SCHEDULE O
(Form 990)

Department of the Treasury
Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or 990-EZ or to provide any additional information.
MediumBullet Attach to Form 990 or 990-EZ.
MediumBullet Go to www.irs.gov/Form990 for the latest information.
OMB No. 1545-0047
2021
Open to Public
Inspection
Name of the organization
Indiana University Health North Hospital Inc
 
Employer identification number

35-1932442
Return Reference Explanation
LINE J - WEB SITE HTTPS://IUHEALTH.ORG/FIND-LOCATIONS/IU-HEALTH-NORTH-HOSPITAL
Form 990, Part III, Line 4d Description of other program services (Expenses $ 612,951 including grants of $ 0)(Revenue $ 891,697) IU Health North Hospital leases physician office and clinic space to tax-exempt related 501(c)(3) organizations.
Form 990, Part VI, Line 1b INDEPENDENT VOTING MEMBERS IU HEALTH NORTH HOSPITAL IS PART OF A MULTI-ENTITY HOSPITAL SYSTEM CONTROLLED BY IU HEALTH, A 501(C)(3) TAX-EXEMPT ORGANIZATION WHOSE BOARD IS COMPRISED OF VOTING MEMBERS, OF WHICH SUBSTANTIALLY ALL ARE INDEPENDENT COMMUNITY MEMBERS.
Form 990, Part VI, Line 13 PART VI, LINES 12, 13, 14, AND 16B - POLICIES IU Health North Hospital is part of the IU Health system. As the sole member and controlling parent of IU Health North Hospital, IU Health and its Board of Directors have mandated that certain policies be followed to ensure greater standardization throughout the system. Thus, IU Health North Hospital's Board of Directors was not required to separately adopt a conflict of interest, whistleblower, document retention and destruction and joint venture policies because IU Health's Board of Directors had already adopted and required these policies to be followed by its subsidiaries.
Form 990, Part VI, Line 15 PROCESS FOR DETERMINING COMPENSATION IU Health North Hospital's Regional President is employed by IU Health. IU Health's process for determining compensation is as follows: (1) The Board of Directors ("Board") has established a Talent Management and Executive Compensation Committee ("TMECC"), the purpose of which includes reviewing and making recommendations regarding executive (Senior Vice Presidents and above) pay and benefits (collectively referred to as "compensation") on an annual basis in April. The TMECC is made up of members of the Board that are neither physicians nor employees and do not otherwise have a conflict of interest regarding any of IU Health's compensation arrangements. The TMECC reviews an executive's entire compensation package including base salary, short-term and long-term incentives, health and welfare benefits, qualified and nonqualified retirement plans, as well as any additional fringe benefits. As deemed appropriate, the Committee on Finance, which is also made up of members of the Board, may also review executive compensation and benefits. (2) The TMECC engages an independent compensation consulting firm on an annual basis to conduct a compensation analysis for its executive group, which consists of employees at the level of senior vice president and above. The current compensation advisor is SullivanCotter. SullivanCotter performs its analysis in the form of a compensation survey ("survey") that includes relevant comparability data for compensation levels paid by similarly situated organizations (both governmental and tax exempt) for functionally comparable positions as well as the availability of similar services in the geographic area. SullivanCotter then prepares a survey report and provides recommendations to the TMECC, if deemed appropriate, on changes in executive compensation. A separate analysis using the same methodology is done for the President and Chief Executive Officer. (3) The TMECC then reviews SullivanCotter's report and recommendations and, if appropriate, votes on whether to recommend any changes in executive compensation to the Board. The TMECC will only recommend changes to the Board if they are consistent with the Board's philosophy on compensation matters and are deemed reasonable based upon the independent analysis provided by SullivanCotter. The TMECC's review, discussion and vote are documented in the minutes for the meeting. There are no executives present during the final discussion and approval. (4) The Board then reviews the report prepared by SullivanCotter as well as the recommendations of the TMECC as to any changes in executive compensation. As deemed appropriate, the Committee on Finance may also provide its review of the TMECC's recommendations on any changes in executive compensation. This review and discussion are documented in the minutes. (5) The Board then votes on whether to accept the TMECC's recommendations on any changes in executive compensation. Changes in executive compensation are made if approved by the TMECC and Board on an annual basis, or as necessary throughout the year. The discussion and approval are documented in the minutes of the meeting. There are no executives present during the final discussion and approval. IU Health's General Counsel also prepares a formal written opinion reviewing the executive compensation approval process, comparing it to the Intermediate Sanctions Test of IRC Section 4958. If warranted, IU Health's General Counsel may also provide comments regarding the executive compensation approval process as it relates to meeting the requirements for a rebuttable presumption of reasonableness as provided in the Intermediate Sanctions Test. (6) After the end of each year, the TMECC and Board also review the achievements of the executive group as it relates to the long-term and short-term shared and individual goals developed by the executives and the Board. These achievements may also be reviewed with the Committee on Finance. The Board, at its discretion, may approve bonus payments based upon the achievement of the goals. The discussion and vote of the TMECC and Board is documented in the minutes for each such meeting. The bonuses are not paid until approval is made by the Board. (7) The TMECC and Audit Committee also review Form 990 disclosures related to executive compensation as well as the organization's practices and approval processes prior to the filing of the Form 990 return with the Internal Revenue Service. IU Health North Hospital's President (Part Year)/VP of Operations (Part Year), and other officers and key employees of IU Health North are employed by IU Health or other related entities, which have a process in place to determine the compensation for the other officers and key employees. IU Health Human Resources uses market data from multiple compensation experts/vendors who utilize a variety of methods and procedures to obtain compensation ranges for comparable officer and employee positions. This market data and multiple other factors (including market pay benchmarks, internal equity, candidate/employee qualifications & performance, and business needs) are used to recommend compensation ranges for its officers and other employees, which are then used as a guide for setting reasonable compensation by management.
Form 990, Part VI, Line 6 Classes of members or stockholders THE SOLE MEMBER OF IU HEALTH NORTH HOSPITAL IS IU HEALTH, A 501(C)(3) TAX-EXEMPT ORGANIZATION.
Form 990, Part VI, Line 7a Members or stockholders electing members of governing body THE BOARD OF DIRECTORS OF THE IU HEALTH NORTH HOSPITAL SHALL CONSIST OF UP TO FIFTEEN (15) VOTING MEMBERS ALL APPOINTED BY IU HEALTH, WHO SHALL INCLUDE REPRESENTATIVES FROM THE MEDICAL STAFFS OF IU HEALTH NORTH HOSPITAL AND IU HEALTH WEST HOSPITAL, AND THE PRESIDENT OF THE INDIANAPOLIS SUBURBAN REGION, WHO SHALL BE AN EX-OFFICIO, VOTING DIRECTOR OF THE BOARD. AT ALL TIMES, THE IU HEALTH NORTH HOSPITAL DIRECTORS SHALL CONSIST OF THE SAME INDIVIDUALS APPOINTED BY IU HEALTH TO SERVE AS DIRECTORS OF IU HEALTH WEST HOSPITAL.
Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders THE BOARD OF DIRECTORS SHALL NOT, WITHOUT THE PRIOR APPROVAL OF THE IU HEALTH: - ANY PROPOSED AMENDMENT TO THE CORPORATION'S ARTICLES OF INCORPORATION OR THESE BYLAWS; - ADOPTION OF THE CORPORATION'S ANNUAL CAPITAL AND OPERATING BUDGETS; - APPROVAL OF ANY UNBUDGETED OPERATING OR CAPITAL BUDGET ITEMS OR DEVIATIONS, INCLUDING ANY ISSUANCE OR GUARANTEE OF ANY UNBUDGETED DEBT; - APPROVAL OF ANY STRATEGIC PLAN FOR THE CORPORATION, INCLUDING ANY AMENDMENTS TO A STRATEGIC PLAN; - APPROVAL OF ANY ENCUMBRANCE, SALE OR CONVEYANCE OF ASSETS; - ANY MERGER, CONSOLIDATION, JOINT VENTURE OR AFFILIATION INVOLVING THE CORPORATION OR ANY OF ITS AFFILIATES AND ANY OTHER ENTITY; - APPOINTMENT AND REMOVAL OF THE CORPORATION'S PRESIDENT AND OTHER OFFICERS; - CONSTRUCTION, ACQUISITION OR LEASE OF HOSPITAL BUILDINGS; - APPROVE ANY MANAGEMENT AGREEMENT FOR THE MANAGEMENT OF ALL OR SUBSTANTIAL PART OF IU HEALTH WEST HOSPITAL'S OPERATIONS; - PROJECTS OR CONTRACTS THAT REQUIRE MEMBER APPROVAL IN ACCORDANCE WITH THE MEMBER'S RESOLUTION AND POLICY GOVERNING SYSTEM-WIDE CONTRACT EXECUTION AUTHORITY AND PAYMENT APPROVAL LIMITS; AND - THE DISSOLUTION OF THE CORPORATION OR ANY OF ITS AFFILIATES.
Form 990, Part VI, Line 11b Review of form 990 by governing body The Indianapolis Suburban Chief Financial Officer and Finance Committee reviewed and approved the Form 990. Following their review and approval, a complete copy of the Form 990 was made available to each board member prior to its filing. Each member was also informed of the availability of IU Health's Tax Department to answer any questions.
Form 990, Part VI, Line 12c Conflict of interest policy IU HEALTH NORTH HOSPITAL FOLLOWS IU HEALTH'S CONFLICT OF INTEREST POLICY. IU HEALTH'S CONFLICT OF INTEREST POLICY INCLUDES THE FOLLOWING PROVISIONS: ALL IU HEALTH EMPLOYEES, ASSOCIATES, COLLEAGUES AND CONTRACTED PERSONNEL, INCLUDING EMPLOYED PHYSICIANS AND PAID MEDICAL DIRECTORS ("IU HEALTH REPRESENTATIVES") ARE COVERED BY AND SUBJECT TO ITS CONFLICT OF INTEREST POLICY. IU HEALTH REGULARLY AND CONSISTENTLY MONITORS AND ENFORCES COMPLIANCE WITH THE POLICY THROUGH THE FOLLOWING PROCEDURES: (A) ON AN ANNUAL BASIS, EACH IU HEALTH REPRESENTATIVE AT THE LEVEL OF MANAGER OR ABOVE, TOGETHER WITH EVERY OTHER PERSON DESIGNATED BY THE CORPORATE COMPLIANCE DEPARTMENT ("DEPARTMENT"), MUST COMPLETE, SIGN AND SUBMIT A CONFLICT OF INTEREST QUESTIONNAIRE ("QUESTIONNAIRE") TO THE DEPARTMENT. GOVERNING BOARD MEMBERS, COMMITTEE MEMBERS, CORPORATE OFFICERS, MEDICAL STAFF AND RESEARCHERS MUST COMPLY WITH THE ADMINISTRATIVE REQUIREMENTS NOTED IN THE RESPECTIVE POLICIES AND PROCEDURES RELATIVE TO THOSE AREAS. (B) AN IU HEALTH REPRESENTATIVE MUST SUPPLEMENT A QUESTIONNAIRE IN WRITING, IF AFTER COMPLETION OF THE ORIGINAL QUESTIONNAIRE, A SITUATION ARISES, OR MAY REASONABLY BE EXPECTED TO ARISE, THAT WOULD CHANGE ANY ANSWER OR INFORMATION ON THE ORIGINAL QUESTIONNAIRE IF THE SITUATION HAD EXISTED OR BEEN ANTICIPATED AT THE TIME OF COMPLETION OF THE ORIGINAL QUESTIONNAIRE. (C) IF A FULLY AND PROPERLY COMPLETED QUESTIONNAIRE REVEALS FACTS OR OTHER INFORMATION THAT MIGHT REASONABLY INDICATE A CONFLICT OF INTEREST OR VIOLATION OF THE POLICY, THE IU HEALTH REPRESENTATIVE COMPLETING THE QUESTIONNAIRE MUST SECURE APPROVAL BY HIS/HER SUPERVISOR, EVIDENCED IN WRITING. (D) THE DEPARTMENT WILL REVIEW EACH QUESTIONNAIRE AND DETERMINE WHETHER A CONFLICT OF INTEREST EXISTS AND, IF SO, WHETHER AND HOW IT SHOULD OR MAY BE ELIMINATED, AVOIDED OR MANAGED IN ORDER TO COMPLY WITH THE SPIRIT OF THE POLICY AND WITH THE BEST INTERESTS OF IU HEALTH AND ITS PATIENTS. IN MAKING THE DETERMINATION, THE CORPORATE COMPLIANCE DEPARTMENT MAY CONSULT WITH THE IU HEALTH REPRESENTATIVE'S SUPERVISOR AND OTHER APPROPRIATE INDIVIDUALS AND GROUPS. (E) THE SCOPE OF THE POLICY IS NOT LIMITED TO THOSE WHO ARE REQUIRED TO COMPLETE QUESTIONNAIRES. IF AN IU HEALTH REPRESENTATIVE IS INVOLVED IN A SITUATION OR RELATIONSHIP THAT WOULD CONSTITUTE A VIOLATION OF THE POLICY IN THE ABSENCE OF DISCLOSURE AND APPROVAL AS DESCRIBED ABOVE, THEN THE IU HEALTH REPRESENTATIVE MUST DISCLOSE THE MATTER TO HIS/HER SUPERVISOR, SECURE HIS/HER SUPERVISOR'S APPROVAL IN WRITING, AND DISCLOSE THE MATTER TO THE DEPARTMENT. OTHERWISE, THE IU HEALTH REPRESENTATIVE IS IN VIOLATION OF THE POLICY AND SUBJECT TO CORRECTIVE ACTION, UP TO AND INCLUDING TERMINATION. (F) THE CHIEF COMPLIANCE OFFICER, IN CONSULTATION WITH ONSITE COMPLIANCE PERSONNEL, MAY FROM TIME TO TIME APPOINT STANDING OR AD HOC COMMITTEES TO ASSIST IN RESOLVING ISSUES THAT ARISE UNDER PROVISIONS OF THE POLICY.
Form 990, Part VI, Line 19 Required documents available to the public IU Health North Hospital's Articles of Incorporation are available to the public through the Indiana Secretary of State's website. IU Health North Hospital's conflict of interest policy is described on Form 990, Schedule O. IU Health North Hospital is a consolidated subsidiary in the consolidated financial statements for IU Health. The consolidated financial statements for IU Health are available to the public through its bond filings and as an attachment to IU Health's Form 990 as well as IU Health North Hospital's Form 990.
Form 990, Part VIII, Line 11d Other Miscellaneous Revenue OTHER - Total Revenue: 433075, Related or Exempt Function Revenue: , Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: 433075;
Form 990, Part IX, Line 11g Other Fees SHARED SERVICES/PROF. FEES - Total Expense: 54590550, Program Service Expense: 50188114, Management and General Expenses: 4402436, Fundraising Expenses: ;
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990) 2021


Additional Data


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Software Version: 2021v4.2