Form990
Click to see attachment
Department of the Treasury
Internal Revenue Service
Return of Organization Exempt From Income Tax
Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except black lung benefit trust or private foundation)

MediumBullet The organization may have to use a copy of this return to satisfy state reporting requirements.
OMB No. 1545-0047
2011
Open to Public Inspection
A For the calendar year, or tax year beginning 01-01-2011 and ending 12-31-2011
BCheck if applicable:
CName of organization
INDIANA UNIVERSITY HEALTH LAPORTE
PHYSICIANS INC
Doing Business As
 
 
Number and street (or P.O. box if mail is not delivered to street address)
PO BOX 250 1100 LINCOLNWAY
 
Room/suite
City or town, state or country, and ZIP + 4
LAPORTE, IN46352
D Employer identification number

31-1070868
E Telephone number

G Gross receipts $ 24,176,579
F Name and address of principal officer:
Mark Rafalski CFO
PO Box 250 1007 Lincolnway
Laporte,IN46352
I
Tax-exempt status: (   ) LeftBullet (insert no.) or
J
Website:MediumBullet
http://iuhealth.org/laporte/
H(a)
Is this a group return for
affiliates?
H(b)
Are all affiliates included?
If "No," attach a list. (see instructions)
H(c)
Group exemption number MediumBullet  
K Form of organization:
 
L Year of formation: 1984
M State of legal domicile: IN
Part I
Summary
Activities & Governance 1 Briefly describe the organization’s mission or most significant activities: TO IMPROVE THE HEALTH OF OUR PATIENTS AND COMMUNITIES.
2 Check this box MediumBullet
3 Number of voting members of the governing body (Part VI, line 1a)..... 3 15
4 Number of independent voting members of the governing body (Part VI, line 1b) .... 4 9
5 Total number of individuals employed in calendar year 2011 (Part V, line 2a) ... 5 367
6 Total number of volunteers (estimate if necessary) .... 6 0
7a Total unrelated business revenue from Part VIII, column (C), line 12 .. 7a 0
b Net unrelated business taxable income from Form 990-T, line 34 .. 7b 0
Revenues; Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 0 0
9 Program service revenue (Part VIII, line 2g) ......... 20,648,568 23,997,037
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 160 1,436
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 516,121 178,106
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)................... 21,164,849 24,176,579
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 0 0
14 Benefits paid to or for members (Part IX, column (A), line 4)..... 0 0
15 Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10) 22,791,597 28,518,273
16a Professional fundraising fees (Part IX, column (A), line 11e)..... 0 0
b Total fundraising expenses (Part IX, column (D), line 25) MediumBullet0    
17 Other expenses (Part IX, column (A), lines 11a–11d, 11f–24f).... 7,354,831 9,170,864
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 30,146,428 37,689,137
19 Revenue less expenses. Subtract line 18 from line 12....... -8,981,579 -13,512,558
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............. 9,539,080 10,948,279
21 Total liabilities (Part X, line 26)............. 2,927,307 3,368,758
22 Net assets or fund balances. Subtract line 21 from line 20..... 6,611,773 7,579,521
Part II
Signature Block
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge.
Sign Here
JumboBullet
Signature of officer Date
JumboBullet
Type or print name and title.
Paid preparer use only
Print/type preparer's name
 
Preparer's signature
Date
PTIN
Firm's name Right pointing arrowhead image

Firm's EIN Right pointing arrowhead image
Firm's address Right pointing arrowhead image



Phone no.
May the IRS discuss this return with the preparer shown above? See instructions .........bullet
For Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 11282Y
Form 990 (2011)
Form 990 (2011)
Page 2
Part III
Statement of Program Service Accomplishments
Check if Schedule O contains a response to any question in this Part III .........
1
Briefly describe the organization’s mission: THE MISSION OF INDIANA UNIVERSITY LAPORTE PHYSICIANS, INC. (IUHLP) IS TO PROVIDE HIGH QUALITY MEDICAL CARE TO THE RESIDENTS OF LAPORTE COUNTY AND SURROUNDING AREAS. IUHLP COMPLEMENTS INDIANA UNIVERSITY LA PORTE HOSPITAL, INC. (IUHLH) IN PROVIDING INTEGRATED AND COMMUNITY-BASED HEALTH CARE BY ENCOURAGING AND SUPPORTING HEALTHIER COMMUNITIES AND LIFESTYLES WITHIN OUR SERVICE AREA.
2
Did the organization undertake any significant program services during the year which were not listed on
the prior Form 990 or 990-EZ? ....................
If “Yes,” describe these new services on Schedule O.
3
Did the organization cease conducting, or make significant changes in how it conducts, any program services? ..........................
If “Yes,” describe these changes on Schedule O.
4
Describe the organization’s program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations and section 4947(a)(1) trusts are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.
4a (Code:   ) (Expenses $ 30,435,367 including grants of $ 0 ) (Revenue $ 23,997,037 )
IU HEALTH LAPORTE PHYSICIANS HAS ACHIEVED IN PROVIDING HIGHLY SKILLED AND BOARD CERTIFIED/ELIGIBLE PHYSICIANS IN CARDIOLOGY, PEDIATRIC, FAMILY CARE, WOMEN'S HEALTHCARE, ORTHOPEDIC, AND INTERNAL MEDICINE WITHIN THE COUNTY AS WELL AS SURROUNDING AREAS. WITH WELL OVER 100,000 PATIENTS SEEN ANNUALLY, IU HEALTH LAPORTE PHYSICIANS CONTINUES TO EXPAND ITS SERVICES IN CONVENIENT LOCATIONS BY OFFERING QUALITY HEALTHCARE TO THOSE IN NEED OF SPECIALTY CARE SERVICES AS NEUROLOGICAL, GENERAL SURGERY, AND PAIN MANAGEMENT SERVICES. IN COMMITTING ITSELF TO THE COMMUNITY, IUHLP PARTICIPATES IN HEALTH FAIRS AS WELL AS PROVIDES SPORTS PHYSICALS TO STUDENTS IN THE AREA IT SERVES. ALSO, PHYSICIANS WITHIN THE GROUP HAVE BEEN RECOGNIZED NATIONALLY FOR PROVIDING QUALITY DIABETES CARE AND DESIGNING JOINT REPLACEMENT INSTRUMENTS AND IMPLANTS THAT ARE USED NATIONWIDE.
4b (Code:   ) (Expenses $   including grants of $   ) (Revenue $   )
4c (Code:   ) (Expenses $   including grants of $   ) (Revenue $   )
4d Other program services (Describe in Schedule O.)
(Expenses $   including grants of $   ) (Revenue $   )
4e Total program service expensesMediumBullet$ 30,435,367
Form 990 (2011)
Form 990 (2011)
Page 3
Part IV
Checklist of Required Schedules
Yes
No
1
Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If “Yes,” complete Schedule AClick to see attachment.....................
1
Yes
 
2
Is the organization required to complete Schedule B, Schedule of Contributors? ........
2
 
No
3
Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for public office? If “Yes,” complete Schedule C, Part I..........
3
 
No
4
Section 501(c)(3) organizations. Did the organization engage in lobbying activities? If “Yes,” complete Schedule C,
Part II.........................
4
 
No
5
Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or similar amounts as defined in Revenue Procedure 98-19? If “Yes,” complete Schedule C, Part III........................
5
 
 
6
Did the organization maintain any donor advised funds or any similar funds or accounts for which donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts? If “Yes,” complete Schedule D, Part IClick to see attachment....................
6
 
No
7
Did the organization receive or hold a conservation easement, including easements to preserve open space,
the environment, historic land areas or historic structures? If “Yes,” complete Schedule D, Part IIClick to see attachment...
7
 
No
8
Did the organization maintain collections of works of art, historical treasures, or other similar assets? If “Yes,” complete Schedule D, Part III Click to see attachment....................
8
 
No
9
Did the organization report an amount in Part X, line 21; serve as a custodian for amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or debt negotiation services? If “Yes,”
complete Schedule D, Part IVClick to see attachment...................
9
 
No
10
Did the organization, directly or through a related organization, hold assets in temporarily restricted endowments, permanent endowments, or quasi-endowments? If “Yes,” complete Schedule D, Part VClick to see attachment
10
 
No
11
If the organization’s answer to any of the following questions is ‘Yes,’ then complete Schedule D, Parts VI, VII, VIII, IX, or X as applicable:
a
Did the organization report an amount for land, buildings, and equipment in Part X, line10? If “Yes,” complete Schedule D, Part VI.Click to see attachment
11a
Yes
 
b
Did the organization report an amount for investments—other securities in Part X, line 12 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VII.Click to see attachment
11b
 
No
c
Did the organization report an amount for investments—program related in Part X, line 13 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VIII.Click to see attachment
11c
 
No
d
Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part IX.Click to see attachment
11d
Yes
 
e
Did the organization report an amount for other liabilities in Part X, line 25? If “Yes,” complete Schedule D, Part X.Click to see attachment
11e
 
No
f
Did the organization’s separate or consolidated financial statements for the tax year include a footnote that addresses the organization’s liability for uncertain tax positions under FIN 48 (ASC 740)? If “Yes,” complete Schedule D, Part X.Click to see attachment
11f
 
No
12a
Did the organization obtain separate, independent audited financial statements for the tax year?
If “Yes,” complete Schedule D, Parts XI, XII, and XIII Click to see attachment
12a
 
No
b
Was the organization included in consolidated, independent audited financial statements for the tax year? If “Yes,” and if the organization answered ‘No’ to line 12a, then completing Schedule D, Parts XI, XII, and XIII is optional Click to see attachment
12b
Yes
 
13
Is the organization a school described in section 170(b)(1)(A)(ii)? If “Yes,” complete Schedule E
13
 
No
14a
Did the organization maintain an office, employees, or agents outside of the United States?....
14a
 
No
b
Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business, investment, and program service activities outside the United States or aggregate foreign investments valued at $100,000 or more? If “Yes,” complete Schedule F, Part I.........
14b
 
No
15
Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or assistance to any organization or entity located outside the U.S.? If “Yes,” complete Schedule F, Part II..
15
 
No
16
Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or assistance to individuals located outside the U.S.? If “Yes,” complete Schedule F, Part III..
16
 
No
17
Did the organization report a total of more than $15,000, of expenses for professional fundraising services on Part IX, column (A), lines 6 and 11e? If “Yes,” complete Schedule G, Part I
17
 
No
18
Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VIII, lines 1c and 8a? If “Yes,” complete Schedule G, Part II..........
18
 
No
19
Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a? If “Yes,” complete Schedule G, Part III...................
19
 
No
20a
Did the organization operate one or more hospitals? If “Yes,” complete Schedule H.....
20a
 
No
b
If “Yes” to line 20a, did the organization attach a copy of its audited financial statement to this return? Note. All Form 990 filers that operated one or more hospitals must attach audited financial statements.
20b
 
 
Form 990 (2011)
Form 990 (2011)
Page 4
Part IV
Checklist of Required Schedules (continued)
21
Did the organization report more than $5,000 of grants and other assistance to any government or organization in the United States on Part IX, column (A), line 1? If “Yes,” complete Schedule I, Parts I and II..
21
 
No
22
Did the organization report more than $5,000 of grants and other assistance to individuals in the United States on Part IX, column (A), line 2? If “Yes,” complete Schedule I, Parts I and III.....
22
 
No
23
Did the organization answer “Yes” to Part VII, Section A, questions 3, 4, or 5, about compensation of the organization’s current and former officers, directors, trustees, key employees, and highest compensated employees? If “Yes,” complete Schedule J................ Click to see attachment
23
Yes
 
24a
Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as of the last day of the year, that was issued after December 31, 2002? If “Yes,” answer questions 24b–24d and complete Schedule K. If “No,” go to line 25................
24a
 
No
b
Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...
24b
 
 
c
Did the organization maintain an escrow account other than a refunding escrow at any time during the year
to defease any tax-exempt bonds?......................
24c
 
 
d
Did the organization act as an “on behalf of” issuer for bonds outstanding at any time during the year?...
24d
 
 
25a
Section 501(c)(3) and 501(c)(4) organizations. Did the organization engage in an excess benefit transaction with a disqualified person during the year? If “Yes,” complete Schedule L, Part I......
25a
 
No
b
Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and that the transaction has not been reported on any of the organization’s prior Forms 990 or 990-EZ? If “Yes,” complete Schedule L, Part I................
25b
 
No
26
Was a loan to or by a current or former officer, director, trustee, key employee, highly compensated employee, or disqualified person outstanding as of the end of the organization’s tax year? If “Yes,” complete Schedule L,
Part II.........................
26
 
No
27
Did the organization provide a grant or other assistance to an officer, director, trustee, key employee, substantial contributor or employee thereof, a grant selection committee member, or to a 35% controlled entity or family member of any of these persons? If “Yes,” complete Schedule L, Part III.........
27
 
No
28
Was the organization a party to a business transaction with one of the following parties? (see Schedule L, Part IV instructions for applicable filing thresholds, conditions, and exceptions):
a
A current or former officer, director, trustee, or key employee? If “Yes,” complete Schedule L, Part IV .........................
28a
 
No
b
A family member of a current or former officer, director, trustee, or key employee? If “Yes,”
complete Schedule L, Part IV...................
28b
 
No
c
An entity of which a current or former officer, director, trustee, or key employee (or a family member thereof) was an officer, director, trustee, or owner? If “Yes,” complete Schedule L, Part IV..
28c
 
No
29
Did the organization receive more than $25,000 in non-cash contributions? If “Yes,” complete Schedule M
29
 
No
30
Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? If “Yes,” complete Schedule M............
30
 
No
31
Did the organization liquidate, terminate, or dissolve and cease operations? If “Yes,” complete Schedule N,
Part I...........................
31
 
No
32
Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If “Yes,” complete Schedule N, Part II.......................
32
 
No
33
Did the organization own 100% of an entity disregarded as separate from the organization under Regulations sections 301.7701-2 and 301.7701-3? If “Yes,” complete Schedule R, Part I........ Click to see attachment
33
Yes
 
34
Was the organization related to any tax-exempt or taxable entity? If “Yes,” complete Schedule R, Parts II, III, IV, and V, line 1..................... Click to see attachment
34
Yes
 
35a
Did the organization have a controlled entity within the meaning of section 512(b)(13)?
35a
Yes
 
b
If ‘Yes’ to line 35a, did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)? If “Yes,” complete Schedule R, Part V, line 2... Click to see attachment
35b
 
No
36
Section 501(c)(3) organizations. Did the organization make any transfers to an exempt non-charitable related organization? If “Yes,” complete Schedule R, Part V, line 2........... Click to see attachment
36
 
No
37
Did the organization conduct more than 5% of its activities through an entity that is not a related organization and that is treated as a partnership for federal income tax purposes? If “Yes,” complete Schedule R, Part VIClick to see attachment
37
 
No
38
Did the organization complete Schedule O and provide explanations in Schedule O for Part VI, lines 11 and 19? Note. All Form 990 filers are required to complete Schedule O. ............
38
Yes
 
Form 990 (2011)
Form 990 (2011)
Page 5
Part V
Statements Regarding Other IRS Filings and Tax Compliance
Check if Schedule O contains a response to any question in this Part V .........
Yes
No
1a
Enter the number reported in Box 3 of Form 1096. Enter -0- if not applicable. .......
1a
0
b
Enter the number of Forms W-2G included in line 1a. Enter -0- if not applicable.
1b
0
c
Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners? ..................
1c
 
 
2a
Enter the number of employees reported on Form W-3, Transmittal of Wage and Tax Statements filed for the calendar year ending with or within the year covered by this return .....................
2a
367
b
If at least one is reported on line 2a, did the organization file all required federal employment tax returns?

Note. If the sum of lines 1a and 2a is greater than 250, you may be required to e-file. (see instructions)
2b
Yes
 
3a
Did the organization have unrelated business gross income of $1,000 or more during the year?.............................
3a
 
No
b
If “Yes,” has it filed a Form 990-T for this year? If “No,” provide an explanation in Schedule O.....
3b
 
 
4a
At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a financial account in a foreign country (such as a bank account or securities account)?.......................
4a
 
No
b
If "Yes," enter the name of the foreign country: MediumBullet
See instructions for filing requirements for Form TD F 90-22.1, Report of Foreign Bank and Financial Accounts.
5a
Was the organization a party to a prohibited tax shelter transaction at any time during the tax year?..
5a
 
No
b
Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?
5b
 
No
c
If “Yes” to line 5a or 5b, did the organization file Form 8886-T? ........
5c
 
 
6a
Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit any contributions that were not tax deductible?..........
6a
 
No
b
If “Yes,” did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible?........................
6b
 
 
7
Organizations that may receive deductible contributions under section 170(c).
a
Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and services provided to the payor?....................
7a
 
No
b
If “Yes,” did the organization notify the donor of the value of the goods or services provided?.....
7b
 
 
c
Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file Form 8282?...........................
7c
 
No
d
If “Yes,” indicate the number of Forms 8282 filed during the year ....
7d
 
e
Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?..........................
7e
 
No
f
Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract?..
7f
 
No
g
If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required?...................
7g
 
 
h
If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C?...............
7h
 
 
8
Sponsoring organizations maintaining donor advised funds and section 509(a)(3) supporting organizations. Did the supporting organization, or a donor advised fund maintained by a sponsoring organization, have excess business holdings at any time during the year?................
8
 
 
9
Sponsoring organizations maintaining donor advised funds.
a
Did the organization make any taxable distributions under section 4966?.........
9a
 
 
b
Did the organization make a distribution to a donor, donor advisor, or related person?......
9b
 
 
10
Section 501(c)(7) organizations. Enter:
a
Initiation fees and capital contributions included on Part VIII, line 12 ...
10a
 
b
Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities
10b
 
11
Section 501(c)(12) organizations. Enter:
a
Gross income from members or shareholders .........
11a
 
b
Gross income from other sources (Do not net amounts due or paid to other sources against amounts due or received from them) ........
11b
 
12a
Section 4947(a)(1) non-exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041?
12a
 
 
b
If “Yes,” enter the amount of tax-exempt interest received or accrued during the year.
12b
 
13
Section 501(c)(29) qualified nonprofit health insurance issuers.
a
Is the organization licensed to issue qualified health plans in more than one state?
Note. All 501(c)(29) organizations must list in Schedule O each state in which they are licensed to issue qualified health plans, the amount of reserves required by each state, and the amount of reserves the organization allocated to each state.
13a
 
 
b
Enter the aggregate amount of reserves the organization is required to maintain by the states in which the organization is licensed to issue qualified health plans.
13b
 
c
Enter the aggregate amount of reserves on hand.
13c
 
14a
Did the organization receive any payments for indoor tanning services during the tax year?.....
14a
 
 
b
If "Yes," has it filed a Form 720 to report these payments? If “No,” provide an explanation in Schedule O..
14b
 
 
Form 990 (2011)
Form 990 (2011)
Page 6
Part VI
Governance, Management, and Disclosure For each “Yes” response to lines 2 through 7b below, and for a “No” response to lines 8a, 8b, or 10b below, describe the circumstances, processes, or changes in Schedule O. See instructions.
Check if Schedule O contains a response to any question in this Part VI .........
Section A. Governing Body and Management
Yes
No
1a
Enter the number of voting members of the governing body at the end of the tax year
If the governing body delegated broad authority to an executive committee or similar committee, explain in Schedule O.
1a
15
b
Enter the number of voting members included in line 1a, above, who are independent .................
1b
9
2
Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other officer, director, trustee, or key employee? .................
2
 
No
3
Did the organization delegate control over management duties customarily performed by or under the direct supervision of officers, directors or trustees, or key employees to a management company or other person? .
3
 
No
4
Did the organization make any significant changes to its governing documents since the prior Form 990 was filed?
4
 
No
5
Did the organization become aware during the year of a significant diversion of the organization’s assets? .
5
 
No
6
Did the organization have members or stockholders? ................
6
Yes
 
7a
Did the organization have members, stockholders, or other persons who had the power to elect or appoint one or more members of the governing body? .................
7a
Yes
 
b
Are any governance decisions of the organization reserved to (or subject to approval by) members, stockholders, or persons other than the governing body? ............
7b
Yes
 
8
Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:
a
The governing body? .........................
8a
Yes
 
b
Each committee with authority to act on behalf of the governing body? ..........
8b
Yes
 
9
Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the organization’s mailing address? If “Yes,” provide the names and addresses in Schedule O .....
9
 
No
Section B. Policies (This Section B requests information about policies not required by the Internal
Revenue Code.)
Yes
No
10a
Did the organization have local chapters, branches, or affiliates? ............
10a
Yes
 
b
If “Yes,” did the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with the organization's exempt purposes? ....
10b
Yes
 
11a
Has the organization provided a complete copy of this Form 990 to all members of its governing body before filing the form?
11a
 
No
b
Describe in Schedule O the process, if any, used by the organization to review the Form 990. .....
12a
Did the organization have a written conflict of interest policy? If “No,” go to line 13.......
12a
Yes
 
b
Were officers, directors or trustees, and key employees required to disclose annually interests that could give rise to conflicts? ........................
12b
Yes
 
c
Did the organization regularly and consistently monitor and enforce compliance with the policy? If “Yes,” describe in Schedule O how this was done ....................
12c
Yes
 
13
Did the organization have a written whistleblower policy? ...............
13
Yes
 
14
Did the organization have a written document retention and destruction policy? .........
14
Yes
 
15
Did the process for determining compensation of the following persons include a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision?
a
The organization’s CEO, Executive Director, or top management official ...........
15a
 
No
b
Other officers or key employees of the organization ................
15b
Yes
 
If "Yes," to line 15a or 15b, describe the process in Schedule O (see instructions).
16a
Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a taxable entity during the year? ......................
16a
 
No
b
If “Yes,” did the organization follow a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and take steps to safeguard the organization’s exempt status with respect to such arrangements? ............
16b
 
 
Section C. Disclosure
17
List the States with which a copy of this Form 990 is required to be filedMediumBullet
IN
18
Section 6104 requires an organization to make its Form 1023 (or 1024 if applicable), 990, and 990-T (501(c)(3)s only) available for public inspection. Indicate how you made these available. Check all that apply.
19
Describe in Schedule O whether (and if so, how), the organization made its governing documents, conflict of interest policy, and financial statements available to the public during the tax year.
20
State the name, physical address, and telephone number of the person who possesses the books and records of the organization: MediumBullet
MARK A RAFALSKI
PO BOX 250 1007 LINCOLNWAY
LAPORTE,IN46352
(219) 326-1234
Form 990 (2011)
Form 990 (2011)
Page 7
Part VII
Compensation of Officers, Directors,Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors
Check if Schedule O contains a response to any question in this Part VII .........
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees
1a Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the organization’s tax year.
RoundBullet List all of the organization’s current officers, directors, trustees (whether individuals or organizations), regardless of amount
of compensation, and current key employees. Enter -0- in columns (D), (E), and (F) if no compensation was paid.

RoundBullet List all of the organization’s current key employees, if any. See instructions for definition of "key employee."
RoundBullet List the organization’s five current highest compensated employees (other than an officer, director, trustee or key employee)
who received reportable compensation (Box 5 of Form W-2 and/or Box 7 of Form 1099-MISC) of more than $100,000 from the
organization and any related organizations.

RoundBullet List all of the organization’s former officers, key employees, or highest compensated employees who received more than $100,000
of reportable compensation from the organization and any related organizations.

RoundBullet List all of the organization’s former directors or trustees that received, in the capacity as a former director or trustee of the
organization, more than $10,000 of reportable compensation from the organization and any related organizations.

List persons in the following order: individual trustees or directors; institutional trustees; officers; key employees; highest
compensated employees; and former such persons.
Check this box if neither the organization nor any related organizations compensated any current or former officer, director, or trustee.
(A)
Name and Title 		(B)
Average hours per week (describe hours for related organizations in Schedule O) 		(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee) 		(D)
Reportable compensation from the organization (W- 2/1099-MISC) 		(E)
Reportable compensation from related organizations (W- 2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; Officer; Key Employee; Highest compensated employee; Former;
(1) Dr John Rogers
SECRETARY/TREASURER
 40.0 X   X       208,052 0 26,002
(2) Dr James Serwatka
BOARD MEMBER/PHYSICIAN
 40.0 X           125,148 0 13,905
(3) Thor Thordarson
PRESIDENT & CEO/BOARD MEMBER
 5.0 X   X       0 430,938 37,451
(4) Rhonda Volk
BOARD MEMBER/VICE PRESIDENT
 40.0 X   X       144,794 0 6,067
(5) John Weithers
BOARD MEMBER
 2.0 X           0 0 0
(6) Paul Wilkins
BOARD MEMBER
 2.0 X           0 0 0
(7) Cindy Berchem
BOARD MEMBER
 2.0 X           0 0 0
(8) Dr Caroline Bjonback
BOARD MEMBER/PHYSICIAN
 40.0 X           115,247 0 14,275
(9) Cathy Buckman
BOARD MEMBER
 2.0 X           0 0 0
(10) Dr Rodney Guimont
BOARD MEMBER/PHYSICIAN
 40.0 X           192,202 0 7,751
(11) Jonathan Howes
BOARD MEMBER
 2.0 X           0 0 0
(12) Mark Kendall
CHAIRPERSON
 2.0 X   X       0 0 0
(13) David McCain
BOARD MEMBER
 2.0 X           0 0 0
(14) Sandra Menne
BOARD MEMBER
 2.0 X           0 0 0
(15) Drummond Osborn
BOARD MEMBER
 2.0 X           0 0 0
(16) Mark Rafalski
CFO
 5.0     X       0 289,206 28,554
(17) Stephanie Smith
CFO (through 4/20/11)
 5.0     X       0 155,828 13,330
Form 990 (2011)
Form 990 (2011)
Page 8
Part VII
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (continued)
(A)
Name and Title 		(B)
Average hours per week (describe hours for related organizations in Schedule O) 		(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee) 		(D)
Reportable compensation from the organization (W- 2/1099-MISC) 		(E)
Reportable compensation from related organizations (W- 2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; Officer; Key Employee; Highest compensated employee; Former;
(18) Dr David Gorecki
PHYSICIAN
 40.0         X   824,285 0 26,899
(19) Dr Thomas Magill
PHYSICIAN
 40.0         X   702,160 0 36,747
(20) Dr Roman Filipowicz
PHYSICIAN
 40.0         X   705,665 0 34,852
(21) Dr McKindra Fletcher
PHYSICIAN
 40.0         X   720,497 0 35,431
(22) Dr Julius Ellis
PHYSICIAN
 40.0         X   694,496 0 34,760
















1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)............MediumBullet 4,432,546 875,972 316,024
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organizationMediumBullet58
Yes
No
3
Did the organization list any former officer, director or trustee, key employee, or highest compensated employee on line 1a? If “Yes,” complete Schedule J for such individual .............
3
 
No
4
For any individual listed on line 1a, is the sum of reportable compensation and other compensation from the organization and related organizations greater than $150,000? If “Yes,” complete Schedule J for such individual...........................
4
Yes
 
5
Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual for services rendered to the organization? If “Yes,” complete Schedule J for such person .....
5
 
No
Section B. Independent Contractors
1
Complete this table for your five highest compensated independent contractors that received more than $100,000 of compensation from the organization. Report compensation for the calendar year ending with or within the organization’s tax year.
(A)
Name and business address 		(B)
Description of services 		(C)
Compensation
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization MediumBullet0
Form 990 (2011)
Form 990 (2011)
Page 9
Part VIII
Statement of Revenue
(A)
Total revenue 		(B)
Related or
exempt
function
revenue 		(C)
Unrelated
business
revenue 		(D)
Revenue
excluded from
tax under sections
512, 513, or 514
Contributions, Gifts, Grants and Other Similar Amounts 1a Federated campaigns..1a  
b Membership dues....1b  
c Fundraising events....1c  
d Related organizations...1d  
e Government grants (contributions)1e  
f All other contributions, gifts, grants, and
similar amounts not included above1f 		 
g Noncash contributions included in lines 1a-1f:$  
h Total. Add lines 1a-1f.......MediumBullet 0
Program Service Revenue Business Code
2a NET PATIENT SERVICE REVENUE 621,110 23,997,037 23,997,037    
b
c
d
e
f All other program service revenue .        
g Total. Add lines 2a–2f........MediumBullet 23,997,037
Other Revenue 3 Investment income (including dividends, interest
and other similar amounts).....MediumBullet 1,436     1,436
4 Income from investment of tax-exempt bond proceeds..MediumBullet 0      
5 Royalties............MediumBullet 0      
(i) Real (ii) Personal
6a Gross rents    
b Less: rental expenses    
c Rental income or (loss)    
d Net rental income or (loss).......MediumBullet        
(i) Securities (ii) Other
7a Gross amount from sales of assets other than inventory    
b Less: cost or other basis and sales expenses    
c Gain or (loss)    
d Net gain or (loss)..........MediumBullet 0      
8a Gross income from fundraising events (not including
$  
of contributions reported on line 1c). See Part IV, line 18 ...
a  
b Less: direct expenses ...b  
c Net income or (loss) from fundraising events..MediumBullet 0    
9a Gross income from gaming activities.
See Part IV, line 19 ...
a  
b Less: direct expenses ...b  
c Net income or (loss) from gaming activities...MediumBullet 0      
10a Gross sales of inventory, less
returns and allowances .
a  
b Less: cost of goods sold ..b  
c Net income or (loss) from sales of inventory..MediumBullet 0      
Miscellaneous Revenue Business Code
11a LEASED EMPLOYEE REVENUE 900,099 156,313     156,313
b CHC MGMT FEE 900,099 24,000     24,000
c OTHER REVENUE 900,099 -2,207     -2,207
d All other revenue ....        
e Total. Add lines 11a–11d ......MediumBullet 178,106
12 Total revenue. See Instructions....MediumBullet 24,176,579 23,997,037 0 179,542
Form 990 (2011)
Form 990 (2011)
Page 10
Part IX
Statement of Functional Expenses
Section 501(c)(3) and 501(c)(4) organizations must complete all columns. All other organizations must complete column (A) but are not required to complete columns (B), (C), and (D).
Check if Schedule O contains a response to any question in this Part IX. .........
Do not include amounts reported on lines 6b,
7b, 8b, 9b, and 10b of Part VIII. 		(A)
Total expenses 		(B)
Program service expenses 		(C)
Management and general expenses 		(D)
Fundraising expenses
1 Grants and other assistance to governments and organizations in the United States. See Part IV, line 21 0  
2 Grants and other assistance to individuals in the United States. See Part IV, line 22 0  
3 Grants and other assistance to governments, organizations, and individuals outside the United States. See Part IV, lines 15 and 16 0  
4 Benefits paid to or for members 0  
5 Compensation of current officers, directors, trustees, and key employees .... 853,443   853,443  
6 Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .... 0      
7 Other salaries and wages 26,337,114 21,752,447 4,584,667  
8 Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) .... 0      
9 Other employee benefits ....... 21,515 17,212 4,303  
10 Payroll taxes ........... 1,306,201 1,044,961 261,240  
11 Fees for services (non-employees):        
a Management ...... 24,923 19,938 4,985  
b Legal ......... 0      
c Accounting ........... 0      
d Lobbying ........... 0      
e Professional fundraising. See Part IV, line 17.. 0  
f Investment management fees ...... 8,320 6,656 1,664  
g Other .......... 1,800,681 1,440,545 360,136  
12 Advertising and promotion .... 10,025 8,020 2,005  
13 Office expenses ....... 1,908,777 1,527,022 381,755  
14 Information technology ...... 717,730 574,184 143,546  
15 Royalties .. 0      
16 Occupancy ........... 2,252,615 1,802,092 450,523  
17 Travel ............ 83,190 66,552 16,638  
18 Payments of travel or entertainment expenses for any federal, state, or local public officials ...... 0      
19 Conferences, conventions, and meetings .... 0      
20 Interest ........... 74,331 59,465 14,866  
21 Payments to affiliates ....... 0      
22 Depreciation, depletion, and amortization ..... 678,689 542,951 135,738  
23 Insurance .............. 0      
24 Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24f. If line 24f amount exceeds 10% of line 25, column (A) amount, list line 24f expenses on Schedule O.)
a BAD DEBT 1,420,279 1,420,279    
b DUES & AFFILIATIONS 89,435 71,548 17,887  
c MISCELLANEOUS 101,869 81,495 20,374  
d
e
f All other expenses        
25 Total functional expenses. Add lines 1 through 24f 37,689,137 30,435,367 7,253,770 0
26 Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here MediumBullet if following SOP 98-2 (ASC 958-720).        
Form 990 (2011)
Form 990 (2011)
Page 11
Part X Balance Sheet
(A)
Beginning of year 		(B)
End of year
Assets 1 Cash—non-interest-bearing .......... 0 1 0
2 Savings and temporary cash investments ....... 969,365 2 442,743
3 Pledges and grants receivable, net ......... 0 3 0
4 Accounts receivable, net ......... 3,619,962 4 4,378,672
5 Receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
Schedule L .......... 0 5 0
6 Receivables from other disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B). Complete Part II of
Schedule L .......... 0 6 0
7 Notes and loans receivable, net ............. 0 7 0
8 Inventories for sale or use .............. 0 8 0
9 Prepaid expenses and deferred charges ............ 391,606 9 354,059
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 6,183,512
b Less: accumulated depreciation. ..... 10b 3,279,012 2,275,005 10c 2,904,500
11 Investments—publicly traded securities .......... 0 11 0
12 Investments—other securities. See Part IV, line 11 ...... 0 12 0
13 Investments—program-related. See Part IV, line 11 .. 0 13 0
14 Intangible assets ......... 0 14 0
15 Other assets. See Part IV, line 11 ........... 2,283,142 15 2,868,305
16 Total assets. Add lines 1 through 15 (must equal line 34)... 9,539,080 16 10,948,279
Liabilities 17 Accounts payable and accrued expenses . 1,959,320 17 2,631,011
18 Grants payable .......... 0 18 0
19 Deferred revenue .......... 0 19 0
20 Tax-exempt bond liabilities .......... 0 20 0
21 Escrow or custodial account liability. Complete Part IV of Schedule D.. 0 21 0
22 Payables to current and former officers, directors, trustees, key
employees, highest compensated employees, and disqualified
persons. Complete Part II of Schedule L.......... 0 22 0
23 Secured mortgages and notes payable to unrelated third parties .. 967,987 23 737,747
24 Unsecured notes and loans payable to unrelated third parties .... 0 24 0
25 Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D..... 0 25 0
26 Total liabilities. Add lines 17 through 25..... 2,927,307 26 3,368,758
Net Assets or Fund Balance Organizations that follow SFAS 117, check here MediumBullet and complete lines 27 through 29, and lines 33 and 34.
27 Unrestricted net assets ..... 6,611,773 27 7,579,521
28 Temporarily restricted net assets ..... 0 28 0
29 Permanently restricted net assets ..... 0 29 0
Organizations that do not follow SFAS 117, check here MediumBullet and complete lines 30 through 34.
30 Capital stock or trust principal, or current funds .....   30  
31 Paid-in or capital surplus, or land, building or equipment fund .....   31  
32 Retained earnings, endowment, accumulated income, or other funds   32  
33 Total net assets or fund balances ..... 6,611,773 33 7,579,521
34 Total liabilities and net assets/fund balances ..... 9,539,080 34 10,948,279
Form 990 (2011)
Form 990 (2011)
Page 12
Part XI
Reconcilliation of Net Assets
Check if Schedule O contains a response to any question in this Part XI .........
1
Total revenue (must equal Part VIII, column (A), line 12) ...
1
24,176,579
2
Total expenses (must equal Part IX, column (A), line 25) ....
2
37,689,137
3
Revenue less expenses. Subtract line 2 from line 1 ...
3
-13,512,558
4
Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) ..
4
6,611,773
5
Other changes in net assets or fund balances (explain in Schedule O) ...
5
14,480,306
6
Net assets or fund balances at end of year. Combine lines 3, 4, and 5 (must equal Part X, line 33, column (B)) ....
6
7,579,521
Part XII
Financial Statements and Reporting
Check if Schedule O contains a response to any question in this Part XII .........
Yes
No
1
Accounting method used to prepare the Form 990:  
If the organization changed its method of accounting from a prior year or checked "Other," explain in
Schedule O.
2a
Were the organization’s financial statements compiled or reviewed by an independent accountant?....
2a
 
No
b
Were the organization’s financial statements audited by an independent accountant?........
2b
Yes
 
c
If “Yes,” to 2a or 2b, does the organization have a committee that assumes responsibility for oversight of the audit, review, or compilation of its financial statements and selection of an independent accountant? If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O. ...........................
2c
Yes
 
d
If “Yes” to line 2a or 2b, check a box below to indicate whether the financial statements for the year were issued on a separate basis, consolidated basis, or both:
3a
As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the Single Audit Act and OMB Circular A-133? ................
3a
 
No
b
If “Yes,” did the organization undergo the required audit or audits? If the organization did not undergo the required audit or audits, explain why in Schedule O and describe any steps taken to undergo such audits. ..
3b
 
 
Form 990 (2011)
Additional Data


Software ID:  
Software Version:  
Form 990, Special Condition Description:
Special Condition Description
SCHEDULE A
(Form 990 or 990EZ)

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.
right arrow Attach to Form 990 or Form 990-EZ. right arrow See separate instructions.
OMB No. 1545-0047
2011
Open to Public
Inspection
Name of the organization
INDIANA UNIVERSITY HEALTH LAPORTE
PHYSICIANS INC
Employer identification number

31-1070868
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
f
g
(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
(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) 2011
Schedule A (Form 990 or 990-EZ) 2011
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) 2007 (b) 2008 (c) 2009 (d) 2010 (e) 2011 (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) 2007 (b) 2008 (c) 2009 (d) 2010 (e) 2011 (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
12
 
13
Section C. Computation of Public Support Percentage
14
14
 
15
15
 
16a
b
17a
b
18
Schedule A (Form 990 or 990-EZ) 2011
Schedule A (Form 990 or 990-EZ) 2011
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) 2007 (b) 2008 (c) 2009 (d) 2010 (e) 2011 (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) 2007 (b) 2008 (c) 2009 (d) 2010 (e) 2011 (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
Section C. Computation of Public Support Percentage
15
15
 
16
16
 
Section D. Computation of Investment Income Percentage
17
17
 
18
18
 
19a
b
20
Schedule A (Form 990 or 990-EZ) 2011
Schedule A (Form 990 or 990-EZ) 2011
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
Although Indiana University Health La Porte Physicians, Inc. qualifies as a public charity under 170(b)(1)(A)(iii), it does not operate a hospital and is therefore not required to complete Schedule H.
 
 
 
Schedule A (Form 990 or 990-EZ) 2011

Additional Data


Software ID:  
Software Version:  
SCHEDULE D
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Financial Statements
SchDMd Bullet Complete if the organization answered "Yes," to Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b
SchDMd Bullet Attach to Form 990. SchDMd Bullet See separate instructions.
OMB No. 1545-0047
2011
Open to Public Inspection
Name of the organization
INDIANA UNIVERSITY HEALTH LAPORTE
PHYSICIANS INC
Employer identification number

31-1070868
Part I
Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" to Form 990, Part IV, line 6.
(a) Donor advised funds (b) Funds and other accounts
1 Total number at end of year .......    
2 Aggregate contributions to (during year) ...    
3 Aggregate grants from (during year) ...    
4 Aggregate value at end of year .......    
5
Did the organization inform all donors and donor advisors in writing that the assets held in donor advised
funds are the organization's property, subject to the organization's exclusive legal control? ............
6
Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be
used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ...................................
Part II
Conservation Easements. Complete if the organization answered "Yes" to Form 990, Part IV, line 7.
1
Purpose(s) of conservation easements held by the organization (check all that apply).
2
Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.
Held at the End of the Year
a Total number of conservation easements ....................... 2a  
b Total acreage restricted by conservation easements .................. 2b  
c Number of conservation easements on a certified historic structure included in (a) ..... 2c  
d Number of conservation easements included in (c) acquired after 8/17/06, and not on a historic structure listed in the National Register .................... 2d  
3
Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the tax year SchDMd Bullet  
4
Number of states where property subject to conservation easement is located SchDMd Bullet  
5
Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and
enforcement of the conservation easements it holds? .............................
6
Staff and volunteer hours devoted to monitoring, inspecting and enforcing conservation easements during the year SchDMd Bullet  
7
Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet $  
8
Does each conservation easement reported on line 2(d) above satisfy the requirements of section
170(h)(4)(B)(i) and 170(h)(4)(B)(ii)? ....................................
9
In Part XIV, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" to Form 990, Part IV, line 8.
1a
If the organization elected, as permitted under SFAS 116 (ASC 958), not to report in its revenue statement and balance sheet works of
art, historical treasures, or other similar assets held for public exhibition, education or research in furtherance of public service,
provide, in Part XIV, the text of the footnote to its financial statements that describes these items.
b
If the organization elected, as permitted under SFAS 116 (ASC 958), to report in its revenue statement and balance sheet works of art,
historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service,
provide the following amounts relating to these items:
(i)
Revenues included in Form 990, Part VIII, line 1 ........................SchDMd Bullet $  
(ii)
Assets included in Form 990, Part X ..............................SchDMd Bullet $  
2
If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under SFAS 116 (ASC 958), relating to these items:
a
Revenues included in Form 990, Part VIII, line 1 ..........................SchDMd Bullet $  
b
Assets included in Form 990, Part X ...............................SchDMd Bullet $  
For Privacy Act and Paperwork Reduction Act Notice, see the Intructions for Form 990
Cat. No. 52283D
Schedule D (Form 990) 2011

Schedule D (Form 990) 2011
Page 2
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)
3
Using the organization’s accession and other records, check any of the following that are a significant use of its collection
items (check all that apply):
a
d
b
e
 
c
4
Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIV.
5
During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?........
Part IV
Escrow and Custodial Arrangements. Complete if the organization answered "Yes" to Form 990,
Part IV, line 9, or reported an amount on Form 990, Part X, line 21.
1a
Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................
b
If "Yes," explain the arrangement in Part XIV and complete the following table:
Amount
c Beginning balance ................................. 1c  
d Additions during the year .............................. 1d  
e Distributions during the year ............................. 1e  
f Ending balance ................................... 1f  
2a
Did the organization include an amount on Form 990, Part X, line 21? .....................
b
If “Yes,” explain the arrangement in Part XIV.
Part V
Endowment Funds. Complete if the organization answered "Yes" to Form 990, Part IV, line 10.
(a)Current Year (b)Prior Year (c)Two Years Back (d)Three Years Back (e)Four Years Back
1a Beginning of year balance ....        
b Contributions ........        
c Net investment earnings, gains, and losses ...        
d Grants or scholarships .....        
e Other expenditures for facilities
and programs ........ 		       
f Administrative expenses ....        
g End of year balance ......        
2
Provide the estimated percentage of the year end balance (line 1g) held as:
a
Board designated or quasi-endowment SchDMd Bullet  
b
Permanent endowment SchDMd Bullet  
c
Temporarily restricted endowment SchDMd Bullet  
The percentages in lines 2a, 2b, and 2c should equal 100%.
3a
Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes
No
(i) unrelated organizations ........................
3a(i)
 
 
(ii) related organizations ........................
3a(ii)
 
 
b
If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? .........
3b
 
 
4
Describe in Part XIV the intended uses of the organization's endowment funds.
Part VI
Land, Buildings, and Equipment. See Form 990, Part X, line 10.
Description of property (a) Cost or other basis (investment) (b)Cost or other basis (other) (c) Accumulated depreciation (d) Book value
1a Land .................      
b Buildings ................        
c Leasehold improvements ............   429,332 181,403 247,929
d Equipment ................   5,741,022 3,097,609 2,643,413
e Other .................   13,158 0 13,158
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......SchDMdBullet 2,904,500
Schedule D (Form 990) 2011

Schedule D (Form 990) 2011
Page 3
Part VII
Investments—Other Securities. See Form 990, Part X, line 12.
(a) Description of security or category
(including name of security)		 (b)Book value (c) Method of valuation:
Cost or end-of-year market value
(1)Financial derivatives    
(2)Closely-held equity interests    
Other








Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)Small Bullet  
Part VIII
Investments—Program Related. See Form 990, Part X, line 13.
(a) Description of investment type (b) Book value (c) Method of valuation:
Cost or end-of-year market value








Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)Small Bullet  
Part IX
Other Assets. See Form 990, Part X, line 15.
(a) Description (b) Book value
(1) GOODWILL 2,868,305








Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........Small Bullet 2,868,305
Part X
Other Liabilities. See Form 990, Part X, line 25.
1.(a) Description of Liability (b) Book value
Federal Income Taxes  








Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)Small Bullet  
2. Fin 48 (ASC 740) Footnote. In Part XIV, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC740).
Schedule D (Form 990) 2011

Schedule D (Form 990) 2011
Page 4
Part XI Reconciliation of Change in Net Assets from Form 990 to Financial Statements
1 Total revenue (Form 990, Part VIII, column (A), line 12) .................... 1  
2 Total expenses (Form 990, Part IX, column (A), line 25) ..................... 2  
3 Excess or (deficit) for the year. Subtract line 2 from line 1 ............. 3  
4 Net unrealized gains (losses) on investments .......................... 4  
5 Donated services and use of facilities ............................. 5  
6 Investment expenses ................................... 6  
7 Prior period adjustments .................................. 7  
8 Other (Describe in Part XIV.) ................................. 8  
9 Total adjustments (net). Add lines 4 through 8 ......................... 9  
10 Excess or (deficit) for the year per financial statements. Combine lines 3 and 9 ......... 10  
Part XII Reconciliation of Revenue per Audited Financial Statements With Revenue per Return
1 Total revenue, gains, and other support per audited financial statements ....... 1  
2 Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a Net unrealized gains on investments .......... 2a  
b Donated services and use of facilities ......... 2b  
c Recoveries of prior year grants ........... 2c  
d Other (Describe in Part XIV.) ............ 2d  
e Add lines 2a through 2d ..................... 2e  
3 Subtract line 2e from line 1..................... 3  
4 Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b . 4a  
b Other (Describe in Part XIV.) ........... 4b  
c Add lines 4a and 4b....................... 4c  
5 Total Revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ...... 5  
Part XIII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return
1 Total expenses and losses per audited financial statements ............. 1  
2 Amounts included on line 1 but not on Form 990, Part IX, line 25:
a Donated services and use of facilities .......... 2a  
b Prior year adjustments .............. 2b  
c Other losses ................ 2c  
d Other (Describe in Part XIV.) ............ 2d  
e Add lines 2a through 2d...................... 2e  
3 Subtract line 2e from line 1..................... 3  
4 Amounts included on Form 990, Part IX, line 25, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b .. 4a  
b Other (Describe in Part XIV.) ............ 4b  
c Add lines 4a and 4b....................... 4c  
5 Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ...... 5  
Part XIV
Supplemental Information
Complete this part to provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b;
Part V, line 4; Part X; Part XI, line 8; Part XII, lines 2d and 4b; and Part XIII, lines 2d and 4b. Also complete this part to provide any additional information.
Identifier Return Reference Explanation
FIN 48 Footnote Schedule D, Part X, Line 2 Indiana University Health La Porte Physicians, Inc. is a subsidiary in the consolidated financial statements of Indiana University Health, Inc. Indiana University Health, Inc. adopted FIN 48 in 2007. No disclosures were required under GAAP as Indiana University Health, Inc. does not have any material tax contingencies that required disclosures in the footnotes.
Schedule D (Form 990) 2011

Additional Data


Software ID:  
Software Version:  




Schedule J
(Form 990)
Department of the Treasury
Internal Revenue Service
Compensation Information
For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet Complete if the organization answered "Yes" to Form 990,
Part IV, question 23.
SchJMediumBullet Attach to Form 990. SchJMediumBullet See separate instructions.
OMB No. 1545-0047
2011
Open to Public Inspection
Name of the organization
INDIANA UNIVERSITY HEALTH LAPORTE
PHYSICIANS INC
Employer identification number

31-1070868
Part I
Questions Regarding Compensation
Yes
No
1a
Check the appropiate box(es) if the organization provided any of the following to or for a person listed in Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.
b
If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all the expenses described above? If "No," complete Part III to explain....
1b
 
 
2
Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
officers, directors, trustees, and the CEO/Executive Director, regarding the items checked in line 1a? ....
2
 
 
3
Indicate which, if any, of the following the organization uses to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.
4
During the year, did any person listed in Form 990, Part VII, Section A, line 1a with respect to the filing organization or a related organization:
a
Receive a severance payment or change-of-control payment? ...............
4a
 
No
b
Participate in, or receive payment from, a supplemental nonqualified retirement plan? ........
4b
Yes
 
c
Participate in, or receive payment from, an equity-based compensation arrangement? ........
4c
 
No
If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.
Only 501(c)(3) and 501(c)(4) organizations only must complete lines 5-9.
5
For persons listed in form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:
a
The organization? ...........................
5a
 
No
b
Any related organization? .........................
5b
 
No
If "Yes," to line 5a or 5b, describe in Part III.
6
For persons listed in form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:
a
The organization? ...........................
6a
 
No
b
Any related organization? .........................
6b
 
No
If "Yes," to line 6a or 6b, describe in Part III.
7
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization provide any non-fixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............
7
 
No
8
Were any amounts reported in Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III .............................
8
 
No
9
If "Yes" to line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................
9
 
 
For Privacy Act and Paperwork Reduction Act Notice, see the Intructions for Form 990
Cat. No. 50053T
Schedule J (Form 990) 2011

Schedule J (Form 990) 2011
Page 2
Part II
Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed.
For each individual whose compensation must be reported in Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.

Note. The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and column (E) for that individual.
(A) Name (B) Breakdown of W-2 and/or 1099-MISC compensation (C) Retirement and other deferred compensation (D) Nontaxable
benefits		 (E) Total of columns
(B)(i)-(D) 		(F) Compensation
reported as deferred
in prior Form 990
(i) Base compensation (ii) Bonus & incentive compensation (iii) Other reportable compensation
(1) Dr John Rogers (i)
(ii)		 192,215
0 		2,079
0 		13,758
0 		16,271
0 		9,731
0 		234,054
0 		0
0
(2) Thor Thordarson (i)
(ii)		 0
416,908 		0
280 		0
13,750 		0
29,619 		0
7,832 		0
468,389 		0
0
(3) Rhonda Volk (i)
(ii)		 143,362
0 		880
0 		552
0 		2,911
0 		3,156
0 		150,861
0 		0
0
(4) Dr Rodney Guimont (i)
(ii)		 190,777
0 		1,425
0 		0
0 		3,693
0 		4,058
0 		199,953
0 		0
0
(5) Mark Rafalski (i)
(ii)		 0
262,410 		0
972 		0
25,824 		0
20,319 		0
8,235 		0
317,760 		0
0
(6) Dr David Gorecki (i)
(ii)		 822,929
0 		324
0 		1,032
0 		25,872
0 		1,027
0 		851,184
0 		0
0
(7) Dr Thomas Magill (i)
(ii)		 291,600
0 		399,297
0 		11,263
0 		27,066
0 		9,681
0 		738,907
0 		0
0
(8) Dr Roman Filipowicz (i)
(ii)		 645,417
0 		33,685
0 		26,563
0 		29,650
0 		5,202
0 		740,517
0 		0
0
(9) Dr McKindra Fletcher (i)
(ii)		 719,234
0 		250
0 		1,013
0 		29,650
0 		5,781
0 		755,928
0 		0
0
(10) Dr Julius Ellis (i)
(ii)		 494,218
0 		181,346
0 		18,932
0 		29,570
0 		5,190
0 		729,256
0 		0
0
(11) Stephanie Smith (i)
(ii)		 0
149,924 		0
880 		0
5,024 		0
7,592 		0
5,738 		0
169,158 		0
0





Schedule J (Form 990) 2011

Schedule J (Form 990) 2011
Page 3
Part III
Supplemental Information
Complete this part to provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4c, 5a, 5b, 6a, 6b, 7, and 8. Also complete this part for any additional information.
Identifier Return Reference Explanation
Schedule J, Part I, Line 3   Officers receive compensation for services provided as employees of Indiana University Health LaPorte Physicians, Inc. and not for their role as board member. The CEO's compensation is determined by Indiana University Health LaPorte Hospital, Inc., a related organization, which uses the following process to establish compensation: Compensation committee, Independent compensation consultant, Written employment contract, Compensation survey or study, and Approval by the board or compensation committee.
Schedule J, Part I, Line 4b   Certain executives participate in a supplemental retirement plan, provisions of which are designed to retain these critical employees. The plan provides for an additional retirement benefit for service through normal retirement or other key dates. If the executive leaves prior to retirement or other key dates, the benefit may be forfeited or reduced.
Schedule J (Form 990) 2011

Additional Data


Software ID:  
Software Version:  
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.
MediumBullet Attach to Form 990 or 990-EZ.
OMB No. 1545-0047
2011
Open to Public
Inspection
Name of the organization
INDIANA UNIVERSITY HEALTH LAPORTE
PHYSICIANS INC
Employer identification number

31-1070868
Identifier Return Reference Explanation
Description of Classes of Members or Stockholders Form 990, Part VI, Lines 6, 7a & 7b Description of Classes of Members or Stockholders Indiana University Health La Porte Hospital, Inc. (IUHLH) is the sole member of Indiana University Health La Porte Physicians, Inc. (IUHLP). The Board of Directors of IUHLP shall consist of not more than seventeen (17) persons who shall be selected in the following manner: (a) The following persons shall serve as members of the Board of Directors ex-officio: 1. The Vice Chairperson of IUHLH Board of Directors; 2. The Chief Executive Officer and President of IUHLH; and 3. A member of the IUHLH Board of Directors shall be selected annually by the IUHLH Board of Directors who shall not be affiliated with or employed by IUHLH or IUHLP. 4. Person designated by the Chief Executive Officer and President of IUHLH as the administrator responsible for the day-to-day operations of IUHLP (the "Manager"). (b) Four (4) Directors shall be employed IUHLP physicians selected by the IUHLP physicians' organization subject to the approval of the IUHLP and IUHLH Boards of Directors. (Added 10/22/05) (c) The remaining directors shall be individuals who are not employed by, or receive compensation from IUHLP or IUHLH ("Community Directors"). Such Community Directors shall comprise a majority of the membership of the Board of Directors. A list of prospective nominees to be elected to serve as Community Directors shall be prepared by the IUHLP Nominating Committee consisting of the IUHLP Chairperson, the Manager of IUHLP, the Chief Executive Officer/President of IUHLH, and the Chairperson of the IUHLH Executive/Finance Committee or its Special Nominating Committee. This list shall then be submitted to the IUHLP Board of Directors for its approval, and then, if so approved, be forwarded to the IUHLH Board of Directors as a recommendation of individuals to be nominated to serve on the IUHLP Board of Directors. (d) Those community directors selected by the IUHLH Board shall serve for terms not to exceed three (3) years, or until the election and qualification of their successor, whichever occurs first. The employed directors, except for the Manager of IUHLP and the IUHLP Chief Executive Officer and President of IUHLH, shall serve for terms of two (2) years. Any vacancies on the Board of Directors are to be filled by the action of the IUHLH Board described in Article III, Section 1, Paragraph c, as to Community Directors, and by the IUHLP Physicians as to Employed IUHLP Physicians. The Directors shall conform to the conflict of interest policy adopted by IUHLH. The CEO of IUHLH shall select and appoint a competent executive who shall be its representative in the management of IUHLP and who shall be designated by the title of "Manager". The Manager shall be given the necessary authority and responsibility to operate IUHLP in all its activities and departments, subject only to such policies as may be issued by Board or by IUHLH. By virtue of his or her office, the Manager serves as a voting member of the Board of Directors. The Board will be accountable to the IUHLH Board of Directors for the effective and efficient operation of IUHLP. The Board shall have primary responsibility for compliance with all necessary licensures and accreditation standards, assuring that the care, services and products are uniformly high, and that such care, services and products are provided efficiently and effectively. The Board will monitor the overall performance of IUHLP and help to assure its ongoing vitality and viability. Operating policies and procedures and relationships with other physician groups are also the province of the IUHLP Board. Amendments to these Bylaws may be recommended to the IUHLH Board by affirmative vote of a two-thirds (2/3) majority of the Board members present, at the annual meeting or any regular meeting or any special meeting of IUHLP, provided that a full presentation of such proposed amendments shall have been published in the notice calling the meeting. Notice of the meeting shall be in accordance with the provision of Article III, Section 6 of these Bylaws. Any amendment, or amendments, to be effective must also be approved by the IUHLH Board of Directors.
Describe the Process used by Management &/or Governing Body to Review 990 Form 990, Part VI, Line 11b After the return is prepared by outside public accountants, the 990 is reviewed by the CFO prior to filing. Then it is presented to the board for review and approval after filing with the IRS.
Description of Process to Monitor Transactions for Conflicts of Interest Form 990, Part VI, Line 12c IUHLP Representative at the level of Manager or above is required to complete a questionnaire each year. An IUHLP 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 the completion of the original Questionnaire. The key employees, physicians, officers, directors and trustees questionnaires are forwarded to Administration where they are logged and tracked for compliance. The completed forms are forwarded to legal counsel for review. The legal counsel advises if conflicts arise for members on certain issues, those members do not participate in the discussion and do not vote on the issue. The summary of board conflicts are reviewed with the full board at their first board meeting of the year. The summaries of manager and physician conflicts are reviewed with the CEO and Board Chairman.
Process for Determining Compensation for CEO Form 990, Part VI, Line 15a Multiple salary surveys and market analyses are completed by IUHLH human resources department. Their findings are presented to the IUHLH Transaction and Compensation committee for review and approval of which are documented in the minutes. This process is used for IUHLH CEO who is also the CEO of IUHLP.
Avail of Gov Docs, Conflict of Interest Policy, & Fin Stmts to Gen Public Form 990, Part VI, Line 19 Copies of the 990, Governing documents, conflict of interest statements, IUHLP board of director listing, and financial statements are available to the public from IUHLP Administration upon request.
Other changes in net assets or fund balances Form 990, Part XI, Line 5 A $14,480,306 net adjustment was made to fund balance to eliminate intercompany balances between Indiana University Health La Porte Hospital, Inc. and Indiana University Health La Porte Physicians, Inc.
Form 5471 Disclosure   Indiana University Health LaPorte Physicians, Inc. (FEIN: 31-1070868) constructively owned a controlled foreign corporation in 2011 through its affiliate, Indiana University Health (FEIN: 35-1955875). Pursuant to IRC Section 6038, the 2011 controlled foreign corporation filing requirement of Indiana University Health LaPorte Physicians, Inc. was fulfilled on the 2011 Form 5471 filed on its behalf by: Indiana University Health FEIN: 35-1955872 950 N. Meridian Street, Suite 800 Indianapolis, IN 46204 The 2011 Form 5471 for Indiana University Health was filed at the following IRS processing center: Ogden, UT 84201-0012
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Thor Thordarson TITLE:PRESIDENT & CEO/BOARD MEMBER HOURS:35
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Mark Rafalski TITLE:CFO HOURS:35
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Stephanie Smith TITLE:CFO (through 4/20/11) HOURS:35
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2011

Additional Data


Software ID:  
Software Version:  
SCHEDULE R
(Form 990)
Department of the Treasury
Internal Revenue Service
Related Organizations and Unrelated Partnerships
MediumBulletComplete if the organization answered "Yes" to Form 990, Part IV, line 33, 34, 35, 36, or 37.
MediumBulletAttach to Form 990. MediumBullet See separate instructions.

OMB No. 1545-0047
2011
Open to Public Inspection
Name of the organization
INDIANA UNIVERSITY HEALTH LAPORTE
PHYSICIANS INC
Employer identification number

31-1070868
Part I
Identification of Disregarded Entities (Complete if the organization answered "Yes" on Form 990, Part IV, line 33.)
(a)
Name, address, and EIN of disregarded entity


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

 		(d)
Total income
(e)
End-of-year assets


 		(f)
Direct controlling
entity







(1) IUH Occupational Services La Porte LLC
1007 Lincolnway
La Porte,IN46350
26-3975368 		hlth/wellness IN 1,385,612 469,143 NA
 










Part II
Identification of Related Tax-Exempt Organizations (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.)
(a)
Name, address, and EIN of related organization


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

 		(d)
Exempt Code section
(e)
Public charity status
(if section 501(c)(3))

 		(f)
Direct controlling
entity

 		(g)
Section 512(b)(13) controlled organization
Yes No
(1) Indiana University Health La Porte Hosp

1007 Lincolnway

La Porte,IN46350
35-1125434 		healthcare IN 501(c)(3) 3 IU Health
 
Yes
 
(2) Indiana University Health Arnett Inc

950 N Meridian St Ste 800

Indianapolis,IN46204
26-3162145 		healthcare IN 501(c)(3) 3 IU HEALTH
 
Yes
 
(3) Clarian Transplant Institute Inc

950 N Meridian St Ste 800

Indianapolis,IN46204
13-4350599 		healthcare IN 501(c)(3) 9 IU Health
 
Yes
 
(4) IU Health North Hospital Inc

950 N Meridian St Ste 800

Indianapolis,IN46204
35-1932442 		healthcare IN 501(c)(3) 3 Meth Med Grp
 
Yes
 
(5) Methodist Health Foundation Inc

1800 North Capitol Avenue

Indianapolis,IN46202
35-6043086 		fundraising IN 501(c)(3) 11, Type I IU HEALTH
 
Yes
 
(6) Methodist Health Group Inc

950 N Meridian St Ste 800

Indianapolis,IN46204
35-0876390 		healthcare IN 501(c)(3) 11, III-FI na
 
 
No
(7) Methodist Medical Group Inc

950 N Meridian St Ste 800

Indianapolis,IN46204
35-1945384 		healthcare IN 501(c)(3) 3 IU HEALTH
 
Yes
 
(8) IU Health West Hospital Inc

950 N Meridian St Ste 800

Indianapolis,IN46204
35-1814660 		healthcare IN 501(c)(3) 3 IU Health
 
Yes
 
(9) Methodist Occupational Health Ctrs Inc

950 N Meridian St Ste 800

Indianapolis,IN46204
35-1844176 		healthcare IN 501(c)(3) 3 IU HEALTH
 
Yes
 
(10) Methodist Research Institute Inc

950 N Meridian St Ste 800

Indianapolis,IN46204
35-2023710 		healthcare IN 501(c)(3) 11, Type I IU Health
 
Yes
 
(11) MH Healthcare Inc

950 N Meridian St Ste 800

Indianapolis,IN46204
35-1766531 		healthcare IN 501(c)(3) 3 METH MED GRP
 
Yes
 
(12) IU Health Bedford Inc

2900 West 16th Street

Bedford,IN47421
23-7042323 		healthcare IN 501(c)(3) 3 IU HEALTH
 
Yes
 
(13) Goshen Health System Inc

200 High Park Avenue

Goshen,IN46527
35-1974765 		healthcare IN 501(c)(3) 11, Type I IU Health
 
Yes
 
(14) Goshen Hospital Association Inc

200 High Park Avenue

Goshen,IN46527
35-6001540 		healthcare IN 501(c)(3) 3 GOSH HLH SYS
 
Yes
 
(15) IU Health Tipton Hospital Inc

950 N Meridian St Ste 800

Indianapolis,IN46204
26-2772226 		healthcare IN 501(c)(3) 3 IU HEALTH
 
Yes
 
(16) IU Health Ball Memorial Hospital Inc

2401 West University Avenue

Muncie,IN47303
35-0867958 		healthcare IN 501(c)(3) 3 IU HEALTH
 
Yes
 
(17) IU Health Blackford Hospital Inc

410 Pilgrim Boulevard

Hartford City,IN47348
01-0646166 		healthcare IN 501(c)(3) 3 IUH Ball
 
Yes
 
(18) IU Health Paoli Inc

PO Box 499

Paoli,IN47454
35-2090919 		healthcare IN 501(c)(3) 3 IUH Blooming
 
Yes
 
(19) IU Health Bloomington Inc

PO Box 1149

Bloomington,IN47402
35-1720796 		healthcare IN 501(c)(3) 3 IU HEALTH
 
Yes
 
(20) Ball Memorial Hospital Auxiliary Inc

2401 West University Avenue

Muncie,IN47303
35-6025400 		healthcare IN 501(c)(3) 11, III-FI IUH Ball
 
Yes
 
(21) IU Health Ball Memorial Physicians Inc

2401 West University Avenue

Muncie,IN47303
35-1925641 		healthcare IN 501(c)(3) 9 IUH Ball
 
Yes
 
(22) Indiana University Health Care Assoc

950 N Meridian St Ste 800

Indianapolis,IN46204
35-1747218 		healthcare IN 501(c)(3) 9 IU HEALTH
 
Yes
 
(23) IU Health Ball Memorial Hosp Foundation

2401 West University Avenue

Muncie,IN47303
31-1111784 		fundraising IN 501(c)(3) 11, Type I IUH Ball
 
Yes
 
(24) Indiana University Health Inc

950 N Meridian St Ste 800

Indianapolis,IN46204
35-1955872 		Healthcare IN 501(c)(3) 3 NA
 
 
No
(25) HealthLinc Inc

200 High Park Avenue

Goshen,IN46527
26-3571507 		Healthcare IN 501(c)(3) 3 GOSH HLH SYS
 
Yes
 
(26) IU Health Morgan Hospital Inc

2209 John R Wooden Drive

Martinsville,IN46151
27-3533027 		Healthcare IN 501(c)(3) 3 IU HEALTH
 
Yes
 
(27) IU Health White Memorial Hospital Inc

720 South Sixth Street

Monticello,IN47960
27-3532963 		Healthcare IN 501(c)(3) 3 IU HEALTH
 
Yes
 
(28) Indiana Radiology Partners Inc

950 N Meridian St Ste 800

Indianapolis,IN46204
20-1017034 		Healthcare IN 501(c)(3) 3 IU Health
 
Yes
 
(29) Indiana University Health Arnett Foundat

2600 Greenbush Street

Lafayette,IN47904
35-6079797 		healthcare IN 501(c)(3) 11, Type I IUH Arnett
 
Yes
 
(30) Morgan County Memorial Foundation Inc

2209 John R Wooden Drive

Martinsville,IN46151
35-2035162 		healthcare IN 501(c)(3) 11, Type I IUH Morgan
 
Yes
 
(31) Morgan Health Services Inc

1949 Hospital Drive

Martinsville,IN46151
35-1968564 		healthcare IN 501(c)(3) 3 IUH Morgan
 
Yes
 
(32) White County Memorial Hosp Foundation

PO Box 952

Monticello,IN47960
35-1671806 		healthcare IN 501(c)(3) 11, III-O IUH White
 
Yes
 
(33) IU Health Paoli Hospital Foundation Inc

PO Box 499

Paoli,IN47454
31-0992486 		Fundraising IN 501(c)(3) 11, III-O IUH Paoli
 
Yes
 
(34) IU Medical Group Foundation Inc

340 W 10th St No FS5100

Indianapolis,IN46202
20-1093251 		Fundraising IN 501(c)(3) 11, II NA
 
 
No
(35) Morgan County Memorial Hosp Guild Inc

2209 John R Wooden Dr

Martinsville,IN46151
31-0886844 		Fundraising IN 501(c)(3) 11, III-FI IUH Morgan
 
Yes
 
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2011
Schedule R (Form 990) 2011
Page 2
Part III
Identification of Related Organizations Taxable as a Partnership (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year.)
(a)
Name, address, and EIN of
related organization



 		(b)
Primary activity




 		(c)
Legal
domicile
(state or foreign
country)


 		(d)
Direct controlling
entity



 		(e)
Predominant income(related, unrelated, excluded from tax under sections 512-514)

(f)
Share of total income




 		(g)
Share of end-of-year
assets



 		(h)
Disproprtionate allocations?




 		(i)
Code V—UBI
amount in box 20 of
Schedule K-1
(Form 1065)
 		(j)
General or
managing
partner?



 		(k)
Percentage
ownership
Yes No Yes No
(1) Clarian Health Network LLC

950 N Meridian Street Suite 800
Indianapolis,IN46204
35-2055030 		healthcare IN NA
  		N/A 0 0     0     0 %
(2) Clarian Health North LLC

11700 North Meridian STreet
Carmel,IN46032
43-1980602 		healthcare IN NA
  		N/A 0 0     0     0 %
(3) Clarian Hlth Vent Fund I LLC

950 N Meridian Street Suite 800
Indianapolis,IN46204
26-2523206 		VENTURE CAPITAL IN NA
  		N/A 0 0     0     0 %
(4) Clarian Health West LLC

1111 North Ronald Reagan Parkway
Avon,IN46123
43-1980611 		healthcare IN NA
  		N/A 0 0     0     0 %
(5) Health Venture Management LLC

950 N Meridian Street Suite 800
Indianapolis,IN46204
20-5740218 		MANAGEMENT IN NA
  		N/A 0 0     0     0 %
(6) Indiana Endoscopy Centers LLC

3000 Riverchase Galleria Suite 500
Birmingham,AL35244
20-8398421 		healthcare IN NA
  		N/A 0 0     0     0 %
(7) IN Lakes Managed Care Org LLC

310 S Main Street
Goshen,IN46526
35-1946663 		healthcare IN NA
  		N/A 0 0     0     0 %
(8) Senate St Surgery Center LLC

3000 Riverchase Galleria Suite 500
Birmingham,AL35244
42-1709357 		healthcare IN NA
  		N/A 0 0     0     0 %
(9) The Healthcare Group LLC

8802 N Meridian STreet Suite 100
Indianapolis,IN46260
35-2067373 		managed care IN NA
  		N/A 0 0     0     0 %
(10) Ball Outpatient Surgery Center

3000 Riverchase Galleria Suite 500
Birmingham,AL35244
27-0275794 		healthcare IN NA
  		N/A 0 0     0     0 %
(11) Cardinal Health Initiatives

2401 WEst University Avenue
Muncie,IN47303
30-0102702 		purchasing IN NA
  		N/A 0 0     0     0 %
(12) Mid-America Surgery Center

2401 WEst University Avenue
Muncie,IN47303
35-2002953 		healthcare IN NA
  		N/A 0 0     0     0 %
(13) BMH Outpatient Surg Svcs

2401 West University Avenue
Muncie,IN47303
20-4567998 		healthcare IN NA
  		N/A 0 0     0     0 %
(14) CHV Fund Management LLC

950 North Meridian Street Suite 80
Indianapolis,IN46204
26-2523151 		VENTURE CAPITAL IN NA
  		N/A 0 0     0     0 %
(15) ROC Surgery LLC

3000 Riverchase Galleria Suite 500
Birmingham,AL35244
27-1497960 		healthcare IN NA
  		N/A 0 0     0     0 %
(16) IUH Surgery Centers LLC

3000 Riverchase Galleria Suite 500
Birmingham,AL35244
45-2314634 		Healthcare IN NA
  		N/A 0 0     0     0 %
(17) EHSC Holdings LLC

3000 Riverchase Galleria Suite 500
Birmingham,AL35244
45-4147879 		Healthcare IN NA
  		N/A 0 0     0     0 %
(18) SSSC Holdings LLC

3000 Riverchase Galleria Suite 500
Birmingham,AL35244
45-4148167 		Healthcare IN NA
  		N/A 0 0     0     0 %
(19) IEC Holdings LLC

3000 Riverchase Galleria Suite 500
Birmingham,AL35244
45-4148032 		Healthcare IN NA
  		N/A 0 0     0     0 %
(20) ROCS Holdings LLC

3000 Riverchase Galleria Suite 500
Birmingham,AL35244
45-4148369 		Healthcare IN NA
  		N/A 0 0     0     0 %
(21) BOSC Holdings LLC

3000 Riverchase Galleria Suite 500
Birmingham,AL35244
45-4147343 		Healthcare IN NA
  		N/A 0 0     0     0 %
(22) Bloomington Endoscopy Centers LLC

PO Box 1149
Bloomington,IN47402
35-2117943 		Healthcare IN NA
  		N/A 0 0     0     0 %
(23) Beltway Surgery Centers LLC

3000 Riverchase Galleria Ste 500
Birmingham,AL35244
35-2072586 		Healthcare IN NA
  		N/A 0 0     0     0 %
(24) CTF International Growth Portfolio

280 Congress St Ste 500
Boston,MA02210
20-0231923 		Investments MA NA
  		N/A 0 0     0     0 %
(25) Eagle Highlands Surgery Center LLC

3000 Riverchase Galleria Ste 500
Birmingham,AL35244
35-2259204 		Healthcare IN NA
  		N/A 0 0     0     0 %
Part IV
Identification of Related Organizations Taxable as a Corporation or Trust (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.)
(a)
Name, address, and EIN of related organization



 		(b)
Primary activity



 		(c)
Legal domicile
(state or
foreign
country)
 		(d)
Direct controlling
entity


 		(e)
Type of entity
(C corp, S corp,
or trust)

 		(f)
Share of total income



 		(g)
Share of
end-of-year
assets

 		(h)
Percentage
ownership
(1) IUH Assurance Ltd
720 West Bay Road PO Box 69
Grand Cayman    
CJ
98-0395429 		Insurance CJ NA
  		C 0 0 0 %
(2) IU Health Plans Inc
1776 Meridian Street suite 300
Indianapolis,IN46202
26-2127080 		HMO IN NA
  		C 0 0 0 %
(3) CHV Capital Inc
950 N Meridian Street Suite 800
Indianapolis,IN46204
26-0752507 		VENTURE CAPITAL IN NA
  		C 0 0 0 %
(4) IU Health Risk Purchasing Group Inc
151 Meeting Street Suite 301
Charleston,SC29401
26-0202446 		insurance IN NA
  		C 0 0 0 %
(5) IU Health Risk Retention Group Inc
151 Meeting Street Suite 301
Charleston,SC29401
20-1107674 		insurance SC NA
  		C 0 0 0 %
(6) OCC-Health Revenue Systems Inc
950 N Meridian Street Suite 800
Indianapolis,IN46204
20-3308057 		WORK COMP PPO IN NA
  		C 0 0 0 %
(7) Parkmor Drug Inc
1501 South Main Street
Goshen,IN46526
13-1394980 		pharmacy sales IN NA
  		C 0 0 0 %
(8) BMH Medical Pavillion Association Inc
2525 West University Avenue
Muncie,IN47303
35-1858408 		condo management IN NA
  		C 0 0 0 %
(9) Cardinal Health Ventures Inc
2401 West University Avenue
Muncie,IN47303
35-1611424 		management IN NA
  		C 0 0 0 %
(10) Pilr Inc
200 High Park AVenue
Goshen,IN46204
20-4294750 		development IN NA
  		C 0 0 0 %
(11) IU Health Southern Indiana Phys Inc
PO Box 1149
Bloomington,IN47402
35-1913875 		healthcare IN NA
  		C 0 0 0 %
(12) Radiation Oncology Resources Inc
200 High Park Avenue
Goshen,IN46527
26-2008424 		healthcare IN NA
  		C 0 0 0 %
(13) University Health Management Inc
950 N Meridian Street Suite 800
Indianapolis,IN46204
27-2891143 		management IN NA
  		C 0 0 0 %
(14) University Health Mgmt (China) Inc
950 N Meridian Street Suite 800
Indianapolis,IN46204
27-3891311 		Management IN NA
  		C 0 0 0 %
(15) Indiana University Health ACO Inc
950 N Meridian Street Suite 800
Indianapolis,IN46204
45-4421020 		Healthcare IN NA
  		C 0 0 0 %
(16) SCANS Inc
950 N Meridian Street Suite 800
Indianapolis,IN46204
45-3080392 		Healthcare IN NA
  		C 0 0 0 %
(17) IU Health Board Designated Trust
400 Howard St
San Francisco,CA94105
30-6309021 		Investments IN NA
  		T 0 0 0 %
(18) IU Health NTGI S&P500 Fund CF
PO Box 804358
Chicago,IL60680
30-6298263 		Investments IN NA
  		T 0 0 0 %
Schedule R (Form 990) 2011
Schedule R (Form 990) 2011
Page 3
Part V
Transactions With Related Organizations (Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35, 35A, or 36.)
Note. Complete line 1 if any entity is listed in Parts II, III or IV.
Yes
No
1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?
a Receipt of (i) interest (ii) annuities (iii) royalties (iv) rent from a controlled entity . . . . . . . . . . . . . . . . . . . . . . .
1a
 
No
b Gift, grant, or capital contribution to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1b
 
No
c Gift, grant, or capital contribution from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1c
Yes
 
d Loans or loan guarantees to or for related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1d
 
No
e Loans or loan guarantees by related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1e
 
No
f Sale of assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1f
 
No
g Purchase of assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1g
 
No
h Exchange of assets with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1h
 
No
i Lease of facilities, equipment, or other assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1i
 
No
j Lease of facilities, equipment, or other assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .
1j
 
No
k Performance of services or membership or fundraising solicitations for related organization(s) . . . . . . . . . . . . . . . . . . . .
1k
 
No
l Performance of services or membership or fundraising solicitations by related organization(s) . . . . . . . . . . . . . . . . . . . .
1l
 
No
m Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) . . . . . . . . . . . . . . . . . . . . .
1m
 
No
n Sharing of paid employees with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1n
 
No
o Reimbursement paid to related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1o
Yes
 
p Reimbursement paid by related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1p
 
No
q Other transfer of cash or property to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1q
 
No
r Other transfer of cash or property from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1r
 
No
2
If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.
(a)
Name of other organization 		(b)
Transaction
type(a-r) 		(c)
Amount involved 		(d)
Method of determining amount involved
(1)
(2)
(3)
(4)
(5)
(6)
Schedule R (Form 990) 2011
Schedule R (Form 990) 2011
Page 4
Part VI
Unrelated Organizations Taxable as a Partnership (Complete if the organization answered "Yes" on Form 990, Part IV, line 37.)
Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.
(a)
Name, address, and EIN of entity 		(b)
Primary activity 		(c)
Legal domicile
(state or foreign
country) 		(d)
Predominant income(related, unrelated, excluded from tax under sections 512-514)

(e)
Are all
partners
section
501(c)(3)
organizations? 		(f)
Share of total income




 		(g)
Share of
end-of-year
assets 		(h)
Disproprtionate allocations? 		(i)
Code V—UBI
amount in box
20 of Schedule K-1
(Form 1065) 		(j)
General or
managing
partner? 		(k)
Percentage
ownership
Yes No Yes No Yes No






























Schedule R (Form 990) 2011
Schedule R (Form 990) 2011
Page 5
Part VII
Supplemental Information
Complete this part to provide additional information for responses to questions on Schedule R (see instructions).
Identifier Return Reference Explanation
Additional Data


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