Department of the Treasury Internal Revenue Service
Public Charity Status and Public Support
Complete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.
Attach to Form 990 or Form 990-EZ. See separate instructions.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
METHODIST MEDICAL GROUP PHYSICIANS INC
Employer identification number
35-1814660
Part I
Reason for Public Charity Status
(All organizations must complete this part.) See instructions
The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)
1
2
3
4
5
section 170(b)(1)(A)(iv). (Complete Part II.)
6
7
8
9
receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of
its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses
acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)
10
11
e
By checking this box, I certify that the organization is not controlled directly or indirectly by one or more disqualified persons other than foundation managers and other than one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2).
f
If the organization received a written determination from the IRS that it is a Type I, Type II or Type III supporting organization, check this box
..................................................
g
Since August 17, 2006, has the organization accepted any gift or contribution from any of the following persons?
(i) a person who directly or indirectly controls, either alone or together with persons described in (ii)
Yes
No
and (iii) below, the governing body of the the supported organization?
................
11g(i)
(ii)
a family member of a person described in (i) above?
......................
11g(ii)
(iii)
a 35% controlled entity of a person described in (i) or (ii) above?
................
11g(iii)
h
Provide the following information about the supported organization(s).
(i) Name of supported organization
(ii) EIN
(iii) Type of organization (described on lines 1- 9 above or IRC section (see instructions))
(iv) Is the organization in col. (i) listed in your governing document?
(v) Did you notify the organization in col. (i) of your support?
(vi) Is the organization in col. (i) organized in the U.S.?
(vii) Amount of support?
Yes
No
Yes
No
Yes
No
Total
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 2
Part II
Support Schedule for Organizations Described in IRC 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi) (Complete only if you checked the box on line 5, 7, or 8 of Part I or if the
organization failed to qualify under Part III. If the organization fails to
qualify under the tests listed below, please complete Part III.)
Section A. Public Support
Calendar year(or fiscal year beginning in)
(a) 2006
(b) 2007
(c) 2008
(d) 2009
(e) 2010
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....
2
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......
3
The value of services or facilities furnished by a governmental unit to the organization without charge..
4
Total. Add lines 1 through 3..
5
The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included
on line 1 that exceeds 2% of the amount shown on line 11, column (f)..
6
Public Support. Subtract line 5 from line 4.
Section B. Total Support
Calendar year(or fiscal year beginning in)
(a) 2006
(b) 2007
(c) 2008
(d) 2009
(e) 2010
(f) Total
7
Amounts from line 4..
8
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
9
Net income from unrelated business activities, whether or not the business is regularly carried on..
10
Other income. (Explain in Part IV.) Do not include gain or loss from the sale of capital assets..
11
Total support (Add lines 7 through 10).
12
Gross receipts from related activities, etc. (See instructions.)
..................
12
13
First Five Years
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here..........................................
Section C. Computation of Public Support Percentage
14
Public Support Percentage for 2010 (line 6 column (f) divided by line 11 column (f))
.........
14
15
Public Support Percentage for 2009 Schedule A, Part II, line 14
...............
15
16a
33 1/3% support test—2010.
If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization
......................
b
33 1/3% support test—2009.
If the organization did not check the box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization
.....................
17a
10%-facts-and-circumstances test—2010.
If the organization did not check a box on line 13, 16a, or 16b and line 14
is 10% or more, and if the organization meets the "facts and circumstances" test, check this box and stop here. Explain
in Part IV how the organization meets the "facts and circumstances" test. The organization qualifies as a publicly supported
organization
..................................................
b
10%-facts-and-circumstances test—2009.
If the organization did not check a box on line 13, 16a, 16b, or 17a and line
15 is 10% or more, and if the organization meets the "facts and circumstances" test, check this box and stop here.
Explain in Part IV how the organization meets the "facts and circumstances" test. The organization qualifies as a publicly supported organization
..............................................
18
Private Foundation
If the organization did not check a box on line 13, 16a, 16b, 17a or 17b, check this box and see
instructions
...................................................
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 3
Part III
Support Schedule for Organizations Described in IRC 509(a)(2) (Complete only if you checked the box on line 9 of Part I or if the organization
failed to qualify under Part II. If the organization fails to qualify under
the tests listed below, please complete Part II.)
Section A. Public Support
Calendar year(or fiscal year beginning in)
(a) 2006
(b) 2007
(c) 2008
(d) 2009
(e) 2010
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
2
Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......
3
Gross receipts from activities that are not an unrelated trade or business under section 513..
4
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5
The value of services or facilities furnished by a governmental unit to the organization without charge..
6
Total. Add lines 1 through 5.
7a
Amounts included on lines 1, 2, and 3 received from disqualified persons...
b
Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
c
Add lines 7a and 7b..
8
Public Support (Subtract line 7c from line 6.)
Section B. Total Support
Calendar year (or fiscal year beginning in)
(a) 2006
(b) 2007
(c) 2008
(d) 2009
(e) 2010
(f) Total
9
Amounts from line 6...
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c
Add lines 10a and 10b.
11
Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
12
Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)
13
Total support (Add lines 9, 10c, 11 and 12.).
14
First Five Years
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here.............................................
Section C. Computation of Public Support Percentage
15
Public Support Percentage for 2010 (line 8 column (f) divided by line 13 column (f))
.........
15
16
Public support percentage from 2009 Schedule A, Part III, line 15
...............
16
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2010 (line 10c column (f) divided by line 13 column (f))
......
17
18
Investment income percentage from 2009 Schedule A, Part III, line 17
.............
18
19a
33 1/3% support tests—2010.
If the organization did not check the box on line 14, and line 15 is more than 33 1/3% and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
..........
b
33 1/3% support tests—2009.
If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
....
20
Private Foundation
If the organization did not check a box on line 14, 19a or 19b, check this box and see instructions
.....
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 4
Part IV
Supplemental Information.
Supplemental Information. Complete this part to provide the explanation required by Part II, line 10; Part II, line 17a or 17b; or Part III, line 12. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
Explanation
Schedule A (Form 990 or 990-EZ) 2010
Additional Data
Software ID:
Software Version:
-
TIN:
SCHEDULE O (Form 990 or 990-EZ)
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 to provide any additional information.
Attach to Form 990 or 990-EZ.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
METHODIST MEDICAL GROUP PHYSICIANS INC
Employer identification number
35-1814660
Identifier
Return Reference
Explanation
Part VI, Section A - Governing Body and Management
Line 1B - Number of Voting Members That Are Independent
Methodist Medical Group Physicians, Inc. is part of a multi-entity hospital system controlled by Indiana University Health, Inc., a 501(c)(3) exempt organization whose board is comprised of voting members, of which substantially all are independent community members.
Part VI, Section A - Governing Body and Management
Line 2 - Family or Business Relationships
Daniel F. Evans, Jr. and Stephen H. Pollom, M.D. serve on the board of directors of M-Plan, Inc. No additional compensation is provided. Daniel F. Evans, Jr. and Stephen H. Pollom, M.D. serve on the board of directors of The Healthcare Group, LLC. No additional compensation is provided.
Part VI, Section A - Governing Body and Management
Lines 6, 7A and 7B - Members or Stockholders
Line 6: The sole member of Methodist Medical Group Physicians, Inc. ("MMGP") is Methodist Medical Group, Inc. ("MMG"), a 501(c)(3) tax-exempt organization. Line 7A: The Corporation shall have no less than three (3) nor more than nine (9) directors elected by MMG, as the sole member. Line 7B: Notwithstanding any other provisions of the Articles of Incorporation or any provision of MMGP's Bylaws, the following matters require the approval of Indiana University Health, Inc. ("IU Health"), formerly known as Clarian Health Partners, Inc., as the parent of MMG, the sole member of MMGP, prior to implementation: - Any amendment to the Articles of Incorporation or Bylaws of MMGP; - Adoption or revision of any operating or capital budget of MMGP; - A merger or consolidation of MMGP; - Any sale, lease, exchange, conveyance, mortgage, pledge or other disposition of a substantial portion of the property, assets or interests of MMGP, other than pursuant to a budget approved by IU Health; - Any incurrence of debt by, or the creation of any lien upon the property or revenues of, MMGP other than in the ordinary course of business or pursuant to a budget approved by IU Health. Notwithstanding any other provisions of the Articles of Incorporation, or any provision of MMGP's Bylaws, IU Health shall have the power to direct the Board of MMGP to do any of the following: - Transfer property of MMGP in amounts sufficient to pay the principal and interest of any obligation of IU Health; and - Take such actions as are required in order for MMGP to comply with the covenants contained in any financing document to which IU Health is a party or under which IU Health is bound.
Part VI, Section A - Governing Body and Management
Line 11b - Review of Form 990
Methodist Medical Group Physicians, Inc. has established the following process for reviewing the Form 990: The Form 990 and related schedules are reviewed by the Treasurer. After the Treasurer approves the Form 990 and related schedules, a finalized complete Form 990 is made available to each board member on a protected intranet site prior to filing the form with the IRS. Each member is informed of the availability of the Tax Department to answer any questions.
Part VI, Section B - Policies
Lines 12, 13, and 14
Methodist Medical Group Physicians, Inc. is part of the Indiana University Health, Inc. system. As the sole member and controlling parent of Methodist Medical Group Physicians, Inc., Indiana University Health, Inc. and its board of directors have mandated that certain policies be followed to ensure greater standardization throughout the system. Thus, Methodist Medical Group Physicians, Inc.'s board of directors was not required to separately adopt the conflict of interest, whistleblower, document retention and destruction and joint venture policies because Indiana University Health, Inc.'s board had already adopted and required these policies to be followed by subsidiaries.
Part VI, Section B - Policies
Line 12C - Conflict of Interest Policy
Methodist Medical Group Physicians, Inc. has a Conflict of Interest Policy, the purpose of which is, to protect Methodist Medical Group Physicians, Inc.'s interests when it is contemplating entering into a transaction or arrangement that might benefit the private interest of an officer or director. Each officer and director is required to annually sign a statement which affirms that such person (1) has received a copy of the conflict of interest policy; (2) has read and understands the policy; (3) has agreed to comply with the policy; and (4) understands and acknowledges that the Corporation is a tax-exempt organization and that in order to maintain its federal tax exemption it must engage primarily in activities which accomplish one or more of its tax-exempt purposes. The policy requires all forms be submitted for review and approval. Failure to complete and update the questionnaire and failure to disclose interests that should be disclosed, may subject the individual to disciplinary actions, including dismissal.
Part VI, Section C - Disclosures
Line 19 - Public Disclosure
Methodist Medical Group Physicians, Inc.'s Articles of Incorporation are available to the public through the Indiana Secretary of State's web-site. Methodist Medical Group Physicians, Inc.'s conflict of interest policy is described on Form 990, Schedule O. Methodist Medical Group Physicians, Inc. is a consolidated subsidiary in the consolidated financial statements for Indiana University Health, Inc. The consolidated financial statements for Indiana University Health, Inc. are available to the public through its bond filings.
Part VII, Section A - Governing Body and Management
Line 1a, Column (B) - Average hours per week
Stephen H. Pollom, M.D. is the Service Line Chief, Primary Care for Indiana University Health Care Associates, Inc. and devotes 55 hours per week. Norman G. Tabler, Jr. is the Senior Vice President, General Counsel, and Secretary for Indiana University Health, Inc. and devotes 55 hours per week. Daniel F. Evans, Jr. is the President and Chief Executive Officer for Indiana University Health, Inc. and devotes 55 hours per week. Kyle L. Allen is the Vice President, Primary Care for Indiana Clinic Support Services, LLC and devotes 55 hours per week.
Part XI - Reconciliation of Net Assets
Line 5 - Other Changes in Net Assets or Fund Balances
During 2010, Indiana University Health, Inc. ("IU Health"), a related 501(c)(3) tax-exempt organization, made an equity transfer to Methodist Medical Group Physicians, Inc. ("MMGP") of $444,834. Throughout the existence of MMGP, IU Health has provided funds to support MMGP's exempt purpose. Although there was never an intent for MMGP to repay IU Health, these amounts were recorded as intercompany balances rather than equity transfers. During 2010, IU Health and MMGP made adjustments to their books and records to reflect these intercompany balances as equity transfers for both book and tax purposes.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.