DIRECTOR 2.0 4.0 X 0 0 0 MOHAN SHENOY MD Director 2.0 53.0 X 0 773403 65247 VANESSA MCCLARY DIRECTOR 2.0 4.0 X 0 0 0 MICHAEL L CRAIG VP & CFO (SCR) 5.0 50.0 X 0 375821 65857 ALAN W BIGGS VP & COO (SCR) (PART YEAR) 10.0 45.0 X 0 243099 9954 BRECHIN NEWBY MD Chief Physician Executive (SCR) 35.0 20.0 X 0 457578 26749 BRUCE R WADE VP - HUMAN RESOURCES (SCR) 10.0 45.0 X 0 253974 69763 CYNTHIA R HERRINGTON VP & CNO (SCR) 10.0 45.0 X 0 343081 51826 DEREK B FIELDS VP - Prof Services (SCR) (Part Year) 5.0 55.0 X 0 259467 33324 LARRY R BAILEY COO (SCR) (PART YEAR) 10.0 40.0 X 0 299844 67511 ANGELA M CONKLIN HIGGS ANESTHETIST 50.0 0 X 222208 0 28823 FRANKLIN R FRAZIER ANESTHETIST 50.0 0 X 219898 0 9645 JEROME B SNEED MD Physician 25.0 25.0 X 182174 110788 80425 MICHELE RIDGE VP - COO / CNO 50.0 0 X 239235 0 43275 PAMELLA J BOND MANAGER-PHARMACY 50.0 0 X 199219 0 52470 BRIAN T SHOCKNEY FORMER OFFICER 10.0 45.0 X 0 1330269 225805 PAUL M CALKINS MD FORMER KEY EMPLOYEE 10.0 45.0 X 0 355971 52208 1062734 8693045 1469118 true true false 29859 718 30577 NET PATIENT SERVICE REVENUE 622110 36023436 36023436 RENT FROM RELATED 501(C)(3) ORGS. 532000 29203 29203 SHARED SERVICES 541900 4508 4508 PHARMACY 446110 555638 555638 0 0 0 0 36612785 1479830 1479830 22188 22188 0 22188 22188 2611287 2277540 333747 0 333747 333747 All Other Revenue 900099 489466 489466 0 0 0 0 489466 38968593 36612785 0 2325231 X 0 0 0 0 12599798 12174943 424855 428414 413968 14446 1722454 1664374 58080 811400 784040 27360 84 84 1772 1772 17594 17594 11572475 10795618 776857 0 133 133 105747 98648 7099 29064 14532 14532 1179474 1179474 18707 17451 1256 1107025 1054871 52154 237018 237018 Drugs and Medical Supplies 4294362 4294362 Hospital Assessment Fee 1550977 1550977 All Other Expenses 57042 54308 2734 Noncapitalized Equipment 50062 47663 2399 1814 1814 0 0 35785416 34147043 1638373 0 23589509 493560 718 0 3427764 3663396 0 0 0 0 0 676861 731125 109125 128618 26869853 16532184 10934878 10337669 11139195 12692848 0 0 0 21983499 49878050 50030715 6040968 1283665 0 0 1922405 2951323 7963373 4234988 X 41914677 45795727 41914677 45795727 49878050 50030715 X 3183177 697874 -1 X false true true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 1772 1772 false Schedule C, Part II-B, Line 1 DETAILED DESCRIPTION OF THE LOBBYING ACTIVITY IU Health Paoli paid institutional membership dues to the American Hospital Association ("AHA") and the Indiana Hospital Association ("IHA") during 2024 in the amount of $4,338 and $3,262. Each membership organization notified IU Health Paoli that a portion of the dues it paid were used for lobbying purposes. The AHA used 32.00%, or $1,388 of 2024 membership dues paid by IU Health Paoli, for lobbying expenditures. The IHA used 11.78%, or $384 of the 2024 membership dues paid by IU Health Paoli, for lobbying expenditures. The total membership dues paid to these organizations by IU Health Paoli during 2024 that were attributable to lobbying expenditures was $1,772. 183505 183505 8531552 4171353 4360199 791602 791602 0 13390972 10031837 3359135 3972222 1537392 2434830 10337669 Intercompany Receivables 21983499 21983499 0 Federal Income Taxes 0 DUE TO THIRD-PARTY PAYERS 2807342 Intercompany Payables (Net) 0 Self-Insurance Liabilities 61188 Operating Lease Liabilities 82793 2951323 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 Paoli 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 Paoli, 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 Paoli, 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 3354 1663413 1663413 0.04648 5283 8887371 8823211 64160 0.00179 0 0.0 0 8637 10550784 8823211 1727573 0.04828 4 589 477459 3000 474459 0.01326 3 18 48102 48102 0.00134 1 3899 2915037 2516492 398545 0.01114 0 0.0 0 0.0 8 4506 3440598 2519492 921106 0.02574 8 13143 13991382 11342703 2648679 0.07402 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 1 100 0 0.0 0 0.0 1 100 0 0 0 0.0 false 0 8455521 8204968 250553 X true true 1 1 INDIANA UNIVERSITY HEALTH PAOLI INC 560 W Longest Street PAOLI IN 47454 HTTPS://IUHEALTH.ORG/FIND-LOCATIONS/IU-HEALTH-PAOLI-HOSPITAL 22-005065-1 X X X X INDIANA UNIVERSITY HEALTH PAOLI INC 1 false false true X X X X X X X X X 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 PAOLI'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 PAOLI HOSPITAL. IU Health Paoli Hospital The defined community per the most recent CHNA conducted in the current tax year (i.e., 2024) is Lawrence and Orange Counties, Indiana. The hospital resides in Orange County. 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 Paoli Hospital obtained the insight and views of those who live in and service Lawrence and Orange counties through community meetings (including those possessing public health expertise). 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. Lawrence County Between March and April 2024, IU Health facilitated three community meetings to receive input on the health needs in Lawrence County. The meetings were attended by 32 people in total. The significant community health needs from the 2021 CHNA of IU Health Bedford Hospital were presented at the beginning of each meeting. Participants were asked to share their feedback on the status of these health needs in Lawrence County, any additions to the list of health needs, thoughts regarding the root causes of the health needs and the status of COVID-19 and its impacts. The meetings concluded by asking participants to finalize the top health needs impacting the health of the community. Once this list was confirmed, the participants were asked to prioritize and select the top health needs for their community (i.e., the significant community health needs). Highlights of the discussion during the community meetings include many, if not all, of the 2021 CHNA significant community health needs. Suggested additions to the list include adolescent mental health, stigma surrounding mental health and food insecurity. Additional highlights of the 2024 discussion include: - The noticeable prevalence of substance use disorders, excessive tobacco and alcohol consumption - Low education levels influence personal choices and beliefs - People of all ages are struggling with mental health and substance use disorders and accessing services is challenging due to a shortage of services or existing services can have lengthy wait times - Social determinants of health - including violence in the home, transportation, poor nutrition, poverty and affordable and quality housing - are concerns in the community - Access to healthcare services is challenging because of costs and insurance coverage; trust; no urgent care; shortage of family physicians; navigating the healthcare system; and the days and hours of services are not flexible - There are not enough pediatric practitioners in the community - There seems to be a lot of overlap in the availability of social services - Rural areas in the county do not have access to the internet, making telehealth an unrealistic option for healthcare and mental health treatment - Certain groups face worse health outcomes than the general population. - Poor air and water quality is a concern, especially its impact on youth - Changing population - Children's health is linked to academic achievement and there is concern that academic achievement is at risk for many children due to their access to electronic devices, extreme behaviors, rise in anger, poor attendance, poor mental health and the physical and mental health of parents/guardians When thinking about Lawrence County, the participants thought the greatest assets to promote health and well-being in the community were the IU Center for Rural Engagement and Social Work, school/education system, Hoosier Uplands, United Way, Boys and Girls Club, dentists brought into schools, juvenile justice systems with lots of resources and access to IU Health. Participants from the community meetings identified the following needs as most significant in Lawrence County, which are not listed in any order: - Access to healthcare services (including trustworthy and affordable services, more providers and flexibility in hours and days of service) - Maternal health - Mental health and substance use disorder (especially the need for more, affordable services for people of all ages) - School health - Social determinants of health (especially food access, poverty and housing) Orange County In March 2024, IU Health facilitated two community meetings to receive input on the health needs in Orange County. The meetings were attended by 20 people in total. This meeting followed the same format as those meetings held in Lawrence County. Highlights of the discussion during the meetings include many, if not all, of the previously identified 2021 CHNA significant community health needs. Suggested additions to the list include the aging population and needs of older adults. Additional highlights of the 2024 discussion include: - Economic stability, food access, childcare and pre-school costs, and obtaining affordable housing are challenges in the community - Older adults are struggling to find assisted living and housing - Accessing specialty care is challenging and more providers are turning to private practice due to low reimbursement rates - There is a lack of healthy habits in the community - Mental health conditions are increasing in the community, including in youth, and accessing mental health services is challenging due to a shortage of providers and services, costs and insurance coverage and no emergency mental health aid - Concerns for youth and adolescent health including lack of health education, poor health on behavior and academic achievement, social isolation, lower immunizations, mental health, substance abuse, self-harm and family trauma - Internet access is limited in the community, which impacts the availability of telehealth - The lack of obstetric services and those that are present in the community are leaving is concerning to residents - Reproductive and sexual health education and services are needed in the community for people of all ages - No dentists in the county take Medicaid - The prevalence of domestic violence and parent incarceration is going up - There is a growing mistrust of the healthcare system When thinking about Orange County, the participants thought the greatest assets to promote health and well-being in the community were compassionate community members, many people want to help each other, backpack blessings boxes/meal programs, trustee assistance, safe areas with the county, THRIVE Orange County, local elected officials advocating with state elected officials, collaboration between partners and "everybody knows everybody." Participants from the community meetings identified the following needs as most significant in Orange County, which are not listed in any order: - Access to healthcare services (including affordable and trustworthy services; more providers and specialty services) - Maternal health (especially a focus on provider shortage and teen pregnancy) - Mental health and substance use disorder - School health - Social determinants of health (especially food access, poverty, transportation and safe and affordable housing) 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 members - South Central Philanthropy Council - Lawrence County Health Department - Mitchell Community Schools - North Lawrence Community School Corporation - Orange County Economic Development Partnership - Orange County Youth Mentoring and CASA - Thrive Orange County - Southern Indiana Community Health Center - IU Health Paoli Hospital - IU Health Positive Link Schedule H, Part V, Section B, Line 11 Facility , 1 Facility , 1 - IU HEALTH PAOLI HOSPITAL. In April 2025, IU Health's board of directors approved the implementation strategy for IU Health Paoli Hospital to respond to the needs identified in their 2024 CHNA. IU Health Paoli 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 Paoli Hospital will address all the community health needs identified in the 2024 CHNA. In 2024, IU Health Paoli Hospital addressed needs identified in the 2021 CHNA used the 2022-2024 implementation strategy plan adopted in April 2022. The hospital, along with community partnered, 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 Paoli Hospital planned to address significant needs included 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; 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 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 154 people at IU Health Paoli Hospital. The hospital offered free health screenings in Orange County during 2024. IU Health Paoli Hospital also provided clients with free blood pressure monitored when needed for home monitored. Launched Integrated Social Work Initiative in IU Health clinical settings. Virtual Integrated Social Work (VISW) assisted providers and patients with urgent complex situations such as abuse and neglect concerns, domestic violence, housing insecurity, and social barriers to care. This team of licensed social workers and coordinators were skilled in assessing and identifying social determinants of health (SDOH), provided resources, and made recommendations unique to the patient and their circumstances. ISW provided urgent medical social work services through an iPad cart to all primary care and pediatric primary care practices throughout the system. The SDOH screener PRAPARE was live in 73 primary care practices. ISW Social Determinants of Health Coordinators provided resources and support to patients with urgent needs identified in the screener. There was a total of 7,715 referrals in 2024. Of those referrals, 1,040 referrals made to ISW included patients seen at IU Health Bedford, IU Health Bloomington and IU Health Paoli Hospitals. Behavioral Health Developed access points for referral to behavioral health care. Offered virtual behavioral health appointments in Orange County schools in 2024 to support students with access to mental health support. During 2024, IU Health Paoli Hospital partnered with Paoli Jr./Sr. High Health Class students to provide behavioral health education regarding stress management. Further implemented the Virtual Care Peer Recovery Coaching Program (provided patients who had 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. 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 3,668 visits included patients seeking care in the emergency departments in the South Central Region (which included IU Health Paoli 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. Chronic Disease and Chronic Disease Management Provided screenings for chronic disease and linkage to care. Provided blood pressure screenings to the community in 2024. Diabetic education was shared with local food pantries and their clients as appropriate. Maternal and Infant Health and Child Well-being Connected pregnant women to the appropriate resources in the community. In 2024, provided resources and education during a Community Baby Shower sponsored by IU Health Paoli Hospital. Performed Fetal Infant Mortality Reviews along with many community partners to identify reasons for fetal and infant deaths and developed workgroups to combat in 2024. Nurse Home Visitors helped first-time mothers with mother's health, child's health and economic self-sufficiency of the family by partners with Nurse Family Partnerships in 2024. Schedule H, Part V, Section B, Line 11 Facility , 2 Facility , 2 - IU HEALTH PAOLI HOSPITAL (CONTINUED). Smoking, Tobacco Use and Exposure to Secondhand Smoke Screened individuals for tobacco use and link to tobacco cessation resources and services. Provided a Tobacco Coordinator to the community in 2024 with a focus on policy change. Referred tobacco users to provider Quitline. Worked with Orange County Schools to develop strategies to prevent vaping and supported students in need of cessation. IU Health Community Health Offered Tobacco Prevention and Cessation outreach and education at local schools, festivals, fairs and other community events in 2024. Additionally, those who attended Beat Tobacco classes received Carbon Monoxide testing, free nicotine replacement patches and Quitline referrals as appropriate and/or requested. 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 trained. 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 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 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 had received 3,921 patient referrals (this information cannot be separated by hospital or region at this time). Social Determinants of Health All Community Health Strategies supported social determinants of health. IUHealthfindhelp.org was promoted at community events. Increased findhelp utilization in the community by 25%. Significant Needs Hospital Did Not Address IU Health Paoli Hospital addressed all the significant health needs identified in the 2022 Community Health Needs Assessment. Schedule H, Part V, Section B, Line 13 Facility , 1 Facility , 1 - INDIANA UNIVERSITY HEALTH PAOLI, INC.. IN ADDITION TO FPG, IU HEALTH PAOLI MAY TAKE INTO CONSIDERATION A PATIENT'S INCOME AND/OR ABILITY TO PAY IN CALCULATION OF A FINANCIAL ASSISTANCE AWARD. Schedule H, Part V, Section B, Line 13 Facility , 1 Facility , 1 - IU HEALTH PAOLI HOSPITAL. IU Health Paoli 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 PAOLI HOSPITAL. IU Health Paoli takes several other measures to broadly publicize its FAP within the community. These measures include the following: 1. Post this Policy, a Plain Language Summary of this Policy, and the Financial Assistance Application on its website. 2. Provide patients with a Plain Language Summary of this Policy during registration and/or discharge. 3. Post conspicuous displays in appropriate acute care settings such as emergency departments and registration areas describing the available assistance and directing eligible patients to the Financial Assistance Application. 4. Include a conspicuous written notice on all patient post-discharge billing statements notifying the patient about this Policy and the telephone number of the Customer Service Department which can assist patients with questions regarding this Policy. 5. Make available Customer Service representatives via telephone during normal business hours. 6. Mail copies of this Policy, a Plain Language Summary of this Policy, and a Financial Assistance Application to patients or their guarantor free of charge upon request. 7. Broadly communicate this Policy as a part of its general outreach efforts. 8. Educate patient-facing team members on this Policy and the process for referring patients to the program. 8 IU HEALTH PAOLI HOSPITAL SURGERY DEPT 642 W HOSPITAL RD PAOLI IN 47454 SPECIALTY CARE IU HEALTH PAOLI MULTI-SPECIALITY 642 W HOSPITAL RD PAOLI IN 47454 SPECIALTY CARE IU HEALTH PAOLI WALK-IN 560 W LONGEST ST PAOLI IN 47454 PRIMARY CARE IU HEALTH PRIMARY CARE - PAOLI 560 W LONGEST ST PAOLI IN 47454 PRIMARY CARE IU HEALTH PAOLI HOSPITAL REHABILITATION 642 W HOSPITAL RD PAOLI IN 47454 REHABILITATION SERVICES IU HEALTH PAOLI RADIOLOGY 642 W HOSPITAL RD PAOLI IN 47454 RADIOLOGY IU HEALTH PAOLI HOSPITAL LAB 642 W HOSPITAL RD PAOLI IN 47454 LAB IU HEALTH PAOLI INFUSION 642 W HOSPITAL RD PAOLI IN 47454 OUTPATIENT Schedule H, Part I, Line 6a C.B. REPORT PREPARED BY A RELATED ORG. IU Health Paoli's community benefit and other investments, encompassing its total community investment, are included in the IU Health Community Benefit Report which is prepared on behalf of and includes IU Health and its related hospital entities in the State of Indiana. The IU Health Community Benefit Report is made available to the public on IU Health's website at https://iuhealth.org/in-the-community. The IU Health Community Benefit Report is also distributed to numerous key organizations throughout the State of Indiana in order to broadly share the IU Health Statewide System's community benefit efforts. It is also available by request through the Indiana State Department of Health or IU Health. Schedule H, Part I, Line 7f BAD DEBT EXPENSE THE AMOUNT OF BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE OF TOTAL EXPENSE ON LINE 7, COLUMN (F) IS $0. 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 39.10%. Schedule H, Part II PROMOTION OF HEALTH IN COMMUNITIES SERVED IU Health Paoli Hospital supports and/or participates in a variety of community-building activities that address the non-medical, root causes of health problems in the communities it serves. IU Health Paoli Hospital and its related hospital entities across the state of Indiana ("IU Health Statewide System") investments include economic development efforts across the state, workforce development opportunities, collaborate with community partners such as: Love Never Fails Church Veterans Outreach event; Safe Haven Summer of Recovery event; Orange County Tobacco Prevention and Cessation Coalition; Hoosier Uplands Head Start tobacco prevention activities; Paoli Food Pantry blood pressure screenings; IU Health School of Nursing free health screenings; Qsource education and outreach. Schedule H, Part I, Line 7g DESCRIBE SUBSIDIZED HEALTH SERVICE COSTS FROM PHYSICIAN CLINIC IU HEALTH PAOLI INCLUDES COSTS ASSOCIATED WITH PHYSICIAN CLINICS AS SUBSIDIZED HEALTH SERVICES BUT IS NOT ABLE TO SEGREGATE THE COSTS ASSOCIATED WITH PHYSICIAN CLINICS. Schedule H, Part I, Line 3c Eligibility criteria for free or discounted care IU Health Paoli 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 III, Line 2 Bad debt expense - methodology used to estimate amount THE BAD DEBT EXPENSE REPORTED ON SCHEDULE H, PART III, LINE 2 IS REPORTED AT COST, AS CALCULATED USING THE COST TO CHARGE RATIO METHODOLOGY. Schedule H, Part III, Line 3 Bad Debt Expense Methodology IU Health Paoli will deem patients or their guarantors presumptively eligible for Financial Assistance if they are found to be eligible for one of the following programs and care was initiated via an eligible facility's emergency department, direct admission from a physician's office, or transfer from another hospital facility: 1. Medicaid (any state) 2. Indiana Children's Special Health Care Services 3. Healthy Indiana Plan 4. Patients who are awarded Hospital Presumptive Eligibility (HPE) 5. A state and/or federal program that verifies the patient or guarantor's gross household income meets the FPL income threshold. No Financial Assistance Application is required to receive Financial Assistance under this Presumptive Eligibility section. IU Health Paoli will conduct a quarterly review of all accounts placed with a collection agency partner for at least one hundred and twenty (120) days after the account is eligible for an ECA as set forth in this Policy. If the patient or guarantor's individual scoring criteria demonstrates the patient has a low likelihood and/or propensity to pay or no credit, the patient or guarantor may be deemed presumptively eligible for Financial Assistance. Financial Assistance may additionally be granted in the following circumstances: a) If the patient or their guarantor is found to have filed a petition for bankruptcy. b) If the patient is deceased and found to have no estate. c) If the patient is deceased and was under 21 years of age at the time of death. Due to this comprehensive methodology, IU Health Paoli does not believe any amount of bad debt is attributable to patients who may be eligible under the financial assistance policy and no portion of bad debt is included as community benefit. Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote IU HEALTH'S CONSOLIDATED FINANCIAL STATEMENTS, FOOTNOTE 5, ADDRESSES BAD DEBT EXPENSE AS FOLLOWS: The Indiana University Health System does not require collateral or other security from its patients, substantially all of whom are residents of the State, for the delivery of health care services. However, consistent with industry practice, the Indiana University Health System routinely obtains assignment of (or is otherwise entitled to receive) patients' benefits payable under their health insurance programs, plans, or policies (e.g., Medicare, Medicaid, managed care payers, and commercial insurance policies). The Indiana University Health System uses a portfolio approach to account for categories of patient contracts as a collective group, rather than recognizing revenue on an individual contract basis. The portfolios consist of major payer classes for inpatient revenue and outpatient revenue. Based on the historical collection trends and other analysis, the Indiana University Health System believes that revenue recognized by utilizing the portfolio approach approximates the revenue that would have been recognized if an individual contract approach were used. In support of its mission, the Indiana University Health System provides care to uninsured and underinsured patients. The Indiana University Health System provides charity care to patients who lack the financial resources to pay for their medical care. Financial assistance is available to qualifying uninsured and underinsured patients receiving care at an Indiana University Health System hospital location. Under its financial assistance policy, the Indiana University Health System provides medically necessary care to uninsured patients. Financial assistance up to the full amount of patient financial responsibility is available for uninsured and underinsured patients receiving care via the emergency department, direct admission from a physician's office, or transfer from another hospital. The federal poverty level (FPL) thresholds are used when 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 Paoli Medicare Cost Report. "Allowable costs" for Medicare Cost Report purposes, however, are not reflective of all costs associated with IU Health Paoli's participation in Medicare programs. For example, the Medicare Cost Report excludes certain costs such as billed physician services, the costs of Medicare Parts C and D, fee schedule reimbursed services, and durable medical equipment services. Inclusion of all costs associated with IU Health Paoli's participation in Medicare programs would significantly increase the Medicare shortfall reported on Schedule H, Part III, Line 7. IU Health Paoli's Medicare shortfall is attributable to reimbursements that are less than the cost of providing patient care and services to Medicare beneficiaries and does not include any amounts that result from inefficiencies or poor management. IU Health Paoli accepts all Medicare patients knowing that there may be shortfalls; therefore it has taken the position that any shortfall should be counted as part of its community benefit. Additionally, it is implied in Internal Revenue Service Revenue Ruling 69-545 that treating Medicare patients is a community benefit. Revenue Ruling 69-545, which established the community benefit standard for nonprofit hospitals, states that if a hospital serves patients with governmental health benefits, including Medicare, then this is an indication that the hospital operates to promote the health of the community. Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance IU Health PAOLI'S FAP and written debt collection policy describe the collection practices applicable to patients, including those who may qualify for financial assistance. Schedule H, Part V, Section B, Line 16a FAP website - INDIANA UNIVERSITY HEALTH PAOLI, INC.: Line 16a URL: HTTPS://IUHEALTH.ORG/PAY-A-BILL/FINANCIAL-ASSISTANCE; Schedule H, Part V, Section B, Line 16b FAP Application website - INDIANA UNIVERSITY HEALTH PAOLI, INC.: Line 16b URL: HTTPS://IUHEALTH.ORG/PAY-A-BILL/FINANCIAL-ASSISTANCE; Schedule H, Part V, Section B, Line 16c FAP plain language summary website - INDIANA UNIVERSITY HEALTH PAOLI, INC.: Line 16c URL: HTTPS://IUHEALTH.ORG/PAY-A-BILL/FINANCIAL-ASSISTANCE; Schedule H, Part VI, Line 2 Needs assessment Though IU Health Paoli Hospital believes its CHNA process is comprehensive, the CHNA is done on a triennial basis. Between CHNA cycles, IU Health Paoli Hospital gathers data and information to monitor the most current needs of the community. Additional sources of data and information include: * IU Health data analytics and information service teams; * Secondary data sources from Federal, state, and local entities with a focus on health behaviors, health outcomes, and social determinants of health; * Obtaining community organization and governmental agency perspectives; priority population perspectives; and other healthcare and hospital perspectives; * Reports that share findings and recommendations on certain populations within the community and/or health behaviors, health outcomes, or social determinants of health; * Evidence informed sources; and * Team member participation in partnering efforts (e.g., coalitions, advisory committees, task forces, etc.). The regular review of these sources of data and information rarely impact what the significant needs are between CHNA cycles. However, it does help influence the types or level of interventions to address the significant needs; prioritize resources to those groups or neighborhoods experiencing health disparities in the community; identify funding opportunities to support interventions; and strengthen or mobilize partnerships to improve health. Schedule H, Part VI, Line 3 Patient education of eligibility for assistance IU Health Paoli is committed to serving the healthcare needs of all of its patients regardless of their ability to pay for such services. To assist in meeting those needs, IU Health Paoli has established a FAP to provide Financial Assistance to Uninsured Patients. IU Health Paoli is committed to ensuring its patients are compliant with all provisions of the Patient Protection & Affordable Care Act. To that end, IU Health Paoli will make a good faith effort to locate and obtain health insurance coverage for patients prior to considering patients for coverage under the FAP. IU Health Paoli takes several measures to inform its patients of the FAP and FAP-eligibility. These measures include the following: 1. Post this Policy, a Plain Language Summary of this Policy, and the Financial Assistance Application on its website. 2. Provide patients with a Plain Language Summary of this Policy during registration and/or discharge. 3. Post conspicuous displays in appropriate acute care settings such as emergency departments and registration areas describing the available assistance and directing eligible patients to the Financial Assistance Application. 4. Include a conspicuous written notice on all patient post-discharge billing statements notifying the patient about this Policy and the telephone number of the Customer Service Department which can assist patients with questions regarding this Policy. 5. Make available Customer Service representatives via telephone during normal business hours. 6. Mail copies of this Policy, a Plain Language Summary of this Policy, and a Financial Assistance Application to patients or their guarantor free of charge upon request. 7. Broadly communicate this Policy as a part of its general outreach efforts. 8. Educate patient-facing team members on this Policy and the process for referring patients to the program. Schedule H, Part VI, Line 4 Community information IU HEALTH PAOLI IS LOCATED IN ORANGE COUNTY, INDIANA, A COUNTY LOCATED IN SOUTH CENTRAL INDIANA. ORANGE COUNTY INCLUDES ZIP CODES WITHIN THE TOWNS OF FRENCH LICK, ORLEANS, PAOLI, AND WEST BADEN SPRINGS. BASED ON THE MOST RECENT CENSUS BUREAU STATISTICS, ORANGE COUNTY'S POPULATION IS 19,824 PERSONS WITH APPROXIMATELY 49.7% BEING FEMALE AND 50.3% MALE. Schedule H, Part VI, Line 5 Promotion of community health IU Health Paoli Hospital is a subsidiary of Indiana University Health, Inc., a tax-exempt healthcare organization, whose Board of Directors is composed of members of which substantially all are independent community members. IU Health Paoli 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 Paoli Hospital can be accessed on the IU Health website. A nondiscrimination clause is explicitly stated in IU Health Paoli 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 Paoli Hospital's promotion of community health included the following highlights: IU Health Paoli Hospital partners with the local school systems and community partners to provide preventive health educational programs. - IU Health Paoli Hospital has a car seat station, as designated by the state, for car seat safety inspections and has two certified CPSTs (child passenger safety technician). Ten hours per month are devoted to inspection appointments, available for free to parents and caregivers. Technicians inspect, educate, and assist those community members with their car seat questions and problems. Monthly community car seat inspections ensure children in our community are safely traveling in vehicles. The department also can also replace or give out a car seat if needed once inspection and education are completed. The car seats available range from newborn to booster seats to cover all children that are required by Indiana law to be in an appropriate car seat. - In 2024, IU Health Community Health continued Coordinated School Health in Orange County. A school health coordinator worked with all of the county schools to improve the health and wellness of students and staff. In 2024, the coordinator worked with teachers on mental health and suicide prevention, preparing to be better equipped to handle school issues post pandemic. The coordinator also assisted the school with sexual education, healthy eating, vaping education and increasing student physical activity. The coordinator also provided CPR training for staff. Schedule H, Part VI, Line 6 Affiliated health care system Indiana University Health Paoli Hospital is part of Indiana University Health ("IU Health "the healthcare system"), which is Indiana's most comprehensive healthcare system. A unique partnership with the Indiana University School of Medicine ("IU School of Medicine"), one of the nation's leading medical schools, gives patients access to innovative treatments and therapies. The healthcare system is comprised of hospitals, physicians and allied services dedicated to providing preeminent patient care and community health improvement throughout Indiana. IU Health's affiliate hospitals are divided into six regions that serve communities in Northwest, Northeast, Central and Southern Indiana. The 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 DENZIL ROSS MD Director/President (SCR) (Part Year) 0 423818 0 100420 0 136582 0 91274 0 49881 0 801975 0 0 JOHN SPARZO MD Director/President (Part Year)/CMO (SCR) (Part Year) 0 426785 0 92067 0 2322 0 14503 0 49317 0 584994 0 0 KEVIN B GEBKE MD DIRECTOR 0 643514 0 322391 0 5631 0 120600 0 30502 0 1122638 0 0 BRYAN HOFF MD DIRECTOR 0 434536 0 222542 0 1242 0 13800 0 69016 0 741136 0 0 CORINNA REPETTO MD Director 0 316022 0 15889 0 3564 0 13057 0 67447 0 415979 0 0 HOJJAT M SHAMLOO MD DIRECTOR 0 525904 0 166942 0 3564 0 13800 0 52583 0 762793 0 0 MOHAN SHENOY MD Director 0 595853 0 176740 0 810 0 13800 0 51447 0 838650 0 0 BRIAN T SHOCKNEY FORMER OFFICER 0 858567 0 378478 0 93224 0 163560 0 62245 0 1556074 0 0 MICHAEL L CRAIG VP & CFO (SCR) 0 329178 0 43079 0 3564 0 13500 0 52357 0 441678 0 0 PAUL M CALKINS MD FORMER KEY EMPLOYEE 0 276784 0 75758 0 3429 0 11833 0 40375 0 408179 0 0 LARRY R BAILEY COO (SCR) (PART YEAR) 0 257714 0 38566 0 3564 0 12219 0 55292 0 367355 0 0 ALAN W BIGGS VP & COO (SCR) (PART YEAR) 0 57808 0 40090 0 145201 0 3936 0 6018 0 253053 0 0 DEREK B FIELDS VP - Prof Services (SCR) (Part Year) 0 200205 0 46636 0 12626 0 10548 0 22776 0 292791 0 0 CYNTHIA R HERRINGTON VP & CNO (SCR) 0 273921 0 66838 0 2322 0 7107 0 44719 0 394907 0 0 BRECHIN NEWBY MD Chief Physician Executive (SCR) 0 418210 0 38558 0 810 0 13046 0 13703 0 484327 0 0 BRUCE R WADE VP - HUMAN RESOURCES (SCR) 0 215436 0 35292 0 3246 0 10210 0 59553 0 323737 0 0 ANGELA M CONKLIN HIGGS ANESTHETIST 222028 0 0 0 180 0 5819 0 23004 0 251031 0 0 0 JEROME B SNEED MD Physician 181887 98635 0 11198 287 955 7212 4982 25496 42735 214882 158505 0 0 PAMELLA J BOND MANAGER-PHARMACY 179085 0 9852 0 10282 0 6660 0 45810 0 251689 0 0 0 FRANKLIN R FRAZIER ANESTHETIST 219718 0 0 0 180 0 6778 0 2867 0 229543 0 0 0 MICHELE RIDGE VP - COO / CNO 206170 0 31111 0 1954 0 9778 0 33497 0 282510 0 0 0 Schedule J, Part I, Line 3 Arrangement used to establish the top management official's compensation IU HEALTH PAOLI'S REGIONAL PRESIDENT IS EMPLOYED BY INDIANA UNIVERSITY HEALTH, INC. IU HEALTH, IU HEALTH PAOLI, AND OTHER RELATED ORGANIZATIONS HAVE A PROCESS IN PLACE TO DETERMINE THE COMPENSATION FOR ITS OFFICERS AND KEY EMPLOYEES. IU HEALTH HUMAN RESOURCES USES MARKET DATA FROM MULTIPLE COMPENSATION EXPERTS/VENDORS WHO UTILIZE A VARIETY OF METHODS AND PROCEDURES TO OBTAIN COMPENSATION RANGES FOR COMPARABLE OFFICERS AND EMPLOYEE POSITIONS. THIS MARKET DATA AND MULTIPLE OTHER FACTORS (INCLUDING MARKET PAY BENCHMARKS, INTERNAL EQUITY, CANDIDATE/EMPLOYEE QUALIFICATIONS & PERFORMANCE, AND BUSINESS NEEDS) ARE USED TO RECOMMEND COMPENSATION RANGES FOR ITS OFFICERS AND OTHER EMPLOYEES, WHICH ARE THEN USED AS A GUIDE FOR SETTING REASONABLE COMPENSATION BY MANAGEMENT. PLEASE SEE SCHEDULE O FOR ADDITIONAL DETAILS. Schedule J, Part I, Line 4b Supplemental nonqualified retirement plan Denzil Ross, Brian T. Shockney, AND KEVIN GEBKE PARTICIPATE IN A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN, PROVISIONS OF WHICH ARE DESIGNED TO RETAIN THESE CRITICAL EMPLOYEES. THE PLAN PROVIDES FOR AN ADDITIONAL RETIREMENT BENEFIT FOR SERVICE THROUGH NORMAL RETIREMENT OR OTHER KEY DATES. IF THE EXECUTIVE LEAVES PRIOR TO RETIREMENT OR OTHER KEY DATES, THE BENEFIT MAY BE FORFEITED OR REDUCED. EACH OF THE EXECUTIVES LISTED ABOVE HAVE AN AMOUNT INCLUDED IN COLUMN C, DEFERRED COMPENSATION, REPRESENTING THE CURRENT YEAR UNVESTED CONTRIBUTIONS MADE UNDER THE SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN. THESE AMOUNTS WERE NOT PAID TO THE EXECUTIVES DURING THE YEAR. THE FOLLOWING EXECUTIVE HAS AN AMOUNT INCLUDED IN COLUMN B (III), OTHER REPORTABLE COMPENSATION, REPRESENTING THE CURRENT YEAR VESTED AMOUNTS RECEIVED UNDER THE SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN: - BRIAN SHOCKNEY: $87,593 Schedule J, Part I, Line 7 Non-fixed payments AMOUNTS DISCLOSED IN COLUMN B(II) INCLUDE A LONG TERM INCENTIVE FOR CERTAIN EXECUTIVES. ALTHOUGH THESE PLANS ARE BASED ON A FIXED FORMULA THAT HAS BEEN APPROVED BY THE BOARD OF DIRECTORS BASED UPON CERTAIN QUALITATIVE AND QUANTITATIVE FACTORS AND GOALS, ALL DISCRETIONARY INCENTIVE PLANS MUST BE APPROVED BY THE BOARD OF DIRECTORS PRIOR TO ANY INCENTIVE PAYOUT. Form 990, Part III, Line 4a-4c Description of program services (Expenses $ 4,204 including grants of $ 0)(Revenue $ 4,508) IU HEALTH PAOLI RECEIVES "SHARED SERVICES" REVENUE BY SHARING/PROVIDING SERVICES WITH IU Health Bloomington and INDIANA UNIVERSITY HEALTH CARE ASSOCIATES, INC. ("IU HEALTH PHYSICIANS") SECTION B, LINES 12, 13, 14, AND 16B - POLICIES IU HEALTH PAOLI IS PART OF THE IU HEALTH SYSTEM. AS THE SOLE MEMBER AND CONTROLLING PARENT OF IU HEALTH PAOLI, IU HEALTH AND ITS BOARD OF DIRECTORS HAVE MANDATED THAT CERTAIN POLICIES BE FOLLOWED TO ENSURE GREATER STANDARDIZATION THROUGHOUT THE SYSTEM. THUS, IU HEALTH PAOLI'S BOARD OF DIRECTORS WAS NOT REQUIRED TO SEPARATELY ADOPT A CONFLICT OF INTEREST, WHISTLEBLOWER, DOCUMENT RETENTION AND DESTRUCTION AND JOINT VENTURE POLICIES BECAUSE IU HEALTH'S BOARD OF DIRECTORS HAD ALREADY ADOPTED AND REQUIRED THESE POLICIES TO BE FOLLOWED BY ITS SUBSIDIARIES. Form 990, Part VI, Line 6 Classes of members or stockholders THE SOLE MEMBER OF IU HEALTH PAOLI IS IU HEALTH, INC., A 501(C)(3) TAX-EXEMPT ORGANIZATION. Form 990, Part VI, Line 7a Members or stockholders electing members of governing body THE BOARD OF DIRECTORS SHALL CONSIST FROM NINE (9) TO THIRTEEN (13) MEMBERS. TO BE ELIGIBLE FOR BOARD MEMBERSHIP, A DIRECTOR CANDIDATE SHALL SATISFY THE SELECTION CRITERIA AND PERSONAL CHARACTERISTICS AS MAY BE ESTABLISHED BY THE MEMBER AND IU HEALTH FROM TIME TO TIME. IT IS PREFERRED THAT AT LEAST THREE (3) OF THE DIRECTORS ARE PHYSICIAN MEMBERS, BUT IS NOT REQUIRED. THE COMPOSITION OF THE BOARD OF DIRECTORS SHALL BE CONSISTENT WITH THE FOLLOWING CRITERIA: I. TWO (2) MEMBER SHALL BE REPRESENTATIVES OF INDIANA UNIVERSITY HEALTH BEDFORD, INC.; II. TWO (2) MEMBERS SHALL BE REPRESENTATIVES OF INDIANA UNIVERSITY HEALTH PAOLI, INC.; III. TWO (2) MEMBERS SHALL BE REPRESENTATIVES OF INDIANA UNIVERSITY HEALTH MORGAN, INC.; IV. FOUR (4) MEMBERS SHALL BE REPRESENTATIVES OF INDIANA UNIVERSITY HEALTH BLOOMINGTON, INC.; AND V. TWO (2) MEMBERS SHALL BE THE PRESIDENT OF THE IU HEALTH SOUTH CENTRAL REGION AND AN IU HEALTH EXECUTIVE LEADERSHIP REPRESENTATIVE. VI. ONE (1) MEMBER DIRECTLY APPOINTED BY THE LOCAL COUNCIL OF WOMEN, INC. ("COUNCIL DIRECTOR") Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders ALL ACTION OF THE HOSPITAL SHALL BE BY ITS BOARD, SUBJECT TO THE FOLLOWING MATTERS WHICH ARE RESERVED TO AND REQUIRE THE APPROVAL OF IU HEALTH, AS THE MEMBER: A) AUTHORIZE THE ESTABLISHMENT OR ACQUISITION OF ANY SUBSIDIARIES, AFFILIATES OR JOINT VENTURE ARRANGEMENTS OR ACQUISITION OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF ANY OTHER BUSINESS OR ENTITY; B) APPROVE OR AMEND ANY OPERATING OR CAPITAL BUDGET (PROVIDED THAT THE APPROVAL OR AMENDMENT OF ANY OPERATING OR CAPITAL BUDGET, OR ANY OTHER ACTION, THAT WOULD ELIMINATE A CORE SERVICE (AS THAT TERM IS DEFINED IN THAT CERTAIN INTEGRATION DEFINITIVE AGREEMENT BETWEEN IU HEALTH BLOOMINGTON HOSPITAL, FOUNDATION AND IU HEALTH, DATED MARCH 5, 2009 (THE "DEFINITIVE AGREEMENT")). THE ELIMINATION OF A CORE SERVICE MUST ALSO BE APPROVED BY A MAJORITY VOTE OF THE BOARD; C) AUTHORIZE ANY UNBUDGETED OPERATING OR CAPITAL BUDGET ITEMS OR DEVIATIONS, INCLUDING ANY ISSUANCE OR GUARANTEE OF ANY UNBUDGETED DEBT, GREATER THAN THE BUDGETED AMOUNT BY $100,000 FOR ANY INDIVIDUAL ITEM OR $300,000 PER FISCAL YEAR IN THE AGGREGATE; D) AUTHORIZE THE INCURRENCE OF DEBT BY THE HOSPITAL IN ACCORDANCE WITH POLICIES AND PROCEDURES ISSUED BY IU HEALTH (THE "SYSTEM POLICIES"), INCLUDING TO SERVE AS A GUARANTOR, SURETY OR CO-OBLIGER; E) APPROVE ANY STRATEGIC PLANS AND AMENDMENTS THERETO; F) AMEND OR REPEAL THE HOSPITAL'S ARTICLES OF INCORPORATION OR THESE BY-LAWS (OR OTHER CORRESPONDING ORGANIZATIONAL DOCUMENTS IF AN AFFILIATE IS NOT A CORPORATION) IN ANY MANNER, INCLUDING WITHOUT LIMITATION ANY CHANGE RELATING TO THE NONPROFIT PURPOSES OF HOSPITAL; G) AUTHORIZE ANY MERGER, CONSOLIDATION, REORGANIZATION, SALE OR TRANSFER OF ALL OR SUBSTANTIALLY ALL OF THE HOSPITAL'S ASSETS OR A SUBSIDIARY ORGANIZATION OF THE HOSPITAL; H) AUTHORIZE ANY VOLUNTARY DECLARATION OF BANKRUPTCY, PLAN OF DISSOLUTION, LIQUIDATING DISTRIBUTION OF ASSETS OR OTHER ACTION RELATED TO ITS DISSOLUTION OR LIQUIDATION OF THE HOSPITAL; I) APPROVE, UPON RECOMMENDATION OF THE NOMINATING COMMITTEE AS PROVIDED IN THESE BYLAWS, THE MEMBERS OF THE BOARD OF DIRECTORS OF HOSPITAL; J) APPROVE ANY MANAGEMENT AGREEMENT FOR THE MANAGEMENT OF ALL OR A SUBSTANTIAL PART OF HOSPITAL'S OR ANY OF ITS AFFILIATE'S OPERATIONS; AND K) APPROVE ANY ACTION TO TERMINATE ACUTE CARE SERVICES OR TO CLOSE THE HOSPITAL OWNED BY THE SOLE MEMBER. Form 990, Part VI, Line 11b Review of form 990 by governing body THE 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 PAOLI FOLLOWS IU HEALTH'S CONFLICT OF INTEREST POLICY. IU HEALTH'S CONFLICT OF INTEREST POLICY INCLUDES THE FOLLOWING PROVISIONS: ALL IU HEALTH EMPLOYEES, ASSOCIATES, COLLEAGUES AND CONTRACTED PERSONNEL, INCLUDING EMPLOYED PHYSICIANS AND PAID MEDICAL DIRECTORS ("IU HEALTH REPRESENTATIVES") ARE COVERED BY AND SUBJECT TO ITS CONFLICT OF INTEREST POLICY. IU HEALTH REGULARLY AND CONSISTENTLY MONITORS AND ENFORCES COMPLIANCE WITH THE POLICY THROUGH THE FOLLOWING PROCEDURES: (A) ON AN ANNUAL BASIS, EACH IU HEALTH REPRESENTATIVE AT THE LEVEL OF MANAGER OR ABOVE, TOGETHER WITH EVERY OTHER PERSON DESIGNATED BY THE CORPORATE COMPLIANCE DEPARTMENT ("DEPARTMENT"), MUST COMPLETE, SIGN AND SUBMIT A CONFLICT OF INTEREST QUESTIONNAIRE ("QUESTIONNAIRE") TO THE DEPARTMENT. GOVERNING BOARD MEMBERS, COMMITTEE MEMBERS, CORPORATE OFFICERS, MEDICAL STAFF AND RESEARCHERS MUST COMPLY WITH THE ADMINISTRATIVE REQUIREMENTS NOTED IN THE RESPECTIVE POLICIES AND PROCEDURES RELATIVE TO THOSE AREAS. (B) AN IU HEALTH REPRESENTATIVE MUST SUPPLEMENT A QUESTIONNAIRE IN WRITING, IF AFTER COMPLETION OF THE ORIGINAL QUESTIONNAIRE, A SITUATION ARISES, OR MAY REASONABLY BE EXPECTED TO ARISE, THAT WOULD CHANGE ANY ANSWER OR INFORMATION ON THE ORIGINAL QUESTIONNAIRE IF THE SITUATION HAD EXISTED OR BEEN ANTICIPATED AT THE TIME OF COMPLETION OF THE ORIGINAL QUESTIONNAIRE. (C) IF A FULLY AND PROPERLY COMPLETED QUESTIONNAIRE REVEALS FACTS OR OTHER INFORMATION THAT MIGHT REASONABLY INDICATE A CONFLICT OF INTEREST OR VIOLATION OF THE POLICY, THE IU HEALTH REPRESENTATIVE COMPLETING THE QUESTIONNAIRE MUST SECURE APPROVAL BY HIS/HER SUPERVISOR, EVIDENCED IN WRITING. (D) THE DEPARTMENT WILL REVIEW EACH QUESTIONNAIRE AND DETERMINE WHETHER A CONFLICT OF INTEREST EXISTS AND, IF SO, WHETHER AND HOW IT SHOULD OR MAY BE ELIMINATED, AVOIDED OR MANAGED IN ORDER TO COMPLY WITH THE SPIRIT OF THE POLICY AND WITH THE BEST INTERESTS OF IU HEALTH AND ITS PATIENTS. IN MAKING THE DETERMINATION, THE CORPORATE COMPLIANCE DEPARTMENT MAY CONSULT WITH THE IU HEALTH REPRESENTATIVE'S SUPERVISOR AND OTHER APPROPRIATE INDIVIDUALS AND GROUPS. (E) THE SCOPE OF THE POLICY IS NOT LIMITED TO THOSE WHO ARE REQUIRED TO COMPLETE QUESTIONNAIRES. IF AN IU HEALTH REPRESENTATIVE IS INVOLVED IN A SITUATION OR RELATIONSHIP THAT WOULD CONSTITUTE A VIOLATION OF THE POLICY IN THE ABSENCE OF DISCLOSURE AND APPROVAL AS DESCRIBED ABOVE, THEN THE IU HEALTH REPRESENTATIVE MUST DISCLOSE THE MATTER TO HIS/HER SUPERVISOR,SECURE HIS/HER SUPERVISOR'S APPROVAL IN WRITING, AND DISCLOSE THE MATTER TO THE DEPARTMENT. OTHERWISE, THE IU HEALTH REPRESENTATIVE IS IN VIOLATION OF THE POLICY AND SUBJECT TO CORRECTIVE ACTION, UP TO AND INCLUDING TERMINATION. (F) THE CHIEF COMPLIANCE OFFICER, IN CONSULTATION WITH ONSITE COMPLIANCE PERSONNEL, MAY FROM TIME TO TIME APPOINT STANDING OR AD HOC COMMITTEES TO ASSIST IN RESOLVING ISSUES THAT ARISE UNDER PROVISIONS OF THE POLICY. Form 990, Part VI, Line 19 Required documents available to the public IU HEALTH PAOLI'S ARTICLES OF INCORPORATION ARE AVAILABLE FOR PUBLIC INSPECTION THROUGH THE INDIANA SECRETARY OF STATE'S WEBSITE. IU HEALTH PAOLI'S CONFLICT OF INTEREST PROCEDURES ARE DESCRIBED ON FORM 990, SCHEDULE O. IU HEALTH PAOLI IS A SUBSIDIARY IN IU HEALTH'S CONSOLIDATED AUDITED FINANCIAL STATEMENTS. IU HEALTH'S CONSOLIDATED AUDITED FINANCIAL STATEMENTS ARE AVAILABLE FOR PUBLIC INSPECTION THROUGH ITS BOND FILINGS AND AS AN ATTACHMENT TO IU HEALTH'S FORM 990 AS WELL AS IU HEALTH PAOLI'S FORM 990. Form 990, Part IX, Line 11g Other Fees Professional fees - Total Expense: 303791, Program Service Expense: 283398, Management and General Expenses: 20393, Fundraising Expenses: ; Other Fees - Total Expense: 38705, Program Service Expense: 36107, Management and General Expenses: 2598, Fundraising Expenses: ; Consulting - Total Expense: 105570, Program Service Expense: 98483, Management and General Expenses: 7087, Fundraising Expenses: ; Intercompany fees - Total Expense: 9452790, Program Service Expense: 8818226, Management and General Expenses: 634564, Fundraising Expenses: ; Contract service - Total Expense: 1646619, Program Service Expense: 1536082, Management and General Expenses: 110537, Fundraising Expenses: ; Physician Fees - Total Expense: 25000, Program Service Expense: 23322, Management and General Expenses: 1678, 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 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