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
INDIANA UNIVERSITY HEALTH CARE ASSOC INC
Employer identification number
35-1747218
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.") .
5,434,781
5,726,916
3,040,342
0
0
14,202,039
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......
57,088,517
28,583,649
21,794,831
60,461,533
217,100,267
385,028,797
3
Gross receipts from activities that are not an unrelated trade or business under section 513..
469,888
414,151
137,893
864,798
7,739,538
9,626,268
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.
62,993,186
34,724,716
24,973,066
61,326,331
224,839,805
408,857,104
7a
Amounts included on lines 1, 2, and 3 received from disqualified persons...
0
0
0
0
0
0
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.
0
0
0
3,093,972
27,666,033
30,760,005
c
Add lines 7a and 7b..
0
0
0
3,093,972
27,666,033
30,760,005
8
Public Support (Subtract line 7c from line 6.)
378,097,099
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...
62,993,186
34,724,716
24,973,066
61,326,331
224,839,805
408,857,104
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
673,899
487,287
1,087,676
3,817,378
2,619,461
8,685,701
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
17,437
17,437
c
Add lines 10a and 10b.
673,899
487,287
1,087,676
3,817,378
2,636,898
8,703,138
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.).
63,667,085
35,212,003
26,060,742
65,143,709
227,476,703
417,560,242
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
90.549 %
16
Public support percentage from 2009 Schedule A, Part III, line 15
...............
16
96.607 %
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2010 (line 10c column (f) divided by line 13 column (f))
......
17
2.084 %
18
Investment income percentage from 2009 Schedule A, Part III, line 17
.............
18
2.611 %
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
INDIANA UNIVERSITY HEALTH CARE ASSOC INC
Employer identification number
35-1747218
Identifier
Return Reference
Explanation
Part VI, Section A - Governing Body and Management
Line 2 - Family or Business Relationships
Samuel L. Odle and Larry H. Stevens, M.D. serve on the board of directors of Clarian Health North, LLC. No additional compensation is provided. Marvin G. Pember, Samuel L. Odle, and Michael R. Niemeier, M.D. serve on the board of directors of Clarian Health West, LLC. Additionally, Marvin G. Pember is an Officer of Clarian Health West, LLC. No additional compensation is provided. Marvin G. Pember and John F. Fitzgerald, M.D. serve on the board of directors of Clarian Health Plans, Inc. Additionally, Marvin G. Pember is an Officer of Clarian Health Plans, Inc. No additional compensation is provided. Marvin G. Pember, John F. Fitzgerald, M.D., and Charles Shufflebarger, M.D. serve on the board of directors of Clarian Health Risk Retention Group, Inc. and IUH Assurance, Ltd. No additional compensation is provided.
Part VI, Section A - Governing Body and Management
Lines 6, 7A, and 7B - Members or Stockholders
Line 6: Indiana University Health Care Associates, Inc. ("IUHCA") has two Members, which are designated as the Class A Member and the Class B Member. The Class A Member consists of those individuals who serve from time to time as the Trustees of Indiana University ("IU"). The Class B Member is Indiana University Health, Inc. ("IU Health"), formerly known as Clarian Health Partners, Inc. Line 7a: The Board of Directors consists of: (a) two individuals appointed by IU as the Class A Member, (b) three individuals appointed by IU Health as the Class B Member, (c) four Associates appointed by IU as the Class A Member, and (d) four Associates appointed by IU Health as the Class B Member. A physician or any non-physician health care provider approved by IUHCA may be an Associate of IUHCA if he or she (a) has medical staff privileges (if applicable) and conducts a substantial practice activity at a hospital affiliated with IU Health, at William M. Wishard Hospital, Larue D. Carter Memorial Hospital or the Richard L. Roudebush Medical Center or at some other site authorized by the Corporation; (b) holds a faculty position with the Indiana University School of Medicine; and (c) is party to an employment agreement with IUHCA or, if not party to an employment agreement, meets the written criteria for nonemployee Associate status approved by the Board and the members from time to time. Line 7b: Any decision by the Board of Directors to amend, supplement, or repeal all or any part of the provisions contained in the Articles of Incorporation must be duly approved by a vote of both Members.
Part VI, Section A - Governing Body and Management
Line 11b - Review of Form 990
Indiana University Health Care Associates, Inc. has established the following process for reviewing the Form 990: The Form 990 and related schedules are reviewed by the CFO. After the CFO 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
Indiana University Health Care Associates, Inc. is part of the Indiana University Health, Inc. system. As the controlling parent of Indiana University Health Care Associates, 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, Indiana University Health Care Associates, 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
Indiana University Health Care Associates, Inc. has a Conflict of Interest Policy, the purpose of which is to protect Indiana University Health Care Associates, Inc.'s interests when it is contemplating entering into a transaction or arrangement that might benefit the private interest of an officer, director, physician or employee. All executive management, physicians, directors, practice administrators, purchasing, and human resources staff, are 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 to the Human Resources department and a review committee to review and approve. 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 B - Policies
Line 15 - Process for Determining Compensation
Indiana University Health Care Associates, Inc. has a process in place to determine the compensation for its President and CEO, as well as for its CFO. Indiana University Health Care Associates, Inc. uses an independent compensation consultant who utilizes a variety of methods and procedures to obtain reasonable compensation ranges for comparable officer and employee positions. The independent compensation consultant provides Indiana University Health Care Associates, Inc. with recommended compensation ranges for its President/CEO and CFO, which are then used as a guide for setting compensation by the Board of Directors. Compensation changes of the President/CEO and CFO are subject to the review and approval of the Board of Directors. The Board's decisions are documented in the Board's minutes.
Part VI, Section B - Policies
Line 19 - Public Disclosure
Indiana University Health Care, Inc.'s Articles of Incorporation are available for public inspection through the Indiana Secretary of State's web-site. Indiana University Health Care, Inc.'s conflict of interest procedures are disclosed on the Form 990, Schedule O.
Part VII, Section A - Governing Body and Management
Line 1a, Column (B) - Average hours per week
Herbert E. Cushing, M.D. is the Chief Medical Officer of University Hospital for Indiana University Health, Inc. and devotes 15 hours per week. Richard F. Graffis, M.D. is the Executive Vice President and Chief Medical Officer for Indiana University Health, Inc. and devotes 55 hours per week. Eric S. Williams is the the Executive Vice President for Academic Affairs for Indiana University Health, Inc. and a Service Line Chief for Indiana University Health Care Associates, Inc. and devotes 55 hours per week. Marvin G. Pember is the Executive Vice President and Chief Financial Officer for Indiana University Health, Inc. and devotes 55 hours per week. Samuel L. Odle is the Executive Vice President and Chief Operating Officer for Indiana University Health, Inc. and devotes 55 hours per week. Michael R. Niemeier, M.D. was a medical director for Indiana University Health, Inc. and devoted 55 hours per week prior to joining Indiana University Health Care Associates, Inc. as a Service Line Chief. Arthur C. Coffey, M.D. is a staff physician for Indiana University Health, Inc. and devotes 55 hours per week. James E. Lingeman, M.D. serves on the Board of Directors of Indiana University Health, Inc. and devotes 6 hours per week.
Part XI - Reconciliation of Net Assets
Line 5 - Other Changes in Net Assets or Fund Balances
During 2010, Indiana University Health Care Associates, Inc. recorded a change in its minimum pension liability in the amount of -$1,420,163. Additionally, there were book/tax differences on its program-related investments reported on Schedules K-1 in the amount of -$448,874.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.