Attach to Form 990 or Form 990-EZ.
See separate instructions.| (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? |
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| Yes | No | Yes | No | Yes | No | ||||
| Total | |||||||||
| 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. | ||||||
| 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). | ||||||






| 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.) | ||||||
| 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.). | ||||||




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Attach to Form 990 or 990-EZ.| Identifier | Return Reference | Explanation |
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| Part VI, Section A - Governing Body and Management | Line 2 - Family or Business Relationships | James A. Fisher, Peter M. Voss, M.D., Terry L. Walker, Michael E. Haley, and Michael L. Cox serve on the board of directors of Cardinal Health Ventures, Inc. Additionally, Michael E. Haley and Harold L. Berfiend serve as officers of Cardinal Health Ventures, Inc. No additional compensation is provided. Michelle R. Altobella, Harold L. Berfiend, and Carol E. Seals serve on the board of managers and are officers of Cardinal Health Initiatives, LLC. No additional compensation is provided. Michael E. Haley and Harold L. Berfiend serve on the board of managers of Ball Outpatient Surgery Center, LLC. No additional compensation is provided. |
| Part VI, Section A - Governing Body and Management | Lines 6, 7a and 7b - Members or Stockholders | Line 6: Indiana University Health Ball Memorial Hospital, Inc. ("IU Health Ball Memorial Hospital") has one class of membership and the sole member is Indiana University Health, Inc. ("IU Health"). Line 7a: IU Health elects one more than one-half of the total number of Directors. Immediately following such election the remainder are elected by the Directors, excluding those whose terms are set to expire. Line 7b: Notwithstanding any other provisions of the Articles of Incorporation, the following matters require the written approval of IU Health prior to implementation: - Authorization for the establishment or acquisition of any subsidiaries, affiliates or joint venture arrangements or acquisition of all or substantially all of the assets of any other business or entity; - Approval or amendment to any operating or capital budget; - Authorization of any unbudgeted operating or capital budget items or deviations, including any issuance or guarantee of any unbudgeted debt, greater than the budgeted amount by $1 million for any individual item or $3 million per fiscal year in the aggregate; - Authorization of any agreement to act as primary obligor, or to serve as a guarantor, surety or co-obligor with respect to the indebtedness of any other party, to borrow amounts from third-party lenders, or to loan money to any person or entity; - Approval of strategic plans and amendments, which will be integrated with IU Health's strategic plan; - Amendment or repeal of the Corporation's or an Affiliate's articles of incorporation or bylaws (or other corresponding organizational documents of an Affiliate that is not a corporation); - Authorization of any merger, consolidation, reorganization, sale or transfer of all or substantially all of the Corporation's assets; - Authorization of any voluntary declaration of bankruptcy, plan of dissolution, any liquidating distribution of assets or other action related to its dissolution or liquidation; - Authorization of any pledge of, or grant any security interest or mortgage in, or otherwise encumber, any tangible assets of the Corporation in excess of $2,000,000, other than in the ordinary course of business or pursuant to a budget or strategic plan approved by IU Health; - Approval of any management agreement for the management of all or a substantial part of the Corporation's operations; or - Appointment or removal of any of the Corporation's Directors with or without cause. |
| Part VI, Section A - Governing Body and Management | Line 11b - Form 990 Provided to Governing Body | Indiana University Health Ball Memorial Hospital, Inc. ("IU Health Ball Memorial Hospital") has established the following process for the review of the Form 990 and related schedules before it is filed: The Chief Financial Officer reviewed and approved the Form 990 and related schedules. After the review and approval from the Chief Financial Officer, a final complete copy, as filed with the Internal Revenue Service, of the Form 990 and related schedules was made available to each board member on a secure intranet site. Each member was informed of the availability of the Tax Department to answer any questions. |
| Part VI, Section B - Policies | Lines 12, 13, 14, and 16b | Indiana University Health Ball Memorial Hospital, Inc. ("IU Health Ball Memorial Hospital") is part of the Indiana University Health, Inc. ("IU Health") system. As the sole member and controlling parent of IU Health Ball Memorial Hospital, IU Health and its Board of Directors have mandated that certain policies be followed to ensure greater standardization throughout the system. Thus, IU Health Ball Memorial Hospital's Board of Directors was not required to separately adopt a conflict of interest, whistleblower, document retention and destruction and joint venture policies because IU Health's Board of Directors had already adopted and required these policies to be followed by its subsidiaries. |
| Part VI, Section B - Policies | Line 12c - Conflict of Interest Policy | Indiana University Health Ball Memorial Hospital, Inc. ("IU Health Ball Memorial Hospital") has a Conflict of Interest Policy, the purpose of which is to protect IU Health Ball Memorial Hospital's interests when it is contemplating entering into a transaction or arrangement that might benefit the private interest of an officer, director, or employee. Each employee that is manager level or above, including officers and directors, is required to annually sign a statement which affirms that such person (1) has received a copy of the conflict of interest policy; (2) has read and understands the policy; (3) has agreed to comply with the policy; and (4) understands and acknowledges that the Corporation is a tax-exempt organization and that in order to maintain its federal tax exemption it must engage primarily in activities which accomplish one or more of its tax-exempt purposes. If an interest is disclosed, the form requires that the discloser's supervisor sign the form to indicate his/her knowledge and approval of the interest. The form is then submitted to Corporate Compliance for review. If the disclosure is by the CEO/President, it is reviewed by the board chairman for approval. If the disclosure is by a member of the board of directors, the General Counsel/Chief Compliance Officer reviews the disclosures and determines whether to consent. Board members with a conflict of interest cannot participate in any decision related to that conflict. Breach of the conflict of interest policy, including failure to complete and update the questionnaire and failure to disclose an interest that should be disclosed, may subject an individual to disciplinary action, including dismissal. |
| Part VI, Section B - Policies | Line 15 - Process for Determining Compensation | The CEO/Top Management Official for Indiana University Health Ball Memorial Hospital, Inc. ("IU Health Ball Memorial Hospital") is employed by Indiana University Health, Inc. ("IU Health"). IU Health has the following process for determining compensation: 1. The Board of Directors has established a Committee on Personnel and Compensation. The individuals on this Committee are made up of individuals who are on the Board and who do not have a conflict of interest with Indiana University Health, Inc. ("IU Health"). There are no physicians or employees on this Committee. This Committee develops and reviews annually the executive compensation philosophy, market analysis as to comparability and reasonableness. One of the purposes of this Committee is to review, approve and make recommendations regarding executive compensation and benefits to the IU Health Board. As deemed appropriate, this Committee also reviews the same detail with the Committee on Finance. The Committee on Finance is represented by certain members of the Board as well. 2. Each year the Committee on Personnel and Compensation engages an outside compensation consulting firm to conduct a compensation and benefits study for all senior vice presidents and above. The current compensation advisor is the Hay Group. Hay Group performs an independent compensation survey. The relevant comparability data includes: compensation and benefit levels paid by similarly situated organizations (both governmental and tax exempt) for functionally comparable positions as well as the availability of similar services in the geographic area. The Committee reviews the entire compensation package including: base compensation, short term and long term incentive plans, basic health and welfare benefits, qualified and nonqualified plans as well as any additional fringe benefits. Further, Hay Group will provide recommendations based upon the reasonable compensation information as it relates to salary increases, bonuses and benefits that are consistent with the compensation philosophy of the Committee. A separate analysis using the same methodology is done for the Chief Executive Officer. 3. The Committee reviews the salary survey and, if appropriate, makes recommendations on increases in salary and any changes in bonuses or benefits. The Committee's goal is to ensure that the total compensation and benefits package is reasonable based upon the independent data provided by Hay Group. The Committee votes on any changes in compensation or benefits. This review, discussion and vote are documented in the minutes for the meeting. There are no executives present during the final discussion and approval of compensation. 4. The Board reviews the report prepared by the Hay Group as well as the recommendations of the Committee on Personnel and Compensation as to changes in compensation approved by the Committee. As requested, the Committee on Finance also provides its review of recommendations on changes in executive compensation and benefits. This review, discussion and vote are documented in the minutes. 5. The Board then reviews the recommendations provided by the Committee on Personnel and Compensation and votes on the changes as well. No additional compensation or benefits are paid to the executives until the changes have been approved by the Committee and the Board. The discussion and approval are documented in the minutes of the meeting. There are no executives present during the final discussion and approval of compensation. The General Counsel prepares a formal written opinion reviewing the compensation and benefits approval process, comparing that process to the Intermediate Sanctions Test of IRC Section 4958 and, if the facts warrant, provides comments regarding the compensation and benefits approval process as this relates to meeting the requirements for a rebuttable presumption of reasonableness as provided in the Intermediate Sanctions Test. 6. After the end of each year, the Committee and Board also reviews the achievements of the executive group as it relates to the long-term and short-term shared and individual goals developed by the executive and the Board. These achievements may also be reviewed with the Committee on Finance. The Board, at its discretion, may approve bonus payments based upon the achievement of the goals and the compensation survey. The discussion and vote of the Committee and Board is documented in the minutes for each such meeting. The bonuses are not paid until approval is made by the Board. 7. The Committee on Personnel and Compensation and Audit Committee also review the required Form 990 disclosures related to executive compensation and benefits as well as compensation practices and approval processes prior to the filing of the Form 990 return with the Internal Revenue Service. IU Health Ball Memorial Hospital has a yearly process in place to determine the compensation for the other officers and key employees. IU Health Ball Memorial Hospital uses an independent compensation consultant who utilizes a variety of methods and procedures to obtain compensation ranges for comparable officer and employee positions. The independent compensation consultant provides IU Health Ball Memorial Hospital with recommended compensation ranges for its officers and other employees, which are then used as a guide for setting reasonable compensation by management. Management decisions with regard to determining compensation are subject to the review and approval of the Compensation Committee and Board of Directors. |
| Part VI, Section C - Disclosure | Line 19 - Public Disclosure | Indiana University Health Ball Memorial Hospital, Inc.'s ("IU Health Ball Memorial Hospital") Articles of Incorporation are available for public inspection through the Indiana Secretary of State's web-site. IU Health Ball Memorial Hospital's conflict of interest procedures are disclosed on the Form 990, Schedule O. IU Health Ball Memorial Hospital is a consolidated subsidiary in the consolidated financial statements for Indiana University Health, Inc. ("IU Health"). The consolidated financial statements for IU Health are available to the public through its bond filings. |
| Part VII, Section A - Governing Body and Management | Line 1a, Column (B) - Average hours per week | Daniel F. Evans, Jr. is the President and CEO for Indiana University Health, Inc. and devotes 55 hours per week. Patrick A. Cleary, M.D., Ph.D. is a physician for IU Health Ball Memorial Physicians, Inc. and devotes 55 hours per week. Christina C. Drummond, M.D. is a staff physician for Indiana University Health Physicians, Inc. and devotes 55 hours per week. |
| Part XI - Reconciliation of Net Assets | Line 5 - Other Changes in Net Assets or Fund Balances | During 2011, Indiana University Health Ball Memorial Hospital, Inc. ("IU Health Ball Memorial Hospital"), made an equity transfer to Indiana University Health Ball Memorial Physicians, Inc. ("IU Health Ball Memorial Physicians"), a subsidiary of IU Health Ball Memorial Hospital, in the amount of $12,716,343. Throughout the existence of IU Health Ball Memorial Physicians, IU Health Ball Memorial Hospital has provided funds to support IU Health Ball Memorial Physicians' exempt purpose. Although there was never any intent for IU Health Ball Memorial Physicians to repay IU Health Ball Memorial Hospital, these amounts were recorded as intercompany balances rather than equity transfers. During 2011, IU Health Ball Memorial Hospital and IU Health Ball Memorial Physicians made adjustments to their books and records to reflect these intercompany balances as equity transfers for both book and tax purposes. Also, during 2011, Indiana University Health Ball Memorial Hospital, Inc. recorded the following other changes in net assets or fund balances: Unrealized Gain/(Loss) on Investments: -75,694 Book/Tax Differences - Partnerships: -5,916,592 Change in Pension Obligation: -24,949,622 Net Asset Transfer to IU Health: 6,445,622 |
| Form 5471 - Information Return of U.S. Persons With Respect | To Certain Foreign Corporations | Indiana University Health Ball Memorial Hospital, Inc. ("IU Health Ball Memorial Hospital") (FEIN: 35-0867958) constructively owned a controlled foreign corporation in 2011 through its affiliate, Indiana University Health, Inc. (FEIN: 35-1955872). Pursuant to IRC Section 6038, the 2011 controlled foreign corporation filing requirement of IU Health Ball Memorial Hospital was fulfilled on the 2011 Form 5471 filed on its behalf by: Indiana University Health, Inc. FEIN: 35-1955872 950 N. Meridian Street, Suite 800 Indianapolis, IN 46204 The 2011 Form 5471 for Indiana University Health, Inc. was filed at the following IRS processing center: Ogden, UT 84201-0012 |
| Schedule K, Part I - Bond Issues | Page 1 - Line A, Column (f) - Description of Purpose | 2006 Series Bonds: The 2006 Series Bonds were issued in order to provide funding for new construction of buildings and structures and the purchase of equipment. |
| Schedule K, Part I - Bond Issues | Page 1 - Line B, Column (f) - Description of Purpose | 2009A Series Bonds: The 2009A Series Bonds were issued in order to refund the 1998 Series Bonds. The 1998 Series Bonds were issued on March 11, 1998. |
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