2024-11-12T14:07:14+00:00 2023-12-31 990 2023-01-01 351814660 Indiana University Health West Hospital Inc INDI 3179634842 950 N MERIDIAN STREET 1200 INDIANAPOLIS IN 46204 CARA L BREIDSTER CFO 2024-11-12 2023 2024-10-15 13:58:12Z KENNETH D PUCKETT 950 N MERIDIAN STREET 1200 INDIANAPOLIS IN 46204 383389200 false X HTTPS://IUHEALTH.ORG/FIND-LOCATIONS/IU-HEALTH-WEST-HOSPITAL X 1990 IN Lead the transformation of healthcare through quality, innovation & education, and make Indiana one of the nation's healthiest states. 9 6 2813 292 0 0 698759 365849 299713001 357337778 3289107 24444643 803727 1240930 304504594 383389200 2540 140400 0 0 118669354 105750790 0 0 0 153455789 195135237 272127683 301026427 32376911 82362773 639315613 720869351 26227126 25417433 613088487 695451918 Lead the transformation of healthcare through quality, innovation & education, and make Indiana one of the nation's healthiest states. false false 288146352 140400 355698952 IU HEALTH WEST HOSPITAL IS A 173-BED MULTIDISCIPLINARY HEALTHCARE FACILITY LOCATED IN AVON, IN. THE HOSPITAL OFFERS A FULL RANGE OF SERVICES, INCLUDING MATERNITY, ORTHOPEDICS AND CANCER CARE. BUILT WITH A SPECIFIC GOAL TO MEET THE NEEDS OF OUR PATIENTS, FAMILIES AND VISITORS. IU HEALTH WEST HOSPITAL INCLUDES FEATURES DESIGNED TO ENSURE PRIVACY AND CREATE A QUIET, SOOTHING ATMOSPHERE IN PATIENT SPACES. FROM ALL-PRIVATE ROOMS AND INTIMATE, COMFORTABLE FAMILY WAITING AREAS TO SEPARATE CORRIDORS AND ELEVATORS AWAY FROM PUBLIC SPACES FOR STAFF AND SUPPLY MOVEMENT, IU HEALTH WEST HOSPITAL DELIVERS ON OUR GOALS TO CREATE A HEALING SANCTUARY FOR PATIENTS. 1035353 0 1278079 IU HEALTH WEST HOSPITAL, INC. RECEIVES RENT FROM A RELATED EXEMPT ORGANIZATION, INDIANA UNIVERSITY HEALTH CARE ASSOCIATES, INC. FOR SPACE IN THEIR MEDICAL OFFICE BUILDING THAT'S CONNECTED TO THE HOSPITAL AND THE ORTHO, SPORT & SPINE CENTER. 292236 0 360747 IU Health West Hospital provides services, which include coordinated activities and polices, to related tax-exempt organizations designed to meet the mission of the Indiana University Health System. 289473941 true true false true false false false false false true false false false true true false true false false false false false false false false true true true false true false false false false false false false false false false false false false true true true false false true 0 0 2813 true false false false false false false false false false false false false X 9 6 false false false false true true true true true false false true true true true true true false true false IN X CRAIG J JONES 3179634842 950 N MERIDIAN ST STE 800 INDIANAPOLIS IN 46204 KENNETH DOUG PUCKETT DIRECTOR / PRESIDENT (ISR) 10.0 45.0 X X 0 901248 183503 MARSHA A WURSTER Director/Chair 2.0 2.0 X X 0 11250 0 MICHELE M KAWIECKI Director/Vice Chair 2.0 2.0 X X 0 10000 0 CHARLES E SCHALLIOL Director 2.0 2.0 X 0 8500 0 CLAUDIA J SOMES MD DIRECTOR 2.0 2.0 X 0 8000 0 JAY L HESS MD DIRECTOR 2.0 10.0 X 0 44500 0 KEVIN L SMITH MD DIRECTOR (Part Year) 2.0 53.0 X 0 582698 35700 MARK R BENSON DO DIRECTOR (Part Year) 2.0 2.0 X 0 3750 0 MATT MURPHY DIRECTOR 2.0 2.0 X 0 7000 0 MEGAN CRITTENDON MD DIRECTOR 2.0 53.0 X 0 363805 30129 TONY PEARSON Director 2.0 2.0 X 0 6000 0 CARA L BREIDSTER CFO (ISR) 10.0 45.0 X 0 339481 64209 JENNIFER GIROD Secretary 5.0 45.0 X 0 176547 16698 ATHANASIA SOULA BANICH VP, COO (ISR) 10.0 45.0 X 0 298930 53689 CARRIE WING VP-CNO (ISR) 10.0 45.0 X 0 264751 34144 Harpreetinder Singh MD VP-CMO (ISR) 15.0 50.0 X 0 476838 76110 TAMARAH D BROWNLEE REGIONAL VP-HR (ISR) 10.0 45.0 X 0 245872 58312 ANNE K STEGEMOLLER DIRECTOR - PHARMACY 50.0 0 X 194931 0 28455 JAMES R BILLMAN PHARMACIST 50.0 0 X 242243 0 29632 JUAN GUZMAN VP COO (West) 55.0 0 X 265569 0 50542 Kapri D Ames VP - CNO West 55.0 0 X 246685 0 51870 MARIA CAMACHO CLINICAL NURSE 50.0 0 X 220153 0 74801 ALLISON EMHARDT Former Officer 5.0 45.0 X 0 181746 39916 ARTHUR VASQUEZ FORMER OFFICER & KEY EMPLOYEE 0.0 55.0 X 0 742860 154953 DEREK E EMPIE FORMER OFFICER 0.0 55.0 X 0 335206 62375 LISA A SPARKS Former Key Employee 10.0 45.0 X 283785 0 13054 PAMELA V CHAPMAN FORMER KEY EMPLOYEE 0.0 50.0 X 0 195337 43640 1453366 5204319 1101732 136 true true false 0 365849 365849 NET PATIENT SERVICE REVENUE 622110 355698952 355698952 SHARED SERVICES 541900 360747 360747 RENT FROM RELATED 501(C)(3) ORGS. 532000 1278079 1278079 0 0 0 0 357337778 24444643 24444643 403375 403375 0 403375 403375 0 0 All Other Revenue 900099 558412 558412 GIFT SHOP 453220 265504 265504 TELEPHONE 517000 13639 13639 0 0 0 0 837555 383389200 357337778 0 25685573 X 140400 140400 686520 663371 23149 0 86926230 83995149 2931081 2749127 2656429 92698 10008514 9671035 337479 5380399 5198976 181423 12375 12375 73294776 68374512 4920264 0 331370 0 331370 139429 130069 9360 141010 70505 70505 4670534 4670534 38627 36034 2593 14614841 13926310 688531 1458084 1458084 Drugs and Medical Supplies 51076188 51076188 Bad Debt 23347291 23347291 Hospital Assessment Fee 18540297 18540297 Equipment Repairs & Maintenance 3479990 3246379 233611 3990425 3730462 259963 0 301026427 289473941 11552486 0 440382454 522650843 33560285 40223772 0 0 0 0 5389854 7783613 673179 748190 301938895 152475962 157514721 149462933 0 0 1795120 0 639315613 720869351 17693622 13145339 0 0 8533504 12272094 26227126 25417433 X 613088487 695451918 613088487 695451918 639315613 720869351 82362773 658 0 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 12375 12375 false Schedule C, Part II-B, Line 1 DETAILED DESCRIPTION OF THE LOBBYING ACTIVITY IU Health West Hospital paid institutional membership dues to the American Hospital Association ("AHA") and Indiana Hospital Association ("IHA") during 2023 in the amount of $39,736 and $17,231, respectively. Each membership organization notified IU Health West Hospital that a portion of the dues it paid were used for lobbying purposes. The AHA used 26.47%, or $10,518 of 2023 membership dues paid by IU Health West Hospital, for lobbying expenditures. The IHA used 10.78%, or $1,857 of the 2023 membership dues paid by IU Health West Hospital, for lobbying expenditures. The total membership dues paid to these organizations by IU Health West Hospital during 2023 that were attributable to lobbying expenditures was $12,375. 152102571 45471360 106631211 1261768 1247136 14632 104489511 79699433 24790078 44085045 26058033 18027012 149462933 INTERCOMPANY PAYABLES (NET) 10002335 DUE TO THIRD-PARTY PAYERS 1985848 SELF-INSURANCE LIABILITIES 283911 OTHER 12272094 X Schedule D, Part X, Line 2 FIN 48 (ASC 740) footnote IU Health West Hospital is a subsidiary in Indiana University Health, Inc.'s ("IU Health") Consolidated Audited Financial Statements. THE INTERNAL REVENUE SERVICE (IRS) HAS DETERMINED THAT INDIANA UNIVERSITY HEALTH AND CERTAIN OF ITS AFFILIATED ENTITIES ARE TAX-EXEMPT ORGANIZATIONS AS DEFINED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (IRC). INDIANA UNIVERSITY HEALTH AND ITS TAX-EXEMPT AFFILIATES ARE, HOWEVER, SUBJECT TO FEDERAL AND STATE INCOME TAXES ON UNRELATED BUSINESS INCOME UNDER THE PROVISIONS OF IRC SECTION 511. DEFERRED INCOME TAXES WHICH, AS OF DECEMBER 31, 2023 AND 2022, HAVE NO NET CARRYING VALUE, REFLECT THE NET TAX EFFECT OF TEMPORARY DIFFERENCES BETWEEN THE CARRYING AMOUNTS OF ASSETS AND LIABILITIES FOR FINANCIAL REPORTING AND THE AMOUNTS USED FOR INCOME TAX PURPOSES. AS OF DECEMBER 31, 2023 AND 2022, THE INDIANA UNIVERSITY HEALTH SYSTEM HAD GROSS DEFERRED TAX ASSETS OF $141,386,000 AND $145,194,000, RESPECTIVELY, RELATING TO NET OPERATING LOSS CARRYOVERS. MANAGEMENT DETERMINED THAT A FULL VALUATION ALLOWANCE AT DECEMBER 31, 2023 AND 2022 WAS NECESSARY TO REDUCE THE DEFERRED TAX ASSETS TO THE AMOUNT THAT WOULD MORE LIKELY THAN NOT BE REALIZED. BASED ON THE WEIGHT OF THE EVIDENCE, IF IT IS MORE LIKELY THAN NOT THAT SOME PORTION OR ALL OF THE DEFERRED TAX ASSETS WILL NOT BE REALIZED, A VALUATION ALLOWANCE TO REDUCE THE DEFERRED TAX ASSETS IS RECORDED. THE DECREASE IN THE GROSS DEFERRED TAX ASSET AND THE VALUATION ALLOWANCE FOR THE CURRENT YEAR IS $3,009,000. AT DECEMBER 31, 2023, INDIANA UNIVERSITY HEALTH SYSTEM HAS AVAILABLE NET OPERATING LOSS CARRYFORWARDS OF $571,690,000, NET OPERATING LOSSES GENERATED FROM 2004 THROUGH 2017 EXPIRE BETWEEN 2024 AND 2037. NET OPERATING LOSSES GENERATED AFTER 2017 DO NOT EXPIRE. true true X true X 300 false true true true false true true 0 5571 3644824 0 3644824 0.0131 11886 58440359 48575355 9865004 0.0355 0 0 0 0 0 0.0 0 17457 62085183 48575355 13509828 0.0487 8 2345 1214117 0 1214117 0.0044 2 915 326751 0 326751 0.0012 1 463 2102627 1035741 1066886 0.0038 0 0 0 0 0 0.0 2 18069 297308 116400 180908 0.0007 13 21792 3940803 1152141 2788662 0.0100 13 39249 66025986 49727496 16298490 0.0587 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 1 1 1449 1449 0.0000 0 0.0 0 0.0 0 0.0 1 1 1449 0 1449 0.0000 false 4024935 44914648 54547154 -9632506 X true true 1 1 IU HEALTH WEST HOSPITAL 1111 N RONALD REAGAN PKWY AVON IN 46123 HTTPS://IUHEALTH.ORG/FIND-LOCATIONS/IU-HEALTH-WEST-HOSPITAL 23-003776-1 X X X X IU HEALTH WEST HOSPITAL 1 false false true X X X X X X X X X 21 true false false true X HTTPS://IUHEALTH.ORG/IN-THE-COMMUNITY true 22 true HTTPS://IUHEALTH.ORG/IN-THE-COMMUNITY 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 West Hospital's 2021 Community Health Needs Assessment (CHNA) Report includes a prioritized description of significant health needs in the community. The CHNA report identified the following needs as priorities for IU Health West Hospital: 1. Access to Healthcare Services 2. Aging Population and Needs of Seniors 3. Behavioral Health 4. Chronic Disease and Chronic Disease Management 5. Health Education and Navigation 6. Maternal and Infant Health and Child Well-being 7. Smoking, Tobacco Use and Exposure to Secondhand Smoke 8. Social Determinants of Health Schedule H, Part V, Section B, Line 5 Facility , 1 Facility , 1 - IU Health West Hospital. In conducting each its most recent CHNA, IU Health West Hospital took into account input from persons who represent the broad interests of the communities it serves by hosting six community focus groups and three interviews. These events engaged public health officials and community-based organizations that provide services and/or reflect community members who are medically underserved, low-income, or of a minority subpopulation to discuss the health needs of the service area and what role IU Health could play in addressing the identified needs. IU Health West Hospital The defined community per the most recent CHNA is Hendricks and Marion Counties, Indiana. The hospital resides in Hendricks County. Hendricks County - Community Meetings and Interview Two community meetings were held in May 2021 to receive input from stakeholders regarding the health needs in Hendricks County. Secondary data was presented, and each group was asked to discuss their reactions to the data, needs identified from the data, thoughts regarding the causes of the needs, impacts of the COVID-19 pandemic and others. After this discussion, participants were given the opportunity to make additional comments before being asked to select what they believed were the most significant needs in the county. Participants focused discussion on the need for social associations, alcohol abuse and drunk driving, mental health and access to services, costs of care, teen suicide, child abuse and ACEs, housing, elderly needs, health insurance, obesity, physical inactivity, diabetes, transportation, sexual abuse and crisis services, domestic violence, isolation in Hispanic (or Latino) and non-English speaking communities and sex education and contraceptives. From this process, participants identified the following needs as most significant for Hendricks County: * Access to behavioral and mental health services * Substance abuse, including alcohol * Social isolation * Child abuse and teen suicide/self-harm * Obesity and related chronic diseases * Housing access and affordability * Transportation In discussing the impacts of the COVID-19 pandemic, residents identified issues regarding increasing violence and domestic violence, inability to access health and social services, increasing stress on caregivers, increased community togetherness, increasing telehealth services and food insecurity. A survey was also issued to internal providers at IU Health that serve Hendricks County, asking them to identify priority needs among the patients they serve. The following issues were identified as the most significant: * Substance abuse access to treatment * Mental health and access to mental health services * Obesity and education on healthy eating The survey also asked about the impacts of the COVID-19 pandemic. Issues most often selected as significant impacts include: * Social isolation and loneliness * Lack of access to healthcare services An additional interview was conducted with a representative of the local public health department to obtain subject-matter expertise into the health needs in Hendricks County. The following issues were discussed as significant: * Mental health is the greatest health need in Hendricks County, and access to mental health services and integration into primary care is needed for complete healthcare * Obesity is an issue, influenced by a lack of physical activity and places to exercise * Smoking and tobacco usage is still a need, including the use of e-cigarettes * Alcohol abuse is a significant concern * Access to affordable housing is difficult for many * Transportation is a barrier, with few public options * Insurance and costs of care are two of the largest barriers to accessing healthcare * Elderly needs are significant, particularly transportation to medical care from rural areas In regard to the COVID-19 pandemic, a wide array of impacts was noted, including: Alcohol abuse has likely increased Mental health needs have increased greatly due to stress and impacts of isolation Marion County - Community Meetings and Interviews In collaboration with other local health systems - Ascension St. Vincent and Community Health Network - four community meetings were held in May 2021 to receive input from stakeholders regarding the health needs in Marion County. Secondary data and a preliminary list of community health need priorities was presented at all meetings. Each group was then asked questions about the preliminary list, including their reactions, additions to the proposed needs, thoughts regarding the causes of the needs, impacts of the COVID-19 pandemic and others. After this discussion, participants were given the opportunity to make additional comments before being asked to vote on what they believed were the most significant needs in the county. Participants were asked to choose three to five significant health needs via an online poll during and after the meeting. Preliminary needs identified include a wide-array of topics, including COVID-19, food insecurity, maternal and child health, racial and ethnic disparities, mental health and access to mental health providers, obesity and physical inactivity, poverty, educational achievement, housing, crime and community safety, public health funding and others. In addition to these topics, participants focused discussion around substance abuse and treatment, transportation barriers, culturally appropriate care and services (including language barriers), affordability of healthy food, smoking and tobacco use, access to and cost of primary care, health insurance, preventive health services, lack of providers within high-need areas, childcare, chronic conditions (including diabetes and hypertension), navigating existing resources, dental health needs, child health, job opportunities and trainings, technology barriers and digital-divide, post-incarceration resources and social connectedness. For those unable to attend community meetings, a separate survey was distributed to receive their input into the most significant needs. These findings were combined with those of the community meeting participants. From this process, participants identified the following needs as most significant for Marion County: * Racial and ethnic health disparities * Access to mental and behavioral healthcare services * Food insecurity and access to affordable, healthy food * Access to safe and affordable housing * Mental health * Poverty and associated community need A survey was also issued to internal providers at the Academic Medical Center, asking them to identify priority needs among the patients they serve. Among 12 responses, the following issues were identified as the most significant: * Food insecurity and nutrition * Health disparities, particularly for racial and ethnic minority populations * Mental health * Poverty and income inequality The survey also asked about the impacts of the COVID-19 pandemic. Issues most often selected as significant impacts include: * Social isolation and loneliness * Health disparities * Digital divide (lack of internet or device access) * Economic disparities * Housing (inability to stay sheltered, pay rent or mortgage) Two additional interviews were conducted with representatives of a local public health department and health equity organization to obtain subject-matter expertise into the health needs in Marion County. The following issues were discussed as significant: * Poverty is a significant issue and impacts almost all areas of wellbeing, including housing, accessing health services, nutrition, stress and mental health, chronic disease, transportation and others (the need for a living wage for all residents is significant) * Health disparities are significant, including large disparities in social determinants of health for racial and ethnic minority populations * Health insurance is a significant barrier to optimal health, with restrictions in coverage leading to a lack of preventive health * Mental health is a significant issue, with depression and anxiety both widespread (self-medication through substance abuse is common) * Obesity continues to be an issue, as well as diabetes, with rates increasing for adults * Infant and maternal mortality are significant issues, with social determinants of health impacting access to prenatal care and other needed services * HIV is still a concern, with some hope that the disease can be eradicated within the next decade through modern medicine and available tools such as PrEP (pre-exposure prophylaxis) * Tobacco and vaping are issues, with a low cigarette tax in Indiana perpetuating the issue Schedule H, Part V, Section B, Line 5 Facility , 2 Facility , 2 - IU Health West Hospital (Continued). * Environmental health - including old housing and air pollution - is leading to poor health, including lead poisoning, arsenic poisoning and pediatric asthma (the need for safe and stable housing is significant) * Health literacy is a need, particularly affecting Hispanic (or Latino) populations due to language barriers (education disparities around health are also leading to generational persistence of health disparities for racial and ethnic minority populations) * Food insecurity is significant and food pantries may have irregular hours and face huge demand * Education needs better funding, including adequate teacher compensation * More community collaboration is needed, with health systems and social service providers sitting at the same table to talk about community improvement and planned interventions In regard to the COVID-19 pandemic, a wide array of impacts were noted, including: * Testing was a large challenge throughout the beginning of the pandemic, due to inadequate federal resources and other limits * The pandemic highlighted the impact of social determinants of health, as homeless populations faced huge concerns due to inability to socially distance in shelters and access care (hotels were turned into isolation areas for patients with COVID-19) * Racial and ethnic disparities in testing, treatment and outcomes were highlighted by the pandemic (elderly Black residents were particularly affected) * Care was delayed for a lot of individuals due to fear of going to a provider and being exposed to the virus, leading to unmet needs and emergency situations * Community collaboration among providers led to a better response, including health systems offering testing and other aid to public health organizations (more collaboration and coordination will be needed in the future) * Vaccination disparities are evident, with Black populations disproportionately unable to access the vaccine if desired * The need for better health information sharing (including the identification of health disparities) between organizations Community meeting and survey participants Individuals from a wide variety of organizations and communities participated in the interview process, community meetings and surveys. Participants included representatives from the following organizations: * Allen Chapel AME Church * Anthem * Anthem Medicaid * Ascension St. Vincent * Aspire Indiana * Health Avon Education Foundation * Avon Community School Corporation * Broadway United Methodist Church * Brownsburg Education Foundation * Care to Change Counseling * Central Indiana Council on Aging (CICOA) * City of Indianapolis * City-County Council staff * City of Indianapolis, Division of Community Nutrition and Food Policy * Coalition for Our Immigrant Neighbors * Coburn Place * Community Action of Greater Indiana * Community Health Network * Concerned Clergy of Indianapolis * Connections IN Health, Indiana Clinical and Translational Sciences Institute (CTSI), Indiana University School of Medicine * Covering Kids & Families of Indiana * Crossroads AME Church/Common Grounds Institute * Cummins Behavioral Health Systems * First Baptist Church North Indianapolis * Gennesaret Free Clinic * Gleaners Food Bank of Indiana * Habitat for Humanity of Greater Indianapolis * Health by Design * Hendricks County Community Foundation * Hendricks County Economic Development Partnership * Hendricks County Health Department * Hendricks County Health Partnership * Hendricks County Senior Services * Hendricks County Trauma Resource Center * Hendricks Regional Health * HOPE Healthcare Services * Horizon House * Immigrant Welcome Center * Indiana Department of Health * Indiana Division of Mental Health and Addiction * Indiana Legal Services * Indiana Native American Indian Affairs Commission * Indiana Public Health Association * Indiana University Richard M. Fairbanks School of Public Health * Indianapolis City Council * Indianapolis Neighborhood Housing Partnership * Indianapolis Urban League * Indy Go * Indy Hunger Network * IU Health * IU Health Indy Suburban Region * IU Health Methodist Hospital * IU Health University Hospital * IU Health West Hospital * Jump IN for Healthy Kids * Managed Health Services (MHS) * Marion County Public Health Department * Marian University/College of Osteopathic Medicine * Mental Health America of Hendricks County * MSD of Wayne Township * Neighborhood Christian Legal Clinic * New Strength Counselling * Nine13sports * Nurse Family Partnership of Goodwill of Central and Southern Indiana * Pathway to Recovery * Plainfield Schools * Playworks * Prevail, Inc. * Prime Life Enrichment * Purdue Extension * Raphael Health Center, Inc. * Richard M. Fairbanks Foundation * Sheltering Wings * Susie's Place * The Julian Center * The Willow Center * United States Congress, Representative Andre Carson (staff) * University of Indianapolis * United Way of Central Indiana * Wayne Township Education Foundation * YMCA of Greater Indianapolis/Top 10 Coalition Schedule H, Part V, Section B, Line 11 Facility , 1 Facility , 1 - IU Health West Hospital. Along with the CHNA, IU Health West Hospital's Board adopted an implementation strategy in April 2022 in response to the 2021 CHNA. IU Health West Hospital, along with community partners, prioritized and determined which of the significant needs identified in its most recently conducted CHNA could be adequately addressed by current or future initiatives, programs, resources, and collaborations. The 2022-2024 implementation strategy outlines how IU Health West Hospital plans to address significant needs including initiatives, strategies, internal/external collaborators, anticipated impact, and hospital resources. Significant Needs Hospital Will Address Below is the progress of the implementation strategy by significant need and its respective initiative(s). The hospital is addressing the following significant needs between 2022 and 2024: Access to Healthcare Services; Aging Population and Needs of Seniors; Behavioral Health; Chronic Disease and Chronic Disease Management; Maternal and Infant Health and Child Well-being; Smoking, Tobacco Use and Exposure to Secondhand Smoke; and Social Determinants of Health. Access to Healthcare Services - Provide operational funding to support HOPE Healthcare Services. - In 2023, IU Health West Hospital provided assistance to HOPE Healthcare Services to support healthcare services for un- and under - insured patients in Hendricks County and the surrounding areas. HOPE Healthcare saw a total of 820 patients for services including medical, dental and mental health. - Provide free vaccines to vulnerable populations. - In 2023, IU Health West administered 90 flu vaccines and 54 COVID-19 vaccines to the Hendricks County area through the execution of two community vaccine clinics. - Ensure all individuals can access healthcare services regardless of their ability to pay. - The hospital provides financial assistance to patients each year that includes discounts, full charity, and personal hardship reductions. IU Health Patient Financial Counselors are certified Indiana Navigators. They can assist patients and families with information and help them with applications for various health coverage programs. In 2023, the counselors served 366 people at IU Health West Hospital. Aging Population and Needs of Seniors - Provide senior-focused programming in the community through a senior health fair. - IU Health West Hospital participates in the Senior Expo at the Hendricks County Senior Center in Danville. The expo is a health fair that IU Health West Hospital attends and provides a variety of free services including vaccines, balance screenings, open enrollment information, blood pressure checks and stroke education. In 2023, there were 75 flu shots and 54 COVID-19 boosters administered, in addition, 35 blood pressure checks and 15 balance screenings were conducted. Over 130 seniors attended the event. Behavioral Health - Provide funding to support the efforts of Sheltering Wings in their mission to provide resources and shelter to those affected by domestic violence and support their educational outreach efforts within the community. - In 2023, IU Health West Hospital provided funding to Sheltering Wings. With this support, Sheltering Wings was able to provide safe housing for 220 residents (93 adults and 127 children), answer 1,384 help line calls, and help 106 victims through their mobile advocacy program. The mobile advocacy program allowed the shelter to connect women and men with resources at a neutral location such as a public library, cafe or church instead of the victims traveling to the shelter for services. - Provide funding to support counseling for Susie's Place clients. - IU Health West Hospital provided support to Susie's Place, which in 2023, conducted 419 forensic interviews in Hendricks County. The funding primarily supports the family advocate role; the family advocate provides social services to victims and families throughout the process of abuse, investigation and aftermath. - Continue supporting the Academic Health Center's successful Addictions and Pain Management Program in the IU Health West Hospital service area. - IU Health West Hospital implements the 24/7 peer counseling telemedicine for patients in the emergency department (ED). Clinicians assess patients with behavioral health concerns in the ED and refer them to virtual peer recovery counseling when necessary. Patients are placed in appropriate treatment programs if virtual services are not recommended. - Fund the SMART (Self-Management And Recovery Training) program. - In 2023 addiction and recovery counselors at IU Health West Hospital continued hosting the SMART step program in the community. Once a week, community members struggling with substance use disorder (SUD) can attend the free program to gain the tools and support needed to achieve and maintain abstinence from drugs. Approximately 15 individuals attend the class each week. - Support Mental Health America of Hendricks County (MHAHC) in their implementation of the Open-Door Social Club program. - The Open-Door Social Club is a free program that provides peer support while teaching daily living activities, computer literacy and healthy coping skills. The Open-Door Social Club aims to reduce hospitalizations, incarcerations and costly alternative treatments while improving mental and physical health along with social well-being. The club accepts veterans and patients receiving behavioral health treatment. In 2023, they had 64 participants. Club members also have access to a computer lab, music and art expression areas, educational classes, a library, a food pantry and are also served a hot meal. Over 160 hot meals were served. Referral and outreach services are also provided as needed. Chronic Disease and Chronic Disease Management - Provide Hendricks County residents with a free 10-week program to improve their overall health through fitness and nutrition. - In 2023, 42 Hendricks County community members completed the Fresh & Fit program. 79 percent of participants lowered their blood pressure and 61% lowered their triglycerides at completion of the program. In addition, a total of 237.4 pounds (an average of 6 pounds per person) were lost between pre-program and post-program. On post-program assessments, 100 percent of participants reported that they plan to further implement healthy habits by continuing a fitness and nutrition regimen into the future. - Further Implement IU Health Serves Days of Service (volunteer event engaging IU Health team members in activities that benefit the community. - IU Health West Hospital participated in the annual Days of Service with a total of five projects. These projects were a mixture of on-site, take-home and in the community. Projects for 2023 included team members painting Blastoff Playground at Williams Park in Brownsburg and rebuilding a fence, assembling Go Bags for the Hendricks County Crisis Response Team, sewing blankets for a memory care facility, and creating greeting cards and ornaments for seniors. 249 team members put in a combined 668 hours of volunteer work during the Days of Service. - Continue support of the B&O trail expansion through Hendricks County. - IU Health West Hospital continues its promise to support the state grant to fund the ten-mile trail expansion through Hendricks County. Once completed the trail will allow a bicyclist to ride from downtown Indianapolis through Hendricks County. Currently, over eight miles have been built. The end goal of the trail is to span 60 miles to the state line, including a wildlife corridor and incorporate equestrian trails. Maternal and Infant Health and Child Well-being. - Provide free child safety seat education. - IU Health West Hospital has funds set aside for child safety seat education. Currently, IU Health West Hospital offers childbirth education classes as part of the IU Health system. Smoking, Tobacco Use and Exposure to Secondhand Smoke - Support the Hendricks County Health Partnership (HCHP) to expand outreach efforts and promote tobacco cessation resources in the community. - In 2023, the HCHP collaborated with community partners including churches, schools, and local businesses to provide resources for tobacco and vaping cessation. The partnership promoted several programs, including Baby & Me Tobacco Free and Catch My Breath youth vaping prevention. Additionally, a library of printable materials on tobacco education and prevention is provided by the partnership. - Further implement the Centralized Tobacco Treatment Program (CTTP) (provides patients access to evidence-based tobacco treatment). Schedule H, Part V, Section B, Line 11 Facility , 2 Facility , 2 - IU Health West Hospital (Continued). - The CTTP program is free to IU Health Primary Care patients. Once a patient's level of care is assessed, they are provided evidence-based tobacco cessation treatment with a trained Tobacco Treatment Specialist (TTSs). Patients had access to Clickotine, a digital cessation app, and support from an Advance Practice Provider (APP) to evaluate and prescribe medication assisted therapy (MAT) for nicotine replacement. Education and support were provided to PCP offices which helped to expand services. Cross-functional teams worked together including the West Central Region TTSs for case conferencing and training. The goal to increase access to Specialty Care patients is on hold until budget allows for additional staffing. The 2023 focus was on improving internal efficiencies to maximize resources and improve patient experience including data collection and reporting enhancements. An additional focus was on improving access and patient experience with medication management. CTTP improved patient tobacco treatment medication support by integrating systems and processes with a dedicated APP resource. They improved documentation to accurately report MAT, demonstrating 70% of patients used NRT/medication to quit. There was a 30% increase in scheduled medication management appointments compared to 2022. The team focused on care continuation, care coordination (TTS/APP), scheduling patient follow-up appointments, and monitoring adherence or complications. These tactics also improved the engagement rate - 78% of scheduled medication management appointments were completed. The above focus on improving patient experience resulted in strong and consistent quit rates of 31% of active patients and harm reduction (patients who reduced use of tobacco) of 54% (July 2022-December 2023). The team received frequent testimonials of lives changed and gratitude for a supportive, compassionate partner. In 2023, CTTP received 1,149 referrals, scheduled 75% of them and completed at least one session with 82% of those scheduled. Additionally, 44% of patients seen completed 2 or more sessions. Over the program's life, CTTP has received 2,678 patient referrals. This program is financially supported by the parent hospital, IU Health Inc., but is offered to and impacts patients in this hospital's defined community. Social Determinants of Health - Provide educational programming for children through Kindergarten Countdown (a summer program designed for kindergarteners in families with lower incomes to get them prepared for the fall semester). - In 2023, IU Health West Hospital provided funding to Avon Community Schools to run their Kindergarten Countdown program. This program provided a three-week summer camp for students identified as academically low and needing additional support before starting kindergarten. The funding went towards teacher salaries, student meals, curriculum and books. 20 students completed the program. - Provide vouchers to residents to purchase healthy produce at Farmers Markets and fund local food pantries (food insecurity). - Support Women, Infants, and Children (WIC) and Supplemental Nutrition Assistance Program (SNAP) acceptance at all county farmers' markets. - Fund Double Up Bucks program to increase the value of vouchers for participants. - IU Health West Hospital funded the Double Up Bucks program in 2023 to provide more farmers market spendable dollars to those in need. Double Up checks were printed for $5 each and WIC participants each received 9 checks for a total of $45 per household. All 900 checks were distributed to 100 households. - IU Health West Hospital provides a food pantry grant to the Hendricks County Food Pantry Coalition to help address the food disparity needs within the community. The funds were used to stock 18 local food pantries with food and hygiene items. -Provide transitional housing through IU Health's Community Impact Investment Fund (CIIF) - In 2023, IU Health's CIIF Fund awarded Volunteers of America a grant to provide transitional housing and recovery support to pregnant women and young mothers who are suffering from substance use disorder. Focused on Hendricks and western Marion counties, the program will help to reduce addictions and help these women to find stable housing, income and improve their mental health and social relationships. Significant Needs Hospital Will Not Address IU Health West Hospital is not addressing the following significant needs between 2022 and 2024: Health Education and Navigation Health Education and Navigation refers to services and resources that are available in the community, but people do not know how to get connected to them (e.g., how to obtain health insurance, understanding insurance benefits, navigating the healthcare system, language barriers and health literacy). IU Health West Hospital perceives this health need as being addressed under many initiatives that fall under the significant needs that the hospital is currently addressing. IU Health West Hospital will monitor this need to see if there are changes or opportunities in the future to address it further. Schedule H, Part V, Section B, Line 13 Facility , 1 Facility , 1 - IU HEALTH WEST HOSPITAL. IN ADDITION TO FPG, IU HEALTH WEST HOSPITAL MAY TAKE INTO CONSIDERATION A PATIENT'S INCOME AND/OR ABILITY TO PAY IN CALCULATION OF A FINANCIAL ASSISTANCE AWARD. Schedule H, Part V, Section B, Line 13 Facility , 1 Facility , 1 - IU HEALTH WEST HOSPITAL. IU Health West Hospital takes into consideration several other factors in determining patient eligibility for financial assistance. These factors include the following: 1. Eligibility for Financial Assistance due to Financial or Personal Hardship In order to be eligible for Financial Assistance due to Financial or Personal Hardship under this Policy, a patient or guarantor must: - Submit a completed Financial Assistance Application with all supporting documentation and be approved in accordance with this Policy; - Be an Indiana Resident as defined in this Policy; and - If Uninsured, consult with a member of IU Health's Individual Solutions department to determine if health care coverage may be obtained from a government insurance or assistance product, the Health Insurance Marketplace, or from any other source of coverage. Financial Assistance due to Financial Hardship is only available for encounters where care was initiated via an eligible facility's emergency department, direct admission from a physician's office, or transfer from another hospital facility. 2. Financial Assistance due to Financial Hardship The FPL income threshold under this section is as follows: - If one or more adults and zero dependents are in the household, the FPL Income Threshold is 200%. - If two or more adults and one or more dependents are in the household, the FPL Income Threshold is 250%. - If one adult and one or more dependents are in the household, the FPL Income Threshold is 300%. In some instances, an adult will also qualify as a dependent. When this occurs, IU Health will treat the adult as a dependent for purposes of the FPL calculation. IU Health will utilize the most recent FPL data available and will apply the FPL data to a patient or guarantor's account balance based upon the calendar date a completed Financial Assistance Application was received, not a patient's date of service. An Uninsured Patient or their guarantor whose household income is less than or equal to the FPL income threshold may be eligible for full Financial Assistance up to 100% of Gross Charges if approved. An Underinsured Patient or their guarantor whose household income is less than or equal to the FPL income threshold may be eligible for full Financial Assistance up to 100% of Patient Responsibility if approved. 3. Financial Assistance due to Personal Hardship An Uninsured or Underinsured patient or their guarantor whose household income is above the FPL income threshold may be eligible for Financial Assistance if the patient's outstanding Patient Responsibility exceeds 20% of the patient's or their guarantor's annual household income. - If approved, the patient's balance will be reduced to 20% of the patient or guarantor's annual household income or the Amounts Generally Billed, whichever is less. - IU Health will work with the patient or guarantor to identify a reasonable payment plan on the remainder of the balance. 4. Eligibility Period If approved for financial assistance by IU Health, the patient will be guaranteed financial assistance for treatment related to the underlying condition, for which the patient was originally screened and approved, through the remainder of the calendar year. As a condition of extending the on-going Financial Assistance, the patient must comply with requests from IU Health to verify that the patient continues to meet the conditions for qualification. 5. Appeals and Assistance Granted By the Financial Assistance Committee The Financial Assistance Committee will review and make determinations on all requests for appeals related to Financial Assistance. If a patient or guarantor seeks to appeal a Financial Assistance Determination, a written request must be submitted, along with the supporting documentation. The Financial Assistance Committee will review requests for and may grant additional Financial Assistance, including but not limited to, the following: - Assistance to patients who are seeking treatment that can only be provided in Indiana by IU Health or who would benefit from continued medical services from IU Health for continuity of care; - Care approved by the IU Health Chief Medical Officer (CMO) or the Chief Executive Officer (CEO) or CMO of an IU Health facility or region, including medically necessary non-elective services for which no payment source can be identified; - Care provided when it is known no payment source exists; - International humanitarian aid; and - Other care identified by the Financial Assistance Committee that fulfills the IU Health Mission. All decisions of the Financial Assistance Committee are final. 6. Presumptive Eligibility No Financial Assistance Application is required to receive Financial Assistance under this Presumptive Eligibility section. IU Health will deem patients or their guarantors presumptively eligible for Financial Assistance if they are found to be eligible for one of the following programs and care was initiated via an eligible facility's emergency department, direct admission from a physician's office, or transfer from another hospital facility: - Medicaid (any state) - Indiana Children's Special Health Care Services - Healthy Indiana Plan - Patients who are awarded Hospital Presumptive Eligibility (HPE) - A state and/or federal program that verifies the patient or guarantor's gross household income meets the FPL income threshold. IU Health will conduct a quarterly review of all accounts placed with a collection agency partner for at least one hundred and twenty (120) days after the account is eligible for an ECA as set forth in this Policy. If the patient or guarantor's individual scoring criteria demonstrates the patient has a low likelihood and/or propensity to pay or no credit, the patient or guarantor may be deemed presumptively eligible for Financial Assistance. Financial Assistance may additionally be granted in the following circumstances: - If the patient or their guarantor is found to have filed a petition for bankruptcy. - If the patient is deceased and found to have no estate. - If the patient is deceased and was under 21 years of age at the time of death. 7. Exhaustion of Alternate Sources of Assistance Patients must exhaust all other state and federal assistance programs prior to receiving Financial Assistance due to Financial or Personal Hardship under this Policy including, but not limited to, Medicaid. Patients who may be eligible for coverage under an applicable health insurance policy must exhaust all insurance benefits. - This includes patients covered under their own policy and those who may be entitled to benefits from a third-party policy. - IU Health may request patients show proof that such a claim was properly submitted to the appropriate insurance provider before awarding Financial Assistance. Eligible patients who receive medical care from an IU Health facility as a result of an injury proximately caused by a third party, and later receive a monetary settlement or award from said third party, may receive Financial Assistance for any outstanding balance not covered by the settlement or award. In the event Financial Assistance has already been granted in the above circumstances, IU Health reserves the right to reverse the Financial Assistance Determination in an amount equal to the amount IU Health would be entitled to receive had no Financial Assistance been awarded. 8. Patient Assets There are situations where a patient or their guarantor may have significant income or assets available to pay for healthcare services such as a legal settlement. The Financial Assistance Committee may evaluate the income or assets in determining Financial Hardship. IU Health may require a list of all property owned by the patient or guarantor and adjust a Financial Assistance Determination as a result. Schedule H, Part V, Section B, Line 16 Facility , 1 Facility , 1 - IU HEALTH WEST HOSPITAL. IU Health West Hospital takes several other measures to publicize its FAP within the community. These measures include the following: 1. Post this Policy, a Plain Language Summary of this Policy, and the Financial Assistance Application on its website. 2. Provide patients with a Plain Language Summary of this Policy during registration and/or discharge. 3. Post conspicuous displays in appropriate acute care settings such as emergency departments and registration areas describing the available assistance and directing eligible patients to the Financial Assistance Application. 4. Include a conspicuous written notice on all patient post-discharge billing statements notifying the patient about this Policy and the telephone number of the Customer Service Department which can assist patients with questions regarding this Policy. 5. Make available Customer Service representatives via telephone during normal business hours. 6. Mail copies of this Policy, a Plain Language Summary of this Policy, and a Financial Assistance Application to patients or their guarantor free of charge upon request. 7. Broadly communicate this Policy as a part of its general outreach efforts. 8. Educate patient-facing team members on this Policy and the process for referring patients to the program. 4 IU HEALTH WEST CANCER CENTER 1111 N RONALD REAGAN PKWY B1600 AVON IN 46123 Specialty Care IU HEALTH WEST HOSPITAL REHABILITATION SERVICES 1115 N RONALD REAGAN PKWY SUITE MG1 00 AVON IN 46123 Rehabilitation Services IU HEALTH WEST RETAIL PHARMACY 1111 N RONALD REAGAN PKWY M105 AVON IN 46123 PHARMACY IU HEALTH WEST HOSPITAL LAB 1111 N RONALD REAGAN PKWY A1110 AVON IN 46123 LAB Schedule H, Part I, Line 6a C.B. REPORT PREPARED BY A RELATED ORG. IU HEALTH WEST HOSPITAL'S COMMUNITY BENEFIT AND OTHER INVESTMENTS, ENCOMPASSING ITS TOTAL COMMUNITY INVESTMENT, ARE INCLUDED IN THE IU HEALTH COMMUNITY BENEFIT REPORT WHICH IS PREPARED ON BEHALF OF AND INCLUDES IU HEALTH AND ITS RELATED HOSPITAL ENTITIES IN THE STATE OF INDIANA. THE IU HEALTH COMMUNITY BENEFIT REPORT IS MADE AVAILABLE TO THE PUBLIC ON IU HEALTH'S WEBSITE AT HTTPS://IUHEALTH.ORG/IN-THE-COMMUNITY/COMMUNITY-BENEFIT. THE IU HEALTH COMMUNITY BENEFIT REPORT IS ALSO DISTRIBUTED TO NUMEROUS KEY ORGANIZATIONS THROUGHOUT THE STATE OF INDIANA IN ORDER TO BROADLY SHARE THE IU HEALTH STATEWIDE SYSTEM'S COMMUNITY BENEFIT EFFORTS. IT IS ALSO AVAILABLE BY REQUEST THROUGH THE INDIANA STATE DEPARTMENT OF HEALTH OR IU HEALTH. Schedule H, Part I, Line 7f BAD DEBT EXPENSE The amount of bad debt expense included on Form 990, Part IX, Line 25, column (A), but subtracted for purposes of calculating the percentage of total expense on Line 7, column (f) is $23,347,291. 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 23.78%. Schedule H, Part II PROMOTION OF HEALTH IN COMMUNITIES SERVED IU Health West Hospital supports and/or participates in a variety of community-building activities that address the non-medical, root causes of health problems in the communities it serves. IU Health West Hospital and its related hospital entities across the state of Indiana ("IU Health Statewide System") investments include economic development efforts across the state, environmental improvement projects, workforce development opportunities, collaboration with like-minded organizations through coalitions that address key issues and advocating for improvements in the health status of vulnerable populations. Several initiatives meet the definition of community benefit and have been reported as such. Coalition Building: IU Health team members participate on the governing boards of nonprofit organizations that seek to increase access to healthcare services, health equity, and advancing public health such as Sheltering Wings and Susie's Place. Additionally, IU Health team members participate in local coalitions to share resources and information as well as improve community and partner capacity to address health needs and advance health equity in the community. Schedule H, Part I, Line 3c Eligibility criteria for free or discounted care IU HEALTH USES SEVERAL FACTORS OTHER THAN FEDERAL POVERTY GUIDELINES ("FPG") IN DETERMINING ELIGIBILITY FOR FREE CARE UNDER ITS FAP. THESE FACTORS INCLUDE THE FOLLOWING: 1. ELIGIBILITY FOR FINANCIAL ASSISTANCE DUE TO FINANCIAL OR PERSONAL HARDSHIP IN ORDER TO BE ELIGIBLE FOR FINANCIAL ASSISTANCE DUE TO FINANCIAL OR PERSONAL HARDSHIP UNDER THIS POLICY, A PATIENT OR GUARANTOR MUST: - SUBMIT A COMPLETED FINANCIAL ASSISTANCE APPLICATION WITH ALL SUPPORTING DOCUMENTATION AND BE APPROVED IN ACCORDANCE WITH THIS POLICY; - BE AN INDIANA RESIDENT AS DEFINED IN THIS POLICY; AND - IF UNINSURED, CONSULT WITH A MEMBER OF IU HEALTH'S INDIVIDUAL SOLUTIONS DEPARTMENT TO DETERMINE IF HEALTH CARE COVERAGE MAY BE OBTAINED FROM A GOVERNMENT INSURANCE OR ASSISTANCE PRODUCT, THE HEALTH INSURANCE MARKETPLACE, OR FROM ANY OTHER SOURCE OF COVERAGE. FINANCIAL ASSISTANCE DUE TO FINANCIAL HARDSHIP IS ONLY AVAILABLE FOR ENCOUNTERS WHERE CARE WAS INITIATED VIA AN ELIGIBLE FACILITY'S EMERGENCY DEPARTMENT, DIRECT ADMISSION FROM A PHYSICIAN'S OFFICE, OR TRANSFER FROM ANOTHER HOSPITAL FACILITY. 2. FINANCIAL ASSISTANCE DUE TO FINANCIAL HARDSHIP THE FPL INCOME THRESHOLD UNDER THIS SECTION IS AS FOLLOWS: -IF ONE OR MORE ADULTS AND ZERO DEPENDENTS ARE IN THE HOUSEHOLD, THE FPL INCOME THRESHOLD IS 200%. -IF TWO OR MORE ADULTS AND ONE OR MORE DEPENDENTS ARE IN THE HOUSEHOLD, THE FPL INCOME THRESHOLD IS 250%. -IF ONE ADULT AND ONE OR MORE DEPENDENTS ARE IN THE HOUSEHOLD, THE FPL INCOME THRESHOLD IS 300%. IN SOME INSTANCES, AN ADULT WILL ALSO QUALIFY AS A DEPENDENT. WHEN THIS OCCURS, IU HEALTH NORTH WILL TREAT THE ADULT AS A DEPENDENT FOR PURPOSES OF THE FPL CALCULATION. IU HEALTH WILL UTILIZE THE MOST RECENT FPL DATA AVAILABLE AND WILL APPLY THE FPL DATA TO A PATIENT OR GUARANTOR'S ACCOUNT BALANCE BASED UPON THE CALENDAR DATE A COMPLETED FINANCIAL ASSISTANCE APPLICATION WAS RECEIVED, NOT A PATIENT'S DATE OF SERVICE. AN UNINSURED PATIENT OR THEIR GUARANTOR WHOSE HOUSEHOLD INCOME IS LESS THAN OR EQUAL TO THE FPL INCOME THRESHOLD MAY BE ELIGIBLE FOR FULL FINANCIAL ASSISTANCE UP TO 100% OF GROSS CHARGES IF APPROVED. AN UNDERINSURED PATIENT OR THEIR GUARANTOR WHOSE HOUSEHOLD INCOME IS LESS THAN OR EQUAL TO THE FPL INCOME THRESHOLD MAY BE ELIGIBLE FOR FULL FINANCIAL ASSISTANCE UP TO 100% OF PATIENT RESPONSIBILITY IF APPROVED. 3. FINANCIAL ASSISTANCE DUE TO PERSONAL HARDSHIP AN UNINSURED OR UNDERINSURED PATIENT OR THEIR GUARANTOR WHOSE HOUSEHOLD INCOME IS ABOVE THE FPL INCOME THRESHOLD MAY BE ELIGIBLE FOR FINANCIAL ASSISTANCE IF THE PATIENT'S OUTSTANDING PATIENT RESPONSIBILITY EXCEEDS 20% OF THE PATIENT'S OR THEIR GUARANTOR'S ANNUAL HOUSEHOLD INCOME. -IF APPROVED, THE PATIENT'S BALANCE WILL BE REDUCED TO 20% OF THE PATIENT OR GUARANTOR'S ANNUAL HOUSEHOLD INCOME OR THE AMOUNTS GENERALLY BILLED, WHICHEVER IS LESS. -IU HEALTH WILL WORK WITH THE PATIENT OR GUARANTOR TO IDENTIFY A REASONABLE PAYMENT PLAN ON THE REMAINDER OF THE BALANCE. 4. ELIGIBILITY PERIOD IF APPROVED FOR FINANCIAL ASSISTANCE BY IU HEALTH, THE PATIENT WILL BE GUARANTEED FINANCIAL ASSISTANCE FOR TREATMENT RELATED TO THE UNDERLYING CONDITION, FOR WHICH THE PATIENT WAS ORIGINALLY SCREENED AND APPROVED, THROUGH THE REMAINDER OF THE CALENDAR YEAR. AS A CONDITION OF EXTENDING THE ON-GOING FINANCIAL ASSISTANCE, THE PATIENT MUST COMPLY WITH REQUESTS FROM IU HEALTH TO VERIFY THAT THE PATIENT CONTINUES TO MEET THE CONDITIONS FOR QUALIFICATION. 5. APPEALS AND ASSISTANCE GRANTED BY THE FINANCIAL ASSISTANCE COMMITTEE THE FINANCIAL ASSISTANCE COMMITTEE WILL REVIEW AND MAKE DETERMINATIONS ON ALL REQUESTS FOR APPEALS RELATED TO FINANCIAL ASSISTANCE. IF A PATIENT OR GUARANTOR SEEKS TO APPEAL A FINANCIAL ASSISTANCE DETERMINATION, A WRITTEN REQUEST MUST BE SUBMITTED, ALONG WITH THE SUPPORTING DOCUMENTATION. THE FINANCIAL ASSISTANCE COMMITTEE WILL REVIEW REQUESTS FOR AND MAY GRANT ADDITIONAL FINANCIAL ASSISTANCE, INCLUDING BUT NOT LIMITED TO, THE FOLLOWING: -ASSISTANCE TO PATIENTS WHO ARE SEEKING TREATMENT THAT CAN ONLY BE PROVIDED IN INDIANA BY IU HEALTH OR WHO WOULD BENEFIT FROM CONTINUED MEDICAL SERVICES FROM IU HEALTH FOR CONTINUITY OF CARE; -CARE APPROVED BY THE IU HEALTH CHIEF MEDICAL OFFICER (CMO) OR THE CHIEF EXECUTIVE OFFICER (CEO) OR CMO OF AN IU HEALTH FACILITY OR REGION, INCLUDING MEDICALLY NECESSARY NON-ELECTIVE SERVICES FOR WHICH NO PAYMENT SOURCE CAN BE IDENTIFIED; -CARE PROVIDED WHEN IT IS KNOWN NO PAYMENT SOURCE EXISTS; -INTERNATIONAL HUMANITARIAN AID; AND -OTHER CARE IDENTIFIED BY THE FINANCIAL ASSISTANCE COMMITTEE THAT FULFILLS THE IU HEALTH MISSION. ALL DECISIONS OF THE FINANCIAL ASSISTANCE COMMITTEE ARE FINAL. 6. PRESUMPTIVE ELIGIBILITY NO FINANCIAL ASSISTANCE APPLICATION IS REQUIRED TO RECEIVE FINANCIAL ASSISTANCE UNDER THIS PRESUMPTIVE ELIGIBILITY SECTION. IU HEALTH WILL DEEM PATIENTS OR THEIR GUARANTORS PRESUMPTIVELY ELIGIBLE FOR FINANCIAL ASSISTANCE IF THEY ARE FOUND TO BE ELIGIBLE FOR ONE OF THE FOLLOWING PROGRAMS AND CARE WAS INITIATED VIA AN ELIGIBLE FACILITY'S EMERGENCY DEPARTMENT, DIRECT ADMISSION FROM A PHYSICIAN'S OFFICE, OR TRANSFER FROM ANOTHER HOSPITAL FACILITY: -MEDICAID (ANY STATE) -INDIANA CHILDREN'S SPECIAL HEALTH CARE SERVICES -HEALTHY INDIANA PLAN -PATIENTS WHO ARE AWARDED HOSPITAL PRESUMPTIVE ELIGIBILITY (HPE) -A STATE AND/OR FEDERAL PROGRAM THAT VERIFIES THE PATIENT OR GUARANTOR'S GROSS HOUSEHOLD INCOME MEETS THE FPL INCOME THRESHOLD. IU HEALTH WILL CONDUCT A QUARTERLY REVIEW OF ALL ACCOUNTS PLACED WITH A COLLECTION AGENCY PARTNER FOR AT LEAST ONE HUNDRED AND TWENTY (120) DAYS AFTER THE ACCOUNT IS ELIGIBLE FOR AN ECA AS SET FORTH IN THIS POLICY. IF THE PATIENT OR GUARANTOR'S INDIVIDUAL SCORING CRITERIA DEMONSTRATES THE PATIENT HAS A LOW LIKELIHOOD AND/OR PROPENSITY TO PAY OR NO CREDIT, THE PATIENT OR GUARANTOR MAY BE DEEMED PRESUMPTIVELY ELIGIBLE FOR FINANCIAL ASSISTANCE. FINANCIAL ASSISTANCE MAY ADDITIONALLY BE GRANTED IN THE FOLLOWING CIRCUMSTANCES: -IF THE PATIENT OR THEIR GUARANTOR IS FOUND TO HAVE FILED A PETITION FOR BANKRUPTCY. -IF THE PATIENT IS DECEASED AND FOUND TO HAVE NO ESTATE. -IF THE PATIENT IS DECEASED AND WAS UNDER 21 YEARS OF AGE AT THE TIME OF DEATH. 7. EXHAUSTION OF ALTERNATE SOURCES OF ASSISTANCE PATIENTS MUST EXHAUST ALL OTHER STATE AND FEDERAL ASSISTANCE PROGRAMS PRIOR TO RECEIVING FINANCIAL ASSISTANCE DUE TO FINANCIAL OR PERSONAL HARDSHIP UNDER THIS POLICY INCLUDING, BUT NOT LIMITED TO, MEDICAID. PATIENTS WHO MAY BE ELIGIBLE FOR COVERAGE UNDER AN APPLICABLE HEALTH INSURANCE POLICY MUST EXHAUST ALL INSURANCE BENEFITS. -THIS INCLUDES PATIENTS COVERED UNDER THEIR OWN POLICY AND THOSE WHO MAY BE ENTITLED TO BENEFITS FROM A THIRD-PARTY POLICY. -IU HEALTH MAY REQUEST PATIENTS SHOW PROOF THAT SUCH A CLAIM WAS PROPERLY SUBMITTED TO THE APPROPRIATE INSURANCE PROVIDER BEFORE AWARDING FINANCIAL ASSISTANCE. ELIGIBLE PATIENTS WHO RECEIVE MEDICAL CARE FROM AN IU HEALTH FACILITY AS A RESULT OF AN INJURY PROXIMATELY CAUSED BY A THIRD PARTY, AND LATER RECEIVE A MONETARY SETTLEMENT OR AWARD FROM SAID THIRD PARTY, MAY RECEIVE FINANCIAL ASSISTANCE FOR ANY OUTSTANDING BALANCE NOT COVERED BY THE SETTLEMENT OR AWARD. IN THE EVENT FINANCIAL ASSISTANCE HAS ALREADY BEEN GRANTED IN THE ABOVE CIRCUMSTANCES, IU HEALTH RESERVES THE RIGHT TO REVERSE THE FINANCIAL ASSISTANCE DETERMINATION IN AN AMOUNT EQUAL TO THE AMOUNT IU HEALTH WOULD BE ENTITLED TO RECEIVE HAD NO FINANCIAL ASSISTANCE BEEN AWARDED. 8. PATIENT ASSETS THERE ARE SITUATIONS WHERE A PATIENT OR THEIR GUARANTOR MAY HAVE SIGNIFICANT INCOME OR ASSETS AVAILABLE TO PAY FOR HEALTHCARE SERVICES SUCH AS A LEGAL SETTLEMENT. THE FINANCIAL ASSISTANCE COMMITTEE MAY EVALUATE THE INCOME OR ASSETS IN DETERMINING FINANCIAL HARDSHIP. IU HEALTH MAY REQUIRE A LIST OF ALL PROPERTY OWNED BY THE PATIENT OR GUARANTOR AND ADJUST A FINANCIAL ASSISTANCE DETERMINATION AS A RESULT. Schedule H, Part I, Line 7 Bad Debt Expense excluded from financial assistance calculation 23347291 Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount THE AMOUNT REPORTED ON LINE 2 AS BAD DEBT IS REPORTED AT COST, AS CALCULATED USING THE COST TO CHARGE RATIO METHODOLOGY. Schedule H, Part III, Line 3 Bad Debt Expense Methodology IU Health will deem patients or their guarantors presumptively eligible for Financial Assistance if they are found to be eligible for one of the following programs and care was initiated via an eligible facility's emergency department, direct admission from a physician's office, or transfer from another hospital facility: 1. Medicaid (any state) 2. Indiana Children's Special Health Care Services 3. Healthy Indiana Plan 4. Patients who are awarded Hospital Presumptive Eligibility (HPE) 5. A state and/or federal program that verifies the patient or guarantor's gross household income meets the FPL income threshold. No Financial Assistance Application is required to receive Financial Assistance under this Presumptive Eligibility section. IU Health will conduct a quarterly review of all accounts placed with a collection agency partner for at least one hundred and twenty (120) days after the account is eligible for an ECA as set forth in this Policy. If the patient or guarantor's individual scoring criteria demonstrates the patient has a low likelihood and/or propensity to pay or no credit, the patient or guarantor may be deemed presumptively eligible for Financial Assistance. Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote IU HEALTH'S CONSOLIDATED FINANCIAL STATEMENTS, FOOTNOTE 5, ADDRESSES BAD DEBT EXPENSE AS FOLLOWS: The Indiana University Health System does not require collateral or other security from its patients, substantially all of whom are residents of the State, for the delivery of health care services. However, consistent with industry practice, the Indiana University Health System routinely obtains assignment of (or is otherwise entitled to receive) patients' benefits payable under their health insurance programs, plans, or policies (e.g., Medicare, Medicaid, managed care payers, and commercial insurance policies). The Indiana University Health System uses a portfolio approach to account for categories of patient contracts as a collective group, rather than recognizing revenue on an individual contract basis. The portfolios consist of major payer classes for inpatient revenue and outpatient revenue. Based on the historical collection trends and other analysis, the Indiana University Health System believes that revenue recognized by utilizing the portfolio approach approximates the revenue that would have been recognized if an individual contract approach were used. In support of its mission, the Indiana University Health System provides care to uninsured and underinsured patients. The Indiana University Health System provides charity care to patients who lack the financial resources to pay for their medical care. Financial assistance is available to qualifying uninsured and underinsured patients receiving care at an Indiana University Health System hospital location. Under its financial assistance policy, the Indiana University Health System provides medically necessary care to uninsured patients. Financial assistance up to the full amount of patient financial responsibility is available for uninsured and underinsured patients receiving care via the emergency department, direct admission from a physician's office, or transfer from another hospital. The Federal Poverty Level (FPL) thresholds are used when a patient applies for financial assistance due to financial hardship. In determining the level of financial assistance based on household makeup, single person households without dependents are eligible for assistance if household income is less than or equal to 200% FPL, two adults and at least one dependent are eligible if household income is less than or equal to 250% FPL, and households with one adult and at least one dependent are eligible if household income is less than or equal to 300% FPL. Qualifying individuals with medical bills totaling more than 20% of annual household income, regardless of FPL, qualify for catastrophic assistance and are eligible for a reduction in patient financial responsibility to 5% of annual household income or Amounts Generally Billed, whichever is less. Since the Indiana University Health System does not pursue collection of these amounts, the discounted amounts are not reported as patient service revenue. The Indiana University Health System uses presumptive eligibility screening procedures for some forms of financial assistance and recognizes net patient service revenue on services provided to self-pay patients at the discounted rate at the time services are rendered. The estimated cost of charity care, using the consolidated cost to charge ratio, was $95,909,000 and $88,213,000 in 2023 and 2022, respectively. Schedule H, Part III, Line 8 Community benefit & methodology for determining medicare costs The amount reported on Schedule H, Part III, Line 6 is calculated, in accordance with the Form 990 instructions, using "allowable costs" from the IU Health West Hospital Medicare Cost Report. "Allowable costs" for Medicare Cost Report purposes, however, are not reflective of all costs associated with IU Health West Hospital's participation in Medicare programs. For example, the Medicare Cost Report excludes certain costs such as billed physician services, the costs of Medicare Parts C and D, fee schedule reimbursed services, and durable medical equipment services. Inclusion of all costs associated with IU Health West's participation in Medicare programs would significantly increase the Medicare shortfall reported on Schedule H, Part III, Line 7. IU Health West Hospital's Medicare shortfall is attributable to reimbursements that are less than the cost of providing patient care and services to Medicare beneficiaries and does not include any amounts that result from inefficiencies or poor management. IU Health West Hospital accepts all Medicare patients knowing that there may be shortfalls; therefore it has taken the position that any shortfall should be counted as part of its community benefit. Additionally, it is implied in Internal Revenue Service Revenue Ruling 69-545 that treating Medicare patients is a community benefit. Revenue Ruling 69-545, which established the community benefit standard for nonprofit hospitals, states that if a hospital serves patients with governmental health benefits, including Medicare, then this is an indication that the hospital operates to promote the health of the community. Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance IU Health West Hospital's FAP and Written Debt Collection Policy describe the collection practices applicable to patients, including those who may qualify for financial assistance. 1. Financial Assistance Application Financial Assistance Applications must include the following documentation: - All sources of Income for the last three (3) months. - Most recent three (3) months of pay stubs or Supplemental Security Income via Social Security. - Most recent three (3) statements from checking and savings accounts, certificates of deposit, stocks, bonds and money market accounts. - Most recent state and Federal Income Tax forms including Schedules C, D, E, and F. In the event the patient or guarantor's income does not warrant the filing of a federal tax statement, the individual may submit a notarized affidavit attesting to the foregoing. - Most recent W-2 statement. - For patients or members of the Household who are currently unemployed, Wage Inquiry from WorkOne. - If applicable, divorce/dissolution decrees and child custody order. Patients or their guarantors wishing to apply for Financial Assistance due to Financial Hardship are encouraged to submit an Application within ninety (90) days of discharge. Patients or their guarantors may submit an Application up to two-hundred and forty (240) days from the date of their initial post-discharge billing statement from IU Health, however, accounts may be subject to Extraordinary Collection Actions (ECA) as soon as one-hundred and twenty (120) days after receipt of the initial post-discharge billing statement. Patients or their guarantors submitting an incomplete Financial Assistance Application will receive written notification of the Application's deficiency upon discovery by IU Health. The Application will be pended for a period of forty-five (45) days from the date the notification is mailed. IU Health will suspend any ECA until the Application is complete or the expiration of the forty-five (45) day period. Patients with limited English proficiency may request a copy of this Policy, a Financial Assistance Application, and a Plain Language Summary in one of the below languages: - Arabic; - Burmese; - Burmese - Falam; - Burmese - Hakha Chin; - Mandarin/Chinese; or - Spanish The patient, and/or their representative, such as the patient's physician, family members, legal counsel, community or religious groups, social services or hospital personnel may request a Financial Assistance Application be mailed to a patient's primary mailing address free of charge. IU Health maintains the confidentiality of all Financial Assistance Applications and supporting documentation. IU Health will deny or revoke Financial Assistance for any patient or guarantor who falsifies any portion of a Financial Assistance Application. 2. Financial Assistance Determinations IU Health will inform patients or guarantors of the results of their Application by providing the patient or guarantor with a Financial Assistance Determination within ninety (90) days of receiving a completed Application and all requested documentation. A patient's Financial Assistance Application and Financial Assistance Determination are specific to each date(s) of service and approved related encounters. If a patient or guarantor is granted less than full charity assistance and the patient or guarantor provides additional information for reconsideration, Revenue Cycle Services may amend a prior Financial Assistance Determination. 3. Extraordinary Collection Actions IU Health may refer delinquent patient accounts to a third-party collection agency after utilizing reasonable efforts to determine a patient's eligibility for assistance under this Policy. Reasonable efforts include the following: - IU Health will notify the patient of this Policy at least thirty (30) days prior to initiating an ECA. - IU Health will not initiate an ECA for at least one-hundred and twenty (120) days after the patient's initial post-discharge billing statement. - IU Health will review all Financial Assistance Applications received up to and including two-hundred and forty (240) days after the patient's initial post-discharge billing statement. IU Health will cease any ECAs it has initiated upon receipt of a Financial Assistance Application until a Financial Assistance Determination is made under this policy. - If an Application is Approved, IU Health will issue a revised statement, issue refunds, and make reasonable efforts to reverse ECAs as necessary. IU Health and its third-party collection agencies may initiate an ECA against a patient or their guarantor in accordance with this Policy and 26 C.F.R. § 1.501(r). ECAs may include the following: - Selling a patient or their guarantor's outstanding financial responsibility to a third party. - Reporting adverse information about the patient or their guarantor to consumer credit reporting agencies or credit bureaus. - Deferring or denying, or requiring a payment before providing, medically necessary care because of a patient or their guarantor's nonpayment of one or more bills for previously provided care covered under this Policy. - Actions requiring a legal or judicial process, including but not limited to placing a lien on a patient's or their guarantor's property, foreclosing on a patient's or their guarantor's real property, attaching or seizing a patient's or their guarantor's bank account or other personal property, commencing a civil action against a patient or their guarantor, causing a patient or guarantor's arrest, causing a patient and/or guarantor to be subject to a writ of body attachment, and garnishing a patient or guarantor's wages When it is necessary to engage in such action, IU Health and its third party collection agencies, will engage in fair, respectful and transparent collections activities. 4. Refunds Patients eligible for Financial Assistance under this Policy who remitted payment to IU Health in excess of their Patient Responsibility will be alerted to the overpayment as promptly after discovery as is reasonable given the nature of the overpayment. Patients with an outstanding account balance due on a separate account will have their refund applied to the outstanding balance. Patients without an outstanding account balance described above will be issued a refund check for their overpayment as soon as technically feasible. Schedule H, Part V, Section B, Line 16a FAP website - IU HEALTH WEST HOSPITAL: Line 16a URL: https://iuhealth.org/pay-a-bill/financial-assistance; Schedule H, Part V, Section B, Line 16b FAP Application website - IU HEALTH WEST HOSPITAL: Line 16b URL: https://iuhealth.org/pay-a-bill/financial-assistance; Schedule H, Part V, Section B, Line 16c FAP plain language summary website - IU HEALTH WEST HOSPITAL: Line 16c URL: https://iuhealth.org/pay-a-bill/financial-assistance; Schedule H, Part VI, Line 2 Needs assessment Though IU Health West Hospital believes its CHNA process is comprehensive, the CHNA is done on a triennial basis. Between CHNA cycles, IU Health West Hospital gathers data and information to monitor the most current needs of the community. Additional sources of data and information include: * IU Health data analytics and information service teams; * Secondary data sources from Federal, state, and local entities with a focus on health behaviors, health outcomes, and social determinants of health; * Obtaining community organization and governmental agency perspectives; priority population perspectives; and other healthcare and hospital perspectives; * Reports that share findings and recommendations on certain populations within the community and/or health behaviors, health outcomes, or social determinants of health; * Evidence informed sources; and * Team member participation in partnering efforts (e.g., coalitions, advisory committees, task forces, etc.). The regular review of these sources of data and information rarely impact what the significant needs are between CHNA cycles. However, it does help influence the types or level of interventions to address the significant needs; prioritize resources to those groups or neighborhoods experiencing health disparities in the community; identify funding opportunities to support interventions; and strengthen or mobilize partnerships to improve health. Schedule H, Part VI, Line 3 Patient education of eligibility for assistance IU Health West Hospital is committed to serving the healthcare needs of all of its patients regardless of their ability to pay for such services. To assist in meeting those needs, IU Health West Hospital has established a FAP to provide Financial Assistance to Uninsured Patients. IU Health West Hospital is committed to ensuring its patients are compliant with all provisions of the Patient Protection & Affordable Care Act. To that end, IU Health West Hospital will make a good faith effort to locate and obtain health insurance coverage for patients prior to considering patients for coverage under the FAP. IU Health West Hospital takes several measures to inform its patients of the FAP and FAP-eligibility. These measures include the following: 1. Post this Policy, a Plain Language Summary of this Policy, and the Financial Assistance Application on its website. 2. Provide patients with a Plain Language Summary of this Policy during registration and/or discharge. 3. Post conspicuous displays in appropriate acute care settings such as emergency departments and registration areas describing the available assistance and directing eligible patients to the Financial Assistance Application. 4. Include a conspicuous written notice on all patient post-discharge billing statements notifying the patient about this Policy and the telephone number of the Customer Service Department which can assist patients with questions regarding this Policy. 5. Make available Customer Service representatives via telephone during normal business hours. 6. Mail copies of this Policy, a Plain Language Summary of this Policy, and a Financial Assistance Application to patients or their guarantor free of charge upon request. 7. Broadly communicate this Policy as a part of its general outreach efforts. 8. Educate patient-facing team members on this Policy and the process for referring patients to the program. Schedule H, Part VI, Line 4 Community information IU Health West Hospital is located in Hendricks County, Indiana, a county located in central Indiana. Based on the most recent Census Bureau (2023) statistics, Hendricks County's population is 186,387 persons with approximately 49.6% being female and 50.4% male. The county's population estimates by race are 76.6% White, 12.3% Black, 5.5% Hispanic or Latino, 3.7% Asian, 0.4% American Indian or Alaska Native, 0.1% Native Hawaiian or Other Pacific Islander and 2.4% persons reporting two or more races. Hendricks County has relatively moderate levels of educational attainment. Among adults 25 and above, 93.5% completed their education with a high school diploma or equivalent. 39.2% of the population had a bachelor's degree or higher. Schedule H, Part VI, Line 5 Promotion of community health IU Health West Hospital is a subsidiary of Indiana University Health, Inc., a tax-exempt healthcare organization, whose Board of Directors is composed of members, of which substantially all are independent community members. IU Health and its related hospital entities across the state of Indiana, including IU Health West Hospital, extends medical privileges to all physicians who meet the credentialing qualifications necessary for appointment to its medical staff. IU Health does not deny appointments based on gender, race, creed or national origin. IU Health, in conjunction with the IU School of Medicine, trains the next generation of physicians in an exceptional environment, blending breakthrough research and treatments with the highest quality of patient care. During 2023, IU Health West Hospital's promotion of community health included the following highlights: In 2023, IU Health West Hospital maintained a strong presence across the Hendricks County area and supported numerous not-for-profit agencies including local parks departments, health partnerships, medical and dental clinics that provide care to the un- and under-insured, behavioral health agencies and organizations that provide health and social services to those who are in need. Schedule H, Part VI, Line 6 Affiliated health care system Indiana University Health West Hospital is part of Indiana University Health ("IU Health "the healthcare system"), which is Indiana's most comprehensive healthcare system. A unique partnership with the Indiana University School of Medicine ("IU School of Medicine"), one of the nation's leading medical schools, gives patients access to innovative treatments and therapies. The healthcare system is comprised of hospitals, physicians and allied services dedicated to providing preeminent patient care and community health improvement throughout Indiana. IU Health's affiliate hospitals are divided into six regions that serve communities in Northwest, Northeast, Central and Southern Indiana. The 16 hospitals in the healthcare system include IU Health Inc. (i.e., the IU Health Academic Health Center consists of IU Health Methodist Hospital, IU Health University Hospital, Riley Hospital for Children at IU Health and IU Health Saxony Hospital); IU Health Arnett; IU Health Ball; IU Health Bedford Hospital; IU Health Bloomington Hospital; IU Health Frankfort; IU Health Jay; IU Health North Hospital; IU Health Paoli Hospital; IU Health Tipton Hospital; IU Health West Hospital; and IU Health White Memorial Hospital. Each affiliate hospital in the healthcare system, along with community partners, conducts and adopts its own community health needs assessment (CHNA) and implementation strategy. IU Health considers the sum of these CHNAs and the implementation strategies part of a system wide vision of making Indiana one of the healthiest states in the nation. The healthcare system and its affiliate hospitals are keenly aware of the positive impact it can have on improving the health of communities throughout the state of Indiana by investing in local, community-based initiatives as well as system level strategies. The healthcare system includes an Academic Health Center (i.e., IU Health Inc.), a regional academic health center (i.e., IU Health Bloomington Hospital) and several affiliate hospitals (IU Health Arnett and IU Health Ball) that work in partnership with the IU School of Medicine to train physicians, blending breakthrough research and treatments with the highest quality of patient care throughout IU Health. Each year, more than 1,000 residents and fellows receive training in affiliate hospitals. Research conducted by IU School of Medicine faculty gives IU Health physicians and patients access to the most leading-edge and comprehensive treatment options. To further promote the health of the communities served by IU Health, the system-level Community Health Division partners with state and local community-based organizations, community coalitions and governmental agencies to focus on innovative models of care; community alliances and partnerships; anchor institution and advocacy strategies; and social determinants of health. All affiliate hospitals in the healthcare system identify and address significant needs unique to the communities they serve. However, some needs are common in communities served by multiple or all affiliate hospitals in the healthcare system and align with system priority areas, warranting a system level strategy. The Community Health Division, along with additional internal partners such as the Office of Health Equity Research and Evaluation (HERE) and the IU Health Foundation, plans and provides technical assistance for system-level strategies that address these common needs including health equity, tobacco and nicotine cessation, behavioral and substance use disorders, infant and maternal health, hypertension, and social determinants of health. For example, the Community Health Division is coordinating efforts to select and train community health workers who are placed throughout the system in outpatient and inpatient sites and do outreach through the WeCare and iHEART initiatives. These valued team members are from the communities being served by IU Health and have an intimate understanding of the needs of residents. Each affiliate hospital works collaboratively with the Community Health Division to align and activate local resources to support local and system strategies. This benefits the community each affiliate hospital serves and works towards a statewide impact (system-level) on health outcomes. As part of the Community Health Division, the Community Outreach and Engagement Program's IU Health Serves initiative, a system-level team member volunteer program, seeks to positively impact the health of communities IU Health affiliate hospitals serve and foster a culture of engagement and social responsibility. Each affiliate hospital coordinates the different initiatives of the program, including Days of Service. This is the largest volunteer event of the year, consisting of projects designed to engage each affiliate hospitals' team members in activities that address local, significant needs. The $200 million Community Impact and Investment (CII) Fund was established in 2018 by IU Health to financially support high-impact community investing. The focus of these efforts will address key social and environmental factors that impact historically marginalized and minoritized populations in the communities IU Health serves. Through the grants provided by this CII Fund, IU Health can strategically and intentionally address the social, economic, and environmental factors that impact the health of affiliate hospitals' surrounding communities. Each affiliate hospital and its team members are eligible to pursue this grant opportunity with a community organization. Schedule H, Part VI, Line 7 State filing of community benefit report IN true Volunteers of America Ohio & Indiana 1780 East Broad St Columbus OH 43203 340861121 501(c)(3) 116400 General Support Hendricks County Economic Development Partnership Inc 5250 E US HWY 36 Suite 1101 Avon IN 46123 351817139 501(c)(3) 20000 General Support La Plaza Inc 8902 East 38th St Indianapolis IN 46226 300029575 501(c)(3) 4000 General Support 3 0 Schedule I, Part I, Line 2 Procedures for monitoring use of grant funds. ALTHOUGH IU HEALTH WEST DOES NOT MONITOR THE USE OF GRANT FUNDS ONCE DISTRIBUTED, THROUGH DUE DILIGENCE THE ORGANIZATION HAS REASONABLY CONFIRMED THAT THE ENTITIES TO WHICH THE CONTRIBUTIONS ARE MADE ARE HIGHLY REPUTABLE IN THE COMMUNITY AND USE THE FUNDS FOR THE PURPOSES INTENDED. false true false false false false false true false KENNETH DOUG PUCKETT DIRECTOR / PRESIDENT (ISR) 0 617426 0 197863 0 85959 0 125376 0 58127 0 1084751 0 55354 KEVIN L SMITH MD DIRECTOR (Part Year) 0 493124 0 57057 0 32517 0 13200 0 22500 0 618398 0 0 MEGAN CRITTENDON MD DIRECTOR 0 286435 0 68810 0 8560 0 7629 0 22500 0 393934 0 0 DEREK E EMPIE FORMER OFFICER 0 302110 0 31854 0 1242 0 13200 0 49175 0 397581 0 0 ALLISON EMHARDT Former Officer 0 164809 0 14979 0 1957 0 7516 0 32400 0 221662 0 0 CARA L BREIDSTER CFO (ISR) 0 309825 0 27333 0 2322 0 12229 0 51980 0 403690 0 0 JENNIFER GIROD Secretary 0 144897 0 12437 0 19213 0 7060 0 9638 0 193245 0 0 ARTHUR VASQUEZ FORMER OFFICER & KEY EMPLOYEE 0 554742 0 186249 0 1869 0 110400 0 44553 0 897813 0 0 LISA A SPARKS Former Key Employee 52984 0 0 0 230801 0 2226 0 10829 0 296839 0 0 0 PAMELA V CHAPMAN FORMER KEY EMPLOYEE 0 172093 0 17074 0 6171 0 8212 0 35427 0 238977 0 0 Harpreetinder Singh MD VP-CMO (ISR) 0 415353 0 60242 0 1242 0 14062 0 62048 0 552948 0 0 TAMARAH D BROWNLEE REGIONAL VP-HR (ISR) 0 225639 0 19460 0 773 0 10527 0 47785 0 304184 0 0 CARRIE WING VP-CNO (ISR) 0 235179 0 28793 0 780 0 10773 0 23372 0 298895 0 0 ATHANASIA SOULA BANICH VP, COO (ISR) 0 274060 0 24330 0 540 0 12128 0 41561 0 352619 0 0 JAMES R BILLMAN PHARMACIST 179229 0 50426 0 12589 0 0 0 29632 0 271875 0 0 0 ANNE K STEGEMOLLER DIRECTOR - PHARMACY 182762 0 11720 0 450 0 7768 0 20687 0 223386 0 0 0 JUAN GUZMAN VP COO (West) 243398 0 21741 0 430 0 10780 0 39762 0 316111 0 0 0 MARIA CAMACHO CLINICAL NURSE 150863 0 65795 0 3495 0 9422 0 65378 0 294954 0 0 0 Kapri D Ames VP - CNO West 197001 0 9876 0 39808 0 7024 0 44846 0 298554 0 0 0 Schedule J, Part I, Line 3 Arrangement used to establish the top management official's compensation IU Health West Hospital's Regional President is employed by IU Health. IU Health, IU Health West Hospital, and other related entities have a process in place to determine the compensation for the other officers and key employees. IU Health human resources uses market data from multiple compensation experts/vendors who utilize a variety of methods and procedures to obtain compensation ranges for comparable officer and employee positions. This market data and multiple other factors (including market pay benchmarks, internal equity, candidate/employee qualifications & performance, and business needs) are used to recommend compensation ranges for its officers and other employees, which are then used as a guide for setting reasonable compensation by management. Please see schedule O for additional details. Schedule J, Part I, Line 4b Supplemental nonqualified retirement plan KENNETH D. PUCKETT AND ARTHUR VASQUEZ PARTICIPATE IN AN IU HEALTH SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN, PROVISIONS OF WHICH ARE DESIGNED TO RETAIN THESE CRITICAL EMPLOYEES. THE PLAN PROVIDES FOR AN ADDITIONAL RETIREMENT BENEFIT FOR SERVICE THROUGH NORMAL RETIREMENT OR OTHER KEY DATES. IF THIS EXECUTIVE LEAVES PRIOR TO RETIREMENT OR OTHER KEY DATES, THAT BENEFIT MAY BE FORFEITED OR REDUCED. THE EXECUTIVES LISTED ABOVE HAVE AN AMOUNT INCLUDED IN COLUMN C, DEFERRED COMPENSATION, REPRESENTING THE CURRENT YEAR UNVESTED CONTRIBUTIONS MADE UNDER THE SUPPLEMENTAL RETIREMENT PLAN. THESE AMOUNTS WERE NOT PAID TO THESE EXECUTIVES DURING THE YEAR. THE FOLLOWING EXECUTIVE HAS AN AMOUNT INCLUDED IN COLUMN B (III), OTHER REPORTABLE COMPENSATION, REPRESENTING THE CURRENT YEAR VESTED AMOUNTS RECEIVED UNDER THESUPPLEMENTAL EXECUTIVE RETIREMENT PLAN: - KENNETH D. PUCKETT: $76,458 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 VI, Line 13 PART VI, LINES 12, 13, AND 14 - POLICIES IU HEALTH WEST HOSPITAL IS PART OF THE IU HEALTH SYSTEM. AS THE SOLE MEMBER AND CONTROLLING PARENT OF IU HEALTH WEST HOSPITAL, IU HEALTH AND ITS BOARD OF DIRECTORS HAVE MANDATED THAT CERTAIN POLICIES BE FOLLOWED TO ENSURE GREATER STANDARDIZATION THROUGHOUT THE SYSTEM. THUS, IU HEALTH WEST HOSPITAL'S BOARD OF DIRECTORS WAS NOT REQUIRED TO SEPARATELY ADOPT A CONFLICT OF INTEREST, WHISTLEBLOWER, DOCUMENT RETENTION AND DESTRUCTION AND JOINT VENTURE POLICIES BECAUSE IU HEALTH'S BOARD OF DIRECTORS HAD ALREADY ADOPTED AND REQUIRED THESE POLICIES TO BE FOLLOWED BY ITS SUBSIDIARIES. Form 990, Part VI, Line 15 PROCESS FOR DETERMINING COMPENSATION IU HEALTH WEST HOSPITAL'S REGIONAL PRESIDENT IS EMPLOYED BY IU HEALTH. IU HEALTH'S PROCESS FOR DETERMINING COMPENSATION IS AS FOLLOWS: (1) THE BOARD OF DIRECTORS ("BOARD") HAS ESTABLISHED A TALENT MANAGEMENT AND EXECUTIVE COMPENSATION COMMITTEE ("TMECC"), THE PURPOSE OF WHICH INCLUDES REVIEWING AND MAKING RECOMMENDATIONS REGARDING EXECUTIVE PAY AND BENEFITS (COLLECTIVELY REFERRED TO AS "COMPENSATION") ON AN ANNUAL BASIS IN APRIL. THE TMECC IS MADE UP OF MEMBERS OF THE BOARD THAT ARE NEITHER PHYSICIANS NOR EMPLOYEES AND DO NOT OTHERWISE HAVE A CONFLICT OF INTEREST REGARDING ANY OF IU HEALTH'S COMPENSATION ARRANGEMENTS. THE TMECC REVIEWS AN EXECUTIVE'S ENTIRE COMPENSATION PACKAGE INCLUDING BASE SALARY, SHORT-TERM AND LONG-TERM INCENTIVES, HEALTH AND WELFARE BENEFITS, QUALIFIED AND NONQUALIFIED RETIREMENT PLANS, AS WELL AS ANY ADDITIONAL FRINGE BENEFITS. AS DEEMED APPROPRIATE, THE COMMITTEE ON FINANCE, WHICH IS ALSO MADE UP OF MEMBERS OF THE BOARD, MAY ALSO REVIEW EXECUTIVE COMPENSATION AND BENEFITS. (2) THE TMECC ENGAGES AN INDEPENDENT COMPENSATION CONSULTING FIRM ON AN ANNUAL BASIS TO CONDUCT A COMPENSATION ANALYSIS FOR ITS EXECUTIVE GROUP, WHICH CONSISTS OF EMPLOYEES AT THE LEVEL OF SENIOR VICE PRESIDENT AND ABOVE. THE CURRENT COMPENSATION ADVISOR IS SULLIVANCOTTER. SULLIVANCOTTER PERFORMS ITS ANALYSIS IN THE FORM OF A COMPENSATION SURVEY ("SURVEY") THAT INCLUDES RELEVANT COMPARABILITY DATA FOR COMPENSATION LEVELS PAID BY SIMILARLY SITUATED ORGANIZATIONS (BOTH GOVERNMENTAL AND TAX EXEMPT) FOR FUNCTIONALLY COMPARABLE POSITIONS AS WELL AS THE AVAILABILITY OF SIMILAR SERVICES IN THE GEOGRAPHIC AREA. SULLIVANCOTTER THEN PREPARES A SURVEY REPORT AND PROVIDES RECOMMENDATIONS TO THE TMECC, IF DEEMED APPROPRIATE, ON CHANGES IN EXECUTIVE COMPENSATION. A SEPARATE ANALYSIS USING THE SAME METHODOLOGY IS DONE FOR THE PRESIDENT AND CHIEF EXECUTIVE OFFICER. (3) THE TMECC THEN REVIEWS SULLIVANCOTTER'S REPORT AND RECOMMENDATIONS AND, IF APPROPRIATE, VOTES ON WHETHER TO RECOMMEND ANY CHANGES IN EXECUTIVE COMPENSATION TO THE BOARD. THE TMECC WILL ONLY RECOMMEND CHANGES TO THE BOARD IF THEY ARE CONSISTENT WITH THE BOARD'S PHILOSOPHY ON COMPENSATION MATTERS AND ARE DEEMED REASONABLE BASED UPON THE INDEPENDENT ANALYSIS PROVIDED BY SULLIVANCOTTER. THE TMECC'S REVIEW, DISCUSSION AND VOTE ARE DOCUMENTED IN THE MINUTES FOR THE MEETING. THERE ARE NO EXECUTIVES PRESENT DURING THE FINAL DISCUSSION AND APPROVAL. (4) THE BOARD THEN REVIEWS THE REPORT PREPARED BY SULLIVANCOTTER AS WELL AS THE RECOMMENDATIONS OF THE TMECC AS TO ANY CHANGES IN EXECUTIVE COMPENSATION. AS DEEMED APPROPRIATE, THE COMMITTEE ON FINANCE MAY ALSO PROVIDE ITS REVIEW OF THE TMECC'S RECOMMENDATIONS ON ANY CHANGES IN EXECUTIVE COMPENSATION. THIS REVIEW AND DISCUSSION ARE DOCUMENTED IN THE MINUTES. (5) THE BOARD THEN VOTES ON WHETHER TO ACCEPT THE TMECC'S RECOMMENDATIONS ON ANY CHANGES IN EXECUTIVE COMPENSATION. CHANGES IN EXECUTIVE COMPENSATION ARE MADE IF APPROVED BY THE TMECC AND BOARD ON AN ANNUAL BASIS, OR AS NECESSARY THROUGHOUT THE YEAR. THE DISCUSSION AND APPROVAL ARE DOCUMENTED IN THE MINUTES OF THE MEETING. THERE ARE NO EXECUTIVES PRESENT DURING THE FINAL DISCUSSION AND APPROVAL. IU HEALTH'S GENERAL COUNSEL ALSO PREPARES A FORMAL WRITTEN OPINION REVIEWING THE EXECUTIVE COMPENSATION APPROVAL PROCESS, COMPARING IT TO THE INTERMEDIATE SANCTIONS TEST OF IRC SECTION 4958. IF WARRANTED, IU HEALTH'S GENERAL COUNSEL MAY ALSO PROVIDE COMMENTS REGARDING THE EXECUTIVE COMPENSATION APPROVAL PROCESS AS IT RELATES TO MEETING THE REQUIREMENTS FOR A REBUTTABLE PRESUMPTION OF REASONABLENESS AS PROVIDED IN THE INTERMEDIATE SANCTIONS TEST. (6) AFTER THE END OF EACH YEAR, THE TMECC AND BOARD ALSO REVIEW THE ACHIEVEMENTS OF THE EXECUTIVE GROUP AS IT RELATES TO THE LONG-TERM AND SHORT-TERM SHARED AND INDIVIDUAL GOALS DEVELOPED BY THE EXECUTIVES AND THE BOARD. THESE ACHIEVEMENTS MAY ALSO BE REVIEWED WITH THE COMMITTEE ON FINANCE. THE BOARD, AT ITS DISCRETION, MAY APPROVE BONUS PAYMENTS BASED UPON THE ACHIEVEMENT OF THE GOALS. THE DISCUSSION AND VOTE OF THE TMECC AND BOARD IS DOCUMENTED IN THE MINUTES FOR EACH SUCH MEETING. THE BONUSES ARE NOT PAID UNTIL APPROVAL IS MADE BY THE BOARD. (7) THE TMECC AND AUDIT COMMITTEE ALSO REVIEW FORM 990 DISCLOSURES RELATED TO EXECUTIVE COMPENSATION AS WELL AS THE ORGANIZATION'S PRACTICES AND APPROVAL PROCESSES PRIOR TO THE FILING OF THE FORM 990 RETURN WITH THE INTERNAL REVENUE SERVICE. IU HEALTH WEST HOSPITAL'S Regional President AND OTHER OFFICERS AND KEY EMPLOYEES OF IU HEALTH WEST ARE EMPLOYED BY IU HEALTH OR IU HEALTH WEST, WHICH HAVE A PROCESS IN PLACE TO DETERMINE THE COMPENSATION FOR THE OTHER OFFICERS AND KEY EMPLOYEES. IU HEALTH HUMAN RESOURCES USES MARKET DATA FROM MULTIPLE COMPENSATION EXPERTS/VENDORS WHO UTILIZE A VARIETY OF METHODS AND PROCEDURES TO OBTAIN COMPENSATION RANGES FOR COMPARABLE OFFICER AND EMPLOYEE POSITIONS. THIS MARKET DATA AND MULTIPLE OTHER FACTORS (INCLUDING MARKET PAY BENCHMARKS, INTERNAL EQUITY, CANDIDATE/EMPLOYEE QUALIFICATIONS & PERFORMANCE, AND BUSINESS NEEDS) ARE USED TO RECOMMEND COMPENSATION RANGES FOR ITS OFFICERS AND OTHER EMPLOYEES, WHICH ARE THEN USED AS A GUIDE FOR SETTING REASONABLE COMPENSATION BY MANAGEMENT. Form 990, Part VI, Line 6 Classes of members or stockholders THE SOLE MEMBER OF IU HEALTH WEST HOSPITAL IS IU HEALTH, A 501(C)(3) TAX-EXEMPT ORGANIZATION. Form 990, Part VI, Line 7a Members or stockholders electing members of governing body THE BOARD OF DIRECTORS OF THE IU HEALTH WEST HOSPITAL SHALL CONSIST OF UP TO FIFTEEN (15) VOTING MEMBERS ALL APPOINTED BY IU HEALTH, WHO SHALL INCLUDE REPRESENTATIVES FROM THE MEDICAL STAFFS OF IU HEALTH NORTH HOSPITAL AND IU HEALTH WEST HOSPITAL, AND THE PRESIDENT OF THE INDIANAPOLIS SUBURBAN REGION, WHO SHALL BE AN EX-OFFICIO, VOTING DIRECTOR OF THE BOARD. AT ALL TIMES, THE IU HEALTH NORTH HOSPITAL DIRECTORS SHALL CONSIST OF THE SAME INDIVIDUALS APPOINTED BY IU HEALTH TO SERVE AS DIRECTORS OF IU HEALTH NORTH HOSPITAL. Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders THE BOARD OF DIRECTORS SHALL NOT, WITHOUT THE PRIOR APPROVAL OF THE IU HEALTH: - ANY PROPOSED AMENDMENT TO THE CORPORATION'S ARTICLES OF INCORPORATION OR THESE BYLAWS; - ADOPTION OF THE CORPORATION'S ANNUAL CAPITAL AND OPERATING BUDGETS; - APPROVAL OF ANY UNBUDGETED OPERATING OR CAPITAL BUDGET ITEMS OR DEVIATIONS, INCLUDING ANY ISSUANCE OR GUARANTEE OF ANY UNBUDGETED DEBT; - APPROVAL OF ANY STRATEGIC PLAN FOR THE CORPORATION, INCLUDING ANY AMENDMENTS TO A STRATEGIC PLAN; - APPROVAL OF ANY ENCUMBRANCE, SALE OR CONVEYANCE OF ASSETS; - ANY MERGER, CONSOLIDATION, JOINT VENTURE OR AFFILIATION INVOLVING THE CORPORATION OR ANY OF ITS AFFILIATES AND ANY OTHER ENTITY; - APPOINTMENT AND REMOVAL OF THE CORPORATION'S PRESIDENT AND OTHER OFFICERS; - CONSTRUCTION, ACQUISITION OR LEASE OF HOSPITAL BUILDINGS; - APPROVE ANY MANAGEMENT AGREEMENT FOR THE MANAGEMENT OF ALL OR SUBSTANTIAL PART OF IU HEALTH WEST HOSPITAL'S OPERATIONS; - PROJECTS OR CONTRACTS THAT REQUIRE MEMBER APPROVAL IN ACCORDANCE WITH THE MEMBER'S RESOLUTION AND POLICY GOVERNING SYSTEM-WIDE CONTRACT EXECUTION AUTHORITY AND PAYMENT APPROVAL LIMITS; AND - THE DISSOLUTION OF THE CORPORATION OR ANY OF ITS AFFILIATES. Form 990, Part VI, Line 11b Review of form 990 by governing body The Indianapolis Suburban Chief Financial Officer and Finance Committee reviewed and approved the Form 990. Following their review and approval, a complete copy of the Form 990 was made available to each board member prior to its filing. Each member was also informed of the availability of IU Health's Tax Department to answer any questions. Form 990, Part VI, Line 12c Conflict of interest policy IU HEALTH WEST HOSPITAL FOLLOWS IU HEALTH'S CONFLICT OF INTEREST POLICY. IU HEALTH'S CONFLICT OF INTEREST POLICY INCLUDES THE FOLLOWING PROVISIONS: ALL IU HEALTH EMPLOYEES, ASSOCIATES, COLLEAGUES AND CONTRACTED PERSONNEL, INCLUDING EMPLOYED PHYSICIANS AND PAID MEDICAL DIRECTORS ("IU HEALTH REPRESENTATIVES") ARE COVERED BY AND SUBJECT TO ITS CONFLICT OF INTEREST POLICY. IU HEALTH REGULARLY AND CONSISTENTLY MONITORS AND ENFORCES COMPLIANCE WITH THE POLICY THROUGH THE FOLLOWING PROCEDURES: (A) ON AN ANNUAL BASIS, EACH IU HEALTH REPRESENTATIVE AT THE LEVEL OF MANAGER OR ABOVE, TOGETHER WITH EVERY OTHER PERSON DESIGNATED BY THE CORPORATE COMPLIANCE DEPARTMENT ("DEPARTMENT"), MUST COMPLETE, SIGN AND SUBMIT A CONFLICT OF INTEREST QUESTIONNAIRE ("QUESTIONNAIRE") TO THE DEPARTMENT. GOVERNING BOARD MEMBERS, COMMITTEE MEMBERS, CORPORATE OFFICERS, MEDICAL STAFF AND RESEARCHERS MUST COMPLY WITH THE ADMINISTRATIVE REQUIREMENTS NOTED IN THE RESPECTIVE POLICIES AND PROCEDURES RELATIVE TO THOSE AREAS. (B) AN IU HEALTH REPRESENTATIVE MUST SUPPLEMENT A QUESTIONNAIRE IN WRITING, IF AFTER COMPLETION OF THE ORIGINAL QUESTIONNAIRE, A SITUATION ARISES, OR MAY REASONABLY BE EXPECTED TO ARISE, THAT WOULD CHANGE ANY ANSWER OR INFORMATION ON THE ORIGINAL QUESTIONNAIRE IF THE SITUATION HAD EXISTED OR BEEN ANTICIPATED AT THE TIME OF COMPLETION OF THE ORIGINAL QUESTIONNAIRE. (C) IF A FULLY AND PROPERLY COMPLETED QUESTIONNAIRE REVEALS FACTS OR OTHER INFORMATION THAT MIGHT REASONABLY INDICATE A CONFLICT OF INTEREST OR VIOLATION OF THE POLICY, THE IU HEALTH REPRESENTATIVE COMPLETING THE QUESTIONNAIRE MUST SECURE APPROVAL BY HIS/HER SUPERVISOR, EVIDENCED IN WRITING. (D) THE DEPARTMENT WILL REVIEW EACH QUESTIONNAIRE AND DETERMINE WHETHER A CONFLICT OF INTEREST EXISTS AND, IF SO, WHETHER AND HOW IT SHOULD OR MAY BE ELIMINATED, AVOIDED OR MANAGED IN ORDER TO COMPLY WITH THE SPIRIT OF THE POLICY AND WITH THE BEST INTERESTS OF IU HEALTH AND ITS PATIENTS. IN MAKING THE DETERMINATION, THE CORPORATE COMPLIANCE DEPARTMENT MAY CONSULT WITH THE IU HEALTH REPRESENTATIVE'S SUPERVISOR AND OTHER APPROPRIATE INDIVIDUALS AND GROUPS. (E) THE SCOPE OF THE POLICY IS NOT LIMITED TO THOSE WHO ARE REQUIRED TO COMPLETE QUESTIONNAIRES. IF AN IU HEALTH REPRESENTATIVE IS INVOLVED IN A SITUATION OR RELATIONSHIP THAT WOULD CONSTITUTE A VIOLATION OF THE POLICY IN THE ABSENCE OF DISCLOSURE AND APPROVAL AS DESCRIBED ABOVE, THEN THE IU HEALTH REPRESENTATIVE MUST DISCLOSE THE MATTER TO HIS/HER SUPERVISOR,SECURE HIS/HER SUPERVISOR'S APPROVAL IN WRITING, AND DISCLOSE THE MATTER TO THE DEPARTMENT. OTHERWISE, THE IU HEALTH REPRESENTATIVE IS IN VIOLATION OF THE POLICY AND SUBJECT TO CORRECTIVE ACTION, UP TO AND INCLUDING TERMINATION. (F) THE CHIEF COMPLIANCE OFFICER, IN CONSULTATION WITH ONSITE COMPLIANCE PERSONNEL, MAY FROM TIME TO TIME APPOINT STANDING OR AD HOC COMMITTEES TO ASSIST IN RESOLVING ISSUES THAT ARISE UNDER PROVISIONS OF THE POLICY. Form 990, Part VI, Line 19 Required documents available to the public IU HEALTH WEST HOSPITAL'S ARTICLES OF INCORPORATION ARE AVAILABLE TO THE PUBLIC THROUGH THE INDIANA SECRETARY OF STATE'S WEBSITE. IU HEALTH WEST HOSPITAL'S CONFLICT OF INTEREST POLICY IS DESCRIBED ON FORM 990, SCHEDULE O. IU HEALTH WEST HOSPITAL IS A CONSOLIDATED SUBSIDIARY IN THE CONSOLIDATED FINANCIAL STATEMENTS FOR IU HEALTH. THE CONSOLIDATED FINANCIAL STATEMENTS FOR IU HEALTH ARE AVAILABLE TO THE PUBLIC THROUGH ITS BOND FILINGS AND AS AN ATTACHMENT TO THE FORM 990 AS WELL AS IU HEALTH WEST'S FORM 990. Form 990, Part IX, Line 11g Other Fees Professional fees - Total Expense: 200093, Program Service Expense: 186661, Management and General Expenses: 13432, Fundraising Expenses: ; Fees - other services - Total Expense: 208804, Program Service Expense: 194787, Management and General Expenses: 14017, Fundraising Expenses: ; Consulting - Total Expense: 369909, Program Service Expense: 345077, Management and General Expenses: 24832, Fundraising Expenses: ; Intercompany fees - Total Expense: 66975823, Program Service Expense: 62479749, Management and General Expenses: 4496074, Fundraising Expenses: ; Physician fees - Total Expense: 135023, Program Service Expense: 125959, Management and General Expenses: 9064, Fundraising Expenses: ; Contract service - Total Expense: 5405124, Program Service Expense: 5042279, Management and General Expenses: 362845, Fundraising Expenses: ; INDIANA HEALTH INFO EXCHANGE INC 846 N SENATE AVE INDIANAPOLIS IN 46202 364550324 HEALTHCARE IN 501(c)(3) Type I N/A 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