Hospitals INDIANA UNIVERSITY HEALTH, INC

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "Hospitals INDIANA UNIVERSITY HEALTH, INC. 35-1955872"

Transcription

1 SCHEDULE H Hospitals OMB No (Form 990) Complete if the organization answered "Yes" to Form 990, Part IV, question 20. Attach to Form 990. See separate instructions. Open to Public Department of the Treasury Internal Revenue Service Inspection Name of the organization Employer identification number INDIANA UNIVERSITY HEALTH, INC Part I Financial Assistance and Certain Other Community Benefits at Cost Yes No 1a Did the organization have a financial assistance policy during the tax year? If "No," skip to question a 1a b If "Yes," was it a written policy? 1b 2 If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year. Applied uniformly to all hospital facilities Applied uniformly to most hospital facilities Generally tailored to individual hospital facilities 3 Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year. a Did the organization use Federal Poverty Guidelines (FPG) as a factor in determining eligibility for providing free care? If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care: 3a 100% 10% 200% Other % b Did the organization use FPG as a factor in determining eligibility for providing discounted care? If "Yes," indicate which of the following was the family income limit for eligibility for discounted care: 200% 20% 300% 30% 00% Other % 3b c If the organization used factors other than FPG in determining eligibility, describe in Part VI the income based criteria for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, as a factor in determining eligibility forfreeordiscountedcare. Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? a Did the organization budget amounts for free or discounted care provided under its financial assistance policy during the tax year? a b If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? b c If "Yes" to line b, as a result of budget considerations, was the organization unable to provide free or discounted care to a patient who was eligible for free or discounted care? c a Did the organization prepare a community benefit report during the tax year? a b If "Yes," did the organization make it available to the public? b Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H. Financial Assistance and Certain Other Community Benefits at Cost Financial Assistance and (a) Number of (b) Persons (c) Total community (d) Direct offsetting (e) Net community (f) Percent activities or Means-Tested Government revenue benefit expense programs served benefit expense of total (optional) (optional) expense Programs a Financial Assistance at cost (from Worksheet 1) ,, ,, b Medicaid (from Worksheet 3, column a) 391 1,13,90.,23,91. -1,23,0. c Costs of other means-tested government programs (from Worksheet3,columnb) d Total Financial Assistance and Means-Tested Government Programs 10323,00,01.,23,91. 9,33, Other Benefits e ,02,. 20,0. 19,,91..0 f g h i j k Community health improvement services and community benefit operations (from Worksheet ) Health professions education (from Worksheet ) Subsidized health services (from Worksheet ) Research (from Worksheet ) Cash and in-kind contributions for community benefit (from Worksheet ) Total. Other Benefits Total. Add lines d and j 2 0,9, ,9, ,200,12.,200, ,2,32. 3,2, ,,03.,0. 3,9, ,0,9. 2,. 119,90, ,12,12.,0,3. 21,23,3..1 For Paperwork Reduction Act Notice, see the Instructions for Form E

2 Page 2 Part II Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves. 1 Physical improvements and housing 2 Economic development 3 Community support Environmental improvements Leadership development and training for community members Coalition building Community health improvement advocacy Workforce development 9 Other 10 Total (a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community building expense (d) Direct offsetting revenue (e) Net community building expense (f) Percent of total expense , ,3..03 Part III Bad Debt, Medicare, & Collection Practices Section A. Bad Debt Expense Yes No 1 Did the organization report bad debt expense in accordance with Healthcare Financial Management Association Statement No. 1? 1 2 Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount 2 2,11,90. 3 Enter the estimated amount of the organization s bad debt expense attributable to patients eligible under the organization s financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit. 3 Provide in Part VI the text of the footnote to the organization's financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements. Section B. Medicare Enter total revenue received from Medicare (including DSH and IME) Enter Medicare allowable costs of care relating to payments on line Subtract line from line. This is the surplus (or shortfall) 2,290,012.,0,3. -,,2. Describe in Part VI the extent to which any shortfall reported in line should be treated as community benefit. Also describe in Part VI the costing methodology or source used to determine the amount reported on line. Check the box that describes the method used: Cost accounting system Cost to charge ratio Other Section C. Collection Practices 9a Did the organization have a written debt collection policy during the tax year? 9a b If "Yes," did the organization's collection policy that applied to the largest number of its patients during the tax year contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI 9b Part IV Management Companies and Joint Ventures (owned 10% or more by officers, directors, trustees, key employees, and physicians-see instructions) (a) Name of entity (b) Description of primary activity of entity (c) Organization's profit % or stock ownership % (d) Officers, directors, trustees, or key employees' profit % or stock ownership % (e) Physicians' profit % or stock ownership % 1 BSC, LLC 2 EHSC, LLC 3 SSSC, LLC IEC, LLC ROCS, LLC BOSC, LLC AMBULATORY SURGERY CENTER AMBULATORY SURGERY CENTER AMBULATORY SURGERY CENTER AMBULATORY SURGERY CENTER AMBULATORY SURGERY CENTER AMBULATORY SURGERY CENTER E INDIANA UNIVERSITY HEALTH, INC , , ,.,..03

3 Page 3 Part V Facility Information Section A. Hospital Facilities (list in order of size, from largest to smallest - see instructions) How many hospital facilities did the organization operate during the tax year? 3 Name, address, and primary website address 1 INDIANA UNIVERSITY HEALTH, INC Licensed hospital General medical & surgical Children's hospital Teaching hospital Critical access hospital Research facility ER-2 hours ER-other Other (describe) INDIANA UNIVERSITY HEALTH, INC. 101 N. SENATE BLVD. SEE ATTACHED INDIANAPOLIS IN IU HEALTH NORTH HOSPITAL 1100 N. MERIDIAN ST. CARMEL IN IU HEALTH WEST HOSPITAL 1111 N. RONALD REAGAN PKWY. AVON IN Facility reporting group E

4 Page Part V Facility Information (continued) Section B. Facility Policies and Practices (Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A) Name of hospital facility or facility reporting group INDIANA UNIVERSITY HEALTH, INC. For single facility filers only: line number of hospital facility (from Schedule H, Part V, Section A) Community Health Needs Assessment (Lines 1 through c are optional for tax years beginning on or before March 23, 2012) 1 During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 9 1 If "Yes," indicate what the CHNA report describes (check all that apply): a A definition of the community served by the hospital facility b Demographics of the community c Existing health care facilities and resources within the community that are available to respond to the health needs of the community d How data was obtained e The health needs of the community f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups g The process for identifying and prioritizing community health needs and services to meet the community health needs h The process for consulting with persons representing the community's interests i Information gaps that limit the hospital facility's ability to assess the community's health needs j Other (describe in Part VI) 2 Indicate the tax year the hospital facility last conducted a CHNA: 20 3 In conducting its most recent CHNA, did the hospital facility take into account input from representatives of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If Yes, describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted 3 Was the hospital facility's CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Part VI Did the hospital facility make its CHNA report widely available to the public? If "Yes," indicate how the CHNA report was made widely available (check all that apply): a Hospital facility's website b Available upon request from the hospital facility c Other (describe in Part VI) If the hospital facility addressed needs identified in its most recently conducted CHNA, indicate how (check all that apply to date): a Adoption of an implementation strategy that addresses each of the community health needs identified through the CHNA b Execution of the implementation strategy c Participation in the development of a community-wide plan d Participation in the execution of a community-wide plan e Inclusion of a community benefit section in operational plans f Adoption of a budget for provision of services that address the needs identified in the CHNA g Prioritization of health needs in its community h Prioritization of services that the hospital facility will undertake to meet health needs in its community i Other (describe in Part VI) Did the hospital facility address all of the needs identified in its most recently conducted CHNA? If "No," explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs a Did the organization incur an excise tax under section 99 for the hospital facility's failure to conduct a CHNA as required by section 01(r)(3)? a b b c If Yes to line a, did the organization file Form 20 to report the section 99 excise tax? If Yes to line b, what is the total amount of section 99 excise tax the organization reported on Form 20 for all of its hospital facilities? $ 1 Yes No 2E

5 Page Part V Facility Information (continued) Section B. Facility Policies and Practices (Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A) Name of hospital facility or facility reporting group IU HEALTH NORTH HOSPITAL For single facility filers only: line number of hospital facility (from Schedule H, Part V, Section A) Community Health Needs Assessment (Lines 1 through c are optional for tax years beginning on or before March 23, 2012) 1 During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 9 1 If "Yes," indicate what the CHNA report describes (check all that apply): a A definition of the community served by the hospital facility b Demographics of the community c Existing health care facilities and resources within the community that are available to respond to the health needs of the community d How data was obtained e The health needs of the community f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups g The process for identifying and prioritizing community health needs and services to meet the community health needs h The process for consulting with persons representing the community's interests i Information gaps that limit the hospital facility's ability to assess the community's health needs j Other (describe in Part VI) 2 Indicate the tax year the hospital facility last conducted a CHNA: 20 3 In conducting its most recent CHNA, did the hospital facility take into account input from representatives of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If Yes, describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted 3 Was the hospital facility's CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Part VI Did the hospital facility make its CHNA report widely available to the public? If "Yes," indicate how the CHNA report was made widely available (check all that apply): a Hospital facility's website b Available upon request from the hospital facility c Other (describe in Part VI) If the hospital facility addressed needs identified in its most recently conducted CHNA, indicate how (check all that apply to date): a Adoption of an implementation strategy that addresses each of the community health needs identified through the CHNA b Execution of the implementation strategy c Participation in the development of a community-wide plan d Participation in the execution of a community-wide plan e Inclusion of a community benefit section in operational plans f Adoption of a budget for provision of services that address the needs identified in the CHNA g Prioritization of health needs in its community h Prioritization of services that the hospital facility will undertake to meet health needs in its community i Other (describe in Part VI) Did the hospital facility address all of the needs identified in its most recently conducted CHNA? If "No," explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs a Did the organization incur an excise tax under section 99 for the hospital facility's failure to conduct a CHNA as required by section 01(r)(3)? a b b c If Yes to line a, did the organization file Form 20 to report the section 99 excise tax? If Yes to line b, what is the total amount of section 99 excise tax the organization reported on Form 20 for all of its hospital facilities? $ 2 Yes No 2E

6 Page Part V Facility Information (continued) Section B. Facility Policies and Practices (Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A) Name of hospital facility or facility reporting group IU HEALTH WEST HOSPITAL For single facility filers only: line number of hospital facility (from Schedule H, Part V, Section A) Community Health Needs Assessment (Lines 1 through c are optional for tax years beginning on or before March 23, 2012) 1 During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 9 1 If "Yes," indicate what the CHNA report describes (check all that apply): a A definition of the community served by the hospital facility b Demographics of the community c Existing health care facilities and resources within the community that are available to respond to the health needs of the community d How data was obtained e The health needs of the community f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups g The process for identifying and prioritizing community health needs and services to meet the community health needs h The process for consulting with persons representing the community's interests i Information gaps that limit the hospital facility's ability to assess the community's health needs j Other (describe in Part VI) 2 Indicate the tax year the hospital facility last conducted a CHNA: 20 3 In conducting its most recent CHNA, did the hospital facility take into account input from representatives of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If Yes, describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted 3 Was the hospital facility's CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Part VI Did the hospital facility make its CHNA report widely available to the public? If "Yes," indicate how the CHNA report was made widely available (check all that apply): a Hospital facility's website b Available upon request from the hospital facility c Other (describe in Part VI) If the hospital facility addressed needs identified in its most recently conducted CHNA, indicate how (check all that apply to date): a Adoption of an implementation strategy that addresses each of the community health needs identified through the CHNA b Execution of the implementation strategy c Participation in the development of a community-wide plan d Participation in the execution of a community-wide plan e Inclusion of a community benefit section in operational plans f Adoption of a budget for provision of services that address the needs identified in the CHNA g Prioritization of health needs in its community h Prioritization of services that the hospital facility will undertake to meet health needs in its community i Other (describe in Part VI) Did the hospital facility address all of the needs identified in its most recently conducted CHNA? If "No," explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs a Did the organization incur an excise tax under section 99 for the hospital facility's failure to conduct a CHNA as required by section 01(r)(3)? a b b c If Yes to line a, did the organization file Form 20 to report the section 99 excise tax? If Yes to line b, what is the total amount of section 99 excise tax the organization reported on Form 20 for all of its hospital facilities? $ 3 Yes No 2E

7 Page Part V Facility Information (continued) Financial Assistance Policy INDIANA UNIVERSITY HEALTH, INC. Did the hospital facility have in place during the tax year a written financial assistance policy that: 9 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 9 10 Used federal poverty guidelines (FPG) to determine eligibility for providing free care? 10 If "Yes," indicate the FPG family income limit for eligibility for free care: % 11 If "No," explain in Part VI the criteria the hospital facility used. Used FPG to determine eligibility for providing discounted care? If "Yes," indicate the FPG family income limit for eligibility for discounted care: 0 % 11 If "No," explain in Part VI the criteria the hospital facility used. 12 Explained the basis for calculating amounts charged to patients? 12 If "Yes," indicate the factors used in determining such amounts (check all that apply): a Income level b Asset level c Medical indigency d Insurance status e Uninsured discount f Medicaid/Medicare g State regulation h Other (describe in Part VI) 13 Explained the method for applying for financial assistance? 13 1 Included measures to publicize the policy within the community served by the hospital facility? 1 If "Yes," indicate how the hospital facility publicized the policy (check all that apply): a b c d e f g The policy was posted on the hospital facility's website The policy was attached to billing invoices The policy was posted in the hospital facility's emergency rooms or waiting rooms The policy was posted in the hospital facility's admissions offices The policy was provided, in writing, to patients on admission to the hospital facility The policy was available on request Other (describe in Part VI) Billing and Collections 1 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment? 1 Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient's eligibility under the facility's FAP: 1 a b c d e a b c d e INDIANA UNIVERSITY HEALTH, INC Reporting to credit agency Lawsuits Liens on residences Body attachments Other similar actions (describe in Part VI) Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient's eligibility under the facility's FAP? If "Yes," check all actions in which the hospital facility or a third party engaged: Reporting to credit agency Lawsuits Liens on residences Body attachments Other similar actions (describe in Part VI) 1 1 Yes No 2E

8 Page Part V Facility Information (continued) Financial Assistance Policy IU HEALTH NORTH HOSPITAL Did the hospital facility have in place during the tax year a written financial assistance policy that: 9 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 9 10 Used federal poverty guidelines (FPG) to determine eligibility for providing free care? 10 If "Yes," indicate the FPG family income limit for eligibility for free care: % 11 If "No," explain in Part VI the criteria the hospital facility used. Used FPG to determine eligibility for providing discounted care? If "Yes," indicate the FPG family income limit for eligibility for discounted care: 0 % 11 If "No," explain in Part VI the criteria the hospital facility used. 12 Explained the basis for calculating amounts charged to patients? 12 If "Yes," indicate the factors used in determining such amounts (check all that apply): a Income level b Asset level c Medical indigency d Insurance status e Uninsured discount f Medicaid/Medicare g State regulation h Other (describe in Part VI) 13 Explained the method for applying for financial assistance? 13 1 Included measures to publicize the policy within the community served by the hospital facility? 1 If "Yes," indicate how the hospital facility publicized the policy (check all that apply): a b c d e f g The policy was posted on the hospital facility's website The policy was attached to billing invoices The policy was posted in the hospital facility's emergency rooms or waiting rooms The policy was posted in the hospital facility's admissions offices The policy was provided, in writing, to patients on admission to the hospital facility The policy was available on request Other (describe in Part VI) Billing and Collections 1 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment? 1 Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient's eligibility under the facility's FAP: 1 a b c d e a b c d e INDIANA UNIVERSITY HEALTH, INC Reporting to credit agency Lawsuits Liens on residences Body attachments Other similar actions (describe in Part VI) Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient's eligibility under the facility's FAP? If "Yes," check all actions in which the hospital facility or a third party engaged: Reporting to credit agency Lawsuits Liens on residences Body attachments Other similar actions (describe in Part VI) 1 1 Yes No 2E

9 Page Part V Facility Information (continued) Financial Assistance Policy IU HEALTH WEST HOSPITAL Did the hospital facility have in place during the tax year a written financial assistance policy that: 9 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 9 10 Used federal poverty guidelines (FPG) to determine eligibility for providing free care? 10 If "Yes," indicate the FPG family income limit for eligibility for free care: % 11 If "No," explain in Part VI the criteria the hospital facility used. Used FPG to determine eligibility for providing discounted care? If "Yes," indicate the FPG family income limit for eligibility for discounted care: 0 % 11 If "No," explain in Part VI the criteria the hospital facility used. 12 Explained the basis for calculating amounts charged to patients? 12 If "Yes," indicate the factors used in determining such amounts (check all that apply): a Income level b Asset level c Medical indigency d Insurance status e Uninsured discount f Medicaid/Medicare g State regulation h Other (describe in Part VI) 13 Explained the method for applying for financial assistance? 13 1 Included measures to publicize the policy within the community served by the hospital facility? 1 If "Yes," indicate how the hospital facility publicized the policy (check all that apply): a b c d e f g The policy was posted on the hospital facility's website The policy was attached to billing invoices The policy was posted in the hospital facility's emergency rooms or waiting rooms The policy was posted in the hospital facility's admissions offices The policy was provided, in writing, to patients on admission to the hospital facility The policy was available on request Other (describe in Part VI) Billing and Collections 1 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment? 1 Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient's eligibility under the facility's FAP: 1 a b c d e a b c d e INDIANA UNIVERSITY HEALTH, INC Reporting to credit agency Lawsuits Liens on residences Body attachments Other similar actions (describe in Part VI) Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient's eligibility under the facility's FAP? If "Yes," check all actions in which the hospital facility or a third party engaged: Reporting to credit agency Lawsuits Liens on residences Body attachments Other similar actions (describe in Part VI) 1 1 Yes No 2E

10 Page Notified individuals of the financial assistance policy on admission Notified individuals of the financial assistance policy prior to discharge Notified individuals of the financial assistance policy in communications with the patients regarding the patients' bills Documented its determination of whether patients were eligible for financial assistance under the hospital facility's financial assistance policy Other (describe in Part VI) e Policy Relating to Emergency Medical Care 19 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility's financial assistance policy? 19 If "No," indicate why: a b c The hospital facility did not provide care for any emergency medical conditions The hospital facility's policy was not in writing The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI) d Other (describe in Part VI) Changes to Individuals Eligible for Assistance under the FAP (FAP-Eligible Individuals) 20 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care. a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged b The hospital facility used the average of its three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged c d The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged Other (describe in Part VI) 21 During the tax year, did the hospital facility charge any of its FAP- eligible individuals, to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care? 20 If "Yes," explain in Part VI. INDIANA UNIVERSITY HEALTH, INC Part V Facility Information (continued) INDIANA UNIVERSITY HEALTH, INC. 1 Indicate which efforts the hospital facility made before initiating any of the actions listed in line 1 (check all that apply): a b c d 22 During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? 21 If "Yes," explain in Part VI. Yes No 2E

11 Page Notified individuals of the financial assistance policy on admission Notified individuals of the financial assistance policy prior to discharge Notified individuals of the financial assistance policy in communications with the patients regarding the patients' bills Documented its determination of whether patients were eligible for financial assistance under the hospital facility's financial assistance policy Other (describe in Part VI) e Policy Relating to Emergency Medical Care 19 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility's financial assistance policy? 19 If "No," indicate why: a b c The hospital facility did not provide care for any emergency medical conditions The hospital facility's policy was not in writing The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI) d Other (describe in Part VI) Changes to Individuals Eligible for Assistance under the FAP (FAP-Eligible Individuals) 20 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care. a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged b The hospital facility used the average of its three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged c d The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged Other (describe in Part VI) 21 During the tax year, did the hospital facility charge any of its FAP- eligible individuals, to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care? 20 If "Yes," explain in Part VI. INDIANA UNIVERSITY HEALTH, INC Part V Facility Information (continued) IU HEALTH NORTH HOSPITAL 1 Indicate which efforts the hospital facility made before initiating any of the actions listed in line 1 (check all that apply): a b c d 22 During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? 21 If "Yes," explain in Part VI. Yes No 2E

12 Page Notified individuals of the financial assistance policy on admission Notified individuals of the financial assistance policy prior to discharge Notified individuals of the financial assistance policy in communications with the patients regarding the patients' bills Documented its determination of whether patients were eligible for financial assistance under the hospital facility's financial assistance policy Other (describe in Part VI) e Policy Relating to Emergency Medical Care 19 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility's financial assistance policy? 19 If "No," indicate why: a b c The hospital facility did not provide care for any emergency medical conditions The hospital facility's policy was not in writing The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI) d Other (describe in Part VI) Changes to Individuals Eligible for Assistance under the FAP (FAP-Eligible Individuals) 20 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care. a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged b The hospital facility used the average of its three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged c d The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged Other (describe in Part VI) 21 During the tax year, did the hospital facility charge any of its FAP- eligible individuals, to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care? 20 If "Yes," explain in Part VI. INDIANA UNIVERSITY HEALTH, INC Part V Facility Information (continued) IU HEALTH WEST HOSPITAL 1 Indicate which efforts the hospital facility made before initiating any of the actions listed in line 1 (check all that apply): a b c d 22 During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? 21 If "Yes," explain in Part VI. Yes No 2E

13 Page Part V Facility Information (continued) Section C. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility (list in order of size, from largest to smallest) How many non-hospital health care facilities did the organization operate during the tax year? Name and address 1 BALL OUTPATIENT SURGERY CENTER 22 W. UNIVERSITY, STE. 200 MUNCIE IN BELTWAY ENDOSCOPY CENTER - SPRINGMILL 200 W. 103RD ST., STE. 200 INDIANAPOLIS IN BELTWAY SURGERY CENTERS 11 N. PENNSYLVANIA PKWY. INDIANAPOLIS IN 20 BELTWAY SURGERY CENTERS - SPRINGMILL 200 W. 103RD ST. INDIANAPOLIS IN 20 EAGLE HIGHLANDS SURGERY CENTER 0 PARKDALE PLACE INDIANAPOLIS IN 2 INDIANA ENDOSCOPY CENTERS 109 ALLISONVILLE RD., STE. 100 FISHERS IN 03 INDIANA ENDOSCOPY CENTERS 111 RONALD REAGAN PKWY., STE. 3 AVON IN 123 INDIANA ENDOSCOPY CENTERS 101 N. SENATE BLVD., STE. 01 INDIANAPOLIS IN RILEY OUTPATIENT SURGERY CENTER 02 BARNHILL DR., STE INDIANAPOLIS IN SENATE STREET SURGERY CENTER 101 N. SENATE BLVD. INDIANAPOLIS IN 202 Type of Facility (describe) AMBULATORY SURGERY AMBULATORY SURGERY AMBULATORY SURGERY AMBULATORY SURGERY AMBULATORY SURGERY AMBULATORY SURGERY AMBULATORY SURGERY AMBULATORY SURGERY AMBULATORY SURGERY AMBULATORY SURGERY 2E

14 Page Part V Facility Information (continued) Section C. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility (list in order of size, from largest to smallest) How many non-hospital health care facilities did the organization operate during the tax year? Name and address Type of Facility (describe) 1 IU HEALTH BARIATRIC & MED. WEIGHT LOSS 0 INTECH BLVD., STE. 300 BARIATRIC AND MEDICAL WEIGHT LOSS INDIANAPOLIS IN 2 2 IU MEL & BREN SIMON CANCER CENTER 1030 W. MICHIGAN ST. CANCER CARE INDIANAPOLIS IN HEART PARTNERS OF INDIANA 109 ALLISONVILLE RD., STE. 20 CARDIOVASCULAR FISHERS IN 03 HEART PARTNERS OF INDIANA 112 ILLINOIS ST., STE. LL00 CARDIOVASCULAR CARMEL IN 032 HEART PARTNERS OF INDIANA 1210B MEDICAL ARTS BLVD., STE. 1 CARDIOVASCULAR ANDERSON IN 011 HEART PARTNERS OF INDIANA E 13TH ST., STE. 300 CARDIOVASCULAR FISHERS IN 03 HEART PARTNERS OF INDIANA 101 N. SENATE BLVD., STE. 20 CARDIOVASCULAR INDIANAPOLIS IN 202 HEART PARTNERS OF INDIANA 231 SHADELAND STATION, STE. 100 CARDIOVASCULAR INDIANAPOLIS IN 20 9 HEART PARTNERS OF INDIANA 0 N. SHADELAND AVE., STE. 30 CARDIOVASCULAR INDIANAPOLIS IN IU HEALTH CARDIOVASCULAR SURGEONS CARDIOVASCULAR 101 N. SENATE BLVD., STE. INDIANAPOLIS IN 202 2E

15 Page Part V Facility Information (continued) Section C. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility (list in order of size, from largest to smallest) How many non-hospital health care facilities did the organization operate during the tax year? Name and address 1 IU HEALTH CARDIOVASCULAR SURGEONS 0 W. 2ND ST. BLOOMINGTON IN 01 2 IU HEALTH CARDIOVASCULAR SURGEONS 3 S. WALKER ST., STE. 2 BLOOMINGTON IN 03 3 METHODIST CARDIOLOGY PHYSICIANS 112 N. ILLINOIS ST., STE. 2 CARMEL IN 032 METHODIST CARDIOLOGY PHYSICIANS 101 N. SENATE BLVD., STE. 310 INDIANAPOLIS IN 202 METHODIST CARDIOLOGY PHYSICIANS 10 RIVER RD., STE. 10 NOBLESVILLE IN 00 METHODIST CARDIOLOGY PHYSICIANS 920 PARKDALE PL., STE. 10 INDIANAPOLIS IN 2 EAST WASHINGTON TIMESHARE 90 E. WASHINGTON ST., STE. 110 INDIANAPOLIS IN 229 GEORGETOWN TIMESHARE 0 CENTURY PLAZA RD., STE. 10 INDIANAPOLIS IN 2 9 IU HEALTH GEORGETOWN MEDICAL PLAZA 0 CENTURY PLAZA RD. INDIANAPOLIS IN 2 10 IU HEALTH METHODIST MEDICAL PLAZA BBURG. 13 N. GREEN ST., STE. 200 BROWNSBURG IN 20 Type of Facility (describe) CARDIOVASCULAR CARDIOVASCULAR CARDIOVASCULAR CARDIOVASCULAR CARDIOVASCULAR CARDIOVASCULAR DIAGNOSTIC AND OTHER MEDICAL DIAGNOSTIC AND OTHER MEDICAL DIAGNOSTIC AND OTHER MEDICAL DIAGNOSTIC AND OTHER MEDICAL 2E

16 Page Part V Facility Information (continued) Section C. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility (list in order of size, from largest to smallest) How many non-hospital health care facilities did the organization operate during the tax year? Name and address 1 IU HEALTH METHODIST MEDICAL PLAZA EHGH. 0 PARKDALE PL. INDIANAPOLIS IN 2 2 IU HEALTH METHODIST MEDICAL PLAZA EAST 90 E. WASHINGTON ST. INDIANAPOLIS IN IU HEALTH METHODIST MEDICAL PLAZA NORTH 11 PENNSYLVANIA PKWY. CARMEL IN 20 IU HEALTH METHODIST MEDICAL PLAZA SOUTH 20 S. MERIDIAN ST. INDIANAPOLIS IN 21 IU HEALTH METHODIST MEDICAL TOWER 133 N. CAPITOL AVE. INDIANAPOLIS IN 202 IU HEALTH SPRING MILL OUTPATIENT CENTER 200 W. 103RD ST., STE INDIANAPOLIS IN 290 METHODIST MEDICAL PLAZA - GLENDALE 220 KESSLER BLVD. E. INDIANAPOLIS IN 220 NORTH MERIDIAN TIMESHARE 201 PENNSYLVANIA PKWY., STE. 30 INDIANAPOLIS IN 20 9 SOUTH 31 TIMESHARE 20 S. MERIDIAN ST., STE. 230 INDIANAPOLIS IN IU HEALTH DIALYSIS 210 N. CAPITOL AVE. INDIANAPOLIS IN 202 Type of Facility (describe) DIAGNOSTIC AND OTHER MEDICAL DIAGNOSTIC AND OTHER MEDICAL DIAGNOSTIC AND OTHER MEDICAL DIAGNOSTIC AND OTHER MEDICAL DIAGNOSTIC AND OTHER MEDICAL DIAGNOSTIC AND OTHER MEDICAL DIAGNOSTIC AND OTHER MEDICAL DIAGNOSTIC AND OTHER MEDICAL DIAGNOSTIC AND OTHER MEDICAL DIALYSIS 2E

17 Page Part V Facility Information (continued) Section C. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility (list in order of size, from largest to smallest) How many non-hospital health care facilities did the organization operate during the tax year? Name and address 1 IU HEALTH HOME DIALYSIS CENTER 30 N. MERIDIAN ST. INDIANAPOLIS IN 20 2 IU HEALTH CHARIS EATING DISORDER CLINIC 0 INTECH BLVD., STE. 19 INDIANAPOLIS IN 2 3 IU HEALTH HOME CARE 111 W. COUNTY LINE RD. GREENWOOD IN 12 IU HEALTH HOME CARE 12 N. ILLINOIS ST. INDIANAPOLIS IN 202 IU HEALTH HOME CARE 202 S. WEST ST. TIPTON IN 02 IU HEALTH HOME CARE 02 N. ILLINOIS ST. INDIANAPOLIS IN 20 CAPITAL NEUROLOGY 201 PENNSYLVANIA PKWY. STE. 300 INDIANAPOLIS IN 20 EAST RETAIL PHARMACY 90 E. WASHINGTON ST. INDIANAPOLIS IN GEORGETOWN RETAIL PHARMACY 0 CENTURY PLAZA RD., STE. 10 INDIANAPOLIS IN 2 10 SOUTH RETAIL PHARMACY 20 S. MERIDIAN ST., STE. 10 INDIANAPOLIS IN 21 Type of Facility (describe) DIALYSIS EATING DISORDERS HOME HEALTH CARE HOME HEALTH CARE HOME HEALTH CARE HOME HEALTH CARE NEUROLOGY PHARMACY PHARMACY PHARMACY 2E

18 Page Part V Facility Information (continued) Section C. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility (list in order of size, from largest to smallest) How many non-hospital health care facilities did the organization operate during the tax year? Name and address 1 IU HEALTH FISHERS RADIOLOGY 1099 ALLISONVILLE RD., STE. 100B FISHERS IN 03 2 IU HEALTH BALL MEMORIAL HOSPITAL LAB 201 W. UNIVERSITY AVE. MUNCIE IN IU HEALTH REHABILITATION 20 PARKDALE PL., STE. 120 INDIANAPOLIS IN 2 IU HEALTH ARNETT SLEEP APNEA ED. CENTER 3900 MCCARTY LN. STE. 102 LAFAYETTE IN 909 IU HEALTH BALL MEMORIAL SLEEP APNEA ED. 000 W. KILGORE AVE., STE. A MUNCIE IN 30 IU HEALTH BEDFORD SLEEP APNEA ED. CENTER 102 CLINIC DR. BEDFORD IN 21 IU HEALTH HOWARD SLEEP APNEA ED. CENTER 29 N. DION RD. KOKOMO IN 901 IU HEALTH SLEEP APNEA ED. CTR. AT INDPLS 1 N. SENATE AVE. STE. 120 INDIANAPOLIS IN IU HEALTH SLEEP LAB 1 N. SENATE AVE. STE. 120 INDIANAPOLIS IN SLEEP APNEA ED. CTR. AT IU HEALTH NORTH 1190 N. MERIDIAN ST., STE. 10 CARMEL IN 032 Type of Facility (describe) RADIOLOGY REFERENCE LABORATORY REHABILITATION SLEEP DISORDERS SLEEP DISORDERS SLEEP DISORDERS SLEEP DISORDERS SLEEP DISORDERS SLEEP DISORDERS SLEEP DISORDERS 2E

19 Page Part V Facility Information (continued) Section C. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility (list in order of size, from largest to smallest) How many non-hospital health care facilities did the organization operate during the tax year? Name and address Type of Facility (describe) 1 SLEEP APNEA ED. CTR. AT IU HEALTH WEST 111 N. RONALD REAGAN PKWY. #31 SLEEP DISORDERS AVON IN SLEEP DISORDERS CTR. AT IU HEALTH NORTH 1190 N. MERIDIAN ST., STE. 10 SLEEP DISORDERS INDIANAPOLIS IN IU HEALTH SPORTS PERFORMANCE 102 CHASE CT. SPORTS PERFORMANCE CARMEL IN 032 IU HEALTH CHILDREN'S THERAPY CENTER 93 W. ARLINGTON RD. THERAPY BLOOMINGTON IN 0 INDIANA ONCOLOGY HEMATOLOGY 92 SHORE TERRACE DR. ONCOLOGY INDIANAPOLIS IN 20 IU HEALTH MINUTE CLINIC E. 9TH ST. IMMEDIATE CARE FISHERS IN 03 IU HEALTH NEUROSCIENCE CENTER NEUROSCIENCE CENTER OF 3 W. 1TH ST. ECELLENCE INDIANAPOLIS IN E

20 Page 1 Required descriptions. Provide the descriptions required for Part I, lines 3c, a, and ; Part II; Part III, lines,, and 9b; Part V, Section A; and Part V, Section B, lines 1j, 3,, c, i,, 10, 11, 12h, 1g, 1e, 1e, 1e, 19c, 19d, 20d, 21, and 22. for Part V, Section B, lines 1j, 3,, c, i,, 10, 11, 12h, 1g, 1e, 1e, 1e, 19c, 20d, 21, and 22. SCHEDULE H, PART I - FINANCIAL ASSISTANCE LINE 3C N/A SCHEDULE H, PART I - FINANCIAL ASSISTANCE LINE A - COMMUNITY BENEFIT REPORT PREPARED BY RELATED ORGANIZATION INDIANA UNIVERSITY HEALTH, INC.'S ("IU HEALTH") COMMUNITY BENEFITS AND INVESTMENTS ARE INCLUDED IN THE IU HEALTH COMMUNITY BENEFIT REPORT WHICH IS MADE AVAILABLE TO THE PUBLIC ON ITS WEBSITE AT THE COMMUNITY BENEFIT REPORT IS ALSO DISTRIBUTED TO NUMEROUS KEY ORGANIZATIONS THROUGHOUT THE STATE OF INDIANA TO BROADLY SHARE IU HEALTH'S COMMUNITY BENEFIT EFFORTS AND INVESTMENTS STATEWIDE, AND IS AVAILABLE BY REQUEST THROUGH THE INDIANA STATE DEPARTMENT OF HEALTH OR IU HEALTH. 2E

21 Page 1 Required descriptions. Provide the descriptions required for Part I, lines 3c, a, and ; Part II; Part III, lines,, and 9b; Part V, Section A; and Part V, Section B, lines 1j, 3,, c, i,, 10, 11, 12h, 1g, 1e, 1e, 1e, 19c, 19d, 20d, 21, and 22. for Part V, Section B, lines 1j, 3,, c, i,, 10, 11, 12h, 1g, 1e, 1e, 1e, 19c, 20d, 21, and 22. SCHEDULE H, PART I - FINANCIAL ASSISTANCE LINE, COLUMN (F) - BAD DEBT EPENSE THE AMOUNT OF BAD DEBT EPENSE INCLUDED ON FORM 990, PART I, LINE 2, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE OF TOTAL EPENSE IS $0,39,991. THE BAD DEBT EPENSE OF $2,11,90 ON SCHEDULE H, PART III, LINE 2 IS REPORTED AT COST. SCHEDULE H, PART I - FINANCIAL ASSISTANCE LINE - TOTAL COMMUNITY BENEFIT EPENSE PERCENTAGE OF TOTAL EPENSES LISTED ON SCHEDULE H, PART I, LINE, COLUMN (F) IS CALCULATED BASED ON NET COMMUNITY BENEFIT EPENSE. THE PERCENTAGE OF TOTAL EPENSES CALCULATED BASED ON TOTAL COMMUNITY BENEFIT EPENSE IS 32.00%. 2E

22 Page 1 Required descriptions. Provide the descriptions required for Part I, lines 3c, a, and ; Part II; Part III, lines,, and 9b; Part V, Section A; and Part V, Section B, lines 1j, 3,, c, i,, 10, 11, 12h, 1g, 1e, 1e, 1e, 19c, 19d, 20d, 21, and 22. for Part V, Section B, lines 1j, 3,, c, i,, 10, 11, 12h, 1g, 1e, 1e, 1e, 19c, 20d, 21, and 22. SCHEDULE H, PART I - FINANCIAL ASSISTANCE LINE G - SUBSIDIZED HEALTH SERVICES INDIANA UNIVERSITY HEALTH, INC. DOES NOT INCLUDE ANY COSTS ASSOCIATED WITH PHYSICIAN CLINICS AS SUBSIDIZED HEALTH SERVICES. SCHEDULE H, PART II - COMMUNITY BUILDING ACTIVITIES PROMOTION OF HEALTH IN COMMUNITIES SERVED IU HEALTH PARTICIPATED IN A VARIETY OF COMMUNITY-BUILDING ACTIVITIES THAT ADDRESS THE UNDERLYING QUALITY OF LIFE IN THE COMMUNITIES IT SERVES. IU HEALTH AS A STATEWIDE HEALTHCARE SYSTEM INVESTED IN ECONOMIC DEVELOPMENT EFFORTS ACROSS THE STATE COLLABORATED WITH LIKE-MINDED ORGANIZATIONS THROUGH COALITIONS THAT ADDRESS KEY ISSUES, AND ADVOCATED FOR IMPROVEMENTS IN THE HEALTH STATUS OF VULNERABLE POPULATIONS. IU HEALTH CONTRIBUTED NEARLY $2 MILLION TO COMMUNITY-BUILDING ACTIVITIES IN 2012, SERVING OVER 2,00 PEOPLE STATEWIDE. TOGETHER, IU HEALTH METHODIST HOSPITAL, IU HEALTH UNIVERSITY HOSPITAL, RILEY HOSPITAL FOR 2E

23 Page 1 Required descriptions. Provide the descriptions required for Part I, lines 3c, a, and ; Part II; Part III, lines,, and 9b; Part V, Section A; and Part V, Section B, lines 1j, 3,, c, i,, 10, 11, 12h, 1g, 1e, 1e, 1e, 19c, 19d, 20d, 21, and 22. for Part V, Section B, lines 1j, 3,, c, i,, 10, 11, 12h, 1g, 1e, 1e, 1e, 19c, 20d, 21, and 22. CHILDREN AT IU HEALTH, IU HEALTH NORTH HOSPITAL, IU HEALTH WEST, IU HEALTH SAONY INVESTED NEARLY $0,000 IN COMMUNITY-BUILDING ACTIVITIES BY PROVIDING INVESTMENTS AND RESOURCES TO LOCAL COMMUNITY INITIATIVES THAT ADDRESSED ECONOMIC DEVELOPMENT, COMMUNITY SUPPORT AND WORKFORCE DEVELOPMENT. ADDITIONALLY, THROUGH IU HEALTH'S TEAM MEMBER COMMUNITY BENEFIT SERVICE PROGRAM, STRENGTH THAT CARES, TEAM MEMBERS ACROSS THE STATE MADE A DIFFERENCE IN THE LIVES OF THOUSANDS OF HOOSIERS. IN 2012, TEAM MEMBERS: - BUILT 2 HABITAT FOR HUMANITY HOME PANELS THROUGHOUT INDIANA. THREE OF THOSE HOMES WERE GIVEN TO VICTIMS OF THE HENRYVILLE, INDIANA TORNADO. - IMPACTED THE LIVES OF JUST OVER 00 AT-RISK CHILDREN BY SERVING AS CAMP OR READING BUDDIES IN IU HEALTH'S KINDERGARTEN COUNTDOWN PROGRAM TO PREPARE AT-RISK CHILDREN FOR THEIR FIRST DAY OF KINDERGARTEN. 2E

24 Page 1 Required descriptions. Provide the descriptions required for Part I, lines 3c, a, and ; Part II; Part III, lines,, and 9b; Part V, Section A; and Part V, Section B, lines 1j, 3,, c, i,, 10, 11, 12h, 1g, 1e, 1e, 1e, 19c, 19d, 20d, 21, and 22. for Part V, Section B, lines 1j, 3,, c, i,, 10, 11, 12h, 1g, 1e, 1e, 1e, 19c, 20d, 21, and 22. SCHEDULE H, PART III - BAD DEBT, MEDICARE, & COLLECTION PRACTICES LINE - BAD DEBT EPENSE THE PROVISION FOR UNCOLLECTED PATIENT ACCOUNTS IS BASED UPON MANAGEMENT'S ASSESSMENT OF HISTORICAL AND EPECTED NET COLLECTIONS CONSIDERING BUSINESS AND ECONOMIC CONDITIONS, CHANGES AND TRENDS IN HEALTH CARE COVERAGE, AND OTHER COLLECTION INDICATORS. PERIODICALLY, MANAGEMENT ASSESSES THE ADEQUACY OF THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS BASED UPON ACCOUNTS RECEIVABLE PAYOR COMPOSITION AND AGING, AND HISTORICAL WRITE-OFF EPERIENCE BY PAYOR CATEGORY, AS ADJUSTED FOR COLLECTION INDICATORS. THE RESULTS OF THE REVIEW ARE THEN USED TO MAKE ANY MODIFICATIONS TO THE PROVISION FOR UNCOLLECTED PATIENT ACCOUNTS AND THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS. IN ADDITION, INDIANA UNIVERSITY HEALTH, INC. ("IU HEALTH") FOLLOWS ESTABLISHED GUIDELINES FOR PLACING CERTAIN PAST DUE PATIENT BALANCES WITH COLLECTION AGENCIES. PATIENT ACCOUNTS THAT ARE UNCOLLECTED, INCLUDING THOSE PLACED WITH COLLECTION AGENCIES, ARE INITIALLY CHARGED AGAINST THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS IN ACCORDANCE WITH COLLECTION POLICIES OF IU HEALTH AND, IN 2E

Hospitals. Complete if the organization answered Yes to Form 990, Part IV, question 20. Attach to Form 990. See separate instructions.

Hospitals. Complete if the organization answered Yes to Form 990, Part IV, question 20. Attach to Form 990. See separate instructions. SCHEDULE H (Form 990) Department of the Treasury Internal Revenue Service Name of the organization Hospitals Complete if the organization answered Yes to Form 990, Part IV, question 20. Attach to Form

More information

Hospitals. Complete if the organization answered Yes to Form 990, Part IV, question 20. Attach to Form 990. See separate instructions.

Hospitals. Complete if the organization answered Yes to Form 990, Part IV, question 20. Attach to Form 990. See separate instructions. SCHEDULE H (Form 990) Department of the Treasury Internal Revenue Service Name of the organization Hospitals Complete if the organization answered to Form 990, Part IV, question 20. Attach to Form 990.

More information

Instructions for Schedule H (Form 990)

Instructions for Schedule H (Form 990) 2013 Instructions for Schedule H (Form 990) Hospitals Department of the Treasury Internal Revenue Service Contents Page Future Developments...1 Purpose of Schedule...1 Specific Instructions...2 Part I.

More information

Hospitals. Complete if the organization answered "Yes" to Form 990, Part IV, question 20. Attach to Form 990. See separate instructions.

Hospitals. Complete if the organization answered Yes to Form 990, Part IV, question 20. Attach to Form 990. See separate instructions. SCHEDULE H (Form 990) Department of the Treasury Internal Revenue Service 2 If "Yes," was it a written policy? If the organization had multiple hospital facilities, indicate which of the following est

More information

Instructions for Schedule H (Form 990)

Instructions for Schedule H (Form 990) 2011 Instructions for Schedule H (Form 990) Hospitals Department of the Treasury Internal Revenue Service Contents Page requirements a hospital organization Purpose of Schedule General Instructions...

More information

Hospitals. MERCY HOSPITAL AND MEDICAL CENTER 36-2170152 Part I Financial Assistance and Certain Other Community Benefits at Cost

Hospitals. MERCY HOSPITAL AND MEDICAL CENTER 36-2170152 Part I Financial Assistance and Certain Other Community Benefits at Cost SCHEDULE H (Form 990) Department of the Treasury Internal Revenue Service 2 If "Yes," was it a written policy? If the organization had multiple hospital facilities, indicate which of the following best

More information

Hospitals. SAINT ALPHONSUS REGIONAL MEDICAL CENTER 82-0200895 Part I Financial Assistance and Certain Other Community Benefits at Cost

Hospitals. SAINT ALPHONSUS REGIONAL MEDICAL CENTER 82-0200895 Part I Financial Assistance and Certain Other Community Benefits at Cost SCHEDULE H (Form 990) Department of the Treasury Internal Revenue Service 2 If "Yes," was it a written policy? If the organization had multiple hospital facilities, indicate which of the following best

More information

The Cornerstone Healthcare Promise: Reliable. Efficient. Responsible.

The Cornerstone Healthcare Promise: Reliable. Efficient. Responsible. The Cornerstone Healthcare Promise: Reliable. Efficient. Responsible. COMPANY OVERVIEW Cornerstone, located in Indianapolis, Indiana, was established in 1985 to operate as a healthcare real estate development,

More information

VIII. FORM 990, SCHEDULE H, HOSPITALS

VIII. FORM 990, SCHEDULE H, HOSPITALS VIII. FORM 990, SCHEDULE H, HOSPITALS A. Overview of Schedule H, Hospitals Form 990, Schedule H, Hospitals, will be used beginning with 2008 tax years to report information by an organization that operates

More information

Vice President, Church and Religious Community Relations

Vice President, Church and Religious Community Relations Position: Company: Vice President, Church and Religious Community Relations Indiana University Health, Indianapolis, Indiana THE OPPORTUNITY The Vice President, Church and Religious Community Relations

More information

Indiana University Health Inpatient & Outpatient Providers Directory. For 2012 IU Health Benefit-eligible Employees & their covered dependents

Indiana University Health Inpatient & Outpatient Providers Directory. For 2012 IU Health Benefit-eligible Employees & their covered dependents Indiana University Health Inpatient & Outpatient Providers Directory For 2012 IU Health Benefit-eligible Employees & their covered dependents 2012 Indiana University Health Employee Facility Providers

More information

Indiana University Health Inpatient & Outpatient Providers Directory. For 2012 IU Health Benefit-eligible Employees & their covered dependents

Indiana University Health Inpatient & Outpatient Providers Directory. For 2012 IU Health Benefit-eligible Employees & their covered dependents Indiana University Health Inpatient & Outpatient Providers Directory For 2012 IU Health Benefit-eligible Employees & their covered dependents 2012 Indiana University Health Employee Facility Providers

More information

HEALTH & SAFETY CODE SUBTITLE F. POWERS AND DUTIES OF HOSPITALS CHAPTER 311. POWERS AND DUTIES OF HOSPITALS

HEALTH & SAFETY CODE SUBTITLE F. POWERS AND DUTIES OF HOSPITALS CHAPTER 311. POWERS AND DUTIES OF HOSPITALS HEALTH & SAFETY CODE SUBTITLE F. POWERS AND DUTIES OF HOSPITALS CHAPTER 311. POWERS AND DUTIES OF HOSPITALS SUBCHAPTER C. HOSPITAL DATA REPORTING AND COLLECTION SYSTEM Sec. 311.031. DEFINITIONS. In this

More information

Holy Cross Hospital is a not-for-profit hospital that operates to further our healing ministry. We do this by:

Holy Cross Hospital is a not-for-profit hospital that operates to further our healing ministry. We do this by: Introduction to the IRS Form 990 Schedule H Holy Cross Hospital is a not-for-profit hospital that operates to further our healing ministry. We do this by: Reinvesting our profits back into the communities

More information

REQUEST FOR MEMBERSHIP AND CLINICAL PRIVILEGES

REQUEST FOR MEMBERSHIP AND CLINICAL PRIVILEGES REQUEST FOR MEMBERSHIP AND CLINICAL PRIVILEGES *Applicant Printed Name: *Denotes required fields (Last) (First) (M.I) (Degree) Maiden Name (Alias): (Last) (First) *DOB: *SSN Sex: Male Female *Applicant

More information

THE 2009 ANNUAL AMBULATORY SURGICAL TREATMENT CENTER QUESTIONNAIRE. 24-29 Definitions

THE 2009 ANNUAL AMBULATORY SURGICAL TREATMENT CENTER QUESTIONNAIRE. 24-29 Definitions THE 2009 ANNUAL AMBULATORY SURGICAL TREATMENT CENTER QUESTIONNAIRE Page Number P1-P2 Preface 3 22 Questionnaire Form 23 Charity Care Worksheet 24-29 Definitions PREFACE TO THE 2009 ANNUAL AMBULATORY SURGICAL

More information

SUMMARY: This document contains proposed regulations that provide guidance

SUMMARY: This document contains proposed regulations that provide guidance [4830-01-p] DEPARTMENT OF THE TREASURY Internal Revenue Service 26 CFR Part 1 [REG-130266-11] RIN 1545-BK57 Additional Requirements for Charitable Hospitals AGENCY: Internal Revenue Service (IRS), Treasury.

More information

POLICY ON FINANCIAL ASSISTANCE FOR UNINSURED PATIENTS, INCLUDING CHARITY CARE

POLICY ON FINANCIAL ASSISTANCE FOR UNINSURED PATIENTS, INCLUDING CHARITY CARE Sutter Health and Mills-Peninsula Health Services Administrative Policies and Procedures POLICY ON FINANCIAL ASSISTANCE FOR UNINSURED PATIENTS, INCLUDING CHARITY CARE Finance Policy Number: 14-294 Supersedes

More information

COPLEY HOSPITAL, INC. FY 2013 BUDGET NARRATIVE

COPLEY HOSPITAL, INC. FY 2013 BUDGET NARRATIVE FY 2013 BUDGET NARRATIVE Overview of Copley Hospital Financial Goals and Objectives Budget Assumptions Other Disclosures OVERVIEW OF COPLEY HOSPITAL Copley Hospital is the critical access-designated community

More information

University of Mississippi Medical Center. Access Management. Patient Access Specialists II

University of Mississippi Medical Center. Access Management. Patient Access Specialists II Financial Terminology in Access Management University of Mississippi Medical Center Access Management Patient Access Specialists II As a Patient Access Specialist You are the FIRST STAGE in the Revenue

More information

HOSPITAL CHARITY CARE: THE CURRENT STATE OF ILLINOIS LAW

HOSPITAL CHARITY CARE: THE CURRENT STATE OF ILLINOIS LAW HOSPITAL CHARITY CARE: THE CURRENT STATE OF ILLINOIS LAW Caroline Chapman January 2013 2 How do uninsured individuals currently pay for and access care? Self-pay CCHS County Care Free/Low Cost Care at

More information

CONSOLIDATED FINANCIAL STATEMENTS AND OTHER INFORMATION INDIANA UNIVERSITY HEALTH, INC. AND SUBSIDIARIES AS OF JUNE 30, 2014 AND DECEMBER 31, 2013

CONSOLIDATED FINANCIAL STATEMENTS AND OTHER INFORMATION INDIANA UNIVERSITY HEALTH, INC. AND SUBSIDIARIES AS OF JUNE 30, 2014 AND DECEMBER 31, 2013 CONSOLIDATED FINANCIAL STATEMENTS AND OTHER INFORMATION INDIANA UNIVERSITY HEALTH, INC. AND SUBSIDIARIES AS OF JUNE 30, 2014 AND DECEMBER 31, 2013 AND FOR THE SIX MONTHS ENDED JUNE 30, 2014 AND 2013 TABLE

More information

Memorial Hospital Administrative Policy

Memorial Hospital Administrative Policy Administrative Policy TITLE: PURPOSE: Accounts Receivable Billing and Collections The following policy and procedure is to be followed for billing and collecting of patient accounts. The purpose of the

More information

Recommendations Regarding Hospital-Based Medical Debt and Collections

Recommendations Regarding Hospital-Based Medical Debt and Collections Recommendations Regarding Hospital-Based Medical Debt and Collections Champaign County Health Care Consumers 44 East Main Street, Suite #208 Champaign, IL 61820 Phone= (217) 352-6533 Email= cchcc@prairienet.org

More information

CHARITY CARE and FINANCIAL AID GUIDELINES for PENNSYLVANIA HOSPITALS

CHARITY CARE and FINANCIAL AID GUIDELINES for PENNSYLVANIA HOSPITALS CHARITY CARE and FINANCIAL AID GUIDELINES for PENNSYLVANIA HOSPITALS JUNE 2012 0 Background Pennsylvania hospitals and health systems have a long history of addressing charity care and financial aid responsibilities

More information

AHLA. FF. Commercial Discounts and Charity Care: Reimbursement and Program Integrity Implications

AHLA. FF. Commercial Discounts and Charity Care: Reimbursement and Program Integrity Implications AHLA FF. Commercial Discounts and Charity Care: Reimbursement and Program Integrity Implications Andrew D. Ruskin Morgan Lewis & Bockius LLP Washington, DC Institute on Medicare and Medicaid Payment Issues

More information

IRC Section 501(r) Compliance with Minimal Pain and Maximum Impact

IRC Section 501(r) Compliance with Minimal Pain and Maximum Impact IRC Section 501(r) Compliance with Minimal Pain and Maximum Impact Kacie L. McEwen, CPA HFMA Fall Conference October 22, 2015 Investment advisory services are offered through CliftonLarsonAllen Wealth

More information

EXECUTIVE SUMMARY OBJECTIVE The objective of our review was to confirm that disproportionate share hospital (DSH) payments to St. Vincent Charity Hospital and St. Luke s Medical Center (collectively, the

More information

Mount Nittany Medical Center Community Benefit Annual Report: Fiscal Year 2014 (July 1, 2013 June 30, 2014)

Mount Nittany Medical Center Community Benefit Annual Report: Fiscal Year 2014 (July 1, 2013 June 30, 2014) Mount Nittany Medical Center Community Benefit Annual Report: Fiscal Year 2014 (July 1, 2013 June 30, 2014) 1 Community benefit has regional economic reach Whether it s offering a free Hunters Health Day,

More information

MEDICARE PART B DRUGS. Action Needed to Reduce Financial Incentives to Prescribe 340B Drugs at Participating Hospitals

MEDICARE PART B DRUGS. Action Needed to Reduce Financial Incentives to Prescribe 340B Drugs at Participating Hospitals United States Government Accountability Office Report to Congressional Requesters June 2015 MEDICARE PART B DRUGS Action Needed to Reduce Financial Incentives to Prescribe 340B Drugs at Participating Hospitals

More information

Indiana University Health Inpatient & Outpatient Providers Directory For Benefit-eligible Employees & their covered dependents

Indiana University Health Inpatient & Outpatient Providers Directory For Benefit-eligible Employees & their covered dependents Indiana University Health Inpatient & Outpatient Providers Directory For Benefit-eligible Employees & their covered dependents 2014 Facility Providers Directory This directory lists the IU Health Business

More information

Clinical Trial Center

Clinical Trial Center Clinical Trial Center QUALITY The mission of the Clinical Trial Center (CTC) is to facilitate the timely execution of quality clinical trials with information, resources and expertise in order to foster

More information

Administrative Policy and Procedure Manual. Financial Assistance Effective Date: 08/22/2013 Scope: Organizationwide Page 1 of 14.

Administrative Policy and Procedure Manual. Financial Assistance Effective Date: 08/22/2013 Scope: Organizationwide Page 1 of 14. Scope: Organizationwide Page 1 of 14 Table of Contents I. Purpose II. Policy Statements III. Definitions A. Amounts Generally Billed B. Application Period C. Completion Deadline D. Extraordinary Collection

More information

ADVENTIST MIDWEST HEALTH REGIONAL POLICY PROFILE Category Patient Financial Services

ADVENTIST MIDWEST HEALTH REGIONAL POLICY PROFILE Category Patient Financial Services Page 1 of 8 This Charity Care Policy describes the charity care practices of the following Adventist Midwest Health entities: Adventist Bolingbrook Hospital, Adventist Hinsdale Hospital, Adventist GlenOaks

More information

Georgia Hospital Primer

Georgia Hospital Primer Georgia Hospital Primer A Project of the Georgia Watch Hospital Accountability Project 2011 Summary Most Georgia Hospitals are non-profit corporations, meaning that any surplus income they receive must

More information

Patient Financial Assistance Policy

Patient Financial Assistance Policy Patient Financial Assistance Policy PURPOSE: To define eligibility, application and the approval processes for Financial Assistance. Financial Assistance is offered to uninsured and patients who indicate

More information

1.1 Applicable Entities: This policy applies to Texas Health Rockwall. 1.2 Applicable Departments: This policy applies to all departments.

1.1 Applicable Entities: This policy applies to Texas Health Rockwall. 1.2 Applicable Departments: This policy applies to all departments. Policy Name: Charity Care Program Owner : President, VP Revenue Cycle Effective Date: 6/19/13 Approved By: Texas Health Rockwall Board of Trustees Last Reviewed Date: 10/16/2013 ; 2/4/14 Page 1 of 11 1.0

More information

Page 2 of 62. Table of Contents

Page 2 of 62. Table of Contents ACTION: Final ENACTED Appendix 5101:3-2-23 DATE: 11/04/2011 8:59 AM Page 1 of 62 Ohio Department of Job and Family Services HOSPITAL COST REPORT (JFS 02930) INSTRUCTIONS For State Fiscal Year 2011 For

More information

Additional Requirements for Charitable Hospitals; Community Health Needs Assessments for Charitable Hospitals; Final Rule

Additional Requirements for Charitable Hospitals; Community Health Needs Assessments for Charitable Hospitals; Final Rule Additional Requirements for Charitable Hospitals; Community Health Needs Assessments for Charitable Hospitals; Final Rule Issued: 12/31/2014 by the Internal Revenue Service 2014 VHA Inc. All rights reserved.

More information

Hackensack University Medical Center Administrative Policy Manual. Effective Date: January 2016 Page 1 of 11

Hackensack University Medical Center Administrative Policy Manual. Effective Date: January 2016 Page 1 of 11 Policy #: 1845 Hackensack University Medical Center Administrative Policy Manual Effective Date: January 2016 Page 1 of 11 Purpose: To identify the governing rules for the collection of all fees associated

More information

Financial Assistance Policy

Financial Assistance Policy REVENUE CYCLE MANAGEMENT Financial Assistance Policy Target Group: The Cleveland Clinic Foundation, its family health centers and its hospital affiliates in the Cleveland Clinic health system, collectively,

More information

FLOYD MEDICAL CENTER POLICY AND PROCEDURE MANUAL PATIENT FINANCIAL SERVICES

FLOYD MEDICAL CENTER POLICY AND PROCEDURE MANUAL PATIENT FINANCIAL SERVICES Page 1 of 6 FLOYD MEDICAL CENTER POLICY AND PROCEDURE MANUAL PATIENT FINANCIAL SERVICES TITLE: Financial Assistance Policy (FAP) Purpose: To set forth the eligibility criteria and process relating to Floyd

More information

Minnesota Hospitals: Uncompensated Care, Community Benefits, and the Value of Tax Exemptions

Minnesota Hospitals: Uncompensated Care, Community Benefits, and the Value of Tax Exemptions Minnesota Hospitals: Uncompensated Care, Community Benefits, and the Value of Tax Exemptions Minnesota Department of Health January, 2007 Division of Health Policy Health Economics Program PO Box 64882

More information

Development Profiles. Pima Medical Pavilion I and II Scottsdale, Arizona. 4105 and 4125 Briargate Parkway Colorado Springs, Colorado

Development Profiles. Pima Medical Pavilion I and II Scottsdale, Arizona. 4105 and 4125 Briargate Parkway Colorado Springs, Colorado Development Profiles Over the last 20 years, Healthcare Realty has developed more than four million square feet of outpatient medical facilities, representing an investment of over $1 billion. These properties,

More information

TECHNICAL HANDBOOK FOR ENVIRONMENTAL HEALTH AND ENGINEERING VOLUME II - HEALTH CARE FACILITIES PLANNING PART 11 - FACILITIES PLANNING GUIDELINES

TECHNICAL HANDBOOK FOR ENVIRONMENTAL HEALTH AND ENGINEERING VOLUME II - HEALTH CARE FACILITIES PLANNING PART 11 - FACILITIES PLANNING GUIDELINES CHAPTER 11-5 - COST ANALYSIS METHODOLOGY - DIRECT VERSUS CONTRACT INPATIENT CARE 11-5.1 PURPOSE..................... (11-5) 1 11-5.2 INTRODUCTION.................. (11-5) 1 11-5.3 METHODOLOGY...................

More information

Hospital Policy Manual. Billing and Collection Policy

Hospital Policy Manual. Billing and Collection Policy Page 1 of 5 Hospital Policy Manual Subject: Billing and Collection Policy Originator: Director, Revenue Cycle Approved By: Vice President/CFO Policy Coordinator: Vicki Salyer Scope: ALL CHA Effective:

More information

DIMENSIONS HEALTHCARE SYSTEM AUGUST 7, 2013 DHS POLICY No. 210-01 Page 1 of 8 FINANCIAL ASSISTANCE PROGRAM

DIMENSIONS HEALTHCARE SYSTEM AUGUST 7, 2013 DHS POLICY No. 210-01 Page 1 of 8 FINANCIAL ASSISTANCE PROGRAM Page 1 of 8 FINANCIAL ASSISTANCE PROGRAM PURPOSE: To identify circumstances when Dimensions Healthcare System (DHS) may provide care without charge or at a discount commensurate with the ability to pay,

More information

MERIDIAN HOSPITALS CORPORATION Patient Financial Services POLICIES AND PROCEDURES

MERIDIAN HOSPITALS CORPORATION Patient Financial Services POLICIES AND PROCEDURES MERIDIAN HOSPITALS CORPORATION Patient Financial Services POLICIES AND PROCEDURES DISTRIBUTION: Meridian Hospitals Corporation, Patient Financial Services & Access Services SUBJECT: IRS Regulation #130266-11

More information

Financial Assistance Program 100-18

Financial Assistance Program 100-18 GWINNETT HOSPITAL SYSTEM ADMINISTRATION Financial Assistance Program 100-18 Original Date Review Dates Revision Dates 04/1987 01/2004; 03/2007 03/1989; 09/1989; 06/1994; 04/1998; 04/2001; 01/2004, 03/2007;

More information

Essential Hospitals VITAL DATA. Results of America s Essential Hospitals Annual Hospital Characteristics Report, FY 2013

Essential Hospitals VITAL DATA. Results of America s Essential Hospitals Annual Hospital Characteristics Report, FY 2013 Essential Hospitals VITAL DATA Results of America s Essential Hospitals Annual Hospital Characteristics Report, FY 2013 Published: March 2015 1 ABOUT AMERICA S ESSENTIAL HOSPITALS METHODOLOGY America s

More information

Domestic Providers & Services Directory Mohawk Valley Health System

Domestic Providers & Services Directory Mohawk Valley Health System Domestic Providers & Services Directory Mohawk Valley Health System This directory is a resource for Mohawk Valley Health System (MVHS) non-union employees who have MVHS-sponsored medical insurance through

More information

Health Care Services Overview. Pennsylvania Department of Corrections

Health Care Services Overview. Pennsylvania Department of Corrections Health Care Services Overview Pennsylvania Department of Corrections Richard S. Ellers Director Bureau of Health Care Services Pennsylvania Department of Corrections rellers@pa.gov 717-728-5311 27 State

More information

501(c)(3) Hospitals: Proposed IRS Rules under 9007 of the Affordable Care Act

501(c)(3) Hospitals: Proposed IRS Rules under 9007 of the Affordable Care Act 501(c)(3) Hospitals: Proposed IRS Rules under 9007 of the Affordable Care Act Erika K. Lunder Legislative Attorney Edward C. Liu Legislative Attorney July 27, 2012 CRS Report for Congress Prepared for

More information

Partners HealthCare Financial Assistance Policy and Uninsured Patient Discount Policy

Partners HealthCare Financial Assistance Policy and Uninsured Patient Discount Policy PURPOSE: Partners HealthCare Financial Assistance Policy and Uninsured Patient Discount Policy Partners HealthCare affiliated entities are tax-exempt entities, whose underlying mission is to provide services

More information

SUBJECT: CHARITY AND UNCOMPENSATED CARE 1 of 13 DEPARTMENT: BUSINESS OFFICE REVISED: 10/2012

SUBJECT: CHARITY AND UNCOMPENSATED CARE 1 of 13 DEPARTMENT: BUSINESS OFFICE REVISED: 10/2012 REFERENCE # SUBJECT: CHARITY AND UNCOMPENSATED CARE 1 of 13 DEPARTMENT: BUSINESS OFFICE REVISED: 10/2012 CHARITY AND UNCOMPENSATED CARE Purpose To provide definition of health care assistance to eligible

More information

Floyd Healthcare Management Inc. Community Benefits Summary

Floyd Healthcare Management Inc. Community Benefits Summary Floyd Healthcare Management Inc. Community Benefits Summary FY 2015 Floyd Healthcare Management Inc. Community Benefits Summary for FY 2015 The Floyd healthcare system, which, for the purposes of this

More information

Differential Charging to Medicare and Self-Pay and Commercial Customers by

Differential Charging to Medicare and Self-Pay and Commercial Customers by Differential Charging to Medicare and Self-Pay and Commercial Customers by Andrew Ruskin Morgan Lewis I. Recent Developments A. Bitter Pill, Time Magazine (March, 2013) 1. Allegations throughout that the

More information

Affordable Care Act FAQs

Affordable Care Act FAQs Note: This material is not intended to serve as legal advice and only constitutes Delta Dental s opinion on the subject matter contained herein based on its own review of available guidance. Delta Dental

More information

Health Care Facilities in Central Indiana

Health Care Facilities in Central Indiana Boone County Health Care Facilities in Central Indiana Essex Nursing and Rehabilitation Center 301 W. Essex Street Lebanon IN 46052 (765) 482-1950 Hickory Creek at Lebanon 1585 Perry Worth Road Lebanon

More information

Financial Assistance Program For the Uninsured & Underinsured

Financial Assistance Program For the Uninsured & Underinsured Our Call to Action Together we promise: Healthcare that works. Healthcare that is safe. Healthcare that leaves no one behind. Version Date: 05/18/2011 Table of Contents Mission Statement, Our Call to Action

More information

Rush Oak Park Hospital Community Benefits Report FY2014. Bruce Elegant President and CEO Rush Oak Park Hospital

Rush Oak Park Hospital Community Benefits Report FY2014. Bruce Elegant President and CEO Rush Oak Park Hospital Rush Oak Park Hospital Community Benefits Report FY2014 Bruce Elegant President and CEO Rush Oak Park Hospital Table of Contents Message from the President/CEO..1 Organizational Information 2 Community

More information

Essential Hospitals VITAL DATA. Results of America s Essential Hospitals Annual Hospital Characteristics Survey, FY 2012

Essential Hospitals VITAL DATA. Results of America s Essential Hospitals Annual Hospital Characteristics Survey, FY 2012 Essential Hospitals VITAL DATA Results of America s Essential Hospitals Annual Hospital Characteristics Survey, FY 2012 Published: July 2014 1 ABOUT AMERICA S ESSENTIAL HOSPITALS METHODOLOGY America s

More information

The Big Data Dividend

The Big Data Dividend The Big Data Dividend Enhancing Revenue in an Era of Change May 7, 2015 Agenda Big Data Sample Healthcare Big Data Sets Healthcare Applications of Big Data Revenue Enhancement Opportunities Rate Benchmarking/Rate

More information

MERIDIAN HEALTH Patient Financial Services POLICIES AND PROCEDURES

MERIDIAN HEALTH Patient Financial Services POLICIES AND PROCEDURES MERIDIAN HEALTH Patient Financial Services POLICIES AND PROCEDURES DISTRIBUTION: Meridian Hospitals Corporation, Patient Financial Services & Access Services SUBJECT: IRS Regulation #130266-11 501(r) (4)

More information

Residency Status Not Required Residency status is not a consideration for eligibility in WFH s Community Care Program.

Residency Status Not Required Residency status is not a consideration for eligibility in WFH s Community Care Program. POLICY & PROCEDURE Subject: Patient Financial Assistance/Community Care Program Classification: Policy Owner: Illinois Regional CFO Approved Sr. VP, CFO Approved By: Regional CEO Effective: January 1,

More information

CHARITY CARE AND FINANCIAL AID GUIDELINES FOR PENNSYLVANIA HOSPITALS

CHARITY CARE AND FINANCIAL AID GUIDELINES FOR PENNSYLVANIA HOSPITALS CHARITY CARE AND FINANCIAL AID GUIDELINES FOR PENNSYLVANIA HOSPITALS JULY 2004 Hospitals and the Uninsured: Statement of the Issue Pennsylvania hospitals and health systems have a long history of addressing

More information

To establish reasonable, interest-free payment mechanisms based on the patient s ability to make payments.

To establish reasonable, interest-free payment mechanisms based on the patient s ability to make payments. POLICY & PROCEDURE SCOPE St. John Medical Center (SJMC), in fulfillment of its mission and values, will serve those with limited or no capacity to pay for medical services with respect, compassion and

More information

Applications must be completed in full to be eligible, please read carefully.

Applications must be completed in full to be eligible, please read carefully. Call Vicki or Terra NRMC Business Office 406-873-2251 NORTHERN ROCKIES MEDICAL CENTER COMMUNITY CARE FINANCIAL ASSISTANCE PROGRAM Applications must be completed in full to be eligible, please read carefully.

More information

YOUR TALENT SEARCH, SIMPLIFIED

YOUR TALENT SEARCH, SIMPLIFIED YOUR TALENT SEARCH, SIMPLIFIED ACADEMIA & RESEARCH American Association for the Study of Liver Diseases American Association of Colleges of Osteopathic Medicine American Association of Diabetes Educators

More information

Patient Account Services. Patient Reference & Frequently Asked Questions. Admissions

Patient Account Services. Patient Reference & Frequently Asked Questions. Admissions Patient Account Services Patient Reference & Frequently Asked Questions Admissions Each time you present for a new medical service, a new account number will be assigned. You will be asked to pay any patient

More information

Carelink CaroMont Provider Directory

Carelink CaroMont Provider Directory Carelink CaroMont Product Service Area: Cleveland, Lincoln, and Gaston Counties November 2013 Carelink from Coventry benefit plans are underwritten and administered by Coventry Health Care of the Carolinas,

More information

MANAGEMENT S DISCUSSION CONDITION AND RESULTS OF OPERATIONS FOR ASCENSION AS OF AND FOR THE SEPTEMBER 30, 2014 AND 2013 AND ANALYSIS OF FINANCIAL

MANAGEMENT S DISCUSSION CONDITION AND RESULTS OF OPERATIONS FOR ASCENSION AS OF AND FOR THE SEPTEMBER 30, 2014 AND 2013 AND ANALYSIS OF FINANCIAL MANAGEMENT S DISCUSSION AND ANALYSIS OF FINANCIAL CONDITION AND RESULTS OF OPERATIONS FOR ASCENSION AS OF AND FOR THE THREE MONTHS ENDED SEPTEMBER 30, 2014 AND 2013 The following information should be

More information

Complying with the New IRS Requirements

Complying with the New IRS Requirements Complying with the New IRS Requirements NRHA Critical Access Hospital Conference October 16, 2008 Maureen Mudron AHA Deputy General Counsel The New Landscape Beginning in tax year 2008, taxexempt organizations

More information

California Health and Safety Code. Chapter 2.5 of Division 107

California Health and Safety Code. Chapter 2.5 of Division 107 California Health and Safety Code Chapter 2.5 of Division 107 AB 1503 (Chapter 445, Statutes of 2010) amended Hospital Fair Pricing Policies established by AB 774 (Statutes of 2006) and added Emergency

More information

Tips from Social Workers for Kidney Patients

Tips from Social Workers for Kidney Patients Tips from Social Workers for Kidney Patients The Ohio State University Medical Center provides a social worker to work closely with you while you are in the hospital during the acute and chronic phases

More information

Charity/Uncompensated Care Policy and Procedure 2015. Disciplines / locations to which this multidisciplinary policy applies:

Charity/Uncompensated Care Policy and Procedure 2015. Disciplines / locations to which this multidisciplinary policy applies: LEE MEMORIAL HEALTH SYSTEM POLICY & PROCEDURE MANUAL Charity/Uncompensated Care Policy and Procedure 2015 LOCATOR NUMBER T Y P E System-wide - A formal statement of values, intents (policy), and expectations

More information

FINANCIAL ASSISTANCE / UNINSURED DISCOUNT POLICY

FINANCIAL ASSISTANCE / UNINSURED DISCOUNT POLICY Tuality Healthcare Corporate Operational Policy O-91 TITLE: FINANCIAL ASSISTANCE / UNINSURED DISCOUNT POLICY POLICY OBJECTIVE To ensure that Tuality Healthcare meets its community obligations to provide

More information

Understanding Insurance and Our Billing Process

Understanding Insurance and Our Billing Process Understanding Insurance and Our Billing Process Thank you for choosing Cleveland Clinic for your healthcare needs. We appreciate the confidence you have placed in us. The purpose of this brochure is to

More information

CHATUGE REGIONAL HOSPITAL AND NURSING HOME POLICY AND PROCEDURE FINANCIAL ASSISTANCE POLICY PURPOSE:

CHATUGE REGIONAL HOSPITAL AND NURSING HOME POLICY AND PROCEDURE FINANCIAL ASSISTANCE POLICY PURPOSE: CHATUGE REGIONAL HOSPITAL AND NURSING HOME POLICY AND PROCEDURE FINANCIAL ASSISTANCE POLICY PURPOSE: It shall be the policy of Chatuge Regional Hospital, Inc. to establish a standard to determine the financial

More information

A partnership that offers an exclusive insurance product! The Chambers of Commerce in Hamilton County and ADVANTAGE Health Solutions, Inc.

A partnership that offers an exclusive insurance product! The Chambers of Commerce in Hamilton County and ADVANTAGE Health Solutions, Inc. The Chambers of Commerce in Hamilton County and ADVANTAGE Health Solutions, Inc. SM A partnership that offers an exclusive insurance product! CHAMBER OF COMMERCE The Chambers of Commerce in Hamilton County

More information

Page 1 of 13 Policy. Revised: 11/30/15. Distribution: All Corporations Vineland Bridgeton Elmer Woodbury

Page 1 of 13 Policy. Revised: 11/30/15. Distribution: All Corporations Vineland Bridgeton Elmer Woodbury Page 1 of 13 Policy I. Policy: Any patient with no insurance or no secondary insurance may be screened for the New Jersey State Charity Care Program and the Inspira Medical Centers and Inspira Medical

More information

Business Office BO:14 10f8 06/13. Section: Policy No: Page: Effective: Revision: POLICY AND PROCEDURE MANUAL HENDRICKS COMMUNITY HOSPITAL ASSOCIA non

Business Office BO:14 10f8 06/13. Section: Policy No: Page: Effective: Revision: POLICY AND PROCEDURE MANUAL HENDRICKS COMMUNITY HOSPITAL ASSOCIA non HENDRICKS COMMUNITY HOSPITAL ASSOCIA non 10f8 06/13 I. INTRODUCTION 1.1 Hendricks Community Hospital Association is committed to providing healthcare services to all persons in need, without regard to

More information

POLICY AND/OR PROCEDURE

POLICY AND/OR PROCEDURE POLICY AND/OR PROCEDURE TITLE: Financial Assistance POLICY NUMBER: 003.003 DEPARTMENT: Patient Accounts/Business Office EFFECTIVE: July 1, 2016 PURPOSE To provide a consistent method of determining eligibility

More information

CHARITY CARE. See Below to view the full policy;

CHARITY CARE. See Below to view the full policy; CHARITY CARE If you do not have health insurance or you are unable to pay for your services, here at Eagleville, you may qualify for Medical Assistance, Medicare or our Charity Care Program. Charity Care

More information

Government Programs Policy No. GP - 6 Title:

Government Programs Policy No. GP - 6 Title: I. SCOPE: Government Programs Policy No. GP - 6 Page: 1 of 12 This policy applies to (1) Tenet Healthcare Corporation and its wholly-owned subsidiaries and affiliates (each, an Affiliate ); (2) any other

More information

League of Women Voters. November 20, 2012

League of Women Voters. November 20, 2012 League of Women Voters November 20, 2012 Palo Alto Medical Foundation Multi-Specialty Medical Group for past 82 years. Outpatient Medical Centers not a hospital Community based, not-for-profit Physician-led

More information

2013 Implementation Strategy Report: UC Irvine Health; A valuable asset to Orange County

2013 Implementation Strategy Report: UC Irvine Health; A valuable asset to Orange County 2013 Implementation Strategy Report: UC Irvine Health; A valuable asset to Orange County UC (University of California) Health is the fourth largest health system in California, and includes the UC Irvine

More information

Southwestern Vermont Medical Center Operating Budget Fiscal Year 2016

Southwestern Vermont Medical Center Operating Budget Fiscal Year 2016 Southwestern Vermont Medical Center Operating Budget Fiscal Year 2016 Southwestern Vermont Medical Center s (hereafter SVMC or Medical Center ) Operating Budget for Fiscal Year (hereafter FY ) 2016 has

More information

4C s Clinic Billing and Collection Policy

4C s Clinic Billing and Collection Policy 4C s Clinic Billing and Collection Policy -Approved GB 07/28/11 -Effective 10/01/11 The 4C s Clinic expects patients to pay their outstanding balances in a timely manner. A bill for services is based on

More information

Healthy PA: Medicaid Expansion. Ann Bacharach PA Health Law Project February 20, 2014

Healthy PA: Medicaid Expansion. Ann Bacharach PA Health Law Project February 20, 2014 Healthy PA: Medicaid Expansion 1 Ann Bacharach PA Health Law Project February 20, 2014 Healthy PA Medicaid Proposal A waiver proposal to: 2 Make substantial changes PA s existing Medical Assistance program

More information

June 2013. To the Residents of Central California

June 2013. To the Residents of Central California 1 June 2013 To the Residents of Central California Community Medical Centers has collaborated with a dozen other Valley hospitals to conduct a multicounty Community Health Needs Assessment. After an extensive

More information

EAST TEXAS MEDICAL CENTER REGIONAL HEALTHCARE SYSTEM CHARITY CARE & UNINSURED PATIENT POLICY

EAST TEXAS MEDICAL CENTER REGIONAL HEALTHCARE SYSTEM CHARITY CARE & UNINSURED PATIENT POLICY EAST TEXAS MEDICAL CENTER REGIONAL HEALTHCARE SYSTEM CHARITY CARE & UNINSURED PATIENT POLICY I. POLICY By virtue of their exemption from federal and state taxes and as a part of their mission to serve

More information

Health Insurance Reform at a Glance Implementation Timeline

Health Insurance Reform at a Glance Implementation Timeline Health Insurance Reform at a Glance Implementation Timeline 2010 Access to Insurance for Uninsured Americans with a Pre-Existing Condition. Provides uninsured Americans with pre-existing conditions access

More information

Trinitas Regional Medical Center Obligated Group Consolidated Balance Sheet At September 30, 2015 and December 31, 2014 (Unaudited)

Trinitas Regional Medical Center Obligated Group Consolidated Balance Sheet At September 30, 2015 and December 31, 2014 (Unaudited) Consolidated Balance Sheet At 3, 215 and December 31, 214 (Unaudited) Assets Current Assets: Cash and cash equivalents (includes certificates of deposit) Assets whose use is limited Patient accounts receivable

More information

Financial Accounting and Management Reports

Financial Accounting and Management Reports Financial Accounting and Management Reports To manage a medical practice effectively, whether it be a solo or a group practice, the practitioner and its managers and advisors must have continual access

More information

Administrative Policy and Procedure Manual. Collections Effective Date: 08/22/2013 Scope: Hospitalwide Page 1 of 9.

Administrative Policy and Procedure Manual. Collections Effective Date: 08/22/2013 Scope: Hospitalwide Page 1 of 9. Collections Effective Date: 08/22/2013 Scope: Hospitalwide Page 1 of 9 Table of Contents I. Purpose II. Policy Statements III. Definitions A. Application Period B. Extraordinary Collection Actions (ECAs)

More information

Policy: Charity Care Application Policy # 4.70 Department: Patient Access Policy Manual: USMD Hospital Revenue Cycle Manual Effective date:

Policy: Charity Care Application Policy # 4.70 Department: Patient Access Policy Manual: USMD Hospital Revenue Cycle Manual Effective date: Approved by: Page: 1 SCOPE: This policy applies to USMD Hospitals. PURPOSE: USMD Hospitals will provide charity care to patients who incur a significant financial burden as a result of receiving medically

More information

Randall Chun, Legislative Analyst Updated: January 2016. MinnesotaCare

Randall Chun, Legislative Analyst Updated: January 2016. MinnesotaCare INFORMATION BRIEF Research Department Minnesota House of Representatives 600 State Office Building St. Paul, MN 55155 Randall Chun, Legislative Analyst is administered by the Minnesota Department of Human

More information

Ascension Health Alliance

Ascension Health Alliance and Results of Operations The following information should be read with Ascension Health Alliance s audited consolidated financial statements and related notes to the consolidated financial statements.

More information

May 18, 2015. The Honorable Rick Scott Office of the Governor 400 S. Monroe St. Tallahassee, FL 32399. Dear Governor Scott,

May 18, 2015. The Honorable Rick Scott Office of the Governor 400 S. Monroe St. Tallahassee, FL 32399. Dear Governor Scott, May 1, 01 The Honorable Rick Scott Office of the Governor 00 S. Monroe St. Tallahassee, FL Dear Governor Scott, We appreciate the opportunity to respond to your May 1, 01 data request. As you may know,

More information