2024-05-02T12:14:46+00:00 2021-12-31 990 2021-01-01 822736786 Indiana University Health Jay Inc INDI 3179634842 950 N MERIDIAN STREET 1200 INDIANAPOLIS IN 46204 JONATHAN W VANATOR CFO 2024-05-02 JONATHAN W VANATOR 999009999 2021 2023-04-26 12:10:37Z X JONATHAN W VANATOR 950 N MERIDIAN STREET 1200 INDIANAPOLIS IN 46204 42428469 false X HTTPS://IUHEALTH.ORG/FIND-LOCATIONS/IU-HEALTH-JAY-HOSPITAL X 2017 IN Lead the transformation of healthcare through quality, innovation & education, and make Indiana one of the nation's healthiest states. 18 13 330 41 0 0 24856 38228 36650758 42239870 117734 53771 980677 96600 37774025 42428469 0 2467 0 0 14170919 14648539 0 0 0 27555209 28404297 41726128 43055303 -3952103 -626834 31136066 24114821 19758195 13375129 11377871 10739692 X Lead the transformation of healthcare through quality, innovation & education, and make Indiana one of the nation's healthiest states. false false 40793580 2467 40657007 INDIANA UNIVERSITY HEALTH JAY IS A 25-BED CRITICAL ACCESS HOSPITAL THAT OFFERS A COMPREHENSIVE RANGE OF SERVICES TO CARE FOR ITS PATIENTS WITHOUT REGARD TO THEIR ABILITY TO PAY. IU HEALTH JAY IS PART OF THE INDIANA UNIVERSITY HEALTH SYSTEM, INDIANA'S LARGEST COMPREHENSIVE HEALTH SYSTEM. IU HEALTH IS DEDICATED TO PROVIDING LEADING-EDGE CARE. OUR UNIQUE PARTNERSHIP WITH THE INDIANA UNIVERSITY SCHOOL OF MEDICINE GIVES OUR HIGHLY SKILLED PHYSICIANS ACCESS TO INNOVATIVE TREATMENTS USING THE LATEST RESEARCH AND TECHNOLOGY. 1507089 As of December 31, 2020, Indiana University Health Jay had received stimulus funds from the Provider Relief Fund under the provisions of the Coronavirus Aid, Relief, and Economic Security Act (CARES Act) and Paycheck Protection Program and Health Care Enhancement Act. Indiana University Health Jay recognized $1,507,089 as other program service revenue. Indiana University Health Jay will continue to monitor compliance with the terms and conditions of the Provider Relief Fund. 34774 IU HEALTH JAY LEASES PHYSICIAN AND CLINIC SPACE TO RELATED TAX-EXEMPT ORGANIZATIONS. IU HEALTH JAY RECEIVES REVENUE FROM A RELATED 501(C)(3) ENTITY FOR SHARED SERVICES. 41000 IU HEALTH JAY RECEIVED REVENUE FROM A RELATED 501(C)(3) ENTITY FOR SHARED SERVICES. 41000 40793580 true true false true false false false false false true false false false true true false true false false false false false false false false true true false false true false false false false false false false false false false false false false true true true false false true 0 0 330 true true true false false false false false false false false false false false X 18 13 true false false false true true true true true false false true true true true true true false false false IN X CRAIG J JONES 3179634842 950 N MERIDIAN ST STE 800 INDIANAPOLIS IN 46204 DAVID A LITTLER DIRECTOR/CHAIR (PART YEAR) 1.0 3.0 X X 0 0 0 J STEVEN RHEA Director/Secretary/Treas (Part Year) 1.0 2.0 X X 0 0 0 JEFFREY C BIRD MD DIRECTOR/REGIONAL PRESIDENT (ECR) 10.0 45.0 X X 0 1348455 50692 JOHN D LITTLER DIRECTOR/CHAIR (PART YEAR) 1.0 3.0 X X 0 0 0 PETER M VOSS MD DIRECTOR/VICE CHAIR/CMO (ECR) 10.0 45.0 X X 0 504425 48556 WILBUR R DAVIS Director/ Vice Chair (Part Year) 1.0 2.0 X X 0 0 0 LORI A LUTHER DIRECTOR (PART YEAR)/COO (ECR) 10.0 45.0 X X 0 427171 49584 CHANTILLE ALLEN DIRECTOR (PART YEAR) 1.0 3.0 X 0 0 0 CHARLES R ROUTH MD DIRECTOR (PART YEAR) 1.0 54.0 X 0 287062 50547 DANIEL E BORGENHEIMER DIRECTOR (PART YEAR) 1.0 3.0 X 0 0 0 DAVID M BROWN MD DIRECTOR (PART YEAR) 2.0 53.0 X 0 409218 20189 DAVID W HYATT DIRECTOR (PART YEAR) 2.0 53.0 X 0 293884 50346 DEBRA KUMMER DIRECTOR (PART YEAR) 1.0 0 X 0 0 0 DERRON L BISHOP PHD DIRECTOR (PART YEAR) 1.0 3.0 X 0 0 0 GEOFFREY S MEARNS JD Director (Part Year) 1.0 2.0 X 0 0 0 JANET E BANTZ DIRECTOR (PART YEAR) 1.0 0 X 0 0 0 JOAN V CASTOR DIRECTOR (PART YEAR) 1.0 54.0 X 0 584050 118253 MICHAEL J FISHER DIRECTOR (PART YEAR) 1.0 5.0 X 0 0 0 PATRICK A CLEARY MD DIRECTOR (PART YEAR) 1.0 3.0 X 0 0 0 PATRICK L MILLER DIRECTOR (PART YEAR) 1.0 0 X 0 0 0 RICHARD L HUFFMAN DIRECTOR (PART YEAR) 1.0 0 X 0 0 0 ROGER W LOCKER DIRECTOR (PART YEAR) 1.0 0 X 0 0 0 SAMUEL C KIM MD DIRECTOR (PART YEAR) 1.0 21.0 X 0 53840 0 TERRY W BAILEY DIRECTOR (PART YEAR) 1.0 3.0 X 0 0 0 WILLIAM W HINKLE DIRECTOR 1.0 3.0 X 0 0 0 BETTIE A CALDWELL TREASURER (PART YEAR) 10.0 45.0 X 0 152294 19621 JONATHAN W VANATOR PRESIDENT/CFO (ECR) 20.0 35.0 X 0 394728 44214 MICHELLE R ALTOBELLA SECRETARY (PART YEAR) 10.0 45.0 X 0 280297 49704 ANN M MCGUIRE VP-HUMAN RESOURCES REGIONAL (ECR)-PART YEAR 1.0 3.0 X 0 252844 11848 CARLA C COX RN VP & CNO (ECR) 10.0 45.0 X 0 319533 44150 MEGAN HAYMAKER VP-HUMAN RESOURCES (ECR) (Part Year) 10.0 45.0 X 0 249496 20638 CHERI L KNAPKE Manager-Pharmacy 50.0 0 X 138788 0 42196 CHRISTINA SCHEMENAUR VP - CNO - JAY HOSP 50.0 0 X 159516 0 9682 DIANE R ROESSNER PHARMACIST 50.0 0 X 121976 0 29472 JULIE M TEETER Manager - Maternal Infant Outreach 50.0 0 X 109690 0 35071 MELODY SUE MAHORNEY Respiratory Care Practitioner 50.0 0 X 148387 0 18297 DEREK E EMPIE FORMER OFFICER & DIRECTOR 0.0 55.0 X 0 343499 52495 678356 5900797 765552 11 true true false 0 5000 33228 38228 NET PATIENT SERVICE REVENUE 622110 40657007 40657007 FEDERAL RECOVERY REVENUE 900099 1507089 1507089 RENT FROM RELATED 501(C)(3) ORGS 532000 34774 34774 SHARED SERVICES 541900 41000 41000 0 0 0 0 42239870 45654 45654 34093 34093 0 34093 34093 8117 0 8117 8117 8117 CAFETERIA/FOOD SERVICE 721110 62507 62507 0 0 0 0 62507 42428469 42239870 0 150371 X 2467 2467 10971972 10615573 356399 416843 403303 13540 2450385 2370790 79595 809339 783050 26289 9217 9217 14802431 13606793 1195638 0 11967 11967 78284 71962 6322 49941 24971 24970 2023994 2023994 3647 3352 295 2707087 2589603 117484 303387 303387 BAD DEBT 1952271 1952271 DRUGS AND MEDICAL SUPPLIES 2861629 2861629 HOSPITAL ASSESSMENT FEE 2157432 2157432 Institutional Dues/Licenses 230 138 92 1442780 1326252 116528 0 43055303 40793580 2261723 0 5167550 1862212 3830256 5273422 0 0 0 0 0 670020 638564 166217 154898 29825626 10886525 21297151 18939101 1905223 0 0 4872 -4658599 31136066 24114821 5728610 1919229 0 0 14029585 11455900 19758195 13375129 X 11377871 10739692 11377871 10739692 31136066 24114821 -626834 -11345 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 2641 2641 false Schedule C, Part II-B, Line 1 DETAILED DESCRIPTION OF THE LOBBYING ACTIVITY IU Health Jay paid institutional membership dues to the American Hospital Association ("AHA") and Indiana Hospital Association ("IHA") during 2021 in the amount of $10,085 and $3,532 respectively. Each membership organization notified IU Health Jay that a portion of the dues it paid was used for lobbying purposes. The AHA used 23.32%, or $2,352 of 2021 membership dues paid by IU Health Jay, for lobbying expenditures. The IHA used 8.19%, or $289 of the 2021 membership dues paid by IU Health Jay, for lobbying expenditures. 989148 989148 18977852 4883151 14094701 0 0 0 9829599 5985139 3844460 29027 18235 10792 18939101 INTERCOMPANY PAYABLES (NET) 1445643 DUE TO THIRD-PARTY PAYERS 10010257 11455900 X Schedule D, Part X, Line 2 FIN 48 (ASC 740) footnote IU Health Jay is a subsidiary in IU Health's Consolidated Audited Financial Statements. The Internal Revenue Service (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 that, as of December 31, 2021 and 2020, 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, 2021 and 2020, the Indiana University Health System had gross deferred tax assets of $146,281,000 and $135,889,000 respectively, primarily relating to net operating loss carryovers. Management determined that a full valuation allowance at December 31, 2021 and 2020, 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 increase in the valuation allowance for the current year is $10,392,000. At December 31, 2021, Indiana University Health System has available net operating loss carryforwards of $588,158,000. Net operating losses generated from 2001 through 2017 will expire between 2022 and 2037. Net operating losses generated after 2017 do not expire. true true X true X 300 false true true false true true 1399 1069524 0 1069524 0.0260 4040 9946848 9946848 0 0.0 0 0.0 0 5439 11016372 9946848 1069524 0.0260 16 9830 1126906 172418 954488 0.0232 2 9 5914 0 5914 0.0001 0 0 0 0 0 0.0 0 0 0 0 0 0.0 1 25 876 0 876 0.0000 19 9864 1133696 172418 961278 0.0234 19 15303 12150068 10119266 2030802 0.0494 0 0 0 0 0 0.0 1 6 4713 0 4713 0.0001 0 0 0 0 0 0.0 0 0 0 0 0 0.0 0 0 0 0 0 0.0 1 12 876 0 876 0.0000 0 0 0 0 0 0.0 0 0 0 0 0 0.0 0 0 0 0 0 0.0 2 18 5589 0 5589 0.0001 false 862904 10423445 9896667 526778 X true true 1 1 IU HEALTH JAY 500 W VOTAW ST PORTLAND IN 47371 https://iuhealth.org/find-locations/iu-health-jay-hospital 22-005029-1 X X X X IU HEALTH JAY 1 false false true X X X X X X X X X 21 true false false true X https://iuhealth.org/in-the-community/community-benefit true 22 true https://iuhealth.org/in-the-community/community-benefit false true X 300.0 0.0 X X X X X X X true true X X X true X https://iuhealth.org/pay-a-bill/financial-assistance X https://iuhealth.org/pay-a-bill/financial-assistance X https://iuhealth.org/pay-a-bill/financial-assistance X X X X X X X true X X false X X X X true X false false Schedule H, Part V, Section B, Line 3E IU Health Jay'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 Jay: 1. Access to Healthcare Services 2. Aging Population and Needs of Seniors 3. Behavioral Health 4. Chronic Disease and Chronic Disease Management 5. Smoking, Tobacco Use and Exposure to Secondhand Smoke 6. Social Determinants of Health Schedule H, Part V, Section B, Line 5 Facility , 1 Facility , 1 - IU Health Jay Hospital. In conducting each its most recent CHNA, IU Health Jay took into account input from persons who represent the broad interests of the communities it serves by hosting two community focus groups and an interview. 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 Jay The defined community per the most recent CHNA is Jay County, Indiana, where the hospital resides. Jay County - Community Meetings and Interview Two community meetings were held in 2021 to receive input from stakeholders regarding the health needs in Jay County - one on April 21 and another on April 29. Secondary data and a preliminary list of community health need priorities was presented at both meetings. Each group was then asked questions about the preliminary list, including their reactions, additions to the proposed needs, thoughts regarding the causes, impacts of the COVID-19 pandemic and others. After these discussions, participants were given the opportunity to make additional comments before being asked to vote on the significant needs in the county. Participants were asked to choose three to five significant health needs in a poll during the meeting. Participants focused discussion around an aging population and workforce, transportation as a barrier to accessing services (especially specialists, often not located in the community), disabled population needs, the need for health education, increasing mental health needs such as anxiety and depression, a lack of mental health providers, homelessness, poverty, substance abuse and addiction (along with stigma around seeking help), needs of migrant and Spanish-speaking communities and health insurance. From this process, participants from the April 21 community meeting identified the following needs as most significant for Jay County: * Substance abuse (including opioids and alcohol) * Access to healthcare services (including specialists) * Mental health and access to mental health services * Children in poverty * Transportation Participants from the April 29 community meeting identified the following needs as most significant for Jay County: * Mental health * Poverty * Substance abuse (including opioids and alcohol) * Transportation * Health and wellness education In discussing the impacts of the COVID-19 pandemic on health, participants focused on isolation and its impacts on mental health, increase in pediatric mental health needs, increase in substance abuse, financial impacts on service organizations, lack of preventive care due to fear of going to providers and technology barriers creating a digital divide in an increasingly online world. An additional community survey was issued to stakeholders unable to attend community meetings, asking them to identify priority needs. Among three responses, the following issues were identified as the most significant by respondents: * Substance abuse and addiction (including alcohol) * Obesity, physical inactivity and unhealthy eating * Smoking and tobacco use * Domestic violence * Mental health * Community resources and providers The survey also asked about the impacts of the COVID-19 pandemic. Issues selected as significant impacts by respondents include: * Social isolation and loneliness * Unemployment or underemployment * Childcare access and costs * Learning and development in children * Distrust with the medical community * Digital divide (lack of Internet or device access) An additional interview was conducted with representatives of a local public health department to obtain subject-matter expertise into the health needs in Jay County. The following issues were discussed as significant: * Poverty is an issue in the community, and children in poverty is noticeable * Mental health is an issue and leads to further poverty concerns as mental issues often can lead to inability to work (a stigma around mental health still exists) * Substance abuse is prominent and generational in nature * Physical inactivity and access to exercise opportunities is a significant need * Smoking, tobacco usage and vaping are all common * Specialty services, such as dialysis and radiation treatment, are mostly not located in the county, leading to access issues that are exacerbated by transportation concerns * More health education programs are needed, particularly focused on youth and also elderly education on available resources for seniors * Amish residents are a vulnerable population, often difficult to access and provide information surrounding topics such as COVID-19 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: * A Better Life Briana's Hope * First Presbyterian Church Portland * IU Health * IU Health Jay * Jay Community Center * Jay County Department of Children Services * Jay County Health Department * Jay County Prosecutor * Jay County Sheriff's Office * Jay Randolph Developmental Services, Inc. * Jay School Corporation * LifeStream Services * Persimmon Ridge * Purdue Extension * The Rock Church * WIC Family Services * Youth Service Bureau of Jay County Schedule H, Part V, Section B, Line 11 Facility , 1 Facility , 1 - IU HEALTH JAY. In conjunction with the CHNA, IU Health Jay Hospital's Board adopted an implementation strategy in April 2022 related to the 2021 CHNA. IU Health Jay Hospital prioritized and determined which of the community health needs identified in its most recently conducted CHNA were most critical for it to address. IU Health Jay Hospital will address the following community health needs between 2022 and 2024: - Access to Healthcare Services - Aging Population and Needs of Seniors - Behavioral Health* - Chronic Disease and Chronic Disease Management* - Smoking, Tobacco Use and Exposure to Secondhand Smoke - Social Determinants of Health* *IU Health uses the term Behavioral Health to refer to mental health and drug and substance abuse (including opioids and alcohol) *Chronic Disease and Chronic Disease Management includes needs such as obesity, diabetes, and physical inactivity *Social Determinants of Health includes needs such as food insecurity and healthy eating IU Health Jay Hospital will address all community health needs based on their 2021 Community Health Needs Assessment. There were no identified needs that will not be addressed. In addition, during 2021 IU Health Jay Hospital continued to address the needs identified in the 2018 CHNA, through the implementation strategy adopted in April 2019 related to the 2018 CHNA. IU Health Jay will address the following community health needs between 2019 and 2021: - Access to Healthcare Services - Drug and Substance Abuse (including Opioids and Alcohol) - Mental Health - Obesity, Diabetes, and Physical Inactivity - Smoking and Tobacco Usage - Social Determinants of Health IU Health uses the term "Behavioral Health" to refer to Mental Health and Drug and Substance Abuse (including Opioids and Alcohol). Access to Healthcare IU Health Jay's implementation strategy to address the identified need of Access to Healthcare includes the following: Five-Year Physician Plan - Recruit new primary care, obstetric and mental health medical doctors to practice in East Central Region. In 2021, a new two-physician primary care clinic was established in Upland and also includes a FNP-BC to provide additional primary care support. A partnership with Taylor University began providing a student health center at this practice starting in the fall. Jay Family First Health added a new physician in the fall of 2021. Another newly recruited Family Medicine Physician started in Portland in September. Three new APPs for Family Medicine have been recruited to join clinic opening in Albany late 2021. The capability for any primary care clinic to do acute behavioral health consults virtually was added in 2021. Behavioral Health (including Drug & Substance Abuse and Mental Health) IU Health Jay's implementation strategy to address the identified need of Behavioral Health includes the following: IU Health Ball Memorial Hospital Addiction Treatment and Recovery Center-Adult Intensive Outpatient Program (IOP) - Provide structured therapeutic recovery program. The IU Health Ball Addiction Treatment and Recovery Center opened in 2019 and now offers an Intensive Outpatient Program (IOP) - which includes Group therapy Recreation therapy and individual and family counseling services and peer recovery coaching. Medication Assisted Treatment (MAT) is also offered as well as an Individual outpatient Program and IOP Aftercare Program. During 2021, the Center assessed nearly 150 patients, and enrolled more than 150 in the IOP or individual track. Patients who have completed the IOP demonstrate a 35% increase in sobriety and pregnant women have demonstrated a 100% sobriety rate. IU Health Jay Virtual Care Behavioral Health Hub. In 2021, approximately 70 patients were admitted into the IU Health Jay and Jay Emergency Rooms with an substance use disorder (SUD) diagnosis. Patients are identified by administering an UNCOPE screening; or the patient reports previous Substance use/treatment; or bedside staff identifies substance misuse is the cause for an emergency department (ED) visit. In 2021, approximately 75 episodes of treatment were provided for 60 patients. The Hub employees a total of 7 coaches. There is always a coach available 24/7. Average response time, once a consult is requested is approx. 5 mins. The Hub receives a call from East Central Region (ECR) every 8-10 days. Collaborators include SCS/Virtual Care, Behavioral Health, ED management and staff. Funding is through Family and Social Services Administration and Indiana Department of Health (IDOH). New in 2021- PRC support for IU Health Ball when in person coaches are not available, approximately seven patients seen in 2021. Drug Take Back Program - Provide prescription medication disposal kiosks at IU Health East Central Region facilities. - Drug take-back kiosks have been installed at four East Central Indiana locations: Pavilion Pharmacy at IU Health Ball Memorial Hospital in Muncie; IU Health Yorktown Pharmacy, Yorktown; IU Health Jay Pharmacy, Hartford City; and IU Health Jay Hospital, Portland. The kiosks are open to the public and available during business hours. IU Health has installed drug take-back kiosks at four east central Indiana pharmacy locations: the kiosks are open to the public and available during business hours. In 2021, over 1,400 pounds of prescription medications were recovered. IU Health East Central Region Perinatal Coordinator - Enhance efforts to decrease infant mortality in the IU Health East Central Region. In 2021 the IU Health ECR Perinatal Coordinator implemented a Tobacco Treatment Pilot Program in five ECR physician office settings designed to provide client consultations and referrals to 1-800 Quit Now, Baby and Me Tobacco Free program, and pharmacotherapy options. In 2021 the IDOH awarded 2 years of funding for the implementation of a HIPAA compliant text messaging and remote monitoring virtual platform to all obstetrical practices in the ECR providing prenatal care and offering delivery services at IU Health Ball Memorial Hospital. Obesity, Diabetics and Physical Inactivity IU Health Jay's implementation strategy to address the identified need of Obesity, Diabetes, and Physical Inactivity include the following: Healthy Community Alliance of East Central Indiana (HCA) -The Healthy Community Alliance of East Central Indiana (HCA) engaged 149 collaborating organizations in three ECR counties- Delaware, Blackford and Jay during 2021. HCA makes multiple resources available to collaborators, including facilitated workgroup sessions in each county, materials such as Tobacco Cessation Toolkits and Healthy Lifestyle toolkits; and online resources such a e-newsletter, media messaging and access to community health data for each of the three counties. These resources are provided to all collaborating organizations free of charge. Most HCA Partner organizations are currently utilizing at least one of these provided resources to influence change amongst their audiences. To adapt to COVID-19 restrictions, in 2021 the HCA retooled its virtual workgroup process to focus on specific partner initiatives for obesity prevention and tobacco cessation and ways other partners can become engaged. One new partner was added in 2021. East Central Indiana Food Council -The East Central Indiana Food Council is a volunteer-run organization led by local activists interested in addressing community issues around new food policy, food waste reduction, healthy eating and food access. It receives support from the IU Health-driven Healthy Community Alliance initiative. The group has strategically grown from a Delaware County focus to include participants from Blackford and Jay Counties. The Council is composed of multiple community collaborators representing Ball State University, The Muncie Food Hub, IU Health, Purdue Extension, Second Harvest Food Bank, Grace Baptist Church, the Soup Kitchen of Muncie, Blood-n-Fire Ministries, Community and Family Services Food Pantries in Hartford City, Montpelier and Portland and the Children's Bureau; as well as local farmers and farmers market organizers. The Healthy Community Alliance Nutrition Workgroup was combined into the Food Council in June 2021 and this has brought additional partners into the collaborative discussions as well as integrating a more defined focus on healthy eating. The group organized educational activities and field trip in July 2021 to tour an aquaculture facility which has long term potential to bring fresh produce to underserved areas. Smoking and Tobacco Usage IU Health Jay's implementation strategy to address the identified need of Smoking and Tobacco Usage include the following: Schedule H, Part V, Section B, Line 11 Facility , 2 Facility , 2 - IU HEALTH JAY (CONT.). 1-800-QUIT-NOW: Indiana Tobacco Quitline - Educate staff regarding "Ask, Advise, Refer" process to refer patients and family members to the Indiana Tobacco Quitline. - In 2021, after declining during the COVID-19 pandemic, the Indiana Tobacco Quit Line received a total of 114 referrals from the East Central Region; 76 from Delaware County, 20 from Blackford County and 18 from Jay County. Healthy Community Alliance of East Central Indiana (HCA) *See Initiative Update under Obesity, Diabetics and Physical Inactivity IU Health East Central Region Perinatal Coordinator *See Initiative Update under Behavioral Health. Social Determinants of Health IU Health Jay's implementation strategy to address the identified need of Social Determinants of Health include the following: Jay Community Partnership Plan -Local collaborators deployed the CDC Change tool process in 2020 within Jay County to identify community strengths and opportunities by surveying 13 local organizations from the sectors of Community Institutions and Organizations; Healthcare, Schools, Worksite and Community at Large. Organizing and survey partners included the Healthy Community Alliance of East Central Indiana, IU Health Jay Hospital, the Jay County Drug Prevention Coalition, Jay County Health Department, First Bank of Berne, Meridian Health Services, Jay Youth Service Bureau, Jay Community Schools, The Rock Church, The Jay Community Center, Brianna's Hope, Head Start, Jay County Library, Purdue Extension and FCC Corp. Data will be used to develop future health initiatives. IU Health East Central Region Perinatal Coordinator *See Initiative Update under Behavioral Health. IU Health Jay addressed all community health needs based on their 2018 Community Health Needs Assessment. There were no identified needs that will not be addressed. Schedule H, Part V, Section B, Line 13 Facility , 1 Facility , 1 - IU HEALTH JAY. INCOME LEVEL OTHER THAN FPG IN ADDITION TO FPG, IU HEALTH JAY MAY TAKE INTO CONSIDERATION A PATIENT'S INCOME AND/OR ABILITY TO PAY IN CALCULATION OF A FINANCIAL ASSISTANCE AWARD. Schedule H, Part V, Section B, Line 13 Facility , 1 Facility , 1 - IU HEALTH JAY. IU Health Jay 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 Jay takes several other measures to publicize its FAP within the community. These measures include the following: 1. Post this Policy, a Plain Language Summary of this Policy, and the Financial Assistance Application on its website. 2. Provide patients with a Plain Language Summary of this Policy during registration and/or discharge. 3. Post conspicuous displays in appropriate acute care settings such as emergency departments and registration areas describing the available assistance and directing eligible patients to the Financial Assistance Application. 4. Include a conspicuous written notice on all patient post-discharge billing statements notifying the patient about this Policy and the telephone number of the Customer Service Department which can assist patients with questions regarding this Policy. 5. Make available Customer Service representatives via telephone during normal business hours. 6. Mail copies of this Policy, a Plain Language Summary of this Policy, and a Financial Assistance Application to patients or their guarantor free of charge upon request. 7. Broadly communicate this Policy as a part of its general outreach efforts. 8. Educate patient-facing team members on this Policy and the process for referring patients to the program. 7 IU HEALTH JAY FAMILY FIRST 500 WEST VOTAW ST ENTRANCE B PORTLAND IN 47371 PRIMARY CARE IU HEALTH JAY FAMILY MEDICINE 430 WEST VOTAW ST PORTLAND IN 47371 PRIMARY CARE IU HEALTH JAY FAMILY PRACTICE 428 WEST VOTAW STREET ENTRANCE 1 PORTLAND IN 47371 PRIMARY CARE IU HEALTH JAY GENERAL SURGERY 510 WEST VOTAW STREET SUITE B PORTLAND IN 47371 SPECIALTY CARE IU HEALTH JAY MULTI-SPECIALTY 510 WEST VOTAW STREET ENTRANCE C PORTLAND IN 47371 SPECIALTY CARE IU HEALTH JAY REHAB 1756 W 100 S PORTLAND IN 47371 REHABILITATION SERVICES IU HEALTH JAY HOSPITAL BEHAVIORAL HEALTH 1759 W 100 S PORTLAND IN 47371 BEHAVIORAL HEALTH Schedule H, Part I, Line 6a C.B. REPORT PREPARED BY A RELATED ORG. IU HEALTH JAY HOSPITAL'S COMMUNITY BENEFIT AND OTHER INVESTMENTS, ENCOMPASSING ITS TOTAL COMMUNITY INVESTMENT, ARE INCLUDED IN THE IU HEALTH COMMUNITY BENEFIT REPORT WHICH IS PREPARED ON BEHALF OF AND INCLUDES IU HEALTH AND ITS RELATED HOSPITAL ENTITIES IN THE STATE OF INDIANA ("IU HEALTH STATEWIDE SYSTEM"). THE IU HEALTH COMMUNITY BENEFIT REPORT IS MADE AVAILABLE TO THE PUBLIC ON IU HEALTH'S WEBSITE AT HTTPS://IUHEALTH.ORG/IN-THE-COMMUNITY/COMMUNITY-BENEFIT. THE IU HEALTH COMMUNITY BENEFIT REPORT IS ALSO DISTRIBUTED TO NUMEROUS KEY ORGANIZATIONS THROUGHOUT THE STATE OF INDIANA IN ORDER TO BROADLY SHARE THE IU HEALTH STATEWIDE SYSTEM'S COMMUNITY BENEFIT EFFORTS. IT IS ALSO AVAILABLE BY REQUEST THROUGH THE INDIANA STATE DEPARTMENT OF HEALTH OR IU HEALTH. Schedule H, Part I, Line 7f PERCENTAGE OF TOTAL EXPENSE The amount of bad debt expense included on Form 990, Part IX, Line 25, column (A), but subtracted for purposes of calculating the percentage of total expense on Line 7, column (f) is $1,952,271. Bad debt expense is reported at cost based on the cost-to-charge ratio. Delivered from worksheet 2, ratio of patient care cost-to-charges. Schedule H, Part I, Line 7c TOTAL COMMUNITY BENEFIT EXPENSE Schedule H, Part I, Line 7, Column (f), Percent of Total Expense, is based on column (e) Net Community Benefit Expense. The percent of total expense based on column (c) Total Community Benefit Expense, which does not include direct offsetting revenue, is 29.56%. Schedule H, Part II PROMOTION OF HEALTH IN COMMUNITIES SERVED IU Health Jay is a subsidiary of IU Health, IU Health participates in a variety of community-building activities that address the social determinants of health in communities it serves. IU Health and its related hospital entities across the State of Indiana ("IU Health Statewide System") investments include economic development efforts across the state, collaborate with like-minded organizations through coalitions that address key issues, and advocate for improvements in the health status of vulnerable populations. This includes making contributions to community-building activities by providing investments and resources to local community initiatives that addressed economic development, community support and workforce development. Several examples include IU Health's support numerous organizations and initiatives that focus on some of the root causes of health issues, such as lack of education, employment and poverty. - IU Health Jay is a supporting member of a three-county health coalition focused on obesity prevention and tobacco cessation as a means to reduce the impact of chronic disease including cancer and heart disease. More than 150 organizations are partners in the "Healthy Community Alliance of East Central Indiana" coalition and each pledge to influence audiences to make positive choices regarding improved nutrition, increased physical activity or tobacco cessation. Coalition partners report a collective total audience size of more than 50,000 people. - In 2021 IU Health Jay established a hospital advisory council to engage community partners in discussions around community healthcare topics such as the Community Heath Needs Assessment, Hospital Quality Outcomes, COVID-19 Response, IU Health Foundation, Medical Staff business, Physician recruitment, Team Member Engagement, and Hospital Finances. Participating organizations include: Vista LLC, Hinkle, Racster & Schemenaur, First Merchants Bank, The Portland Foundation, Lockers Touch of Country, and retired community members. The group meets for discussion on a bi-monthly basis. - IU Health Jay is part of the Consortium for Opioids Response Engagement which was created to build sustainable consortium of stakeholders to combat the opioid crisis. Early intervention of children, adolescents and families with a focus on the individual, interpersonal, community, and societal influences that produce health disparities, stigma and bias, and cultural insensitivities. Embed evidence-based prevention, treatment and recovery services into a seamless community-based system of care for both counties through process design and improvement. Increase access to medication-assisted treatment (MAT) for opioid addiction. Participating organizations include: Purdue University, Jay County Drug Prevention Coalition, Blackford County Community Corrections, Hester Hollis Concern Center, A Better Life Brianna's Hope. - IU Health Jay manager sits on the Shaffer Leadership Academy Board of Directors. - IU Health Jay president is a member of the John Jay Center for Learning Board of Directors. Schedule H, Part I, Line 6a Community benefit report prepared by related organization INDIANA UNIVERSITY HEALTH, INC. Schedule H, Part I, Line 7 Bad Debt Expense excluded from financial assistance calculation 1952271 Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount The amount reported on line 2 as bad debt is reported at cost, as calculated using the cost to charge ratio methodology. Schedule H, Part III, Line 3 Bad Debt Expense Methodology IU Health will deem patients or their guarantors presumptively eligible for Financial Assistance if they are found to be eligible for one of the following programs and care was initiated via an eligible facility's emergency department, direct admission from a physician's office, or transfer from another hospital facility: 1. Medicaid (any state) 2. Indiana Children's Special Health Care Services 3. Healthy Indiana Plan 4. Patients who are awarded Hospital Presumptive Eligibility (HPE) 5. A state and/or federal program that verifies the patient or guarantor's gross household income meets the FPL income threshold. No Financial Assistance Application is required to receive Financial Assistance under this Presumptive Eligibility section. IU Health will conduct a quarterly review of all accounts placed with a collection agency partner for at least one hundred and twenty (120) days after the account is eligible for an ECA as set forth in this Policy. If the patient or guarantor's individual scoring criteria demonstrates the patient has a low likelihood and/or propensity to pay or no credit, the patient or guarantor may be deemed presumptively eligible for Financial Assistance. Financial Assistance may additionally be granted in the following circumstances: a) If the patient or their guarantor is found to have filed a petition for bankruptcy. b) If the patient is deceased and found to have no estate. c) If the patient is deceased and was under 21 years of age at the time of death. Due to this comprehensive methodology, IU Health does not believe any amount of bad debt is attributable to patients who may be eligible under the financial assistance policy and no portion of bad debt is included as community benefit. Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote IU Health's consolidated financial statements, Footnote 5, addresses bad debt expense as follows: The Indiana University Health System does not require collateral or other security from its patients, substantially all of whom are residents of the State, for the delivery of health care services. However, consistent with industry practice, the Indiana University Health System routinely obtains assignment of (or is otherwise entitled to receive) patients' benefits payable under their health insurance programs, plans, or policies (e.g., Medicare, Medicaid, managed care payers, and commercial insurance policies). The Indiana University Health System uses a portfolio approach to account for categories of patient contracts as a collective group, rather than recognizing revenue on an individual contract basis. The portfolios consist of major payer classes for inpatient revenue and outpatient revenue. Based on the historical collection trends and other analysis, the Indiana University Health System believes that revenue recognized by utilizing the portfolio approach approximates the revenue that would have been recognized if an individual contract approach were used. In support of its mission, the Indiana University Health System provides care to uninsured and underinsured patients. The Indiana University Health System provides charity care to patients who lack financial resources and are deemed to be medically indigent. 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 for this type of financial assistance are based on household makeup. Households without dependents are eligible for assistance if household income is less than or equal to 200% FPL, two adults and at least one dependent are eligible if household income is less than or equal to 250% FPL, and households with one adult and at least one dependent are eligible if household income is less than or equal to 300% FPL. 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 20% of annual household income. 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 $133,584,000 and $90,358,000 in 2021 and 2020, respectively. Schedule H, Part III, Line 8 Community benefit & methodology for determining medicare costs IU Health Jay did not have a Medicare shortfall for 2021. IU Health Jay's Medicare reimbursements, however, are normally less than the cost of providing patient care and services to Medicare beneficiaries and do not include any amounts that result from inefficiencies or poor management. IU Health Jay accepts all Medicare patients knowing that there may be shortfalls; therefore, it has taken the position that any shortfall should be counted as part of its community benefit. Additionally, it is implied in Internal Revenue Service Revenue Ruling 69-545 that treating Medicare patients is a community benefit. Revenue Ruling 69-545, which established the community benefit standard for nonprofit hospitals, states that if a hospital serves patients with governmental health benefits, including Medicare, then this is an indication that the hospital operates to promote the health of the community. The amount reported on Schedule H, Part III, Line 6 is calculated, in accordance with the Form 990 instructions, using "allowable costs" from the IU Health Medicare Cost Report. "Allowable costs" for Medicare Cost Report purposes, however, are not reflective of all costs associated with IU Health's participation in Medicare programs. For example, the Medicare Cost Report excludes certain costs such as billed physician services, the costs of Medicare Parts C and D, fee schedule reimbursed services, and durable medical equipment services. Inclusion of all costs associated with IU Health Blackford Hospital's participation in Medicare programs would significantly reduce the Medicare surplus reported on Schedule H, Part III, Line 7. Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance IU Health Jay's FAP and Written Debt Collection Policy describe the collection practices applicable to patients, including those who may qualify for financial assistance. 1. Financial Assistance Application Financial Assistance Applications must include the following documentation: - All sources of Income for the last three (3) months. - Most recent three (3) months of pay stubs or Supplemental Security Income via Social Security. - Most recent three (3) statements from checking and savings accounts, certificates of deposit, stocks, bonds and money market accounts. - Most recent state and Federal Income Tax forms including Schedules C, D, E, and F. In the event the patient or guarantor's income does not warrant the filing of a federal tax statement, the individual may submit a notarized affidavit attesting to the foregoing. - Most recent W-2 statement. - For patients or members of the Household who are currently unemployed, Wage Inquiry from WorkOne. - If applicable, divorce/dissolution decrees and child custody order. Patients or their guarantors wishing to apply for Financial Assistance due to Financial Hardship are encouraged to submit an Application within ninety (90) days of discharge. Patients or their guarantors may submit an Application up to two-hundred and forty (240) days from the date of their initial post-discharge billing statement from IU Health, however, accounts may be subject to Extraordinary Collection Actions (ECA) as soon as one-hundred and twenty (120) days after receipt of the initial post-discharge billing statement. Patients or their guarantors submitting an incomplete Financial Assistance Application will receive written notification of the Application's deficiency upon discovery by IU Health. The Application will be pended for a period of forty-five (45) days from the date the notification is mailed. IU Health will suspend any ECA until the Application is complete or the expiration of the forty-five (45) day period. Patients with limited English proficiency may request a copy of this Policy, a Financial Assistance Application, and a Plain Language Summary in one of the below languages: - Arabic; - Burmese; - Burmese - Falam; - Burmese - Hakha Chin; - Mandarin/Chinese; or - Spanish The patient, and/or their representative, such as the patient's physician, family members, legal counsel, community or religious groups, social services or hospital personnel may request a Financial Assistance Application be mailed to a patient's primary mailing address free of charge. IU Health maintains the confidentiality of all Financial Assistance Applications and supporting documentation. IU Health will deny or revoke Financial Assistance for any patient or guarantor who falsifies any portion of a Financial Assistance Application. 2. Financial Assistance Determinations IU Health will inform patients or guarantors of the results of their Application by providing the patient or guarantor with a Financial Assistance Determination within ninety (90) days of receiving a completed Application and all requested documentation. A patient's Financial Assistance Application and Financial Assistance Determination are specific to each date(s) of service and approved related encounters. If a patient or guarantor is granted less than full charity assistance and the patient or guarantor provides additional information for reconsideration, Revenue Cycle Services may amend a prior Financial Assistance Determination. 3. Extraordinary Collection Actions IU Health may refer delinquent patient accounts to a third-party collection agency after utilizing reasonable efforts to determine a patient's eligibility for assistance under this Policy. Reasonable efforts include the following: - IU Health will notify the patient of this Policy at least thirty (30) days prior to initiating an ECA. - IU Health will not initiate an ECA for at least one-hundred and twenty (120) days after the patient's initial post-discharge billing statement. - IU Health will review all Financial Assistance Applications received up to and including two-hundred and forty (240) days after the patient's initial post-discharge billing statement. IU Health will cease any ECAs it has initiated upon receipt of a Financial Assistance Application until a Financial Assistance Determination is made under this policy. - If an Application is Approved, IU Health will issue a revised statement, issue refunds, and make reasonable efforts to reverse ECAs as necessary. IU Health and its third-party collection agencies may initiate an ECA against a patient or their guarantor in accordance with this Policy and 26 C.F.R. § 1.501(r). ECAs may include the following: - Selling a patient or their guarantor's outstanding financial responsibility to a third party. - Reporting adverse information about the patient or their guarantor to consumer credit reporting agencies or credit bureaus. - Deferring or denying, or requiring a payment before providing, medically necessary care because of a patient or their guarantor's nonpayment of one or more bills for previously provided care covered under this Policy. - Actions requiring a legal or judicial process, including but not limited to placing a lien on a patient's or their guarantor's property, foreclosing on a patient's or their guarantor's real property, attaching or seizing a patient's or their guarantor's bank account or other personal property, commencing a civil action against a patient or their guarantor, causing a patient or guarantor's arrest, causing a patient and/or guarantor to be subject to a writ of body attachment, and garnishing a patient or guarantor's wages When it is necessary to engage in such action, IU Health and its third party collection agencies, will engage in fair, respectful and transparent collections activities. 4. Refunds Patients eligible for Financial Assistance under this Policy who remitted payment to IU Health in excess of their Patient Responsibility will be alerted to the overpayment as promptly after discovery as is reasonable given the nature of the overpayment. Patients with an outstanding account balance due on a separate account will have their refund applied to the outstanding balance. Patients without an outstanding account balance described above will be issued a refund check for their overpayment as soon as technically feasible. Schedule H, Part V, Section B, Line 16a FAP website - IU HEALTH JAY: Line 16a URL: https://iuhealth.org/pay-a-bill/financial-assistance; Schedule H, Part V, Section B, Line 16b FAP Application website - IU HEALTH JAY: Line 16b URL: https://iuhealth.org/pay-a-bill/financial-assistance; Schedule H, Part V, Section B, Line 16c FAP plain language summary website - IU HEALTH JAY: Line 16c URL: https://iuhealth.org/pay-a-bill/financial-assistance; Schedule H, Part VI, Line 2 Needs assessment Each IU Health hospital is dedicated to the community it serves. Each hospital conducts a CHNA to understand current community health needs and to inform strategies designed to improve community health, including initiatives designed to address social determinants of health. The CHNAs are conducted using widely accepted methodologies to identify the significant needs of a specific community. The assessments also are conducted to comply with federal laws and regulatory requirements that apply to tax-exempt hospitals. IU Health Jay Hospital assesses the health care needs of the communities it serves by conducting a Community Health Needs Assessment (CHNA) for its hospital location. For the 2021 CHNA, IU Health Jay Hospital obtained community input through focus groups of community stakeholders, additional surveys issued to stakeholders who were unable to attend community meetings, a survey issued to internal providers from IU Health Jay Hospital and key informant interviews with those possessing public health expertise. After completion of the CHNA, IU Health Jay Hospital reviewed secondary data, findings from other community health assessments of areas served by the hospital, input obtained from individuals who participated in community meetings, and input obtained from key stakeholders. The top health needs of the IU Health communities are those that are supported by multiple data sources. Additionally, the effectiveness of an intervention for each need and IU Health's ability to impact positive change was evaluated. IU Health believes its CHNA process is comprehensive and additional assessments are not required. Schedule H, Part VI, Line 3 Patient education of eligibility for assistance IU Health Jay is committed to serving the healthcare needs of all of its patients regardless of their ability to pay for such services. To assist in meeting those needs, IU Health Jay has established a FAP to provide Financial Assistance to Uninsured Patients. IU Health Jay is committed to ensuring its patients are compliant with all provisions of the Patient Protection & Affordable Care Act. To that end, IU Health Jay will make a good faith effort to locate and obtain health insurance coverage for patients prior to considering patients for coverage under the FAP. IU Health Jay takes several measures to inform its patients of the FAP and FAP-eligibility. These measures include the following: 1. Post this Policy, a Plain Language Summary of this Policy, and the Financial Assistance Application on its website. 2. Provide patients with a Plain Language Summary of this Policy during registration and/or discharge. 3. Post conspicuous displays in appropriate acute care settings such as emergency departments and registration areas describing the available assistance and directing eligible patients to the Financial Assistance Application. 4. Include a conspicuous written notice on all patient post-discharge billing statements notifying the patient about this Policy and the telephone number of the Customer Service Department which can assist patients with questions regarding this Policy. 5. Make available Customer Service representatives via telephone during normal business hours. 6. Mail copies of this Policy, a Plain Language Summary of this Policy, and a Financial Assistance Application to patients or their guarantor free of charge upon request. 7. Broadly communicate this Policy as a part of its general outreach efforts. 8. Educate patient-facing team members on this Policy and the process for referring patients to the program. Schedule H, Part VI, Line 4 Community information IU Health Jay is located in Jay County, Indiana, a county located in east-central Indiana. Jay County includes ZIP codes within the towns of Portland, Dunkirk, Bryant, Redkey, Pennville, and Salamonia. Based on the most recent Census Bureau (2021) statistics, Jay County's population is 20,248 persons with approximately 49.5% being female and 50.5% male. The county's population estimates by race are 94.1% White, 3.4% Hispanic or Latino, 0.8% Black, 0.4% Asian, 0.3% American Indian or Alaska Native, and 1.3% persons reporting two or more races. Jay County has relatively low levels of educational attainment. The level of education most of the population has achieved is a high school degree (88.2%). As of 2021, 12.5% of the population had a bachelor's degree or higher. Schedule H, Part VI, Line 5 Promotion of community health IU Health Jay 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 Jay extends medical staff privileges to all qualified physicians in its community for some or all its departments and specialties. 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. IU Health Jay participates in other initiatives and collaborations throughout the year to promote health and wellness in the community. Some of these include: - Reduced priced blood test screenings such as cholesterol, glucose and A1C are offered on a walk-in basis year-round for the entire community. - Lung cancer screenings using low dose CT imaging offered at reduced cost to community members meeting requirements set out by the National Comprehensive Cancer Network. In 2021, 64 individuals received this service. - Reduced the price heart scans available to be scheduled, year-round for the entire community. - IU Health Jay team member annual campaign to raise donations for the local United Way. - Ostomy Support Group meetings held monthly to provide information, advocacy and service to the intestinal and urinary diversion community. - Nutrition counseling was made available to diabetics in the community. - Education for students in the healthcare field such as nursing, pharmacy and radiology. Students job shadowed nurses at IU Health Jay to learn and experience the healthcare field. - In 2021, IU Health Jay held COVID-19 vaccines clinics at the hospital which were open to the community. The clinics at the hospital were the first in the community. There were also clinics held for high school students over the age of 16. More than 5,000 vaccines were administered. Important information on the virus and the vaccine was also translated for the Hispanic speaking population in Jay County. - Additionally, team members at IU Health Jay participated in the IU Health Statewide System's team member community benefit service program, "IU Health Serves", team members across the state make a difference in the lives of thousands of Hoosiers every year. Schedule H, Part VI, Line 6 Affiliated health care system Indiana University Health Jay is part of Indiana University Health ("IU Health "the healthcare system"), which is Indiana's most comprehensive healthcare system. A unique partnership with the Indiana University School of Medicine ("IU School of Medicine"), one of the nation's leading medical schools, gives patients access to innovative treatments and therapies. The healthcare system is comprised of hospitals, physicians and allied services dedicated to providing preeminent care throughout Indiana and beyond. IU Health's affiliate hospitals are divided into five 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 Blackford 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 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 goal of making Indiana one of the healthiest states in the nation. The affiliate hospitals are guided by a system wide mission to improve the health of our patients and community through innovation, and excellence in care, education, research, and service. The healthcare system is keenly aware of the positive impact it can have on improving the health of communities throughout the state of Indiana by aligning resources in a system-level and strategic way. 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 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 team partners with state and local community-based organizations, community coalitions and governmental agencies to focus on clinical care, community investment and advocacy strategy that seeks to improve the health of communities. All affiliate hospitals in the healthcare system identifies and addresses significant health needs unique to the community they serve. Some of these health needs are common in communities served by multiple affiliate hospitals in the healthcare system and align with system priority areas, warranting a system level strategy. The Community Health Division plans and provides technical assistance for system-level strategies that address these common health needs including health inequities, tobacco, behavioral health access, infant and maternal health and social needs. Each affiliate hospital works collaboratively with the Community Health Division team to operationalize system-level strategies through the implementation of specific activities that align and activate local resources too. 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, IU Health Serves, 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. IU Health Jay 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 IU Health Jay team members in activities that address local, identified community health priorities. The Community Impact and Investment (CII) Fund is a $100 million board designated fund that is managed by the IU Health Foundation to financially support high impact community investing designed to address social determinants of health in communities IU Health serves. Each affiliate hospital has a significant impact on and is deeply invested in their local communities. 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 their surrounding communities. Each IU Health affiliate hospital and its team members are eligible to pursue this grant opportunity with a community organization or agency. Schedule H, Part VI, Line 7 State filing of community benefit report IN true true false false false false false true false DEREK E EMPIE FORMER OFFICER & DIRECTOR 0 275806 0 66883 0 810 0 18725 0 33770 0 395995 0 0 JEFFREY C BIRD MD DIRECTOR/REGIONAL PRESIDENT (ECR) 0 539835 0 383684 0 424936 0 18725 0 31967 0 1399147 0 248972 PETER M VOSS MD DIRECTOR/VICE CHAIR/CMO (ECR) 0 371142 0 107040 0 26242 0 18725 0 29831 0 552980 0 0 LORI A LUTHER DIRECTOR (PART YEAR)/COO (ECR) 0 320772 0 83335 0 23064 0 15810 0 33774 0 476755 0 0 DAVID W HYATT DIRECTOR (PART YEAR) 0 233473 0 58329 0 2081 0 17278 0 33068 0 344229 0 0 DAVID M BROWN MD DIRECTOR (PART YEAR) 0 373880 0 21076 0 14262 0 18986 0 1202 0 429407 0 0 JOAN V CASTOR DIRECTOR (PART YEAR) 0 337251 0 243198 0 3601 0 78127 0 40126 0 702303 0 0 CHARLES R ROUTH MD DIRECTOR (PART YEAR) 0 211621 0 55441 0 20000 0 18505 0 32042 0 337609 0 0 JONATHAN W VANATOR PRESIDENT/CFO (ECR) 0 316645 0 77273 0 810 0 17223 0 26991 0 438942 0 0 MICHELLE R ALTOBELLA SECRETARY (PART YEAR) 0 222227 0 56927 0 1143 0 18116 0 31588 0 330000 0 0 BETTIE A CALDWELL TREASURER (PART YEAR) 0 111215 0 21423 0 19657 0 8028 0 11593 0 171915 0 0 CARLA C COX RN VP & CNO (ECR) 0 250515 0 62414 0 6604 0 18145 0 26005 0 363683 0 0 ANN M MCGUIRE VP-HUMAN RESOURCES REGIONAL (ECR)-PART YEAR 0 7136 0 0 0 245708 0 10678 0 1170 0 264692 0 205618 MEGAN HAYMAKER VP-HUMAN RESOURCES (ECR) (Part Year) 0 154045 0 56037 0 39414 0 10467 0 10171 0 270134 0 0 CHERI L KNAPKE Manager-Pharmacy 125362 0 12798 0 627 0 9586 0 32610 0 180984 0 0 0 DIANE R ROESSNER PHARMACIST 121856 0 0 0 120 0 8175 0 21297 0 151448 0 0 0 CHRISTINA SCHEMENAUR VP - CNO - JAY HOSP 130438 0 28824 0 253 0 9682 0 0 0 169198 0 0 0 MELODY SUE MAHORNEY Respiratory Care Practitioner 139692 0 6140 0 2554 0 7953 0 10344 0 166684 0 0 0 Schedule J, Part I, Line 3 Arrangement used to establish the top management official's compensation IU HEALTH'S JAY'S REGIONAL PRESIDENT AND PRESIDENT ARE EMPLOYED BY INDIANA UNIVERSITY HEALTH, INC. IU HEALTH, IU HEALTH BALL MEMORIAL HOSPITAL, IU HEALTH JAY, AND OTHER RELATED ORGANIZATIONS HAVE A PROCESS IN PLACE TO DETERMINE THE COMPENSATION FOR ITS OFFICERS AND KEY EMPLOYEES. IU HEALTH HUMAN RESOURCES USES MARKET DATA FROM MULTIPLE COMPENSATION EXPERTS/VENDORS WHO UTILIZE A VARIETY OF METHODS AND PROCEDURES TO OBTAIN COMPENSATION RANGES FOR COMPARABLE OFFICERS AND EMPLOYEE POSITIONS. THIS MARKET DATA AND MULTIPLE OTHER FACTORS (INCLUDING MARKET PAY BENCHMARKS, INTERNAL EQUITY, CANDIDATE/EMPLOYEE QUALIFICATIONS & PERFORMANCE, AND BUSINESS NEEDS) ARE USED TO RECOMMEND COMPENSATION RANGES FOR ITS OFFICERS AND OTHER EMPLOYEES, WHICH ARE THEN USED AS A GUIDE FOR SETTING REASONABLE COMPENSATION BY MANAGEMENT. PLEASE SEE SCHEDULE O FOR ADDITIONAL DETAILS. Schedule J, Part I, Line 4a Severance or change-of-control payment Ann M. McGuire entered into a severance agreement with IU Health during 2020. Severance of $245,708.40 is included in column B (iii). Deferred severance of $205,618, as disclosed in 2020, is included in column f, as previously reported compensation. Schedule J, Part I, Line 4b Supplemental nonqualified retirement plan Jeffrey C. Bird, M.D. participates in an IU Health supplemental executive retirement plan. Provisions of which are designed to retain its critical employees. The plan provides for an additional retirement benefit for services through normal retirement or other key dates. If the executive leaves prior to retirement or other key dates, the benefit may be forfeited or reduced. Jeffrey C. Bird M.D. and Tory Castor have an amount included in column C, deferred compensation, representing the current year unvested contributions made under the supplemental retirement plan. No amount was actually paid to Jeffrey C. Bird M.D. or Tory Castor during the year. Schedule J, Part I, Line 7 Non-fixed payments AMOUNTS DISCLOSED IN COLUMN B (II) INCLUDE A LONG TERM AND SHORT-TERM INCENTIVE FOR CERTAIN EXECUTIVES AND SHORT-TERM INCENTIVE FOR OTHER EMPLOYEES ALTHOUGH THESE PLANS ARE BASED ON FIXED FORMULA THAT HAS BEEN APPROVED BY THE BOARD OF DIRECTORS BASED UPON CERTAIN QUALITATIVE AND QUANTITATIVE FACTORS AND GOALS. ALL DISCRETIONARY INCENTIVE PLANS MUST BE APPROVED BY THE BOARD OF DIRECTORS PRIOR TO ANY INCENTIVE PAYOUT. Form 990, Part III, Line 4d Description of other program services (Expenses $ including grants of $)(Revenue $ 41,000) IU HEALTH JAY RECEIVED REVENUE FROM A RELATED 501(C)(3) ENTITY FOR SHARED SERVICES. Form 990, Part IV, Line 13 SECTION B, LINE 12, 13, 14 AND 16B - POLICIES IU HEALTH JAY IS PART OF THE IU HEALTH SYSTEM. AS THE SOLE MEMBER AND CONTROLLING PARENT OF IU HEALTH JAY, IU HEALTH AND ITS BOARD OF DIRECTORS HAVE MANDATED THAT CERTAIN POLICIES BE FOLLOWED TO ENSURE GREATER STANDARDIZATION THROUGHOUT THE SYSTEM. THUS, IU HEALTH JAY'S BOARD OF DIRECTORS WAS NOT REQUIRED TO SEPARATELY ADOPT A CONFLICT OF INTEREST, WHISTLEBLOWER, DOCUMENT RETENTION AND DESTRUCTION AND JOINT VENTURE POLICIES BECAUSE IU HEALTH'S BOARD OF DIRECTORS HAD ALREADY ADOPTED AND REQUIRED THESE POLICIES TO BE FOLLOWED BY ITS SUBSIDIARIES. Form 990, Part VI, Line 15 PROCESS OF DETERMINING COMPENSATION IU HEALTH JAY'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 (SENIOR VICE PRESIDENTS AND ABOVE) 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. JON VANATOR EACH SERVED AS PRESIDENT OF IU HEALTH JAY DURING 2021. JON VANATOR IS EMPLOYED BY IU HEALTH. IU HEALTH, INC. AND OTHER RELATED ENTITIES HAVE A PROCESS IN PLACE TO DETERMINE THE COMPENSATION FOR THE OTHER OFFICERS AND KEY EMPLOYEES OF IU HEALTH JAY, INC. 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 2 Family/business relationships amongst interested persons JOHN D. LITTLER AND DAVID A. LITTLER - Family relationship Form 990, Part VI, Line 6 Classes of members or stockholders IU HEALTH JAY HAS ONE CLASS OF MEMBERSHIP AND THE SOLE MEMBER IS IU HEALTH. Form 990, Part VI, Line 7a Members or stockholders electing members of governing body THE BOARD OF DIRECTORS SHALL INITIALLY CONSIST OF ELEVEN (11) MEMBERS, INCLUDING THE LEGACY DIRECTORS AND FOUR (4) ADDITIONAL DIRECTORS APPOINTED BY IU HEALTH. UPON THE EXPIRATION OF THE TRANSITION PERIOD (3/1/2021) AND AT ALL TIMES THEREAFTER, THE BOARD OF DIRECTORS SHALL CONSIST OF THE SAME INDIVIDUALS APPOINTED BY IU HEALTH TO SERVE AS DIRECTORS OF EACH OTHER EAST CENTRAL REGION HOSPITAL. Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders NOTWITHSTANDING ANY OTHER PROVISIONS OF THE BYLAWS, THE FOLLOWING MATTERS REQUIRE THE WRITTEN APPROVAL OF IU HEALTH PRIOR TO IMPLEMENTATION: - APPOINT AND REMOVE GOVERNING BOARD MEMBERS; - WITH NOTICE TO THE CORPORATION'S BOARD OR THE APPLICABLE AFFILIATE'S GOVERNING BOARD, APPOINT AND REMOVE THE PRESIDENT AND OTHER OFFICERS; - APPROVE ANY PROPOSED AMENDMENT TO THE CORPORATION'S ARTICLES OF INCORPORATION OR THESE BYLAWS OR AN AFFILIATE'S ORGANIZATIONAL DOCUMENTS; - APPROVE ANY ANNUAL CAPITAL OR OPERATING BUDGETS; - APPROVE ANY UNBUDGETED OPERATING OR CAPITAL BUDGET ITEMS OR DEVIATIONS, INCLUDING ANY ISSUANCE OR GUARANTEE OF ANY UNBUDGETED DEBT, PROVIDED THAT THE BUDGET(S) FOR ITEMS TO BE FUNDED THROUGH THE CAPITAL IMPROVEMENT FUND, AS DEFINED IN THE DEFINITIVE AGREEMENT, WILL BE APPROVED PURSUANT TO THE STRATEGIC PLANNING PROCESS APPROVE STRATEGIC PLANS AND AMENDMENTS, WHICH WILL BE INTEGRATED WITH THE MEMBER'S STRATEGIC PLAN; - APPROVE ANY ENCUMBRANCE, SALE OR CONVEYANCE OF ASSETS OTHER THAN IN THE ORDINARY COURSE OF BUSINESS; - MONITOR STRATEGIC PLANNING PERFORMANCE AND ACCOUNTABILITY, AND APPROVE/IMPLEMENT RELATED ACTIONS PLANS TO ADDRESS ANY DEFICIENCIES; - APPROVE ANY AFFILIATIONS OR JOINT VENTURES; - AUTHORIZE THE ESTABLISHMENT OR ACQUISITION OF ANY SUBSIDIARIES, AFFILIATES OR JOINT VENTURE ARRANGEMENTS OR ACQUISITION OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF ANY OTHER BUSINESS OR ENTITY; - APPROVE ANY AGREEMENT TO ACT AS PRIMARY OBLIGOR, OR TO SERVE AS A GUARANTOR, SURETY OR CO-OBLIGOR WITH RESPECT TO THE INDEBTEDNESS OF ANY OTHER PARTY, TO BORROW AMOUNTS FROM THIRD-PARTY LENDERS OR TO LOAN MONEY TO ANY INDIVIDUAL OR ENTITY; - AUTHORIZE ANY MERGER, CONSOLIDATION, REORGANIZATION, SALE OR TRANSFER OF ALL OR SUBSTANTIALLY ALL OF ITS ASSETS; - AUTHORIZE ANY VOLUNTARY DECLARATION OF BANKRUPTCY, PLAN OF DISSOLUTION, LIQUIDATING DISTRIBUTION OF ASSETS OR OTHER ACTION RELATED TO ITS DISSOLUTION OR LIQUIDATION; - APPROVE ANY MANAGEMENT AGREEMENT FOR THE MANAGEMENT OF ALL OR PART OF THE CORPORATION'S OR AN AFFILIATE'S OPERATIONS; OR - APPROVE PROJECTS OR CONTRACTS THAT REQUIRE IU HEALTH APPROVAL IN ACCORDANCE WITH IU HEALTH'S RESOLUTION AND POLICY GOVERNING SYSTEM-WIDE CONTRACT EXECUTION AUTHORITY AND PAYMENT APPROVAL LIMITS, AS AMENDED FROM TIME TO TIME. Form 990, Part VI, Line 11b Review of form 990 by governing body THE CFO REVIEWED AND APPROVED THE FORM 990. FOLLOWING 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 JAY FOLLOWS IU HEALTH'S CONFLICT OF INTEREST POLICY. IU HEALTH'S CONFLICT OF INTEREST POLICY INCLUDES THE FOLLOWING PROVISIONS: ALL IU HEALTH EMPLOYEES, ASSOCIATES, COLLEAGUES AND CONTRACTED PERSONNEL, INCLUDING EMPLOYED PHYSICIANS AND PAID MEDICAL DIRECTORS ("IU HEALTH REPRESENTATIVES") ARE COVERED BY AND SUBJECT TO ITS CONFLICT OF INTEREST POLICY. IU HEALTH REGULARLY AND CONSISTENTLY MONITORS AND ENFORCES COMPLIANCE WITH THE POLICY THROUGH THE FOLLOWING PROCEDURES: (A) ON AN ANNUAL BASIS, EACH IU HEALTH REPRESENTATIVE AT THE LEVEL OF MANAGER OR ABOVE, TOGETHER WITH EVERY OTHER PERSON DESIGNATED BY THE CORPORATE COMPLIANCE DEPARTMENT ("DEPARTMENT"), MUST COMPLETE, SIGN AND SUBMIT A CONFLICT OF INTEREST QUESTIONNAIRE ("QUESTIONNAIRE") TO THE DEPARTMENT. GOVERNING BOARD MEMBERS, COMMITTEE MEMBERS, CORPORATE OFFICERS, MEDICAL STAFF AND RESEARCHERS MUST COMPLY WITH THE ADMINISTRATIVE REQUIREMENTS NOTED IN THE RESPECTIVE POLICIES AND PROCEDURES RELATIVE TO THOSE AREAS. (B) AN IU HEALTH REPRESENTATIVE MUST SUPPLEMENT A QUESTIONNAIRE IN WRITING, IF AFTER COMPLETION OF THE ORIGINAL QUESTIONNAIRE, A SITUATION ARISES, OR MAY REASONABLY BE EXPECTED TO ARISE, THAT WOULD CHANGE ANY ANSWER OR INFORMATION ON THE ORIGINAL QUESTIONNAIRE IF THE SITUATION HAD EXISTED OR BEEN ANTICIPATED AT THE TIME OF COMPLETION OF THE ORIGINAL QUESTIONNAIRE. (C) IF A FULLY AND PROPERLY COMPLETED QUESTIONNAIRE REVEALS FACTS OR OTHER INFORMATION THAT MIGHT REASONABLY INDICATE A CONFLICT OF INTEREST OR VIOLATION OF THE POLICY, THE IU HEALTH REPRESENTATIVE COMPLETING THE QUESTIONNAIRE MUST SECURE APPROVAL BY HIS/HER SUPERVISOR, EVIDENCED IN WRITING. (D) THE DEPARTMENT WILL REVIEW EACH QUESTIONNAIRE AND DETERMINE WHETHER A CONFLICT OF INTEREST EXISTS AND, IF SO, WHETHER AND HOW IT SHOULD OR MAY BE ELIMINATED, AVOIDED OR MANAGED IN ORDER TO COMPLY WITH THE SPIRIT OF THE POLICY AND WITH THE BEST INTERESTS OF IU HEALTH AND ITS PATIENTS. IN MAKING THE DETERMINATION, THE CORPORATE COMPLIANCE DEPARTMENT MAY CONSULT WITH THE IU HEALTH REPRESENTATIVE'S SUPERVISOR AND OTHER APPROPRIATE INDIVIDUALS AND GROUPS. (E) THE SCOPE OF THE POLICY IS NOT LIMITED TO THOSE WHO ARE REQUIRED TO COMPLETE QUESTIONNAIRES. IF AN IU HEALTH REPRESENTATIVE IS INVOLVED IN A SITUATION OR RELATIONSHIP THAT WOULD CONSTITUTE A VIOLATION OF THE POLICY IN THE ABSENCE OF DISCLOSURE AND APPROVAL AS DESCRIBED ABOVE, THEN THE IU HEALTH REPRESENTATIVE MUST DISCLOSE THE MATTER TO HIS/HER SUPERVISOR, SECURE HIS/HER SUPERVISOR'S APPROVAL IN WRITING, AND DISCLOSE THE MATTER TO THE DEPARTMENT. OTHERWISE, THE IU HEALTH REPRESENTATIVE IS IN VIOLATION OF THE POLICY AND SUBJECT TO CORRECTIVE ACTION, UP TO AND INCLUDING TERMINATION. (F) THE CHIEF COMPLIANCE OFFICER, IN CONSULTATION WITH ONSITE COMPLIANCE PERSONNEL, MAY FROM TIME TO TIME APPOINT STANDING OR AD HOC COMMITTEES TO ASSIST IN RESOLVING ISSUES THAT ARISE UNDER PROVISIONS OF THE POLICY. Form 990, Part VI, Line 19 Required documents available to the public IU HEALTH JAY'S ARTICLES OF INCORPORATION ARE AVAILABLE FOR PUBLIC INSPECTION THROUGH THE INDIANA SECRETARY OF STATE'S WEBSITE. IU HEALTH JAY'S CONFLICT OF INTEREST PROCEDURES ARE DISCLOSED ON THE FORM 990, SCHEDULE O. IU HEALTH JAY IS A SUBSIDIARY IN IU HEALTH'S CONSOLIDATED AUDITED FINANCIAL STATEMENTS. IU HEALTH'S CONSOLIDATED AUDITED FINANCIAL STATEMENTS ARE AVAILABLE FOR PUBLIC INSPECTION THROUGH ITS BOND FILINGS AND AS AN ATTACHMENT TO IU HEALTH'S FORM 990. Form 990, Part IX, Line 11g Other Fees SHARED SERVICES/PROF. FEES - Total Expense: 14802431, Program Service Expense: 13606793, Management and General Expenses: 1195638, Fundraising Expenses: ; AMENDED RETURN: FORM 990, PART VII & FORM 990, SCHEDULE J AMENDED RETURN FILED AMENDED RETURN FILED TO CORRECT RELATED COMPENSATION REPORTED FOR JOAN V. CASTOR REASON FOR FILING AN AMENDED RETURN: ERRONEOUS OVERSTATEMENT OF JOAN V. CASTOR'S RELATED COMPENSATION DISCLOSED ON THE ORIGINALLY FILED 2021 FORM 990 SUMMARY OF CHANGES FORM 990, PART VII, LINE 2, COLUMN (E): AS ORIGINALLY FILED: $1,168,100 AS AMENDED: $584,050 FORM 990, PART VII, LINE 2 COLUMN (F): AS ORIGINALLY FILED: $169,979 AS AMENDED: $118,253 FORM 990, SCHEDULE J, PART II, LINE 2, ROW (ii), COLUMN (B)(i) AS ORIGINALLY FILED: $674,502 AS AMENDED: $337,251 FORM 990, SCHEDULE J, PART II, LINE 2, ROW (ii), COLUMN (B)(ii) AS ORIGINALLY FILED: $486,396 AS AMENDED: $243,198 FORM 990, SCHEDULE J, PART II, LINE 2, ROW (ii), COLUMN (B)(iii) AS ORIGINALLY FILED: $7,202 AS AMENDED: $3,601 FORM 990, SCHEDULE J, PART II, LINE 2, ROW (ii), COLUMN (C) AS ORIGINALLY FILED: $89,727 AS AMENDED: $78,127 FORM 990, SCHEDULE J, PART II, LINE 2, ROW (ii), COLUMN (D) AS ORIGINALLY FILED: $80,252 AS AMENDED: $40,126 FORM 990, SCHEDULE J, PART II, LINE 2, ROW (ii), COLUMN (E) AS ORIGINALLY FILED: $1,338,080 AS AMENDED: $702,303 FORM 990, SCHEDULE J, PART II, LINE 2, ROW (ii), 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