4A (Expenses $ 2019396100 including grants of $ 17721763) (Revenue $ 2610642907)
"Indiana University Health, Inc. (""IU Health"") is Indiana's most comprehensive healthcare system. A unique partnership with Indiana University School of Medicine, one the nation's leading medical schools, gives patients access to innovative treatments and therapies, all without regard to their ability to pay. IU Health is comprised of hospitals, physicians and allied services dedicated to providing preeminent care through Indiana and beyond. See Schedule O for additional information on IU Health's 2011 program service accomplishments."

Schedule H, Part I - Financial Assistance Line 3c
N/A

Schedule H, Part I - Financial Assistance Line 6a - 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 www.iuhealth.org. 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."

Schedule H, Part I - Financial Assistance Line 7, Column (f) - Bad Debt Expense
The amount of bad debt expense included on Form 990, Part IX, Line 25, column (A), but subtracted for purposes of calculating the percentage of total expense is $87,516,332. The bad debt expense of $35,524,226 on Schedule H, Part III, Line 2 is reported at cost.

Schedule H, Part I - Financial Assistance Line 7 - Total Community Benefit Expense
Percentage of Total Expenses listed on Schedule H, Part I, Line 7, Column (f) is calculated based on Net Community Benefit Expense. The Percentage of Total Expenses calculated based on Total Community Benefit Expense is 30.24%.

Schedule H, Part I - Financial Assistance Line 7g - 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
"Indiana University Health, Inc. (""IU Health"") leaders participate in a wide array of community-building activities that address the underlying quality of life in the communities IU Health serves. IU Health invests in economic development efforts across the state, collaborates with like-minded organizations through coalitions that address key issues, and advocates for improvements in the health status of vulnerable populations. In 2011, IU Health spent over 1.2 million dollars, serving more than 77,000 individuals as a statewide organization, and nearly 800,000 dollars locally at our six Indianapolis area and suburban hospitals on community-building activities. These investments and support provided resources to local community initiatives that addressed economic development, community health improvement, and workforce development. Outreach activities included job fairs and interview seminars; participation in an economic development council and chamber of commerce; and collaborative partnerships to improve community health. Coalition Building IU Health collaborates with organizations throughout Indiana to advance important causes connected to its mission. In 2011, it was involved in diverse coalitions, including Mid-North Quality of Life Plan coalition, Health by Design, United Way, and Near North Development Corporation. Additionally, IU Health supported several working groups committed to preventing domestic violence; joined forces with local partners to advance injury prevention activities; and supported agencies and community groups to fight obesity, as obesity's health effects include an increased risk for a range of problems, such as diabetes, heart disease, osteoarthritis, stroke, and high blood pressure. Habitat for Humanity Habitat for Humanity of Greater Indianapolis is committed to eliminating poverty by providing simple, decent housing and making home ownership available to low-income families, most of whom have children and live in unsafe, overcrowded or substandard conditions. IU Health supports Habitat for Humanity's efforts financially and by providing hundreds of volunteers to help build a home for a family in need, as IU Health recognizes that poverty is recognized as perhaps the single most important risk factor for premature death and disability. Additionally, IU Health West Hospital collaborated with Habitat in 2011 to conduct a ""panel build"" on the hospital campus. A panel build involves all of the materials needed to construct every wall, floor and ceiling panel for the home, which are built individually, loaded onto a truck, and taken to the home site where the pieces are put together like a puzzle. In addition to creating the building blocks of the home for a family in need, the project provided an excellent opportunity for hospital volunteers to collaborate with volunteers from community partner organizations to continue building valuable relationships. Volunteers from Day Nursery Association, Ben Davis High School and the Avon-Washington Township Fire Department all worked alongside volunteers and families from IU Health West Hospital to make the panel build a success. During IU Health's third annual Day of Service, 1,611 employees joined the fight against childhood obesity by increasing access to active places to play and fresh nutritious foods for low-income school children across Indiana. Community assets left behind as a result of the event included: 3 new school playgrounds, 12 improved school playgrounds, and 5 school gardens. Over 65,000 Hoosiers were positively impacted by the construction of new playgrounds and safety improvements made; creating secure & convenient places for community members to play and be active."

Schedule H, Part III - Bad Debt, Medicare, & Collection Practices Line 4 - Bad Debt Expense
"The provision for uncollected patient accounts is based upon management's assessment of historical and expected 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 experience 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 certain cases, are reclassified to charity care if deemed to otherwise meet charity care and financial assistance policies of IU Health. The bad debt expense reported on Line 2 is calculated under the cost to charge ratio methodology. IU Health provides health care services through various programs that are designed, among other matters, to enhance the health of the community and improve the health of low-income patients. In addition, IU Health provides services intended to benefit the poor and underserved, including those persons who cannot afford health insurance because of inadequate resources or are uninsured or underinsured."

Schedule H, Part III - Bad Debt, Medicare, & Collection Practices Line 8 - Medicare Shortfall
"The Medicare shortfall reported on Schedule H, Part III, Line 7 is calculated, in accordance with the Form 990 instructions, using ""allowable costs"" from Indiana University Health, Inc.'s (""IU Health"") Medicare Cost Report. ""Allowable costs"" for Medicare Cost Report purposes 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's participation in Medicare programs would significantly increase the Medicare shortfall reported on Schedule H, Part III, Line 7. IU Health's Medicare shortfall is attributable to reimbursements that are less than the cost of providing patient care and services to Medicare beneficiaries and does not include any amounts that result from inefficiencies or poor management. IU Health accepts all Medicare patients knowing that there may be shortfalls; therefore it has taken the position that the shortfall should be counted as part of its community benefit. Additionally, it is implied in Internal Revenue Service Revenue Ruling 69-545 that treating Medicare patients is a community benefit. Revenue Ruling 69-545, which established the community benefit standard for nonprofit hospitals, states that if a hospital serves patients with governmental health benefits, including Medicare, then this is an indication that the hospital operates to promote the health of the community."

Schedule H, Part III - Bad Debt, Medicare, & Collection Practices Line 9b - Written Debt Collection Policy and Financial Assista
"If a patient cannot satisfy standard payment expectations, a financial assistance screening process for alternative sources of balance resolution is completed. Those resolutions may include: a discount on charges; Medicaid enrollment, interest-free loan or application for charity care. If a patient does not apply for charity care but meets the charity care guidelines established by Indiana University Health, Inc. (""IU Health""), IU Health will waive charges and treat the cost of services as charity care."

Schedule H, Part VI - Supplement Information Line 2 - Needs Assessment
"Communities are multifaceted and so are their health needs. Indiana University Health, Inc. (""IU Health"") understands that the health of individuals and communities are shaped by various social and environmental factors, along with health behaviors and additional influences. IU Health assesses the health care needs of the communities it serves by utilizing the detailed community needs assessments undertaken by organizations such as the Marion County Health Department, the Indiana State Department of Health, the Centers for Disease Control and Prevention and the United Way of Central Indiana."

Schedule H, Part VI - Supplemental Information Line 3 - Patient Education of Eligibility for Assistance
"Indiana University Health, Inc. (""IU Health"") goes to great lengths to ensure patients know that IU Health treats all patients regardless of their ability to pay. IU Health shares financial assistance information with patients during the admission process, billing process and online. Helping patients understand that financial support for their care is a part of IU Health's commitment to its mission. IU Health's financial assistance policy exists to serve those in need by providing financial relief to patients who ask for assistance after care has been provided. During the admissions process, opportunities for financial assistance are discussed with patients who are identified as a self-pay patient, or requests assistance information. The patient is also provided with an Admissions Packet that provides information regarding IU Health's financial assistance program. Financial counselors are onsite to assist financial concerns or questions during the patient's stay. Patient Financial Services - Customer Service representatives can help patients apply for financial assistance, understand their bills, explain what they can expect during the billing process, accept payment (if needed), update their insurance or payor information, and update their address or other demographics. A summary of the financial assistance policy is printed on the back of each patient statement, while the financial assistance application is mailed to all uninsured IU Health patients at the conclusion of their treatment along with a summary of the incurred charges. Additionally, on the back of each patient statement is a phone number that will allow patients the ability to request financial assistance. Uninsured patients are also made aware of this process at the time of registration. The IU Health website (iuhealth.org) has a page dedicated to financial assistance and offers an online application and phone numbers for customer service representatives to assist with the application process. IU Health has an expansive financial assistance program, which aligns with IU Health's policy and utilizes the federal poverty guidelines to determine eligibility, making access to quality care within a patient's reach. The IU Health Financial Assistance policy provides the following support to patients that qualify. - Free care for those earning up to 200 percent of federal poverty guidelines; - Discounted care on a sliding scale for families earning from 200 to 400 percent of federal poverty guidelines; and - Discounted care on a sliding scale for uninsured families earning from 400 to 650 percent of federal poverty guidelines, and - Financial assistance to patients whose health insurance coverage, if any, does not provide full coverage for all of their medical expenses and whose medical expenses would make them indigent if they were forced to pay full charges. Patients are guided through their course of care with particular sensitivity, reviewing changing circumstances and allowing for financial assistance at any point during the relationship and billing process with the patient. For those inpatients that may qualify for the Medicaid program and have not applied, IU Health financial counselors will assist patients with the Medicaid application. If a patient does not apply for financial assistance, but meets the financial assistance guidelines established by IU Health, IU Health will waive charges and treat the cost of services as financial assistance."

Schedule H, Part VI - Supplemental Information Line 4 - Community Information
"Indiana University Health, Inc. (""IU Health""), which includes IU Health Methodist Hospital, IU Health University Hospital, Riley Hospital for Children at IU Health, IU Health West Hospital, IU Health North Hospital, and IU Health Saxony Hospital, serves a large geographic area in Central Indiana. Each individual hospital serves a unique subsection of the community and details for each are included below. IU Health Methodist Hospital - Service Area Counties: Marion, Hendricks, Johnson, Morgan, Hamilton, Madison, Hancock, Shelby, and Boone - 75% of the IU Health Methodist inpatient discharge population resides in Marion (66%), Hendricks (4%), Johnson (3%), and Morgan (2%) counties - 29% of community discharges were for patients with Medicaid, 25% were for patients with Medicare, and 17% were for uninsured/self-pay patients IU Health University Hospital - Service Area Counties: Marion, Hendricks, Hamilton, Johnson, Morgan, Delaware, Allen, Madison, Vigo, Tippecanoe, St. Joseph, Monroe, Bartholomew, Lake, Elkhart, Hancock, Grant, Howard, Vanderburgh, Wayne, Jackson, Henry, and Putnam - 32% of the IU Health University total inpatient discharge population resides in Marion County; the other 68% is distributed fairly evenly across 91 other counties in the state of Indiana - 44% of IU Health University community discharges were for patients with commercial insurance, 31% were for patients with Medicare, 14% were for patients with Medicaid, and 5% were for uninsured or self-pay patients Riley Hospital for Children at IU Health - Service Area Counties: Marion, Johnson, Lake, Hendricks, Hamilton, Morgan, Madison, Delaware, St. Joseph, Tippecanoe, Allen, Elkhart, Bartholomew, Vanderburgh, Vigo, Hancock, Wayne, Monroe, Jackson, Shelby, and La Porte - 33% of the Riley Hospital for Children at IU Health total inpatient discharge population resides in Marion County; the other 67% is distributed fairly evenly across 89 other counties in the state of Indiana. - 57% of IU Health Riley community discharges were for patients with Medicaid, 35% were for patients with commercial insurance, 1% were for patients with Medicare, and 4% were for self-pay patients IU Health West Hospital - Service Area Counties: Marion, Hendricks, Putnam, Morgan, Johnson, Boone, and Montgomery - Approximately 75% of the IU Health West inpatient discharge population resides in Marion (65%) and Hendricks (11%) counties - 12% of community discharges were for patients with Medicaid, 31% were for patients with Medicare, and 8% were for uninsured/self-pay patients IU Health North Hospital - Service Area Counties: Marion, Hamilton, Boone, Hendricks, Hancock, Madison, and Tipton - 78% of the IU Health North inpatient discharge population resides in Marion (35%), Hamilton (32%), Boone (6%), and Hendricks (5%) counties - 8% of community discharges were for patients with Medicaid, 15% were for patients with Medicare, and 4% were for uninsured/self-pay patients IU Health Saxony Hospital - Service Area Counties: Marion, Hamilton, Boone, Hendricks, Hancock, Madison, and Tipton - 78% of the IU Health North inpatient discharge population resides in Marion (35%), Hamilton (32%), Boone (6%), and Hendricks (5%) counties (IU Health Saxony inpatient discharge population data was not available at the time of this report) - 8% of community discharges were for patients with Medicaid, 15% were for patients with Medicare, and 4% were for uninsured/self-pay patients"

Schedule H, Part VI - Supplemental Information Line 5 - Promotion of Community Health
"As an academic medical center, Indiana University Health, Inc. (""IU Health"") and Indiana University School of Medicine work together to train physicians in an exceptional environment, blending breakthrough research and treatments with the highest quality of patient care. In 2011, more than 1,000 residents and fellows received training in IU Health hospitals. IU Health is committed to improving the health and safety of the communities it serves across Indiana. From bike helmet fittings to cancer support groups to diabetes management, we bring our unique and state-of-the-art resources beyond the hospital doors and onto the front steps of Indiana communities. With more than $17 million invested in high-quality and impactful initiatives to address community health needs; IU Health is helping Indiana residents improve their health and their quality of life. In 2011, IU Health impacted over 400,000 people statewide through presentations, health risk screenings, health education programs, and additional educational opportunities made available to the community, especially to our community members in the greatest need of such services."

Schedule H, Part VI - Supplemental Information Line 6 - Affiliated Health Care System
"Indiana University Health, Inc. (""IU Health"") is Indiana's most comprehensive healthcare system. A unique partnership with Indiana University School of Medicine, one of the nation's leading medical schools, gives patients access to innovative treatments and therapies. IU Health is comprised of hospitals, physicians and allied services dedicated to providing preeminent care throughout Indiana and beyond. A collaborative partnership with IU Health and Indiana University School of Medicine, IU Health Physicians is comprised of more than 500 board-certified or board-eligible physicians, 70 locations statewide and more than 1,000 staff, including 170 advanced practice providers. National Recognition: - Eight clinical programs ranked among the top 50 national programs in U.S. News & World Report's 2010-11 Edition of America's Best Hospitals. - Ten specialty programs at Riley Hospital for Children at IU Health ranked among the top 30 children's hospitals in the nation. - Six hospitals designated as Magnet hospital systems by the American Nurses Credentialing Center recognizing excellence in nursing care. - Named to the 2012-2013 U.S. News & World Report's Best Hospitals Honor Roll, their highest distinction. Education and Research: As an academic health center, IU Health works in partnership with Indiana University School of Medicine to train physicians, blending breakthrough research and treatments with the highest quality of patient care. Research conducted by Indiana University School of Medicine faculty gives IU Health physicians and patients access to the most leading-edge and comprehensive treatment options. The IU Health statewide healthcare system consists of IU Health Methodist Hospital, IU Health University Hospital, Riley Hospital for Children at IU Health, IU Health West Hospital, IU Health North Hospital, IU Health Ball Memorial Hospital, IU Health Blackford Hospital, IU Health Bloomington Hospital, IU Health Paoli Hospital, IU Health Bedford Hospital, IU Health Tipton Hospital, IU Health La Porte Hospital, IU Health Starke Hospital, and IU Health Goshen Hospital. In July of 2011, IU Health Morgan Hospital and IU Health White Hospital also became a member of IU Health. In December of 2011, IU Health opened its newest location, IU Health Saxony Hospital in Fishers, Indiana. Although each IU Health healthcare system hospital prepares and submits its own community benefits plan relative to the local community, IU Health considers its community benefit plan as part of an overall vision for strengthening Indiana's overall health. A comprehensive community outreach strategy and community benefit plan is in place that encompasses the academic medical center downtown Indianapolis, suburban Indianapolis and statewide entities around priority areas that focus on health improvement efforts statewide. IU Health is keenly aware of the positive impact it can have on the communities of need in the state of Indiana by focusing on the most pressing needs in a systematic and strategic way. After taking a careful look into IU Health's communities we serve, and by utilizing the detailed community needs assessments undertaken by public health officials and community partners, IU Health identified the following community health needs. Obesity Prevention To improve the lifestyle of Indiana residents, IU Health has utilized best practice methods to attack obesity in our communities. IU Health is working to improve access to nutritious foods and physical activity in low-income neighborhoods, in addition to providing traditional health education and public advocacy efforts. With these initiatives, IU Health strives to prevent chronic diseases such as obesity and diabetes and increase the awareness of the importance of making healthy choices, since Thirty-six percent of Hoosier adults are overweight and 29.5% are obese, costing the nation billions of dollars each year to treat these chronic health conditions. Garden on the Go: Year-round mobile produce delivery program, that aims to increase access to affordable, fresh fruits & vegetables for the city's most disadvantaged neighbors. By the end of December 2011, Garden on the Go served thousands of Indianapolis community members, reaching a total of 8281 residents! Indy Urban Acres: 8-acre organic urban farm that supplies low-income Hoosiers with healthy fruits and vegetables. Produce grown at this site is given to Gleaners Food Bank. In just two months of harvest, more than 1400 pounds of produce was grown on .5 acres and delivered to Gleaners Food Bank. Riley School Gardens: In an effort to increase access to nutritious foods and reduce the incidence of obesity among youth, Riley Hospital for Children at Indiana University Health partnered with Keep Indianapolis Beautiful (KIB) and Indianapolis Public Schools (IPS) to establish school gardens at 10 IPS schools throughout the city. IU Health Bucks: IU Health Bucks is an incentive program designed to increase produce consumption among underserved populations using state-issued Farmers Market Vouchers. Participants who spent their state-issued vouchers at the North United Methodist Church Farmers' Market in Indianapolis received additional IU Health ""Market Money"" to spend on produce. 233 low-income families participated in the pilot program, spending $3,500 on healthy, local produce. Walk Indiana: IU Health Ball Memorial Hospital contributes resources for the implementation of a unique non-competitive walking marathon held in Muncie, Indiana. The program emphasizes walking as a lifestyle choice to enhance health and fitness. Community walking groups were offered during spring and summer months to help community members prepare for the main event held in September. IU Health Ball Memorial staff members provided free blood pressure screenings and health information at each training session. Nearly 500 individuals participated in the Walk Indiana event in September, 2011. Access to Affordable Healthcare One of the first steps to improved health outcomes is having access to healthcare resources. To show its commitment to providing affordable healthcare access, IU Health treats all patients regardless of their ability to pay. IU Health is also working to raise awareness and work to identify individuals within our communities that have barriers to care and connect these individuals with better access and consistency of healthcare resources to meet their needs. Injury Prevention IU Health strives to create safe communities by helping to reduce preventable injuries such as bicycle, motor vehicle, and fall related injuries, as injuries are the leading cause of death for people 1 - 44 years old. The CDC reports 160,000 people die and 50 million people are injured each year, costing over $80 billion in medical costs. IU Health works to provide the necessary tools, such as helmets and education to communities of need to prevent injuries for youth and adults. Additionally, IU Health supports the advocacy of policies, such as the texting while driving ban, to help provide infrastructure to instill the awareness of injury prevention in our communities. Bicycle Helmet Safety Campaign: Outfitted 4,042 children statewide (ages 6-14) with free, properly fitted bicycle helmets and provided bicycle safety education. This initiative resulted in a 37% increase in helmet usage post-activation. IU Health Child Passenger Safety Campaign: On National Seat Check Saturday, IU Health launched a statewide campaign to decrease the incidence of children traveling unrestrained or restrained incorrectly. CPS Technicians distributed 122 free car seats and found that 85% of the 205 car seats inspected were installed improperly. CICOA Aging and In-Home Solutions: Safe at Home Event - targeted homeowners over the age of 65 or persons of any age with a disability to make their homes safe and accessible for daily living. Volunteers made safety modifications to 22 homes including securing grab bars in bathrooms, installing handrails and banisters on steps, repairing steps, and installing comfort height toilets. K-12 Education In 2011, IU Health partnered with the United Way to implement a Kindergarten readiness program for at-risk children called Kindergarten Countdown. IU Health's significant investment in this program allowed hundreds of soon-to-be students to receive necessary vaccinations and screenings as well as attend a 4-week summer camp to enhance their school readiness. With IU Health's support, the program was expanded across the IPS district and into 10 additional IU Health communities, including IU Health Ball Memorial Hospital. Community Revitalization During IU Health's third annual Day of Service, 1,611 employees joined the fight against childhood obesity by increasing access to active places to play and fresh nutritious foods for low-income school children across Indiana. Community assets left behind as a result of the event included: 3 new school playgrounds, 12 improved sc"

STATE FILING OF COMMUNITY BENEFIT REPORT 990 SCHEDULE H, PART VI
IN,