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
2010
Open to Public Inspection
A For the calendar year, or tax year beginning 09-01-2010 and ending 08-31-2011
BCheck if applicable:
CName of organization
UNION HOSPITAL INC
 
Doing Business As
 
 
Number and street (or P.O. box if mail is not delivered to street address)
1606 NORTH SEVENTH STREET
 
Room/suite
City or town, state or country, and ZIP + 4
TERRE HAUTE, IN47804
D Employer identification number

35-0876396
E Telephone number

G Gross receipts $ 424,153,646
F Name and address of principal officer:
WAYNE HUTSON
1606 NORTH SEVENTH STREET
TERRE HAUTE,IN47804
I
Tax-exempt status: (   ) LeftBullet (insert no.) or
J
Website:MediumBullet
WWW.UHHG.ORG
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: 1892
M State of legal domicile: IN
Part I
Summary
Activities & Governance 1 Briefly describe the organization’s mission or most significant activities: WE EXIST TO SERVE OUR PATIENTS WITH COMPASSIONATE HEALTH CARE OF THE HIGHEST QUALITY.
2 Check this box MediumBullet
3 Number of voting members of the governing body (Part VI, line 1a) .... 3 14
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 2010 (Part V, line 2a) ... 5 2,622
6 Total number of volunteers (estimate if necessary) .... 6 394
7a Total unrelated business revenue from Part VIII, column (C), line 12 .. 7a 583,535
b Net unrelated business taxable income from Form 990-T, line 34 .. 7b -93,017
Revenues; Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 1,278,146 1,496,433
9 Program service revenue (Part VIII, line 2g) ......... 393,861,040 413,557,285
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 524,097 598,160
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 4,785,924 4,444,700
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)................... 400,449,207 420,096,578
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 302,195 172,159
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) 135,678,291 138,416,504
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).... 263,549,859 281,589,094
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 399,530,345 420,177,757
19 Revenue less expenses. Subtract line 18 from line 12...... 918,862 -81,179
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............ 455,384,525 464,415,498
21 Total liabilities (Part X, line 26)............ 319,751,492 337,089,154
22 Net assets or fund balances. Subtract line 21 from line 20 ..... 135,633,033 127,326,344
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's Use Only Preparer's
signatureBig Right Arrow 		Date
right pointing bullet image Preparer’s taxpayer identification number
(see instructions)
Firm’s name (or yours
if self-employed),
address, and ZIP + 4Big Right Arrow




 		EIN right pointing bullet image
Phone no. right pointing bullet image
May the IRS discuss this return with the preparer shown above? (see instructions) .........
For Privacy Act and Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 11282Y
Form 990 (2010)
Form 990 (2010)
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: WE EXIST TO SERVE OUR PATIENTS WITH COMPASSIONATE HEALTH CARE OF THE HIGHEST QUALITY.
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 exempt purpose achievements for each of the organization’s three largest program services 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 $ 396,612,015 including grants of $ 172,159 ) (Revenue $ 412,869,553 )
UNION HOSPITAL, UNION HOSPITAL CLINTON, AND OUR NETWORK OF PRIMARY CARE PHYSICIANS JOIN TOGETHER TO PROVIDE COMPREHENSIVE CARE TO RESIDENTS OF WEST CENTRAL INDIANA AND EASTERN ILLINOIS. OUR FACILITIES INCLUDE TWO HOSPITALS AND MORE THAN 40 PRIMARY AND SPECIALTY CARE PHYSICIANS AND MID-LEVEL PROVIDERS. WE ARE THE LARGEST PROVIDER OF HEALTH CARE SERVICES BETWEEN INDIANAPOLIS AND ST. LOUIS ALONG THE I-70 CORRIDOR, SERVING VIGO, PARKE, VERMILLION AND CLAY COUNTIES IN INDIANA, AND CLARK AND EDGAR COUNTIES IN ILLINOIS AS OUR PRIMARY SERVICE AREA. OUR SECONDARY SERVICE AREA INCLUDES GREENE AND SULLIVAN COUNTIES IN INDIANA, AND CRAWFORD COUNTY IN ILLINOIS.CONTINUE TO SCHEDULE O:ACCESS TO HEALTH CARE FOR OUR COMMUNITIES IS A CHALLENGE WE HAVE BEEN WORKING TO MEET FOR MANY YEARS. WHEN AN IMPENDING SHORTAGE OF PRIMARY CARE PROVIDERS WAS IDENTIFIED IN THE 1970'S, UNION HOSPITAL ESTABLISHED A FAMILY MEDICINE RESIDENCY PROGRAM TO TRAIN AND RETAIN DOCTORS FOR SERVICE IN OUR AREA. IN RESPONSE TO HEALTH CARE PROFESSIONAL SHORTAGES IN RURAL AREAS, THE RICHARD G. LUGAR CENTER FOR RURAL HEALTH (FORMERLY THE MIDWEST CENTER FOR RURAL HEALTH) WAS ESTABLISHED IN 1993 AS A DIVISION OF THE FAMILY MEDICINE RESIDENCY PROGRAM. THIS INNOVATIVE CENTER HAS DEVELOPED A CURRICULUM FOR RESIDENTS SPECIALIZING IN RURAL FAMILY MEDICINE AS WELL AS PRACTICE MODELS THAT INCORPORATE A MULTIDISCIPLINARY TEAM APPROACH AND STATE-OF-THE-ART TECHNOLOGY TO ENSURE THE SATISFACTION AND SUCCESS OF PROFESSIONALS WHO CHOOSE TO SERVE IN RURAL AREAS. SINCE 1976, THE PROGRAM HAS PLACED 81 PHYSICIANS IN COMMUNITIES IN INDIANA, 30 IN ILLINOIS, 1 IN JAPAN, 1 IN GUAM, 1 IN CANADA, 1 IN SUDAN AND 47 OTHERS IN COMMUNITIES ACROSS THE UNITED STATES. THE LUGAR CENTER'S INNOVATIVE PROGRAMS AND PROJECTS INCLUDE PARTNERSHIPS WITH THE INDIANA UNIVERSITY SCHOOL OF MEDICINE, THE INDIANA STATE UNIVERSITY SCHOOL OF NURSING, THE STATE AND NATIONAL RURAL HEALTH ASSOCIATIONS, THE STATE OF INDIANA, THE U.S. DEPARTMENT OF AGRICULTURE, AND THE U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, AMONG MANY OTHERS. GRANTS TO SUPPORT ITS INITIATIVES TOTAL MORE THAN NEARLY $15 MILLION. THESE GRANTS SUPPORT ADVANCEMENTS IN RESIDENCY TRAINING, TELEMEDICINE TECHNOLOGY, AND THE FUNDING OF RURAL HEALTH CLINICS AND SERVICES. THE CLAY CITY CENTER FOR FAMILY MEDICINE IS OUR MODEL RURAL HEALTH CLINIC AND TRAINING SITE FOR RESIDENTS AND PROVIDES VITAL CARE TO THE MEDICALLY UNDERSERVED CITIZENS OF CLAY COUNTY, INDIANA. OUR COMMUNITY LOOKS TO UHI FOR A HIGH LEVEL OF SUPPORT. IN FISCAL YEAR 2011, MORE THAN $11 MILLION WAS DONATED TO THE POOR AND THE COMMUNITY THROUGH DONATIONS, SUBSIDIZED HEALTH SERVICES, THE EDUCATION OF MEDICAL PROFESSIONALS, AND EDUCATION FOR PATIENTS AND THE COMMUNITY. ANNUALLY, THE UNION HOSPITAL FOUNDATION AWARDS 20 SCHOLARSHIPS FOR AREA STUDENTS. FINANCIAL COMMITMENT FOR THESE INITIATIVES COMES FROM THE BOARD OF DIRECTORS THROUGH THE ORGANIZATION AS PART OF THE BUDGETING PROCESS. THE UNION HOSPITAL FOUNDATION, THE UNION HOSPITAL CLINTON FOUNDATION AND GUILD, AND THE SERVICE LEAGUE OF UNION HOSPITAL ARE ACTIVELY ENGAGED IN RAISING FUNDS TO SUPPORT THESE VITAL COMMUNITY SERVICES. GRANT SOURCES INCLUDE: THE U.S. DEPARTMENT OF AGRICULTURE, THE U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, THE STATE OF INDIANA, MARCH OF DIMES, AND THE SUSAN G. KOMEN FOUNDATION, AMONG OTHERS.
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$ 396,612,015
Form 990 (2010)
Form 990 (2010)
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? Click to see attachment........
2
Yes
 
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 IClick to see attachment..........
3
 
No
4
Section 501(c)(3) organizations. Did the organization engage in lobbying activities? If “Yes,” complete Schedule C,
Part IIClick to see attachment.........................
4
Yes
 
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 where 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 term, permanent,or quasi-endowments? If “Yes,” complete Schedule D, Part VClick to see attachment
10
Yes
 
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
 
No
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
Yes
 
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
Yes
 
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, and program service activities outside the United States? 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
Form 990 (2010)
Form 990 (2010)
Page 4
Part IV
Checklist of Required Schedules (continued)
20a
Did the organization operate one or more hospitals? If “Yes,” complete Schedule H..... Click to see attachment
20a
Yes
 
b
Did the organization attach its audited financial statement to this return? Note: All Form 990 filers that operate one or more hospitals must attach audited financial statements. ..... Click to see attachment
20b
Yes
 
21
Did the organization report more than $5,000 of grants and other assistance to governments and organizations in the United States on Part IX, column (A), line 1? If “Yes,” complete Schedule I, Parts I and II.. Click to see attachment
21
Yes
 
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..... Click to see attachment
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................ Click to see attachment
24a
Yes
 
b
Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...
24b
 
No
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
 
No
d
Did the organization act as an “on behalf of” issuer for bonds outstanding at any time during the year?...
24d
 
No
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...... Click to see attachment
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................ Click to see attachment
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........................... Click to see attachment
26
 
No
27
Did the organization provide a grant or other assistance to an officer, director, trustee, key employee, substantial contributor, or a grant selection committee member, or to a person related to such an individual? If “Yes,” complete Schedule L, Part III............... Click to see attachment
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 ......................... Click to see attachment
28a
Yes
 
b
A family member of a current or former officer, director, trustee, or key employee? If “Yes,”
complete Schedule L, Part IV................... Click to see attachment
28b
Yes
 
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.. Click to see attachment
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
 
35
Is any related organization a controlled entity within the meaning of section 512(b)(13)? .....
35
Yes
 
a
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
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 (2010)
Form 990 (2010)
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
191
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
Yes
 
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
2,622
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
Yes
 
b
If “Yes,” has it filed a Form 990-T for this year? If “No,” provide an explanation in Schedule O.....
3b
Yes
 
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 (2010)
Form 990 (2010)
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 ..............
1a
14
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
Yes
 
5
Did the organization become aware during the year of a significant diversion of the organization’s assets? .
5
 
No
6
Does the organization have members or stockholders? ................
6
Yes
 
7a
Does the organization have members, stockholders, or other persons who may elect one or more members of the governing body? .........................
7a
Yes
 
b
Are any decisions of the governing body subject to approval by members, stockholders, or other persons? ..
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
Does the organization have local chapters, branches, or affiliates? ............
10a
 
No
b
If “Yes,” does the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with those of the organization? ....
10b
 
 
11a
Has the organization provided a copy of this Form 990 to all members of its governing body before filing the form?
11a
Yes
 
b
Describe in Schedule O the process, if any, used by the organization to review the Form 990. .....
12a
Does the organization have a written conflict of interest policy? If “No,” go to line 13.......
12a
Yes
 
b
Are officers, directors or trustees, and key employees required to disclose annually interests that could give rise to conflicts? ...........................
12b
Yes
 
c
Does the organization regularly and consistently monitor and enforce compliance with the policy? If “Yes,” describe in Schedule O how this is done ....................
12c
Yes
 
13
Does the organization have a written whistleblower policy? ...............
13
Yes
 
14
Does 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
Yes
 
b
Other officers or key employees of the organization ................
15b
Yes
 
If "Yes" to line a or b, 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,” has the organization adopted a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and taken 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 make these available. Check all that apply.
19
Describe in Schedule O whether (and if so, how), the organization makes its governing documents, conflict of interest policy, and financial statements available to the public.
20
State the name, physical address, and telephone number of the person who possesses the books and records of the organization: MediumBullet
WAYNE HUTSON CFO
1606 N SEVENTH STREET
TERRE HAUTE,IN47804
(812) 238-7000
Form 990 (2010)
Form 990 (2010)
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 (check all that apply) 		(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) JOHN LUKENS
CHAIRMAN
 2.00 X           0 0 0
(2) CURTIS BRIGHTON
VICE CHAIRMAN
 2.00 X           0 0 0
(3) WILLIAM G GRIMES
SECRETARY
 2.00 X           0 0 0
(4) DAN DEBARD
TREASURER
 2.00 X           0 0 0
(5) WARD HUBBARD
ASST. TREASURER
 2.00 X           0 0 0
(6) FREDERICK BAUER
ASST. SECRETARY
 2.00 X           0 0 0
(7) ANNA ZIMMERMAN
MEMBER
 2.00 X           0 0 0
(8) CINDY MARTIN
MEMBER
 2.00 X           0 0 0
(9) MARK LYNCH
MEMBER
 2.00 X           0 0 0
(10) MOLLY CALLAHAN
MEMBER
 2.00 X           0 0 0
(11) ROBERT HAERR
MEMBER
 2.00 X           0 0 0
(12) ROBERT MCLAUGHLIN
MEMBER
 2.00 X           0 0 0
(13) STEVEN MCDONALD
MEMBER
 2.00 X           0 0 0
(14) DAVID DOERR
SEE SCH J
 40.00 X   X       296,764 0 20,311
(15) SCOTT TEFFETELLER
SEE SCH J
 40.00     X       287,164 0 26,327
(16) WAYNE HUTSON
SR VP FINANCE/CFO
 40.00     X       237,354 0 20,244
(17) CAROL ROESCH
VICE PRESIDENT
 40.00     X       170,861 0 19,539
Form 990 (2010)
Form 990 (2010)
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 (check all that apply) 		(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) KYM PFRANK
VICE PRESIDENT
 40.00     X       178,716 0 19,025
(19) SALLY ZUEL
VICE PRESIDENT
 40.00     X       157,901 0 11,954
(20) RONALD LEACH
MEDICAL DIRECTOR
 40.00     X       200,084 0 0
(21) KRISTI WILLIAMS
SYSTEM DIRECTOR PHARMACY
 40.00       X     132,090 0 16,931
(22) RONALD KING
SYSTEM DIRECTOR SURGERY
 40.00       X     128,969 0 18,564
(23) NABIL MNAYARJI
CARDIAC PHYSICIAN
 40.00         X   842,921 0 30,478
(24) LINGAN SIDDA
RADIOLOGIST
 40.00         X   1,025,320 0 22,930
(25) PRADEEP NAROTAM
NEUROSURGEON
 40.00         X   849,900 0 28,024
(26) RAMESH TANK
RADIOLOGIST
 40.00         X   1,001,601 0 30,479
(27) SANJAY PATHAK
RADIOLOGIST
 40.00         X   847,512 0 28,457






1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)............MediumBullet 6,096,098 0 257,768
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 in reportable compensation from the organizationMediumBullet92
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.
(A)
Name and business address 		(B)
Description of services 		(C)
Compensation
PROVIDENCE MEDICAL GROUP
2723 S 7TH ST
TERRE HAUTE,IN47802 		MEDICAL SERVICES AND RENT 19,512,732
CARDIOVASCULAR MANAGEMENT
2723 S 7TH ST
TERRE HAUTE,IN47802 		MEDICAL MANAGEMENT SERVICES 18,930,049
AMBULATORY SURGERY MANAGEMENT
221 S 6TH ST
TERRE HAUTE,IN47802 		MEDICAL MANAGEMENT SERVICES 6,284,955
AP&S CLINIC
221 S 6TH ST
TERRE HAUTE,IN47802 		MEDICAL SERVICES AND RENT 5,436,588
GARMONG PEPPER CONSTRUCTION
1659 N 8TH ST
TERRE HAUTE,IN47804 		CONSTRUCTION 4,377,754
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 in compensation from the organization MediumBullet50
Form 990 (2010)
Form 990 (2010)
Page 9
Part VIII
Statement of Revenue
(A)
Total revenue 		(B)
Related or
exempt
function
revenue 		(C)
Unrelated
business
revenue 		(D)
Revenue
excluded from
tax under sections
512, 513, or 514
Contributions, gifts, grants and other similar amounts 1a Federated campaigns..1a  
b Membership dues....1b  
c Fundraising events....1c  
d Related organizations...1d 170,120
e Government grants (contributions)1e 1,114,560
f All other contributions, gifts, grants, and
similar amounts not included above1f 		211,753
g Noncash contributions included in lines 1a-1f:$  
h Total. Add lines 1a-1f.......MediumBullet 1,496,433
Program Service Revenue Business Code
2a NET PATIENT REVENUE 900,099 413,557,285 413,557,285    
b
c
d
e
f All other program service revenue .        
g Total. Add lines 2a–2f........MediumBullet 413,557,285
Other Revenue 3 Investment income (including dividends, interest
and other similar amounts).....MediumBullet 687,872     687,872
4 Income from investment of tax-exempt bond proceeds..MediumBullet        
5 Royalties............MediumBullet        
(i) Real (ii) Personal
6a Gross Rents 1,348,590  
b Less: rental expenses 3,621,775  
c Rental income or (loss) -2,273,185  
d Net rental income or (loss).......MediumBullet -2,273,185 -2,273,185    
(i) Securities (ii) Other
7a Gross amount from sales of assets other than inventory   345,581
b Less: cost or other basis and sales expenses   435,293
c Gain or (loss)   -89,712
d Net gain or (loss)..........MediumBullet -89,712     -89,712
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      
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        
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        
Miscellaneous Revenue Business Code
11a CAFETERIA REVENUE 900,099 1,333,147     1,333,147
b AP & S PURCHASED SERVI 900,099 1,075,759     1,075,759
c CHILD DEVELOPMENT REVE 624,410 645,957   314,010 331,947
d All other revenue .... 3,663,022 1,585,453 269,525 1,808,044
e Total. Add lines 11a–11d ......MediumBullet 6,717,885
12 Total revenue. See Instructions....MediumBullet 420,096,578 412,869,553 583,535 5,147,057
Form 990 (2010)
Form 990 (2010)
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).
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 U.S. See Part IV, line 21 172,159 172,159
2 Grants and other assistance to individuals in the U.S. See Part IV, line 22    
3 Grants and other assistance to governments, organizations, and individuals outside the U.S. See Part IV, lines 15 and 16    
4 Benefits paid to or for members    
5 Compensation of current officers, directors, trustees, and key employees .... 1,183,034 275,591 907,443  
6 Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ....        
7 Other salaries and wages 115,943,733 109,671,177 6,272,556  
8 Pension plan contributions (include section 401(k) and section 403(b) employer contributions) .... 11,308,542 10,696,750 611,792  
9 Other employee benefits ....... 2,052,980 1,941,914 111,066  
10 Payroll taxes ........... 7,928,215 7,499,299 428,916  
11 Fees for services (non-employees):        
a Management ......        
b Legal ......... 9,232 8,733 499  
c Accounting ...........        
d Lobbying ...........        
e Professional fundraising. See Part IV, line 17..    
f Investment management fees ......        
g Other .......... 10,755,239 10,173,381 581,858  
12 Advertising and promotion .... 540,710 511,458 29,252  
13 Office expenses ....... 13,403,019 12,677,916 725,103  
14 Information technology ......        
15 Royalties ..        
16 Occupancy ........... 11,546,387 10,921,727 624,660  
17 Travel ............ 375,029 354,740 20,289  
18 Payments of travel or entertainment expenses for any federal, state, or local public officials ......        
19 Conferences, conventions, and meetings ....        
20 Interest ........... 13,922,753 13,169,532 753,221  
21 Payments to affiliates .......        
22 Depreciation, depletion, and amortization ..... 24,948,134 23,598,440 1,349,694  
23 Insurance .............. 16,535,167 15,640,614 894,553  
24 Other expenses. Itemize expenses not covered above. (Expenses grouped together and labeled miscellaneous may not exceed 5% of total expenses shown on line 25 below.)
a PURCHASED SERVICES 76,074,533 71,958,901 4,115,632  
b MEDICAL SUPPLIES 68,119,852 64,434,568 3,685,284  
c BAD DEBT 41,962,299 39,692,139 2,270,160  
d LICENSES, DUES & SUBSCR 569,775 538,950 30,825  
e
f All other expenses 2,826,965 2,674,026 152,939  
25 Total functional expenses. Add lines 1 through 24f 420,177,757 396,612,015 23,565,742 0
26 Joint costs. Check here MediumBullet if following
SOP 98-2 (ASC 958-720). Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation 		       
Form 990 (2010)
Form 990 (2010)
Page 11
Part X Balance Sheet
(A)
Beginning of year 		(B)
End of year
Assets 1 Cash—non-interest-bearing .......... 21,856,285 1 28,919,312
2 Savings and temporary cash investments .......   2  
3 Pledges and grants receivable, net .........   3  
4 Accounts receivable, net ......... 55,239,274 4 53,853,217
5 Receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
Schedule L ..........   5  
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 ..........   6  
7 Notes and loans receivable, net .............   7  
8 Inventories for sale or use .............. 5,049,617 8 4,386,794
9 Prepaid expenses and deferred charges ............ 5,284,677 9 5,223,132
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 460,456,776
b Less: accumulated depreciation. ..... 10b 170,135,124 299,056,105 10c 290,321,652
11 Investments—publicly traded securities .......... 37,666,679 11 59,682,256
12 Investments—other securities. See Part IV, line 11 ...... 20,230,429 12 13,506,327
13 Investments—program-related. See Part IV, line 11 ..   13  
14 Intangible assets ......... 6,120,840 14 4,651,848
15 Other assets. See Part IV, line 11 ........... 4,880,619 15 3,870,960
16 Total assets. Add lines 1 through 15 (must equal line 34)... 455,384,525 16 464,415,498
Liabilities 17 Accounts payable and accrued expenses . 43,964,421 17 47,653,026
18 Grants payable ..........   18  
19 Deferred revenue .......... 507,720 19 401,447
20 Tax-exempt bond liabilities .......... 235,025,000 20 255,640,000
21 Escrow or custodial account liability. Complete Part IV of Schedule D..   21  
22 Payables to current and former officers, directors, trustees, key
employees, highest compensated employees, and disqualified
persons. Complete Part II of Schedule L..........   22  
23 Secured mortgages and notes payable to unrelated third parties .. 25,791,757 23 23,178,118
24 Unsecured notes and loans payable to unrelated third parties ....   24  
25 Other liabilities. Complete Part X of Schedule D..... 14,462,594 25 10,216,563
26 Total liabilities. Add lines 17 through 25..... 319,751,492 26 337,089,154
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 ..... 127,903,123 27 121,024,812
28 Temporarily restricted net assets ..... 6,783,414 28 5,343,087
29 Permanently restricted net assets ..... 946,496 29 958,445
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 ..... 135,633,033 33 127,326,344
34 Total liabilities and net assets/fund balances ..... 455,384,525 34 464,415,498
Form 990 (2010)
Form 990 (2010)
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
420,096,578
2
Total expenses (must equal Part IX, column (A), line 25) . . . . .
2
420,177,757
3
Revenue less expenses. Subtract line 2 from line 1 . . . .
3
-81,179
4
Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) . .
4
135,633,033
5
Other changes in net assets or fund balances (explain in Schedule O) . . . .
5
-8,225,510
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
127,326,344
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 (2010)
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
2010
Open to Public
Inspection
Name of the organization
UNION HOSPITAL INC
 
Employer identification number

35-0876396
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) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 2
Part II
Support Schedule for Organizations Described in IRC 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization fails to qualify under the tests listed below, please complete Part III.)
Section A. Public Support
Calendar year(or fiscal year beginning in) (a) 2006 (b) 2007 (c) 2008 (d) 2009 (e) 2010 (f) Total
1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....            
2 Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......            
3 The value of services or facilities furnished by a governmental unit to the organization without charge..            
4 Total. Add lines 1 through 3..            
5 The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f)..            
6 Public Support. Subtract line 5 from line 4.            
Section B. Total Support
Calendar year(or fiscal year beginning in) (a) 2006 (b) 2007 (c) 2008 (d) 2009 (e) 2010 (f) Total
7 Amounts from line 4..            
8 Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..            
9 Net income from unrelated business activities, whether or not the business is regularly carried on..            
10 Other income. (Explain in Part IV.) Do not include gain or loss from the sale of capital assets..            
11 Total support (Add lines 7 through 10).            
12
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) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 3
Part III
Support Schedule for Organizations Described in IRC 509(a)(2)
(Complete only if you checked the box on line 9 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)
Section A. Public Support
Calendar year(or fiscal year beginning in) (a) 2006 (b) 2007 (c) 2008 (d) 2009 (e) 2010 (f) Total
1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .            
2 Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......            
3 Gross receipts from activities that are not an unrelated trade or business under section 513..            
4 Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...            
5 The value of services or facilities furnished by a governmental unit to the organization without charge..            
6 Total. Add lines 1 through 5.            
7a Amounts included on lines 1, 2, and 3 received from disqualified persons...            
b Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.            
c Add lines 7a and 7b..            
8 Public Support (Subtract line 7c from line 6.)            
Section B. Total Support
Calendar year (or fiscal year beginning in) (a) 2006 (b) 2007 (c) 2008 (d) 2009 (e) 2010 (f) Total
9 Amounts from line 6...            
10a Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..            
b Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.            
c Add lines 10a and 10b.            
11 Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.            
12 Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)            
13 Total support (Add lines 9, 10c, 11 and 12.).            
14
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) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 4
Part IV
Supplemental Information. Supplemental Information. Complete this part to provide the explanation required by Part II, line 10; Part II, line 17a or 17b; or Part III, line 12. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
 
Explanation
 
 
 
 
Schedule A (Form 990 or 990-EZ) 2010

Additional Data


Software ID:  
Software Version:  
Schedule B
(Form 990, 990-EZ,
or 990-PF)
Department of the Treasury
Internal Revenue Service
Schedule of Contributors
Arrow Bullet Attach to Form 990, 990-EZ, or 990-PF.
OMB No. 1545-0047
2010
Name of organization
UNION HOSPITAL INC
 
Employer identification number

35-0876396
Organization type (check one):
Filers of:
Section:
Form 990 or 990-EZ





Form 990-PF




Check if your organization is covered by the General Rule or a Special Rule.  
Note. Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.
General Rule—
Special Rules
......................... Arrow Bullet   $    
Caution. An Organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2 of its Form 990, or check the box in the heading of its
Form 990-EZ, or on line 2 of its Form 990-PF, to certify that it does not meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).
For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.
Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2010)

Schedule B (Form 990, 990-EZ, or 990-PF) (2010)
Page 1 of 1 of Part I
Name of organization
UNION HOSPITAL INC
  		Employer identification number

35-0876396
Part I
Contributors (see Instructions)
     
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Aggregate contributions		 (d)
Type of contribution
RESTRICTED
RESTRICTED
 

     
RESTRICTED
RESTRICTED  
RESTRICTED, RESTRICTED   RESTRICTED

$RESTRICTED




(Complete Part II if there is
a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Aggregate contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is
a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Aggregate contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is
a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Aggregate contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is
a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Aggregate contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is
a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Aggregate contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is
a noncash contribution.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2010)

Schedule B (Form 990, 990-EZ, or 990-PF) (2010)
Page 1 of 1 of Part II
Name of organization
UNION HOSPITAL INC
  		Employer identification number

35-0876396
Part II
Noncash Property (see Instructions)
     
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
Schedule B (Form 990, 990-EZ, or 990-PF) (2010)

Schedule B (Form 990, 990-EZ, or 990-PF) (2010)
Page 1 of 1 of Part III
Name of organization
UNION HOSPITAL INC
  		Employer identification number

35-0876396
Part III
Exclusively religious, charitable, etc., individual contributions to section 501(c)(7), (8), or (10) organizations
aggregating more than $1,000 for the year. (Complete columns (a) through (e) and the following line entry.)
For organizations completing Part III, enter the total of exclusively religious, charitable, etc.,
contributions of $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet $  
(a) No.
from
Part I		 (b)
Purpose of gift		 (c)
Use of gift		 (d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I		 (b)
Purpose of gift		 (c)
Use of gift		 (d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I		 (b)
Purpose of gift		 (c)
Use of gift		 (d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I		 (b)
Purpose of gift		 (c)
Use of gift		 (d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
Schedule B (Form 990, 990-EZ, or 990-PF) (2010)

Additional Data


Software ID:  
Software Version:  
SCHEDULE C
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service
Political Campaign and Lobbying Activities

For Organizations Exempt From Income Tax Under section 501(c) and section 527
SchCMd Bullet Complete if the organization is described below.
SchCMd Bullet Attach to Form 990 or Form 990-EZ. SchCMd Bullet See separate instructions.
OMB No. 1545-0047
2010
Open to Public
Inspection
If the organization answered “Yes,” to Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet Section 527 organizations: Complete Part I-A only.
If the organization answered “Yes,” to Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)) Complete Part II-A. Do not complete Part II-B.
Round Bullet Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered “Yes,” to Form 990, Part IV, Line 5 (Proxy Tax) or Form 990-EZ, Part V, line 35a (Proxy Tax), then
Round Bullet Section 501(c)(4), (5), or (6) organizations: Complete Part III.
Name of the organization
UNION HOSPITAL INC
 
Employer identification number

35-0876396
Part I-A
Complete if the organization is exempt under section 501(c) or is a section 527 organization.

1
Provide a description of the organization's direct and indirect political campaign activities on behalf of or in opposition to candidates for public office in Part IV.
2
Political expenditures ....................................SchCMd Bullet
$  
3
Volunteer hours ........................................
 

Part I-B
Complete if the organization is exempt under section 501(c)(3).
1
Enter the amount of any excise tax incurred by the organization under section 4955 .........SchCMd Bullet
$  
2
Enter the amount of any excise tax incurred by organization managers under section 4955 ......SchCMd Bullet
$  
3
If the organization incurred a section 4955 tax, did it file Form 4720 for this year? ..............
4a
Was a correction made? .........................................
b
If "Yes," describe in Part IV.
Part I-C
Complete if the organization is exempt under section 501(c) except section 501(c)(3).
1
Enter the amount directly expended by the filing organization for section 527 exempt function activities SchCMd Bullet
$  
2
Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt funtion activities ....................................SchCMd Bullet

$  
3
Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b..SchCMd Bullet

$  
4
Did the filing organization file Form 1120-POL for this year? ..........................
5
Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.
(a) Name (b) Address (c) EIN (d) Amount paid from filing organization's funds. If none, enter -0-. (e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.










For Privacy Act and Paperwork Reduction Act Notice, see the instructions for Form 990.
Cat. No. 50084S
Schedule C (Form 990 or 990-EZ) 2010

Schedule C (Form 990 or 990-EZ) 2010
Page 2
Part II-A
Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).
A Check
B Check
Limits on Lobbying Expenditures
(The term "expenditures" means amounts paid or incurred.) 		(a) Filing
Organization's
Totals 		(b) Affiliated Group
Totals
1a Total lobbying expenditures to influence public opinion (grass roots lobbying) ......    
b Total lobbying expenditures to influence a legislative body (direct lobbying) .......    
c Total lobbying expenditures (add lines 1a and 1b) ...................    
d Other exempt purpose expenditures ........................    
e Total exempt purpose expenditures (add lines 1c and 1d) ...............    
f Lobbying nontaxable amount. Enter the amount from the following table in both
columns.		    
  If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:    
  Not over $500,00020% of the amount on line 1e.    
  Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.    
  Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.    
  Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.    
  Over $17,000,000$1,000,000.    
       
g Grassroots nontaxable amount (enter 25% of line 1f) .................    
h Subtract line 1g from line 1a. If zero or less, enter -0-. ................    
i Subtract line 1f from line 1c. If zero or less, enter -0-. ................    
j If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting
section 4911 tax for this year? ......................................

4-Year Averaging Period Under Section 501(h)
(Some organizations that made a section 501(h) election do not have to complete all of the five
columns below. See the instructions for lines 2a through 2f on page 4.)
Lobbying Expenditures During 4-Year Averaging Period
  Calendar year (or fiscal year
beginning in) 		(a) 2007 (b) 2008 (c) 2009 (d) 2010 (e) Total
             
2a Lobbying non-taxable amount          
             
b Lobbying ceiling amount
(150% of line 2a, column(e)) 		         
             
c Total lobbying expenditures          
             
d Grassroots non-taxable amount          
             
e Grassroots ceiling amount
(150% of line 2d, column (e))		          
             
f Grassroots lobbying expenditures          
Schedule C (Form 990 or 990-EZ) 2010


Schedule C (Form 990 or 990-EZ) 2010
Page 3
Part II-B
Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).
(a)
Yes
No
(b)
Amount
1
During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:
a
Volunteers? .........................................
 
No
b
Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ....
 
No
c
Media advertisements? ....................................
 
No
 
d
Mailings to members, legislators, or the public? .........................
 
No
 
e
Publications, or published or broadcast statements? .......................
 
No
 
f
Grants to other organizations for lobbying purposes? .......................
 
No
 
g
Direct contact with legislators, their staffs, government officials, or a legislative body? ........
 
No
 
h
Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ......
 
No
 
i
Other activities? If "Yes," describe in Part IV ..........................
Yes
 
16,160
j
Total. lines 1c through 1i ...................................
16,160
2a
Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....
 
No
b
If "Yes," enter the amount of any tax incurred under section 4912 .................
 
c
If "Yes," enter the amount of any tax incurred by organization managers under section 4912 .....
 
d
If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? .......
 
 
Part III-A
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).
Yes
No
1
Were substantially all (90% or more) dues received nondeductible by members? ................
1
 
 
2
Did the organization make only in-house lobbying expenditures of $2,000 or less? ................
2
 
 
3
Did the organization agree to carryover lobbying and political expenditures from the prior year? ..........
3
 
 
Part III-B
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) if BOTH Part III-A, lines 1 and 2 are answered “No” OR if Part III-A, line 3 is answered “Yes”.
1
Dues, assessments and similar amounts from members .....................
1
 
2
Section 162(e) non-deductible lobbying and political expenditures (do not include amounts of political
expenses for which the section 527(f) tax was paid).
a
Current year .........................................
2a
 
b
Carryover from last year ....................................
2b
 
c
Total ...........................................
2c
 
3
Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .
3
 
4
If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ................................
4
 
5
Taxable amount of lobbying and political expenditures (see instructions) ..............
5
 
Part IV
Supplemental Information
Complete this part to provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, line 5; and Part ll-B, line 1i.
Also, complete this part for any additional information.
Identifier Return Reference Explanation
EXPLANATION OF OTHER LOBBYING ACTIVITIES: PART II-B, LINE 1I: 5.29% OF INDIANA HOSPITAL ASSOCATION AND 24.42% OF AMERICAN HOSPITAL ASSOCIATION DUES PAID WERE ATTRIBUTABLE TO LOBBYING EXPENSES AS DEFINED IN FEDERAL LAW.
Schedule C (Form 990 or 990EZ) 2010

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, 11, or 12.
SchDMd Bullet Attach to Form 990. SchDMd Bullet See separate instructions.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
UNION HOSPITAL INC
 
Employer identification number

35-0876396
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 may 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–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 ........ 2d  
3
Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the taxable 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, 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, 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 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) 2010

Schedule D (Form 990) 2010
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 .... 946,496 969,067 1,010,484
b Contributions ........      
c Investment earnings or losses ... 44,026 17,441 4,129
d Grants or scholarships ..... 20,970 27,706 33,684
e Other expenditures for facilities
and programs ........ 		     
f Administrative expenses .... 11,108 12,306 11,862
g End of year balance ...... 958,444 946,496 969,067
2
Provide the estimated percentage of the year end balance held as:
a
Board designated or quasi-endowment: SchDMd Bullet  
b
Permanent endowment: SchDMd Bullet100.000 %
c
Term endowment: SchDMd Bullet  
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)
 
No
(ii) related organizations ........................
3a(ii)
 
No
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
Investments—Land, Buildings, and Equipment. See Form 990, Part X, line 10.
Description of investment (a) Cost or other basis (investment) (b)Cost or other basis (other) (c) Accumulated depreciation (d) Book value
1a Land .................   16,928,544 16,928,544
b Buildings ................   319,814,029 92,074,572 227,739,457
c Leasehold improvements ............   2,534,128 1,704,233 829,895
d Equipment ................   108,703,442 76,356,319 32,347,123
e Other .................   12,476,633   12,476,633
Total. Add lines 1a-1e. (Column (d) should equal Form 990, Part X, column (B), line 10(c).)........SchDMdBullet 290,321,652
Schedule D (Form 990) 2010

Schedule D (Form 990) 2010
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) should 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) should 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








Total. (Column (b) should equal Form 990, Part X, col.(B) line 15.)...........Small Bullet  
Part X
Other Liabilities. See Form 990, Part X, line 25.
1.(a) Description of Liability (b) Amount
Federal Income Taxes  
PENSION LIABILITY 10,216,563








Total. (Column (b) should equal Form 990, Part X, col.(B) line 25.)Small Bullet 10,216,563
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) 2010

Schedule D (Form 990) 2010
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 - 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 should 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 should 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
DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: THE CORPORATION'S ENDOWMENT CONSISTS OF INDIVIDUAL FUNDS ESTABLISHED FOR A VARIETY OF PURPOSES WHICH WERE DONOR-RESTRICTED. NET ASSETS ASSOCIATED WITH ENDOWMENT FUNDS, INCLUDING FUNDS DESIGNATED BY THE CORPORATION TO FUNCTION AS ENDOWMENTS, ARE CLASSIFIED AND REPORTED BASED ON THE EXISTENCE OR ABSENCE OF DONOR-IMPOSED RESTRICTIONS.
DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE CORPORATION AND RECOGNIZE A TAX LIABILITY IF THE CORPORATION HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY VARIOUS FEDERAL AND STATE TAXING AUTHORITIES. MANAGEMENT HAS ANALYZED THE TAX POSITIONS TAKEN BY THE CORPORATION, AND HAS CONCLUDED THAT AS OF AUGUST 31, 2011 AND 2010, THERE ARE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY OR DISCLOSURE IN THE ACCOMPANYING FINANCIAL STATEMENTS. THE CORPORATION IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. FILINGS ARE CURRENT THROUGH 2010. THE IMPACT OF THE SUBSIDIARIES TAX CONSEQUENCES IS IMMATERIAL TO THESE FINANCIAL STATEMENTS.
    FORM 990, PART IV LINE 12 HAS BEEN CHECKED NO PER 990 INSTRUCTIONS. PART XI, XII, AND XIII ARE NOT REQUIRED AS THE ORGANIZATION IS PART OF A CONSOLIDATED FINANCIAL STATEMENT. THE CONSOLIDATED FINANCIAL STATEMENTS ARE AUDITED BY AN INDEPENDENT ACCOUNTING FIRM AND PREPARED IN ACCORDANCE WITH GENERALLY ACCEPTED ACCOUNTING PRINCIPLES.
Schedule D (Form 990) 2010

Additional Data


Software ID:  
Software Version:  




SCHEDULE H
(Form 990)
Department of the Treasury
Internal Revenue Service
Hospitals
MediumBullet Complete if the organization answered "Yes" to Form 990, Part IV, question 20.
MediumBullet Attach to Form 990. MediumBullet See separate instructions.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
UNION HOSPITAL INC
 
Employer identification number

35-0876396
Part I
Charity Care and Certain Other Community Benefits at Cost
Yes
No
1a
Does the organization have a charity care policy? If "No," skip to question 6a...........
1a
Yes
 
b
If "Yes," is it a written policy? .......................
1b
Yes
 
2
If the organization has multiple hospitals, indicate which of the following best describes application of the charity care policy to the various hospitals.
3
Answer the following based on the charity care eligibility criteria that applies to the largest number of the organization's patients.
a
Does the organization use Federal Poverty Guidelines (FPG) to determine eligibility for providing free care to low
income individuals? If "Yes," indicate which of the following is the FPG family income limit for eligibility for free care:
3a
Yes
 
b
Does the organization use FPG to determine eligibility for providing discounted care to low income individuals? If
"Yes," indicate which of the following is the family income limit for eligibility for discounted care: .....
3b
Yes
 
c
If the organization does not use FPG to determine eligibility, describe in Part VI the income based criteria for determining eligibility for free or discounted care. Include in the description whether the organization uses an asset test or other threshold, regardless of income, to determine eligibility for free or discounted care.
4
Does the organization's policy provide free or discounted care to the "medically indigent"? ......
4
Yes
 
5a
Does the organization budget amounts for free or discounted care provided under its charity care policy? ...
5a
Yes
 
b
If "Yes," did the organization's charity care expenses exceed the budgeted amount?.........
5b
Yes
 
c
If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discounted
care to a patient who was eligibile for free or discounted care?...............
5c
 
No
6a
Does the organization prepare an annual community benefit report?.............
6a
Yes
 
6b
If "Yes," does the organization make it available to the public? ..............
6b
Yes
 
Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.
7
Charity Care and Certain Other Community Benefits at Cost
Charity Care and
Means-Tested Government Programs		 (a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community benefit expense (d) Direct offsetting revenue (e) Net community benefit expense (f) Percent of total expense
a Charity care at cost (from
Worksheets 1 and 2) .. 		    10,949,501   10,949,501 2.900 %
b Unreimbursed Medicaid (from
Worksheet 3, column a) . 		    57,009,533 27,286,614 29,722,919 7.860 %
c Unreimbursed costs—other means-tested government programs (from Worksheet 3, column b) ....            
dTotal Charity Care and
Means-Tested Government Programs ..... 		    67,959,034 27,286,614 40,672,420 10.760 %
Other Benefits
e Community health improvement
services and community
benefit operations (from
(Worksheet 4) .... 		    1,154,447 57,437 1,097,010 0.290 %
f Health professions education
(from Worksheet 5) .. 		    7,630,293 2,773,395 4,856,898 1.280 %
g Subsidized health services
(from Worksheet 6) .. 		    11,642,909 2,698,810 8,944,099 2.360 %
h Research (from Worksheet 7)            
i Cash and in-kind contributions
to community groups
(from Worksheet 8) .. 		    176,729   176,729 0.050 %
jTotal Other Benefits ...     20,604,378 5,529,642 15,074,736 3.980 %
kTotal. Add lines 7d and 7j. ..     88,563,412 32,816,256 55,747,156 14.740 %
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 2
Part II
Community Building Activities Complete this table if the organization conducted any community building activities.
(a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community building expense (d) Direct offsetting
revenue 		(e) Net community building expense (f) Percent of total expense
1 Physical improvements and housing     819,791   819,791 0.220 %
2 Economic development            
3 Community support            
4 Environmental improvements     1,022,546   1,022,546 0.270 %
5 Leadership development and training for community members            
6 Coalition building     183,893   183,893 0.050 %
7 Community health improvement advocacy            
8 Workforce development     179,391 75,070 104,321 0.030 %
9 Other            
10 Total     2,205,621 75,070 2,130,551 0.570 %
Part III
Bad Debt, Medicare, & Collection Practices
Section A. Bad Debt Expense
Yes
No
1
Does the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................
1
Yes
 
2
Enter the amount of the organization's bad debt expense (at cost).....
2
14,132,858
3
Enter the estimated amount of the organization's bad debt expense (at cost) attributable to patients eligible under the organization's charity care policy ..
3
0
4
Provide in Part VI the text of the footnote to the organization's financial statements that describes bad debt expense. In addition, describe the costing methodology used in determining the amounts reported on lines 2 and 3, and rationale for including a portion of bad debt amounts as community benefit.
Section B. Medicare
5
Enter total revenue received from Medicare (including DSH and IME).....
5
128,357,921
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
144,023,723
7
Subtract line 6 from line 5. This is the surplus or (shortfall)........
7
-15,665,802
8
Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.
Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.
Check the box that describes the method used:
Section C. Collection Practices
9a
Does the organization have a written debt collection policy? ...............
9a
Yes
 
b
If "Yes," does the organization's collection policy contain provisions on the collection practices to be followed for patients who are known to qualify for charity care or financial assistance? Describe in Part VI......
9b
Yes
 
Part IV
Management Companies and Joint Ventures
(a) Name of entity (b) Description of primary
activity of entity 		(c) Organization's
profit % or stock
ownership % 		(d) Officers, directors,
trustees, or key
employees' profit %
or stock ownership% 		(e) Physicians'
profit % or stock
ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 3
Part VFacility Information
Section A. Hospital Facilities
(list in order of size, measured by total revenue per facility, from largest to smallest)
How many hospital facilities did the organization operate during the tax year?2
Name and address 		Licensed Hospital General-Medical-Surgical Children's Hospital Teaching Hospital Critical Hospital Research Facility ER-24Hours ER-Other Other (Describe)
1 UNION HOSPITAL INC
1606 NORTH SEVENTH STREET
TERRE HAUTE,IN47804 		X X   X     X   PHYSICIAN PRACTICES, OFF CAMPUS THERAPY, RADIOLOGY
2 UNION HOSPITAL CLINTON
801 S MAIN ST
CLINTON,IN47842 		X       X   X    
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 4
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
Name of Hospital Facility:UNION HOSPITAL - NOT REQUIRED
Line Number of Hospital Facility (from Schedule H, Part V, Section A):1

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2010)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet those needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess all of the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Development of a community benefit plan for the facility
d Participation in community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the CHNA
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed together with the reasons why it has not addressed such needs. 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explains eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8    
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care to low incomeindividuals?.. 9    
If “Yes,” indicate the FPG family income limit for eligibility for free care:   %
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 5
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care to low income individuals?......... 10    
If “Yes,” indicate the FPG family income limit for eligibility for discounted care:   %
11 Explained the basis for calculating amounts charged to patients?................. 11    
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12    
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13    
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted at all times on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy that explained actions the hospital facility may take upon non-payment?........ 14    
15 Check all of the following collection actions against a patient that were permitted under the hospital facility's policies at any time during the tax year:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments or arrests
e Other (describe in Part VI)
16 Did the hospital facility engage in or authorize a third party to engage in any of the following collection actions during the tax year?................................... 16    
If “Yes,” check all collection actions in which the hospital facility or a third party engaged (check all that apply):
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other (describe in Part VI)
17 Indicate which actions the hospital facility took before initiating any of the collection actions checked in question 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether a patient who applied for financial assistance under the financial assistance policy qualified for financial assistance
e Other (describe in Part VI)
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 6
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18    
If “No,” indicate the reasons why (check all that apply):
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility did not have a policy relating to emergency medical care
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Charges for Medical Care
19 Indicate how the hospital facility determined the amounts generally billed to individuals who had insurance covering emergency or other medically necessary care (check all that apply):
a The hospital facility used the lowest negotiated commercial insurance rate for those services at the hospital facility
b The hospital facility used the average of the three lowest negotiated commercial insurance rates for those services at the hospital facility
c The hospital facility used the Medicare rate for those services
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20    
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its patients an amount equal to the gross charge for services provided to that patient?................................... 21    
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 4
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
Name of Hospital Facility:UNION HOSPITAL CLINTON - NOT REQUIRED
Line Number of Hospital Facility (from Schedule H, Part V, Section A):2

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2010)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet those needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess all of the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Development of a community benefit plan for the facility
d Participation in community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the CHNA
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed together with the reasons why it has not addressed such needs. 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explains eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8    
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care to low incomeindividuals?.. 9    
If “Yes,” indicate the FPG family income limit for eligibility for free care:   %
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 5
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care to low income individuals?......... 10    
If “Yes,” indicate the FPG family income limit for eligibility for discounted care:   %
11 Explained the basis for calculating amounts charged to patients?................. 11    
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12    
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13    
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted at all times on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy that explained actions the hospital facility may take upon non-payment?........ 14    
15 Check all of the following collection actions against a patient that were permitted under the hospital facility's policies at any time during the tax year:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments or arrests
e Other (describe in Part VI)
16 Did the hospital facility engage in or authorize a third party to engage in any of the following collection actions during the tax year?................................... 16    
If “Yes,” check all collection actions in which the hospital facility or a third party engaged (check all that apply):
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other (describe in Part VI)
17 Indicate which actions the hospital facility took before initiating any of the collection actions checked in question 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether a patient who applied for financial assistance under the financial assistance policy qualified for financial assistance
e Other (describe in Part VI)
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 6
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18    
If “No,” indicate the reasons why (check all that apply):
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility did not have a policy relating to emergency medical care
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Charges for Medical Care
19 Indicate how the hospital facility determined the amounts generally billed to individuals who had insurance covering emergency or other medically necessary care (check all that apply):
a The hospital facility used the lowest negotiated commercial insurance rate for those services at the hospital facility
b The hospital facility used the average of the three lowest negotiated commercial insurance rates for those services at the hospital facility
c The hospital facility used the Medicare rate for those services
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20    
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its patients an amount equal to the gross charge for services provided to that patient?................................... 21    
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 7
Part VFacility Information (continued)

Section C. Other Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility
(list in order of size, measured by total revenue per facility, from largest to smallest)
How many non-hospital facilities did the organization operate during the tax year?13
Name and address Type of Facility (Describe)
1 CLARA FAIRBANKS CENTER FOR WOMEN
1711 N 6 1/2 ST HUX CANCER CTR 3RD
FLOOR
TERRE HAUTE,IN47804 		MAMMOGRAPHY CENTER
2 CLARA FAIRBANKS CENTER FOR WOMEN
1711 N 6 1/2 ST HUX CANCER CTR 3RD
FLOOR
TERRE HAUTE,IN47804 		MAMMOGRAPHY CENTER
3 CLARA FAIRBANKS CENTER FOR WOMEN
1711 N 6 1/2 ST HUX CANCER CTR 3RD
FLOOR
TERRE HAUTE,IN47804 		MAMMOGRAPHY CENTER
4 CLARA FAIRBANKS CENTER FOR WOMEN
1711 N 6 1/2 ST HUX CANCER CTR 3RD
FLOOR
TERRE HAUTE,IN47804 		MAMMOGRAPHY CENTER
5 CLARA FAIRBANKS CENTER FOR WOMEN
1711 N 6 1/2 ST HUX CANCER CTR 3RD
FLOOR
TERRE HAUTE,IN47804 		MAMMOGRAPHY CENTER
6 CLARA FAIRBANKS CENTER FOR WOMEN
1711 N 6 1/2 ST HUX CANCER CTR 3RD
FLOOR
TERRE HAUTE,IN47804 		MAMMOGRAPHY CENTER
7 CLARA FAIRBANKS CENTER FOR WOMEN
1711 N 6 1/2 ST HUX CANCER CTR 3RD
FLOOR
TERRE HAUTE,IN47804 		MAMMOGRAPHY CENTER
8 CLARA FAIRBANKS CENTER FOR WOMEN
1711 N 6 1/2 ST HUX CANCER CTR 3RD
FLOOR
TERRE HAUTE,IN47804 		MAMMOGRAPHY CENTER
9 CLARA FAIRBANKS CENTER FOR WOMEN
1711 N 6 1/2 ST HUX CANCER CTR 3RD
FLOOR
TERRE HAUTE,IN47804 		MAMMOGRAPHY CENTER
10 CLARA FAIRBANKS CENTER FOR WOMEN
1711 N 6 1/2 ST HUX CANCER CTR 3RD
FLOOR
TERRE HAUTE,IN47804 		MAMMOGRAPHY CENTER
11 CLARA FAIRBANKS CENTER FOR WOMEN
1711 N 6 1/2 ST HUX CANCER CTR 3RD
FLOOR
TERRE HAUTE,IN47804 		MAMMOGRAPHY CENTER
12 CLARA FAIRBANKS CENTER FOR WOMEN
1711 N 6 1/2 ST HUX CANCER CTR 3RD
FLOOR
TERRE HAUTE,IN47804 		MAMMOGRAPHY CENTER
13 CLARA FAIRBANKS CENTER FOR WOMEN
1711 N 6 1/2 ST HUX CANCER CTR 3RD
FLOOR
TERRE HAUTE,IN47804 		MAMMOGRAPHY CENTER
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 8
Part VI
Supplemental Information
Complete this part to provide the following information.
1 Required descriptions. Provide the description required for Part I, lines 3c, 6a, and 7; Part II; Part III, lines 4, 8, and 9b; and Part V, Section B, lines 1j, 2, 4c, 6i, 7, 11i, 13i, 17l, 18l, 19e, 21d, 25, and 26.
2 Community health needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any community health needs assessments reported in Part V, Section B.
3 Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4 Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5 Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6 Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7 State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.
Identifier ReturnReference Explanation
    PART I, LINE 3C: SCHEDULE H PART I LINE 3BDESCRIPTION OF FAMILY INCOME LIMIT FOR DISCOUNTED CARETHE ORGANIZATION PROVIDES PARTIAL ASSISTANCE FOR INCOME LEVELS BETWEEN 150% AND 200% OF FEDERAL POVERTY GUIDELINES, AND OFFERS DISCOUNTED CARE ON A SLIDING SCALE FOR INCOME LEVELS BETWEEN 250% AND 400% OF FEDERAL POVERTY GUIDELINES.
    PART I, L7 COL(F): TOTAL BAD DEBT EXPENSE OF $41,962,299 INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A) HAS BEEN EXCLUDED FROM THE DENOMINATOR FOR PURPOSES OF CALCULATING THE PERCENTAGE IN SCHEDULE H, PART I, LINE 7, COLUMN (F) PER IRS INSTRUCTION.
    PART II: TO BETTER MEET THE NEEDS OF OUR COMMUNITIES UHI PARTICIPATES IN COMMUNITY BUILDING ACTIVITIES TO IMPROVE THE HEALTH IN THE COMMUNITY. PROGRAMS HAVE BEEN DEVELOPED TO SPECIFICALLY HELP MEET THE NEEDS AS DEFINED BY OUR COMMUNITY HEALTH NEEDS ASSESSMENT. MANY OF THE PROGRAMS OR SERVICES DEVELOPED MEET SEVERAL DEFINED NEEDS AND SOME OF THEM ARE MORE FOCUSED ON A CENTRAL IDEA, FOR EXAMPLE PARTNERING WITH OUR LOCAL WABASH VALLEY HARLEY DAVIDSON DEALER AND OFFERING A FREE PROSTATE CANCER SCREENING TO OUR MALE POPULATION. THE CENTRAL FOCUS IS TO IDENTIFY MALES THAT HAVE AN ELEVATED PSA LEVELS SO THEY CAN GET TREATMENT BEFORE MAJOR HEALTH COMPLICATIONS ARISE. CONTINUED ON SCHEDULE O
    PART III, LINE 4: FOOTNOTE TO ORGANIZATION'S FINANCIAL STATEMENTS THAT DESCRIBES BAD DEBT EXPENSES: THE ALLOWANCE FOR DOUBTFUL ACCOUNTS IS BASED ON MANAGEMENT'S ASSESSMENT OF HISTORICAL AND EXPECTED NET COLLECTIONS CONSIDERING BUSINESS AND ECONOMIC CONDITIONS, TRENDS IN HEALTH CARE COVERAGE, AND OTHER COLLECTION INDICATORS. PERIODICALLY THROUGHOUT THE YEAR, MANAGEMENT ASSESSES THE ADEQUACY FOR UNCOLLECTIBLE RECEIVABLES BASED UPON THE PAYOR COMPOSITION AND AGING OF RECEIVABLES AS OF THE REPORTING DATE WITH CONSIDERATION OF THE HISTORICAL WRITEOFF EXPERIENCE BY PAYOR CATEGORY. THE RESULTS OF THESE REVIEWS ARE THEN USED TO MAKE ANY MODIFICATIONS TO THE PROVISION FOR UNCOLLECTIBLE RECEIVABLES TO ESTABLISH AN APPROPRIATE ALLOWANCE FOR UNCOLLECTIBLE RECEIVABLES. AFTER SATISFACTION OF AMOUNTS DUE FROM INSURANCE, THE CORPORATION FOLLOWS ESTABLISHED GUIDELINES FOR PLACING PAST-DUE PATIENT ACCOUNTS WITH COLLECTION AGENCIES.EXPLANATION FOR LINE 2 AND 3 OR RATIONAL FOR INCLUDING OTHER BAD DEBT AMOUNT IN COMMUNITY BENEFIT: THE HOSPITAL HAS A DETAILED FINANCIAL ASSISTANCE POLICY WHICH STATES THAT TO PARTICIPATE IN CHARITY CARE CANDIDATES MUST COOPERATE FULLY. IN ADDITION THE HOSPITAL EDUCATES PATIENTS WITH LIMITED ABILITY TO PAY REGARDING FINANCIAL ASSISTANCE. FOR THIS REASON THE ORGANIZATION BELIEVES THAT IT ACCURATELY CAPTURES ALL CHARITY CARE DEDUCTIONS PROVIDED ACCORDING TO THE FINANCIAL ASSISTANCE POLICY AND THE AMOUNT OF BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY CARE POLICY IS NEGLIGIBLE.
    PART III, LINE 8: THE SOURCE USED TO DETERMINE THE AMOUNT OF MEDICARE ALLOWABLE COSTS REPORTED FOR PART III, SECTION B, MEDICARE HAS BEEN PROVIDED FROM THE YEAR ENDED AUGUST 31, 2011 REPORT: HOSPITAL STATEMENT OF REIMBURSABLE COST.
    PART III, LINE 9B: IF THE PATIENT DOES NOT QUALIFY FOR CHARITY, BUT QUALIFIES FOR LIMITED MEANS ASSISTANCE, A REDUCTION IN CHARGES WILL BE MADE TO THE ACCOUNT AND THE PATIENT WILL BE NOTIFIED VIA MAIL. AT THE PATIENT'S REQUEST, PAYMENT ARRANGEMENTS WILL BE MADE FOR THE REMAINING BALANCE.
    SCHEDULE H PART I LINE 3BDESCRIPTION OF FAMILY INCOME LIMIT FOR DISCOUNTED CARETHE ORGANIZATION PROVIDES PARTIAL ASSISTANCE FOR INCOME LEVELS BETWEEN 150% AND 200% OF FEDERAL POVERTY GUIDELINES, AND OFFERS DISCOUNTED CARE ON A SLIDING SCALE FOR INCOME LEVELS BETWEEN 250% AND 400% OF FEDERAL POVERTY GUIDELINES.
    PART VI, LINE 2: ASSESSING THE NEEDS OF OUR COMMUNITY IS AN ONGOING ACTIVITY. ALTHOUGH A FORMALIZED ASSESSMENT TOOL IS CURRENTLY BEING EVALUATED, ONLINE DATABASES HAVE PROVED BENEFICIAL IN HELPING THE ORGANIZATION DETERMINE THE BEST WAY TO UTILIZE ITS RESOURCES. THE MOST VALUABLE OF THOSE RESOURCES BEING UNION'S 2,000 PLUS EMPLOYEES WHO DONATE THOUSANDS OF HOURS OF COMMUNITY SERVICE EACH YEAR. UHI EMPLOYS A FULL-TIME POSITION (COMMUNITY LIAISON) DEDICATED TO COMMUNITY BENEFIT ACTIVITIES FOR THE ORGANIZATION. THE COMMUNITY LIAISON TAKES ON THE LEAD ROLE IN COLLECTING DATA TO ASSIST IN ASSESSING THE NEEDS OF OUR COMMUNITY. THE WEBSITE STATSINDIANA.EDU HAS A WEALTH OF HEALTH, DEMOGRAPHIC AND INCOME DATA PROVIDING UNION WITH AN ASSESSMENT OF ALL INDIANA COUNTIES IN OUR SERVICE AREA. THE U.S. CENSUS BUREAU AND COUNTYHEALTHRANKINGS.ORG PROVIDED DATA THAT CAN BE DRILLED DOWN TO THE STATE, COUNTY AND CITY LEVELS TO HELP UHI OFFICIALS ACCURATELY ASSESS COMMUNITY HEALTH NEEDS. UNION ALSO WORKS CLOSELY WITH INDIANA STATE UNIVERSITY COLLEGE OF NURSING HEALTH AND HUMAN SERVICES, AND THE VIGO COUNTY HEALTH DEPARTMENT. THE HOSPITAL UTILIZES NATIONAL RESEARCH CORPORATION (NRC) TO CONDUCT ITS PATIENT SATISFACTION SURVEYS, AND TO PROVIDE UHI WITH COMMUNITY HEALTH NEEDS ASSESSMENT. ON AUGUST 14, 2009, PUBLIC HEALTH SYSTEM PARTNERS OF VIGO COUNTY CONVENED A MEETING TO EVALUATE HOW TO BETTER SERVE THE PUBLIC HEALTH AND HEALTHCARE NEEDS OF THE COUNTY'S ESTIMATED 106,000 RESIDENTS. THE RURAL HEALTH INNOVATION COLLABORATIVE (RHIC) HOSTED THE ALL DAY EVENT, IN PARTNERSHIP WITH THE VIGO COUNTY HEALTH DEPARTMENT. THE INDIANA STATE DEPARTMENT OF HEALTH, IN COLLABORATION WITH PURDUE UNIVERSITY'S HEALTHCARE TECHNICAL ASSISTANCE PROGRAM, WORKED TOGETHER TO CREATE THIS OPPORTUNITY FOR ALL LOCAL PUBLIC HEALTH SYSTEM PARTNERS TO IDENTIFY EXISTING STRENGTHS, AS WELL AS OPPORTUNITIES TO ESTABLISH AND FORMALIZE PUBLIC HEALTH SYSTEM INFRASTRUCTURE IN INDIANA COUNTIES. VIGO COUNTY PARTNERS MET TO COMPLETE THE CDC NATIONAL PUBLIC HEALTH PERFORMANCE STANDARDS, LOCAL PUBLIC HEALTH SYSTEM ASSESSMENT - A NATIONALLY RECOGNIZED PUBLIC HEALTH SYSTEM ASSESSMENT TOOL. THE ASSESSMENT PROCESS AND RESULTS ENABLED GREATER UNDERSTANDING OF HOW THE COUNTY'S HEALTHCARE AND PUBLIC HEALTH ORGANIZATIONS RELATE TO ONE ANOTHER AND HOW THEY PROVIDE ESSENTIAL PUBLIC HEALTH AND HEALTHCARE SERVICES TO THE PUBLIC THEY SERVE. THE ASSESSMENT SPECIFICALLY FOCUSED ON AREAS SUCH AS COMMUNICATION, PARTNERSHIPS, LINKING PEOPLE TO NEEDED SERVICES, AND SHARING OF RESOURCES. FINDINGS OF THE ASSESSMENT REVEALED STRENGTHS OF THE SYSTEM THAT INCLUDED: -IDENTIFICATION AND SURVEILLANCE OF HEALTH THREATS, AND RESPONSE TO PUBLIC HEALTH THREATS AND EMERGENCIES -INFORMING, EDUCATING AND EMPOWERING THE PUBLIC ABOUT PUBLIC HEALTH ISSUES-ENFORCEMENT OF LAWS AND REGULATIONS THAT PROTECT HEALTH AND ENSURE SAFETY THE ASSESSMENT ALSO REVEALED IMPORTANT AREAS FOR PERFORMANCE IMPROVEMENT, INCLUDING:-MOBILIZING COMMUNITY PARTNERSHIPS TO IDENTIFY AND SOLVE HEALTH PROBLEMS -DEVELOPING COMMUNITY HEALTH IMPROVEMENT PROCESSES-USING CURRENT TECHNOLOGY TO MONITOR, MANAGE AND COMMUNICATE POPULATION HEALTH DATA-THE ASSESSMENT PROCESS CAN SERVE AS THE FOUNDATION TO FORMALIZE PROCESSES THAT STRENGTHEN LOCAL PUBLIC HEALTH SYSTEM INFRASTRUCTURE WITH THE CAPACITY AND RESOURCES TO IMPROVE QUALITY AND EFFECTIVENESS OF HEALTHCARE SERVICES IN VIGO COUNTY.
    PART VI, LINE 3: UHI USES A VARIETY OF TOOLS TO EDUCATE PATIENTS ABOUT THEIR ELIGIBILITY FOR FINANCIAL ASSISTANCE. SIGNS ARE DISPLAYED IN THE ADMITTING AREAS, BROCHURES AND THE FINANCIAL ASSISTANCE POLICY IS ATTAINED ON OUR STATEMENTS. CLAIMAID IS AVAILABLE OF POINT OF SERVICE ONSITE MEDICAID ELIGIBILITY ADVISOR THAT ASSISTS OUR PATIENTS IN QUALIFYING FOR ANY MEDICAID PROGRAMS. ALL OF OUR FINANCIAL COUNSELORS ARE TRAINED AND SCRIPTED TO COMMUNICATE FINANCIAL ASSISTANCE PROGRAMS AND ASSIST IN SETTING UP MEETINGS FOR THE CLAIMAID STAFF. FINANCIAL COUNSELORS ARE LOCATED IN THE ADMITTING IN BOTH UNION HOSPITAL EAST AND WEST FACILITIES AND AT UNION CLINTON FACILITY TO ASSIST OUR PATIENTS. THIS INCLUDES STAFF THAT CAN SPEAK SPANISH TO ASSIST IN ANY INTERPRETATION FOR A SPANISH SPEAKING PATIENT.
    PART VI, LINE 4: THE COMMUNITIES SERVED BY UHI REPRESENT A BLENDING OF URBAN AND RURAL PEOPLE. TERRE HAUTE AND VIGO COUNTY ARE LARGELY URBAN AND SUBURBAN WITH A POPULATION OF 106,000. THE REMAINING 147,000 PEOPLE SERVED BY UNION ARE LOCATED IN SMALL TOWNS AND RURAL FARMING AREAS THROUGHOUT EIGHT ADDITIONAL COUNTIES SURROUNDING VIGO COUNTY. PEOPLE IN VIGO COUNTY ARE MORE RACIALLY DIVERSE WITH 89.5% BEING CAUCASIAN, 7% AFRICAN AMERICAN, 1.6% ASIAN AND 1.5% HISPANIC. THE SURROUNDING COUNTIES AVERAGE 96.4% WHITE, 2% AFRICAN AMERICAN AND LESS THAN 1% ASIAN AND HISPANIC POPULATIONS. VIGO COUNTY IS YOUNGER WITH AN AVERAGE AGE OF 35.9 COMPARED TO 39.99 IN THE SURROUNDING COUNTIES WITH 14.5% BEING 65 YEARS OF AGE OR OLDER COMPARED TO 13.7% IN VIGO COUNTY. REGARDLESS OF LOCATION, MEDIAN HOUSEHOLD INCOMES AVERAGING $39,250 FALL FAR BELOW THE INDIANA AVERAGE OF $48,010 AND THE US AVERAGE OF $52,029. MORE THAN 19% OF VIGO COUNTY RESIDENTS AND 10.3% OF SURROUNDING COUNTY RESIDENTS LIVE IN POVERTY. IN VIGO COUNTY, ONE IN FOUR CHILDREN LIVES IN POVERTY. VIGO COUNTY RANKS SECOND IN THE STATE IN POVERTY, AND 5TH IN THE STATE IN POVERTY RANK AMONG CHILDREN UNDER THE AGE OF 18. EMPLOYMENT WITHIN VIGO COUNTY INCLUDES A LARGE RETAIL AND RESTAURANT SERVICE SECTOR, HEALTHCARE, HIGHER EDUCATION AND A DIVERSE MANUFACTURING SECTOR. UHI IS THE LARGEST EMPLOYER IN TERRE HAUTE. THE SURROUNDING COUNTIES OFFER LARGELY AGRICULTURAL AND MINING-BASED EMPLOYMENT WITH MANY RESIDENTS TRAVELING TO VIGO COUNTY FOR EMPLOYMENT OPPORTUNITIES. UNEMPLOYMENT IN VIGO COUNTY WAS 9.9% IN 2009, SLIGHTLY LOWER THAN THE STATE AVERAGE AT THAT TIME OF 10.4%. A HEALTH NEEDS ASSESSMENT CONDUCTED IN 2006 REVEALED THAT PEOPLE IN THE AREA WITH INCOMES BELOW 200% OF THE POVERTY LEVEL HAD SIGNIFICANTLY HIGHER RATES OF PHYSICAL IMPAIRMENT, DEPRESSION, OBESITY, TOBACCO USE, HIGH BLOOD PRESSURE AND DIABETES. THIS POPULATION SEGMENT WAS FAR LESS LIKELY TO ENGAGE IN REGULAR PHYSICAL ACTIVITY. WHILE OVERALL RATES OF TOBACCO USE IN THE AREA WERE SLIGHTLY LOWER (20%) THAN THE STATE AVERAGE (24.9%), THE DEMOGRAPHIC SEGMENT WITH THE LARGEST TOBACCO USE WAS WOMEN OF CHILDBEARING AGE AT 24.8%. ACCESS TO HEALTH CARE IS A CHALLENGE FOR THOSE IN RURAL AREAS WHO OFTEN MUST TRAVEL TO TERRE HAUTE OR ELSEWHERE FOR MEDICAL CARE AND CHRONIC DISEASE MANAGEMENT.
    PART VI, LINE 6: SEE SCHEDULE O.
    PART VI, LINE 7: THE ORGANIZATION IS PART OF AN AFFILATED HEALTH CARE SYSTEM TO PROVIDE VISION AND STRATEGIC DIRECTION IN THE FORMATION OF A REGIONAL HEALTH CARE SYSTEM TO EXPAND AND IMPROVE THE DELIVERY OF HEALTH CARE SERVCIES IN ORDER TO MEET THE HEALTH CARE NEEDS OF RESIDENTS IN THE SYSTEM'S SERVICE AREA.
REPORTS FILED WITH STATES PART VI, LINE 7 IN
Schedule H (Form 990) 2010
Additional Data


Software ID:  
Software Version:  
Schedule I
(Form 990)
Department of the Treasury
Internal Revenue Service
Grants and Other Assistance to Organizations,
Governments and Individuals in the United States
Complete if the organization answered "Yes," to Form 990, Part IV, line 21 or 22.
lBullet Attach to Form 990
OMB No. 1545-0047
2010
Open to Public
Inspection
Name of the organization
UNION HOSPITAL INC
 
Employer identification number
35-0876396
Part I
General Information on Grants and Assistance
1
Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ....................................
2
Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.
Part II
Grants and Other Assistance to Governments and Organizations in the United States. Complete if the organization answered "Yes" to
Form 990, Part IV, line 21 for any recipient that received more than $5,000. Check this box if no one recipient received more than $5,000. Use
Part IV and Schedule I-1 (Form 990) if additional space is needed ......................... lBullet
(a) Name and address of organization
or government		 (b) EIN (c) IRC Code section
if applicable		 (d) Amount of cash grant (e) Amount of non-cash
assistance		 (f) Method of valuation
(book, FMV, appraisal,
other)		 (g) Description of
non-cash assistance		 (h) Purpose of grant
or assistance
(1) VIGO COUNTY SCHOOL CORPORATIONPO BOX 3703
TERRE HAUTE,IN47803 		35-6007261   22,000       GENERAL DONATION
(2) TERRE HAUTE BOYS & GIRLS CLUB220 NORTH THIRD ST
TERRE HAUTE,IN47807 		35-0868182 501C3 5,000       GENERAL DONATION
(3) RURAL HEALTH INNOVATION COLLABORATIVE INC1606 N 7TH STREET
TERRE HAUTE,IN47804 		27-1374208 501C3 0 28,632 FMV DONATION OF OFFICE SPACE DONATION OF RENTAL OFFICE SPACE TO ORGANIZATION TO FURTHER ITS EXEMPT PURPOSE.
(4) AMERICAN CANCER SOCIETY250 WILLIAMS STREET NW
ATLANTA,GA30303 		13-1788491 501C3 5,000 20,006 FMV DONATION OF ADVERTISING SPACE PROVIDING ADVERTISING SPACE FREE OF CHARGE.
















2
Enter total number of section 501(c)(3) and government organizations ......................... Bullet Image
3
3
Enter total number of other organizations ................................ . Bullet Image
0
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50055P
Schedule I (Form 990) 2010

Schedule I (Form 990) 2010
Page 2
Part III
Grants and Other Assistance to Individuals in the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 22.
Use Schedule I-1 (Form 990) if additional space is needed.
(a)Type of grant or assistance (b)Number of
recipients		 (c)Amount of
cash grant		 (d)Amount of
non-cash assistance		 (e)Method of valuation (book,
FMV, appraisal, other)		 (f)Description of non-cash assistance













Part IV
Supplemental Information. Complete this part to provide the information required in Part I, line 2, and any other additional information.
Identifier Return Reference Explanation
PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: GRANTS TO ENTITIES IN THE UNITED STATES: GRANTS ARE PROVIDED TO 501(C)(3) PUBLIC CHARITIES AND LOCAL SCHOOL CORPORATION FOR GENERAL SUPPORT. UNION HOSPITAL DOES NOT MONITOR THE USE OF THESE FUNDS BY THESE PUBLIC CHARITIES.
Schedule I (Form 990) 2010


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
2010
Open to Public Inspection
Name of the organization
UNION HOSPITAL INC
 
Employer identification number

35-0876396
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 orprovision of all the expenses described above? If "No," complete Part III to explain....
1b
Yes
 
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
Yes
 
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.
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
 
No
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
Yes
 
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 Regs. 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) 2010

Schedule J (Form 990) 2010
Page 2
Part II
Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use Schedule J-1 if additional space 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) must equal the applicable column (D) or column (E) amounts on Form 990, Part VII, line 1a.
(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 in prior
Form 990 or
Form 990-EZ
(i) Base compensation (ii) Bonus & incentive compensation (iii) Other reportable compensation
(1) DAVID DOERR (i)
(ii)		 279,034
0 		0
0 		17,730
0 		1,396
0 		18,915
0 		317,075
0 		0
0
(2) SCOTT TEFFETELLER (i)
(ii)		 245,820
0 		0
0 		41,344
0 		4,954
0 		21,373
0 		313,491
0 		0
0
(3) WAYNE HUTSON (i)
(ii)		 205,012
0 		0
0 		32,342
0 		5,105
0 		15,139
0 		257,598
0 		0
0
(4) CAROL ROESCH (i)
(ii)		 141,189
0 		0
0 		29,672
0 		3,904
0 		15,635
0 		190,400
0 		0
0
(5) KYM PFRANK (i)
(ii)		 153,216
0 		0
0 		25,500
0 		3,768
0 		15,257
0 		197,741
0 		0
0
(6) SALLY ZUEL (i)
(ii)		 136,704
0 		0
0 		21,197
0 		3,628
0 		8,326
0 		169,855
0 		0
0
(7) RONALD LEACH (i)
(ii)		 183,584
0 		0
0 		16,500
0 		0
0 		0
0 		200,084
0 		0
0
(8) NABIL MNAYARJI (i)
(ii)		 695,821
0 		0
0 		147,100
0 		7,350
0 		23,128
0 		873,399
0 		0
0
(9) LINGAN SIDDA (i)
(ii)		 437,782
0 		0
0 		587,538
0 		6,891
0 		16,039
0 		1,048,250
0 		0
0
(10) PRADEEP NAROTAM (i)
(ii)		 496,819
0 		0
0 		353,081
0 		5,895
0 		22,129
0 		877,924
0 		0
0
(11) RAMESH TANK (i)
(ii)		 429,003
0 		0
0 		572,598
0 		7,350
0 		23,129
0 		1,032,080
0 		0
0
(12) SANJAY PATHAK (i)
(ii)		 429,999
0 		0
0 		417,513
0 		6,334
0 		22,123
0 		875,969
0 		0
0




Schedule J (Form 990) 2010

Schedule J (Form 990) 2010
Page 3
Part III
Supplemental Information
Complete this part to provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 4c, 5a, 5b, 6a, 6b, 7, and 8. Also complete this part for any additional information.
Identifier Return Reference Explanation
  PART I, LINE 1A COUNTY CLUB OF TERRE HAUTE DUES WERE PAID FOR THE CFO DURING THE YEAR. THE COUNTY CLUB DUES FOR THE COO AND CEO WERE CANCELLED DURING THE FIRST QUARTER OF THE FISCAL YEAR.
  PART I, LINE 7 THE ORGANIZATION PROVIDES NON-FIXED PAYMENTS TO SEVERAL INDIVIDUALS LISTED ON FORM 990, PART VII, SECTION A, LINE 1A. THESE NON-FIXED PAYMENTS ARE BASED ON THE ORGANIZATION'S ABILITY TO PAY AND ARE NOT CONSTRUED AS A CONTRACT BETWEEN UNION AND ITS EXECUTIVES. THE EXECUTIVE BONUS PLAN IS A MIXTURE OF OBJECTIVES, STANDARDS AND SUBJECTIVE STANDARDS THAT BOTH THE POLICY AND THE IMPLEMENTATION OF THE POLICY BY THE PERSONNEL COMMITTEE AND THE BOARD OF DIRECTORS APPROVES AND AWARDS DEPENDING ON UNION'S ABILITY TO PAY. THERE IS NO AUTOMATIC RIGHT TO A BONUS OR A SPECIFIC BONUS AMOUNT EVEN IF ALL CRITERIA ARE MET. THE PERFORMANCE MEASURE PLAN IS LINKED TO THE UNION STRATEGIC AND FISCAL-YEAR BUSINESS PLANNING PROCESS. THE PLAN IS INTENDED TO FOCUS PARTICIPANTS' ATTENTION ON MISSION-CRITICAL GOALS AND KEY STRATEGIC PRIORITIES. THE PLAN IS ALSO INTENDED TO ENHANCE THE PERFORMANCE OF UNION EXECUTIVES AND THE ORGANIZATION. PRIOR TO THE START OF THE FISCAL YEAR AND AS PART OF THE BUSINESS PLANNING PROCESS, THE UNION PRESIDENT AND CEO WILL FINALIZE A LIST OF GOALS, WEIGHTS AND MEASURES TO BE USED TO ASSESS PERFORMANCE DURING THE FISCAL YEAR. THE LIST IS PRESENTED TO AND DISCUSSED WITH THE COMMITTEE. THE COMMITTEE REVIEWS AND APPROVES THE BONUS PLAN GOALS, WEIGHTS, AND MEASURES. ORGANIZATION GOALS WILL BE ASSIGNED TO EACH PARTICIPANT HOSPITAL-WIDE. IN ADDITION TO HOSPITAL-WIDE GOALS INDIVIDUAL AND/OR FUNCTIONAL/DEPARTMENT GOALS MAY OR MAY NOT BE INCLUDED. AFTER THE CONCLUSION OF EACH FISCAL YEAR, THE PRESIDENT & CEO WILL PREPARE AN ANNUAL BONUS PLAN REPORT FOR THE COMMITTEE. THE REPORT CONTAINS: AN APPRAISAL OF UNION AND HOSPITAL/OPERATING UNIT PERFORMANCE DURING THE RECENTLY-COMPLETED FISCAL YEAR; AND THE PRESIDENT & CEO'S RECOMMENDED PAYOUT FOR EACH PLAN PARTICIPANT. THE BONUS RECOMMENDATIONS FOR ALL SR. MANAGEMENT ARE RECEIVED AND REVIEWED FIRST BY THE PERSONNEL COMMITEE WHO THEN MAKE DECISIONS AND SUBMITS TO THE BOARD TO VOTE. THE COMMITTEE WILL DETERMINE AND SUBMIT THE PAYOUT FOR THE PRESIDENT & CEO TO THE BOARD OF DIRECTORS WHO, ABSENT THE PRESDIENT & CEO, WILL VOTE ON APPROVAL. AWARD DETERMINATIONS ARE CALCULATED AS PERCENTAGES OF PARTICIPANT'S SALARIES PAID FOR TIME WORKED DURING THE FISCAL YEAR. PAYOUTS FOR PRESIDENT IS 0% TO 30%; CFO & COO ARE 0% TO 25%; AND OTHER EXECUTIVES ARE 0% TO 20%. THE EXCUTIVE BONUS PLAN PAYOUTS ARE TO BE PAID WHEN DETERMINED BY THE PERSONNEL COMMITTEE, SUBJECT TO THE APPROVAL OF THE BOARD OF DIRECTORS.
SUPPLEMENTAL INFORMATION PART III FORM 990, PART VII, SECTION A, TITLES FOR DOERR AND TEFFETELLER: OCTOBER 1, 2010 DAVID DOERR BECAME AN EMPLOYEE OF UNION HEALTH SYSTEM, THE SOLE MEMBER OF UNION HOSPITAL. UNION HOSPITAL CONTINUES TO PAY WAGES TO MR. DOERR, HOWEVER, HIS WAGES ARE ALLOCATED TO UNION HEALTH SYSTEM FOR HIS SERVICES TO THE UNION HEALTH SYSTEM. MR. DOERR WAS PRESIDENT/CEO FOR UNION HOSPITAL FROM SEPTEMBER 1 - 30, 2010 BEFORE SCOTT TEFFETELLER BECAME PRESIDENT/CEO FOR UNION HOSPITAL ON OCTOBER 1, 2010.
Schedule J (Form 990) 2010

Additional Data


Software ID:  
Software Version:  
Schedule K
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Information on Tax Exempt Bonds
SchKMediumBullet Complete if the organization answered "Yes" to Form 990, Part IV, line 24a. Provide descriptions,
explanations, and any additional information in Schedule O (Form 990).
SchKMediumBullet Attach to Form 990. SchKMediumBullet See separate instructions.
OMB No. 1545-0047
2010
Open to Public
Inspection
Name of the organization
UNION HOSPITAL INC
 
Employer identification number
35-0876396
Part I
Bond Issues
(a) Issuer Name (b) Issuer EIN (c) CUSIP # (d) Date Issued (e) Issue Price (f) Description of Purpose (g) Defeased (h) On
Behalf of
Issuer 		(i) Pool
financing
Yes No Yes No Yes No
A HOSPITAL AUTHORITY OF VIGO COUNTY (REVENUE BONDS SERIES 2007)
  		35-1656988 926742BY2 07-12-2007 176,052,475 CONSTRUCT NEW HOSPITAL BUILDING   X   X   X
B HOSPITAL AUTHORITY OF VIGO COUNTY
  		35-1656988 926742CF2 03-02-2011 53,989,054 CAPITAL ASSET RENOVATION/CONSTRUCTION, REFUNDING OF BONDS   X   X   X
Part II
Proceeds
A B C D
1 Amount of bonds retired. . . . .        
2 Amount of bonds defeased . . . .        
3 Total proceeds of issue . . . . 176,052,475 53,989,054    
4 Gross proceeds in reserve funds . . 15,716,590 5,504,000    
5 Capitalized interest from proceeds.        
6 Proceeds in refunding escrow. . . . .        
7 Issuance costs from proceeds . . . 2,151,525 1,078,426    
8 Credit enhancement from proceeds.        
9 Working capital expenditures from proceeds . .        
10 Capital expenditures from proceeds . . 158,184,360 17,009,396    
11 Other spent proceeds . . 30,397,232 30,397,232    
12 Other unspent proceeds. . .        
13 Year of substantial completion . . . 2010
Yes No Yes No Yes No Yes No
14 Were the bonds issued as part of a current refunding issue?   X X          
15 Were the bonds issued as part of an advance refunding issue?   X   X        
16 Has the final allocation of proceeds been made? . . X     X        
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? . X   X          
Part III
Private Business Use
A B C D
Yes No Yes No Yes No Yes No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? . . .   X   X        
2 Are there any lease arrangements that may result in private business use of bond-financed property? . . . . . X   X          
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50193E
Schedule K (Form 990) 2010
Schedule K (Form 990) 2010
Page 2
Part III
Private Business Use (Continued)
A B C D
Yes No Yes No Yes No Yes No
3a Are there any management or service contracts that may result in private business use? X   X          
b Are there any research agreements that may result in private business use of bond-financed property? . .   X   X        
c Does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts or research agreements relating to the financed property? . X   X          
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government . . . . . . . . . . . . . SchKMediumBullet 0 % 0 %    
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government . SchKMediumBullet 0 % 0 %    
6 Total of lines 4 and 5 . . .. . . . . . 0 % 0 %    
7 Has the organization adopted management practices and procedures to ensure the post-issuance compliance of its tax-exempt bond liabilities? X   X          
Part IV
Arbitrage
A B C D
Yes No Yes No Yes No Yes No
1 Has a Form 8038-T, Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate, been filed with respect to the bond issue? . . .   X   X        
2 Is the bond issue a variable rate issue?   X   X        
3a Has the organization or the governmental issuer entered into a hedge with respect to the bond issue?   X   X        
b Name of provider .  
  		 
  		 
  		 
 
c Term of hedge . .        
d Was the hedge superintegrated? .                
e Was a hedge terminated? .                
4a Were gross proceeds invested in a GIC? .   X   X        
b Name of provider .  
  		 
  		 
  		 
 
c Term of GIC . .        
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? .                
5 Were any gross proceeds invested beyond an available temporary period? .   X   X        
6 Did the bond issue qualify for an exception to rebate? . . .   X   X        
Schedule K (Form 990) 2010

Schedule K (Form 990) 2010
Page 3
Part V
Supplemental Information
Complete this part to provide additional information for responses to questions on Schedule K (see instructions).
Identifier Return Reference Explanation
SERIES 2011 BONDS PURPOSE DETAIL   THE PROCEEDS FROM THE SALE OF THE SERIES 2011 BONDS, TOGETHER WITH CERTAIN OTHER MONEYS, WILL BE USED TO (I) FINANCE THE COST OF CONSTRUCTING, ACQUIRING, EQUIPPING OR RENOVATING CERTAIN CAPITAL ASSETS OF THE CORPORATION,(II) REFUND THE INDIANA HEALTH FACILITY FINANCING AUTHORITY VARIABLE RATE DEMAND REVENUE BONDS, SERIES 2002 AND THE INDIANA HEALTH AND EDUCATIONAL FACILITY FINANCING AUTHORITY VARIABLE RATE DEMAND REVENUE BONDS, SERIES 2006A, (III) FUND A DEBT SERVICE RESERVE FUND FOR THE SERIES 2011 BONDS, AND (IV) PAY A PORTION OF THE COST OF ISSUANCE OF THE SERIES 2011 BONDS.
Schedule K (Form 990) 2010

Additional Data


Software ID:  
Software Version:  

Schedule L
(Form 990 or 990-EZ)
Department of the Treasury
Internal Revenue Service
Transactions with Interested Persons
MediumBullet Complete if the organization answered
"Yes" on Form 990, Part IV, lines 25a, 25b, 26, 27, 28a, 28b, or 28c,
or Form 990-EZ, Part V lines 38a or 40b.
MediumBullet Attach to Form 990 or Form 990-EZ. MediumBulletSee separate instructions.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
UNION HOSPITAL INC
 
Employer identification number

35-0876396
Part I
Excess Benefit Transactions (section 501(c)(3) and section 501 (c)(4) organizations only).
Complete if the organization answered "Yes" on Form 990, Part IV, line 25a or 25b, or Form 990-EZ, Part V, line 40b.
1(a) Name of disqualified person (b) Description of transaction (c) Corrected?
Yes No





2
Enter the amount of tax imposed on the organization managers or disqualified persons during the year under section 4958. ......................... Bullet Image$
 
3
Enter the amount of tax, if any, on line 2, above, reimbursed by the organization ....... Bullet Image$
 

Part II
Loans to and/or From Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 26, or Form 990-EZ, Part V, line 38a.
(a) Name of interested person and purpose (b) Loan to or from the organization? (c)Original principal amount (d)Balance due (e) In default? (f) Approved by board or committee? (g)Written agreement?
To From Yes No Yes No Yes No
Total ...............Small Bullet $  
Part III
Grants or Assistance Benefitting Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 27.
(a) Name of interested person (b)Relationship between interested person and the organization (c)Amount of grant or type of assistance
For Privacy Act and Paperwork Reduction Act Notice, see the
Instructions for Form 990 or 990-EZ.
Cat. No. 50056A
Schedule L (Form 990 or 990-EZ) 2010
Schedule L (Form 990 or 990-EZ) 2010
Page 2
Part IV
Business Transactions Involving Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 28a, 28b, or 28c.
(a) Name of interested person (b) Relationship between interested person and the organization (c) Amount of transaction (d) Description of transaction (e) Sharing of organization's revenues?
Yes No
(1) PHYSICIAN GROUP
  		SEE PART V BELOW 34,720 SEE PART V   No
(2) FOREST SHERER INC
  		SEE PART V BELOW 988,746 SEE PART V   No
(3) AP&S CLINIC NORTH SIDE
  		SEE PART V BELOW 5,436,588 SEE PART V   No
(4) BUNCH NURSERIES INC
  		SEE PART V BELOW 142,337 SEE PART V   No
Part V
Supplemental Information
Complete this part to provide additional information for responses to questions on Schedule L (see instructions).
Identifier Return Reference Explanation
    (A) NAME OF PERSON: PHYSICIAN GROUP(B) RELATIONSHIP BETWEEN INTERESTED PERSON AND ORGANIZATION: ROBERT HAERR IS A UNION HOSPITAL BOARD MEMBER AND PHYSICIAN GROUP MEMBER (D) DESCRIPTION OF TRANSACTION: THE PHYSICIAN GROUP PROVIDES ONCOLOGY SERVICES TO THE HOSPITAL ON AN ARMS LENGTH BASIS.(A) NAME OF PERSON: FOREST SHERER, INC(B) RELATIONSHIP BETWEEN INTERESTED PERSON AND ORGANIZATION: JOHN LUKENS IS THE UNION HOSPITAL BOARD CHAIRMAN AND PRESIDENT OF FORREST SHERER, INC.(D) DESCRIPTION OF TRANSACTION: THE HOSPITAL PURCHASES INSURANCE FROM THE INDEPENDENT INSURANCE AGENCY ON AN ARMS LENGTH BASIS.(A) NAME OF PERSON: AP&S CLINIC NORTHSIDE(B) RELATIONSHIP BETWEEN INTERESTED PERSON AND ORGANIZATION: ANNA ZIMMERMAN IS A UNION HOSPITAL BOARD MEMBER AND MEDICAL DOCTOR FOR AP&S CLINIC NORTHSIDE(D) DESCRIPTION OF TRANSACTION: THE HOSPITAL HAS A CONTRACTUAL ARRANGEMENT FOR SERVICES WHICH ARE PROVIDED ON AN ARMS LENGTH BASIS.A) NAME OF PERSON: BUNCH NURSERIES, INC.(B) RELATIONSHIP BETWEEN INTERESTED PERSON AND ORGANIZATION: ENTITY IS MORE THAN 35% OWNED BY HUSBAND OF CINDY MARTIN, UNION BOARD MEMBER(D) DESCRIPTION OF TRANSACTION: ENTITY PROVIDED SERVICES TO THE HOSPITAL.
Schedule L (Form 990 or 990-EZ) 2010

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
2010
Open to Public
Inspection
Name of the organization
UNION HOSPITAL INC
 
Employer identification number

35-0876396
Identifier Return Reference Explanation
FORM 990, PART VI, SECTION A, LINE 4   THE ORGANIZATION MADE SIGNIFICANT CHANGES TO ITS ARTICLES OF INCORPORATION AND BYLAWS FOR THE PERIOD ENDING 8/31/2011. THE SIGNIFICANT CHANGE TO THE ARTICLES OF INCORPORATION IS TO CHANGE THE MEMBERSHIP TO ONE MEMBER, UNION HEALTH SYSTEM, INC., AN INDIANA NONPROFIT, TAX EXEMPT CORPORATION. THE SIGNIFICANT CHANGES TO THE BYLAWS ARE TO UPDATE ARTICLE II, SECTION 2 FOR THE POWERS RESERVED TO THE MEMBER.
FORM 990, PART VI, SECTION A, LINE 6   UNION HOSPITAL HAS ONE MEMBER, UNION HEALTH SYSTEM, INC., AN INDIANA NONPROFIT, TAX EXEMPT CORPORATION.
FORM 990, PART VI, SECTION A, LINE 7A   THE ORGANIZATION'S MEMBER MAY APPOINT THE HOSPITAL BOARD DIRECTORS WITH THE RECOMMENDATION OF THE HOSPITAL'S BOARD OF DIRECTORS.
FORM 990, PART VI, SECTION A, LINE 7B   GOVERNING BODY DECISIONS SUBJECT TO APPROVAL BY THE MEMBER INCLUDE: 1. MISSION AND VISION STATEMENT CHANGES; 2. CHANGES TO THE GOVERNING DOCUMENT; 3. APPROVAL AND REMOVAL OF BOARD DIRECTORS; 4. INCURRING DEBT; 5. APPROVAL, SALE, TRANSFER OR SUBSTANTIAL CHANGE IN USE OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS; 6. FORMATION OF A SUBSIDIARY; 7. TRANSFER OR ENCUMBRANCE OF THE ASSETS; 8. APPROVAL OF ANNUAL OPERATING BUDGET, CAPITAL PLAN, STRATEGIC PLAN, AND BUSINESS PLAN; 9. APPOINTMENT OF THE CEO; 10. TRANSACTIONS OVER $250,000; AND 11. APPROVAL OF ANY MANAGEMENT AGREEMENTS.
FORM 990, PART VI, SECTION B, LINE 11   THE PROCESS OF REVIEWING THE FORM 990 ENTAILS A DETAILED REVIEW OF THE FORM 990 BY THE ORGANIZATION'S MANAGEMENT. THE GOVERNING BODY REVIEWS AND APPROVES THE FORM 990 AND THE FINAL FORM 990 INCLUDING REQUESTED SCHEDULES, AS ULTIMATELY FILED WITH THE IRS, ARE PROVIDED TO EACH VOTING MEMBER OF THE ORGANIZATION'S GOVERNING BODY PRIOR TO FILING.
  FORM 990, PART VI, SECTION B, LINE 12C THE WRITTEN CONFLICT OF INTEREST POLICY IS REGULARLY AND CONSISTENTLY MONITORED AND COMPLIANCE ENFORCED BY THE CORPORATE COMPLIANCE OFFICER. THE SCOPE OF THIS POLICY INCLUDES DIRECTORS, OFFICERS, MANAGEMENT, AND EMPLOYEES. THE POLICY IS IN PLACE TO AVOID PERSONAL INTERESTS THAT CONFLICT, OR MAY APPEAR TO CONFLICT, WITH THE BEST INTERESTS OF UNION AND ITS AFFILIATES AND THE COMMUNITIES THEY SERVE. THE COVERED PERSONS ARE TO REFRAIN FROM PERSONAL INTERESTS, DIRECT OR INDIRECT WITH ANY THIRD PARTIES. IT IS THE RESPONSIBILITY OF OFFICERS, MANAGEMENT, AND EMPLOYEES TO SCRUTINIZE THEIR TRANSACTIONS AND OUTSIDE BUSINESS INTERESTS AND RELATIONSHIPS FOR POTENTIAL CONFLICTS AND TO IMMEDIATELY MAKE SUCH DISCLOSURES AND ACT ACCORDINGLY. A SELF-DISCLOSURE FROM COVERED PERSONS TO THE CORPORATE COMPLIANCE OFFICER IS REQUIRED ON ANY POTENTIAL CONFLICTS OF INTEREST. THE COVERED PERSONS ARE TO REFRAIN FROM PARTICIPATING IN ANY DELIBERATION OR DECISIONS ON SUCH TRANSACTIONS. THE CONFLICTS DISCLOSED ARE REVIEWED AND RESOLVED BY THE CORPORATE COMPLIANCE OFFICER.
  FORM 990, PART VI, SECTION B, LINE 15 THE PROCESS FOR DETERMINING COMPENSATION UNDER THE BY-LAWS OF UNION HOSPITAL INCLUDES A BOARD OF DIRECTORS PERSONNEL COMMITTEE WHOSE RESPONSIBILITIES INCLUDE IN CHARGE OF DOING THE APPROPRIATE REVIEW OF COMPENSATION FOR THE SR. MANAGEMENT TEAM, INCLUDING THE CEO. THEY GATHER INFORMATION AND FOLLOW THE STEPS SET FORTH BELOW AND IN TURN SUBMIT TO THE FULL BOARD OF DIRECTORS THE RECOMMENDATIONS IN TERMS OF COMPENSATION AND BENEFITS FOR THE CEO AND SR. MANAGEMENT. THE PERSONNEL COMMITTEE CONSISTS OF INDIVIDUALS WHO ARE DISINTERESTED. THE CEO IS EXCUSED FROM THE MEETING WHEN HIS COMPENSATION/BENEFITS ARE REVIEWED BOTH AT THE PERSONNEL COMMITTEE LEVEL AND THE BOARD LEVEL. NOTE: DURING THE CURRENT FISCAL YEAR, SALARY INCREASES WERE NOT GIVEN TO THE SR. MANAGEMENT TEAM INCLUDING THE CEO, AND THUS, AN ANALYSIS OF COMPENSATION WAS NOT COMPLETED. IN FUTURE PERIODS, THIS PROCEDURE WILL RESUME AS STATED IN THIS POLICY. THE STEPS INCLUDE: 1. THE PERSONNEL COMMITTEE RETAINS AN OUTSIDE INDEPENDENT CONSULTANT TO (1) PROVIDE THE COMMITTEE WITH INFORMATION, AND (2) TO REVIEW THE ACTIONS AND COMPENSATION/BENEFITS TO BE SURE THAT THERE IS NOT EXCESSIVE COMPENSATION. THE CONSULTANT THAT HAS BEEN USED THE PAST THREE (3) YEARS IS SULLIVAN COTTER & ASSOCIATES, INC. UNDER THE PROCESS, SULLIVAN COTTER FIRST IS PROVIDED WITH THE NAMES AND JOB DESCRIPTIONS FOR THE SR. MANAGEMENT TEAM THAT IS BEING EVALUATED. THE INDEPENDENT ADVISOR THEN SUBMITS TO THE PERSONNEL COMMITTEE COMPARABLE INFORMATION, SPECIFICALLY: > FIVE COMMERCIALLY AVAILABLE EXECUTIVE HEALTH CARE COMPENSATION SURVEYS PREPARED BY INDEPENDENT FIRMS, WERE REFERENCED TO OBTAIN MARKET DATA FOR THIS REVIEW - INTEGRATED HEALTHCARE STRATEGIES: 2009 HEALTHCARE EXECUTIVE COMPENSATION SURVEY - INDIANA HOSPITAL & HEALTH ASSOCIATION: 2009 COMPENSATION SURVEY REPORT - SULLIVAN, COTTER, AND ASSOCIATES: 2009 SURVEY OF MANAGER AND EXECUTIVE COMPENSATION IN HOSPITALS AND HEALTH SYSTEMS - WATSON WYATT DATA SERVICES: 2009/2010 HOSPITAL AND HEALTHCARE MANAGEMENT COMPENSATION REPORT - MERCER HUMAN RESOURCE CONSULTING: 2009 INTEGRATED HEALTH NETWORKS COMPENSATION SURVEY > MARKET DATA REFLECTING FUNCTIONALLY-COMPARABLE POSITIONS WERE OBTAINED FOR ALL SEVEN EXECUTIVE POSITIONS > DATA WERE ABSTRACTED FOR COMPARABLY-SIZED ORGANIZATIONS AS MEASURED BY NET REVENUE > THE DATA REPORTED REPRESENTED THE 50TH, 75TH, AND 90TH PERCENTILES OF BASE SALARY AND TOTAL CASH COMPENSATION (BASE SALARY PLUS ACTUAL ANNUAL INCENTIVE - ABBREVIATED TCC) > REGIONAL MARKET DATA WERE ALSO COLLECTED FROM THE PUBLISHED COMPENSATION SURVEYS AS WELL AS A SPECIAL CUT OF THE FOLLOWING INDIANA HOSPITALS FROM SULLIVAN COTTER'S 2009 SURVEY OF MANAGER AND EXECUTIVE COMPENSATION IN HOSPITALS AND HEALTH SYSTEMS - BALL MEMORIAL HOSPITAL - REID HOSPITAL & HEALTH CARE SERVICES - BLOOMINGTON HOSPITAL - RILEY HOSPITAL FOR CHILDREN - ELKHART GENERAL HOSPITAL - SAINT JOHN'S HEALTH SYSTEM - GOOD SAMARITAN HOSPITAL - SAINT JOSEPH REGIONAL MEDICAL CENTER - MEMORIAL HOSPITAL OF SOUTH BEND - SAINT MARY'S MEDICAL CENTER - METHODIST HOSPITALS - TERRE HAUTE REGIONAL HOSPITAL - PARKVIEW HOSPITAL > THAT DATA WAS ALSO REPORTED WITH NATIONAL AVERAGE, REGIONAL AVERAGE AND INDIANA AVERAGE. 2. THE PERSONNEL COMMITTEE OF UNION HOSPITAL'S BOARD OF DIRECTORS TAKES THE DATA PROVIDED BY THE INDEPENDENT CONSULTANTS AND FOLLOWING A REVIEW OF THE PERFORMANCE OF EACH INDIVIDUAL SUBMITS TO THE FULL BOARD FOR APPROVAL RECOMMENDATIONS IN TERMS OF SALARIES, BENEFITS, AND BONUSES. FINAL APPROVAL IS BY THE BOARD OF DIRECTORS. THE CEO DOES NOT TAKE PART IN THE DISCUSSION OR ACTION ON HIS SALARY, BENEFITS AND BONUS. 3. MINUTES OF THE PERSONNEL COMMITTEE AND THE BOARD MEETINGS ARE CONTEMPORANEOUSLY KEPT AND MAINTAIN WITH THE CORPORATE MINUTE BOOKS. 4. FOLLOWING THE ACTION OF THE BOARD OF DIRECTORS THE NEW PROPOSED SALARIES, BENEFITS AND BONUSES ARE SENT TO THE INDEPENDENT CONSULTANT (SULLIVAN COTTER) WHO SUBMITS BACK TO THE PERSONNEL COMMITTEE THEIR OPINION IN TERMS OF THE COMPENSATION BEING REASONABLE IN RELATION TO THE MARKET DATA AND MARKET PRACTICES. THIS REPORT IS ALSO RECEIVED AND REVIEWED BY THE BOARD PERSONNEL COMMITTEE.
  FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION DOES NOT MAKE THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, OR FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC.
TITLES PART VII, SECTION A DAVID DOERR WAS PRESIDENT/CEO OF UNION HOSPITAL, INC. UNTIL SEPTEMBER 31, 2010 AT WHICH TIME HE BECAME THE PRESIDENT/CEO FOR UNION HEALTH SYSTEM, INC., A RELATED PARTY. COMPENSATION SCOTT TEFFETELLER BECAME PRESIDENT/CEO OF UNION HOSPITAL ON OCTOBER 1, 2010.
CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: UNREALIZED GAIN ON INVESTMENTS 739,114. CHANGE IN PERMANETLY RESTRICTED NET ASSETS 11,949. CHANGE IN PENSION LIABILITY 3,085,712. TRANSFER TO RELATED PARTY -12,062,285. TOTAL TO FORM 990, PART XI, LINE 5: -8,225,510.
OVERSIGHT OF AUDIT PART XII, LINE 2C THE AUDIT COMMITTEE ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF THE FINANCIAL STATEMENTS AND NO PROCESSES HAVE CHANGED FROM PRIOR YEAR.
  SCHEDULE H, PART VI, LINE 5: RICHARD G LUGAR CENTER FOR RURAL HEALTH RICHARD G. LUGAR CENTER FOR RURAL HEALTH: THE LUGAR CENTER'S MISSION IS TO ADVANCE RURAL HEALTH THROUGH EDUCATION, INNOVATION AND COLLABORATION. THE LUGAR CENTER IS A PART OF UNION HOSPITAL AND ITS FAMILY MEDICINE RESIDENCY PROGRAM DEDICATED TO PREPARING PHYSICIANS TO SERVE IN RURAL COMMUNITIES. THIS PROGRAM CONSISTS OF HANDS-ON CURRICULUM FOR FUTURE RURAL HEALTH PROVIDERS BASED ON A UNIQUE HUB-AND-SPOKE STRUCTURE THAT ALLOWS RESIDENTS TO WORK OUT OF THE MAIN HOSPITAL-BASED SITE DURING THEIR FULL THREE YEARS OF TRAINING WHILE STILL GAINING FIRST-HAND RURAL EXPERIENCE AT A FEDERALLY-DESIGNATED RURAL HEALTH CLINIC AND A FEDERALLY QUALIFIED HEALTH CENTER. IT HAS DEVELOPED INTO A POLICY AND PROGRAM LEADER WITH THE DEVELOPMENT OF INNOVATIVE METHODOLOGIES TO SUPPORT A WORKFORCE THAT IS WELL-PREPARED TO PROVIDE ACCESS TO QUALITY HEALTH CARE SERVICES IN REMOTE AREAS NATIONALLY AND INTERNATIONALLY. IT WAS FIRST ESTABLISHED IN 1993 AS THE MIDWEST CENTER FOR RURAL HEALTH TO PREPARE PRIMARY CARE PHYSICIANS FOR SUCCESSFUL RURAL PRACTICE AND TO EXPOSE INDIVIDUALS NOT YET DECIDED ON A CAREER TO THE REWARDS OF DELIVERING HEALTH CARE IN A RURAL AREA. THE CENTER WAS RENAMED IN 2006 TO HONOR U.S. SENATOR RICHARD G. LUGAR A SUPPORTER OF THE CENTER'S MISSION AND AN ADVOCATE FOR THE ADVANCEMENT OF RURAL HEALTHCARE. IN 1993, UNION SET UP A MODEL RURAL HEALTH CLINIC AND TRAINING SITE IN CLAY CITY, INDIANA TO PROVIDE MUCH NEEDED HEALTH CARE SERVICES TO A MEDICALLY UNDERSERVED COMMUNITY. THIS FEDERALLY DESIGNATED RURAL HEALTH CLINIC (RHC) ALSO PROVIDES A UNIQUE HANDS-ON TRAINING SITE FOR PHYSICIANS ENROLLED IN UNION HOSPITAL'S FAMILY MEDICINE RESIDENCY'S RURAL TRAINING TRACK. A MULTIDISCIPLINARY TEAM OF PHYSICIANS, PHYSICIANS ASSISTANTS, NURSE PRACTITIONERS, MENTAL HEALTH COUNSELORS, PSYCHOLOGY INTERNS, AN X-RAY TECHNICIAN, AND AN OPTOMETRIST PROVIDE COMPREHENSIVE CARE TO ALL REGARDLESS OF THE PATIENT'S ABILITY TO PAY. THE CLINIC COLLABORATES WITH THE LOCALLY OWNED PHARMACY TO PROVIDE PRESCRIPTION SERVICES TO UNINSURED AND UNDERINSURED PATIENTS USING THE SAME DISCOUNTED SLIDING FEE SCALE USED BY THE CLINIC. A VITAL COMPONENT OF THIS CLINIC IS THE 10 MEMBER COMMUNITY ADVISORY BOARD. CLAY CITY CENTER FOR FAMILY MEDICINE SERVES AS A MEDICAL HOME FOR APPROXIMATELY 5,000 AREA RESIDENTS, DELIVERING OVER 10,000 VISITS ANNUALLY, IN ADDITION TO HOUSE CALLS AND IN-PATIENT HOSPITAL CARE. IN 2001, THE LUGAR CENTER DEVELOPED AND IMPLEMENTED A CHRONIC DISEASE MANAGEMENT PROGRAM AT THE CLINIC THAT IS STILL BEING INTEGRATED INTO CARE PLANS FOR PATIENTS AS APPROPRIATE. THIS EVIDENCE BASED PROGRAM INCLUDES FIVE CHRONIC DISEASES-HYPERTENSION, DIABETES MELLITUS, CHRONIC OBSTRUCTIVE PULMONARY DISEASE, CONGESTIVE HEART FAILURE, AND ASTHMA. CLAY CITY CENTER FOR FAMILY MEDICINE REACHED CAPACITY AS A TEACHING SITE FOR RESIDENTS AND THERE REMAINS AN ENORMOUS NEED FOR ADDITIONAL PROVIDERS IN THE SMALL COMMUNITIES SURROUNDING UH AS WELL AS CLINICAL TRAINING SITES. THEREFORE, THE LUGAR CENTER IS EXPANDED TRAINING CAPACITY FOR FUTURE HEALTH CARE PROVIDERS THROUGH COLLABORATIVE EFFORTS WITH A RURAL UNDERSERVED COMMUNITY IN VERMILLION COUNTY. THIS PROJECT FOCUSES ON THE COMMUNITY HEALTH CENTER MODEL OR FQHC (FEDERALLY QUALIFIED HEALTH CENTER). THIS MODEL DELIVERY SYSTEM BEGAN WITH A GROUP OF COMMUNITY MEMBERS WHO SERVE AS THE GOVERNING BOARD OF DIRECTORS FOR A COMMUNITY-OWNED HEALTH CARE FACILITY, RECEIVING FEDERAL 330 FUNDS TO PROVIDE SERVICES TO THE UNINSURED. LUGAR CENTER WAS INSTRUMENTAL IN WRITING THE APPLICATION FOR A HRSA NEW ACCESS POINT GRANT FOR $1.6 MILLION FOR THIS COMMUNITY IN SEPTEMBER 2007. THIS SITE SERVES AS AN INTEGRAL TRAINING SITE FOR UH RESIDENTS, IU SCHOOL OF MEDICINE MEDICAL STUDENTS, AND OTHER LEARNERS. OUR OPERATING EXPENSES FOR THE FISCAL YEAR 2011 WERE $1,037,374. THE LUGAR CENTER ALSO RECEIVED FUNDING FROM THE INDIANA STATE DEPARTMENTS OF HEALTH COMMUNITY HEALTH CENTER GRANT $361,849.
  SCHEDULE H, PART VI, LINE 5: RURAL HEALTH INNOVATION COLLABORATIVE ON DEC. 2, 2008, UNION HOSPITAL'S LUGAR CENTER HELPED LAUNCH A RURAL HEALTH COLLABORATIVE AIMED AT IMPROVING AND EXPANDING HEALTH CARE IN OUR COMMUNITY. WHAT BEGAN AS AN INFORMAL EXERCISE IN CREATIVE PROBLEM-SOLVING HAS BECOME THE RURAL HEALTH INNOVATION COLLABORATIVE (THE RHIC). FOUNDING PARTNERS INCLUDE INDIANA STATE UNIVERSITY (ISU), INDIANA UNIVERSITY SCHOOL OF MEDICINE (IUSM), UNION HOSPITAL AND IT'S RICHARD G. LUGAR CENTER FOR RURAL HEALTH (UH), THE TERRE HAUTE ECONOMIC DEVELOPMENT CORPORATION (THEDC), THE CITY OF TERRE HAUTE (THE CITY), AND IVY TECH COMMUNITY COLLEGE WABASH VALLEY (IVY TECH). THE MISSION OF THE RURAL HEALTH INNOVATION COLLABORATIVE (RHIC) IS TO IMPROVE AND EXPAND EDUCATION AND TRAINING OF HEALTH CARE PROFESSIONALS AND FUTURE HEALTH CARE PROFESSIONALS, ESPECIALLY FOR THOSE COMMITTED TO SERVING RURAL AND UNDERSERVED POPULATIONS. KEY COMPONENTS OF THIS MISSION INCLUDE: TO PROMOTE THE RETENTION OF HEALTH CARE PROFESSIONALS TO SERVE RURAL AND UNDERSERVED POPULATIONS; TO INVITE COMMUNITY REVITALIZATION BY PROMOTING THE ENHANCEMENT OF OPPORTUNITIES FOR EDUCATION, TRAINING, AND EXPERIENCE IN HEALTH-RELATED PROFESSIONS AND FIELDS; TO PROMOTE SOCIAL WELFARE AND TO ENCOURAGE AND COORDINATE COMMUNITY INITIATIVES TO ADDRESS CHALLENGES AFFECTING HEALTH CARE DELIVERY; TO PROMOTE THE EFFICIENT USE OF PUBLIC AND PRIVATE RESOURCES AND COLLABORATE WITH OTHER ENTITIES WITH SIMILAR OR COMPLEMENTARY PURPOSES; TO DESIGN AND IMPLEMENT INNOVATIVE BEST PRACTICES AND STRATEGIES THAT ARE CAPABLE OF REPLICATION IN OTHER AREAS OF THE UNITED STATES; AND TO DISSEMINATE EDUCATIONAL INFORMATION, THEREBY POTENTIALLY OR ACTUALLY BENEFITING THOSE OTHER AREAS. A RECENT STUDY COMMISSIONED BY RHIC PARTNERS AND CONDUCTED BY INDIANA UNIVERSITY SCHOOL OF MEDICINE'S BOWEN RESEARCH CENTER, FOUND SHORTAGES IN ALMOST EVERY HEALTH CARE FIELD IN THE WABASH VALLEY. THE WABASH VALLEY IS A REGION WITH COUNTIES IN BOTH INDIANA AND ILLINOIS. NURSES AND PHYSICIANS TOP THE LIST OF SHORTAGE AREAS. THE SURVEY FOUND A NEED FOR 702 TO 827 ADDITIONAL NURSES AND 134 TO 275 PRIMARY CARE PHYSICIANS IN AN 11-COUNTY AREA OF WEST-CENTRAL INDIANA. THE ELEVEN COUNTIES INCLUDED IN THIS REGION WERE: CLAY, FOUNTAIN, GREENE, MONTGOMERY, OWEN, PARKE, PUTNAM, SULLIVAN, VERMILLION, VIGO, AND WARREN. SIGNIFICANT SHORTAGES WERE ALSO FOUND IN MENTALHEALTH COUNSELORS, PHYSICAL THERAPISTS, PHARMACISTS, SOCIAL WORKERS, HEALTH EDUCATORS, SPEECH PATHOLOGISTS, PHYSICIAN ASSISTANTS AND PSYCHOLOGISTS. IN MORE THAN THREE FOURTHS OF THE PROFESSIONS ANALYZED THE STUDY PROJECTS THAT BY 2016 THE NUMBER OF HEALTH CARE PROVIDERS PER 100,000 RESIDENTS WILL BE LOWER IN THE WABASH VALLEY THAN STATEWIDE. ADDITIONALLY THE STUDY FOUND A NEED FOR INCREASED ACCESS TO EDUCATION PROGRAMS, EXPANDING EXISTING PROGRAMS AND MAKING NEW PROGRAMS AVAILABLE. RHIC LEADERS ENVISION TACKLING THE CURRENT AND WORSENING HEALTH CARE WORKER SHORTAGES THROUGH INNOVATIONS AND COLLABORATIONS IN HEALTH CARE EDUCATION ACROSS THE PARTNERSHIP. THE PARTNERS ARE FOCUSED NOT JUST ON INCREASING NUMBERS OF STUDENTS AND EDUCATIONAL OPPORTUNITIES, BUT ALSO ON TRANSFORMING OUR TRADITIONAL EDUCATION MODEL TO ENSURE AN OPTIMALLY PREPARED WORKFORCE, RESULTING IN IMPROVED ACCESS TO CARE AND PATIENT OUTCOMES. THERE ARE SEVERAL CHALLENGES TO MINIMIZING THE HEALTH CARE WORKFORCE SHORTAGES IN RURAL WEST-CENTRAL INDIANA AND THROUGHOUT THE NATION. ONE OF THE BIGGEST CHALLENGES IS CHANGING THE EDUCATIONAL METHODOLOGY WHEN TRAINING FUTURE HEALTH CARE PROVIDERS. TRADITIONALLY, OUR WORKFORCE IS EDUCATED IN "SILOS", RATHER THAN IN INTERPROFESSIONAL TEAMS. EVEN A QUICK REVIEW OF THE LITERATURE REVEALS QUALITATIVE AND QUANTITATIVE EVIDENCE SUGGESTING THE NEED TO CHANGE THE METHODS THAT HAVE HISTORICALLY BEEN UTILIZED TO TRAIN HEALTH PROFESSIONALS. YET, THIS IS NOT AN EASY TASK. THE RHIC PARTNERS HAVE BEGUN TO ADDRESS THIS CHALLENGE BY EMBRACING INTERPROFESSIONAL EDUCATION (IPE) AS A MAJOR FOCUS OF THE RHIC. ONE IMPORTANT COMPONENT OF THE RHIC'S IPE INITIATIVE IS TO DEVELOP A COLLABORATIVE CURRICULUM WHERE STUDENTS FROM MULTIPLE HEALTH CARE PROFESSIONS LEARN TOGETHER. AS A PART OF THIS EFFORT, THE RHIC IMPLEMENTED A COLLABORATIVE SIMULATION CENTER FOR INTERPROFESSIONAL EDUCATION AND TRAINING. THE PRIMARY PURPOSE OF THE RHIC SIMULATION CENTER IS DEDICATED TO ENHANCING HANDS-ON EDUCATIONAL OPPORTUNITIES FOR TEAMS OF FUTURE HEALTH CARE PROFESSIONALS, PARTICULARLY THOSE PREPARING TO PRACTICE IN RURAL AREAS. THE CENTER ENSURES A ROBUST, WELL-PREPARED TEAM OF HEALTH CARE PROFESSIONALS WHO PROVIDE ENHANCED ACCESS TO QUALITY CARE IN RURAL COMMUNITIES. IN ADDITION TO MORE AND BETTER PREPARED HEALTH CARE PROFESSIONALS THIS COLLABORATIVE LEADS TO ADDITIONAL CUTTING-EDGE TRAINING AND RESEARCH FACILITIES, AS WELL AS SUPPORT FOR BUSINESS AND HEALTH CARE SERVICE EXPANSION. THIS OUTCOME LEADS THE WAY FOR NEIGHBORHOOD REVITALIZATION AND ECONOMIC DEVELOPMENT IN TERRE HAUTE AND IN SURROUNDING RURAL, UNDERSERVED COMMUNITIES. THE RHIC COLLABORATIVE INCLUDES URBAN AND RURAL PARTNERS AS WELL AS PRIVATE, PUBLIC AND GOVERNMENT PARTNERS. THE LEADERS OF EACH PARTNER ORGANIZATION BRING MULTIPLE RESOURCES AND EXPERTISE TO THE COLLABORATIVE AND PROVIDE GUIDANCE AS A PART OF A ROBUST BOARD OF DIRECTORS. COMMITTEES OF THE BOARD MANAGE ACTIVITIES IN: COMMUNICATIONS, EDUCATION, FACILITIES, FINANCE, ECONOMIC DEVELOPMENT AND RESOURCE DEVELOPMENT. AD-HOC COMMITTEES ARE CREATED AS NEEDED FOR TARGETED STUDY AND WORK. THROUGH THIS ROBUST COLLABORATIVE--INCLUDING THROUGH THE SHARING OF RESOURCES AMONG URBAN, RURAL, GOVERNMENT, PUBLIC AND PRIVATE ENTITIES THAT ARE ALL REPRESENTED WITHIN THE RHIC--WE ARE IMPROVING EFFICIENCIES, CREATING AND IMPLEMENTINNOVATING ADVANCES IN CURRICULUM AND TRAINING FOR INTERPROFESSIONAL TEAMS OF PROVIDERS, AND ENSURING LONG-TERM RESULTS TOWARD IMPROVED ACCESS TO QUALITY HEALTH CARE IN ALL OF OUR COMMUNITIES, ESPECIALLY INCLUDING OUR SURROUNDING RURAL COMMUNITIES. NO COLLABORATION EVER COMES EASILY. YET, IT IS THROUGH COLLABORATION THAT WE ARE ABLE TO ACHIEVE THE MOST. RHIC MEMBERS HAVE HIRED A FULL-TIME DIRECTOR TO ASSIST WITH THOUGHTFULLY BUILDING A SOLID FOUNDATION FOR THE RHIC COLLABORATIVE, INCLUDING THROUGH THE CREATION OF FORMAL BYLAWS AND OTHER GOVERNING MECHANISMS. TOWARD THIS END, IN DECEMBER 2009, THE RHIC WAS FORMALLY RECOGNIZED BY THE IRS AS A 501(C)(3) NONPROFIT ENTITY. RHIC MEMBERS COME TOGETHER MONTHLY FOR INTENSE MEETINGS DURING WHAT HAS COME TO BE KNOWN AS "RHIC WEEK" EACH MONTH. THE BOARD IS MADE UP OF MEMBERS FROM THE HIGHEST LEVELS OF LEADERSHIP FROM EACH OF THE PARTNER ENTITIES. IN ADDITION TO RHIC COMMITTEE MEMBERS MEETING MONTHLY, THESE LEADERS ARE ALSO COMING TOGETHER ON A CONTINUOUS, CONSISTENT BASIS. THIS SHARING OF TIME TO REVIEW VISION DOCUMENTS AS WELL AS THE MOST MUNDANE DOCUMENTS, HAS BEEN INVALUABLE IN TERMS OF MOVING THE COLLABORATIVE FORWARD TOWARD ITS ULTIMATE GOAL OF ENSURING A ROBUST WORKFORCE AND ENVIRONMENT TO BE ABLE TO PROVIDE LONG-TERM, SUSTAINABLE ACCESS TO QUALITY HEALTH CARE. FUTURE GOALS, AS STATED ABOVE, INCLUDE CREATING A TRULY INNOVATIVE INTERPROFESSIONAL HEALTH CURRICULUM AND TRAINING PROGRAM. IN ADDITION TO CREATING A ROBUST INNOVATIVE, LEARNING ENVIRONMENT, THE RHIC MEMBERS ENVISION CREATING A "DISTRICT" THAT CONNECTS UNION HOSPITAL TO THE INDIANA STATE UNIVERSITY CAMPUS IN TERRE HAUTE. THIS "NEIGHBORHOOD", ABOUT 270 ACRES, BETWEEN THE UNION HOSPITAL AND ISU CAMPUSES IS A BLIGHTED NEIGHBORHOOD. THROUGH THIS ECONOMIC DEVELOPMENT INITIATIVE OF THE RHIC, WE ENVISION CREATING A MIXED-USE LEARN-LIVE-WORK-PLAY DISTRICT THAT INCORPORATES HEALTHY LIVING DESIGN FEATURES AND FOSTERS JOB CREATION AND A CULTURE OF INNOVATION, CONTINUOUS LEARNING AND EXCELLENCE. TOWARD THIS END, THE RHIC PARTNERS HAVE HIRED AN ARCHITECTURAL FIRM TO LEAD A MASTER PLANNING PROCESS THAT WILL INVOLVE STAKEHOLDERS FROM ACROSS THE COMMUNITY AND FROM ACROSS DISCIPLINES. WE FULLY EXPECT THIS "RHIC DISTRICT" TO BECOME A MODEL IN THE UNITED STATES FOR INNOVATION AND EXCELLENCE. CURRENT OPERATING EXPENSES ARE FUNDED THROUGH THE RHIC MEMBER ORGANIZATIONS. IN ADDITION, SOME INITIAL FEDERAL AND STATE GRANTS HAVE BEEN SECURED TO BEGIN IMPLEMENTATION. FOR EXAMPLE, A $100,000 GRANT WAS SECURED THROUGH THE HEALTH RESOURCES AND SERVICES ADMINISTRATION TO ESTABLISH THE COLLABORATIVE SIMULATION CENTER. IN ADDITION, THE RHIC'S RESOURCE DEVELOPMENT COMMITTEE HAS TAKEN A LEADING ROLE TO BEGIN APPLYING FOR GRANTS TO ASSIST WITH PROGRAM DEVELOPMENT AND IMPLEMENTATION TO MAXIMIZE IMPACT AND FURTHER THE VISION OF PROVIDING A ROBUST HEALTHCARE WORKFORCE THAT IS SUFFICIENT TO MEET ALL OF THE HEALTHCARE NEEDS IN OUR SERVICE AREAS, ESPECIALLY INCLUDING IN OUR RURAL UNDERSERVED COMMUNITIES THROUGHOUT THE WEST-CENTRAL REGION OF INDIANA.
  SCHEDULE H, PART VI, LINE 5: PRE-NATAL CARE FOR INDIGENT POPULATION UNION HOSPITAL SERVES AS THE COMMUNITY SAFETY NET TO ASSURE THAT PRENATAL AND BIRTH CARE IS AVAILABLE TO ALL PREGNANT WOMEN IN THE WABASH VALLEY REGARDLESS OF FINANCIAL STATUS THROUGH ITS FAMILY MEDICINE CENTER. AS IN MANY AREAS OF HEALTH CARE, FISCAL REALITIES AFFECT SERVICES THAT CAN BE PROVIDED. WE ARE STRIVING TO MAINTAIN AND INNOVATIVELY IMPROVE SERVICES AND OPTIONS FOR THE VULNERABLE AND HIGH-RISK POPULATION WE SERVE. EACH COUNTY THAT WE SERVE HAS A HIGHER PERCENT OF REPORTED PRENATAL SMOKING THAN THE 2005 REPORTED STATE OF INDIANA AVERAGE OF 17.9%. THERE IS A COMBINED AVERAGE OF 27.94% FOR WOMEN FROM THE FIVE COUNTIES THAT WE SERVE. WE STRIVE TO ADDRESS THIS PROBLEM AS WELL AS BREASTFEEDING AND PRENATAL CARE INITIATION IN THE FIRST TRIMESTER. THE MHC IS PROUD TO PROVIDE A MULTIDISCIPLINARY APPROACH TO CARE FROM PHYSICIANS, RESIDENT PHYSICIANS, MIDWIVES, A FAMILY NURSE PRACTITIONER, NURSES, SOCIAL WORKERS, A SONOGRAPHER, AND A SUBSTANCE ABUSE COUNSELOR. REFERRALS ARE MADE TO APPROPRIATE COMMUNITY AGENCIES WITH SERVICES FOR HOUSING, FOOD STAMPS, WOMEN INFANTS AND CHILDREN NUTRITION PROGRAM, ADOPTION RESOURCES, DENTAL, TRANSPORTATION, DOMESTIC ABUSE SUPPORT RESOURCES, MENTAL HEALTH COUNSELING, BEREAVEMENT, CHILD PROTECTION, FAMILY PLANNING, AND BABY SUPPLIES. WE ENROLLED 284 NEW PATIENTS IN THE PAST FISCAL YEAR. 130 OF OUR PATIENTS WERE ASSESSED AS BEING MODERATE TO HIGH RISK SOCIALLY. THE POVERTY RATE IN VIGO COUNTY IN 2010 WAS 19.1%. BECAUSE OF THIS, IT IS APPARENT THAT WOMEN IN OUR AREA ARE IN NEED OF THE SERVICES THAT THE MHC PROVIDES. WE ARE A MEDICAID ENROLLMENT SITE, AND WE PROVIDE CARE ON A SLIDING FEE FOR SERVICE SCALE FOR THOSE WHO ARE NOT ELIGIBLE FOR MEDICAID. FIRST TRIMESTER CARE HAS BEEN INCREASED FROM 77% IN 2007 TO 81% IN 2009. BREASTFEEDING RATES HAVE INCREASED FROM 65.8% IN 2007 TO 69.6% IN 2009. OVER HALF OF OUR CLIENTS WHO SMOKED WHEN THEY BECAME PREGNANT STOPPED SMOKING BY THE TIME THEIR BABIES WERE BORN. WE HAVE RECENTLY STARTED AURICULAR (EAR) ACUPRESSURE AND ACUPUNCTURE IN OUR CLINIC TO ASSIST IN DECREASING SMOKING RATES. WOMEN ARE READY TO BE HELPED DURING PREGNANCY TO DECREASE AND/OR STOP SMOKING. WE HAVE IMPLEMENTED HOME VISITS, EDUCATION, AND AURICULAR THERAPY TO AID IN THIS TRANSITION. WE KNOW THAT WOMEN WANT CONSISTENT CARE AND MANY WANT FEMALE PROVIDERS. WE HAVE THE CARE PROVIDERS TO DO JUST THOSE THINGS. WE PROMOTE AND ASSIST WITH BREASTFEEDING EDUCATION AND SUPPORT. WE ADOPTED AN INCENTIVE PROGRAM TO MOTIVATE WOMEN TO PARTICIPATE IN EDUCATIONAL OPPORTUNITIES AND MAKE POSITIVE BEHAVIOR CHANGES. PATIENTS EARN POINTS FOR KEEPING APPOINTMENTS, CHANGING DIETS, RELEASING ADDICTIONS, AND BREASTFEEDING. THESE POINTS CAN BE EXCHANGED FOR USED CLOTHING AND HOUSEHOLD ITEMS AT THE NONPROFIT STORE RUN BY THE HELPING HANDS ORGANIZATION. BY 2012, WE PLAN TO HAVE OUR FIRST TRIMESTER CARE RATES AT 80% AND OUR BREASTFEEDING AT 70%. THROUGH OUR OPTIONS FOR SMOKING REDUCTION, WE PLAN TO DECREASE THIS RATE TO 98%. UNION HOSPITAL'S PERINATAL SERVICE OFFERS THE ONLY LEVEL III-B NICU IN A SEVENTY-MILE RADIUS. IN FACT, UNION HOSPITAL HAD THE FIRST NICU IN THE STATE WHICH WAS DEVELOPED IN 1964 BY A GROUP OF PEDIATRICIANS. WE CURRENTLY OFFER THE EXPERTISE OF NEONATOLOGISTS WHICH ENABLES US TO CARE FOR THE VERY LOW BIRTH WEIGHT NEONATES TO ANY FULL TERM INFANT THAT MAY REQUIRE MEDICAL INTERVENTIONS. RECENT RENOVATIONS WILL INCREASE THE NICU BEDS FROM NINE TO FIFTEEN. IN 2011 OVER THREE-HUNDRED NEWBORNS WERE ADMITTED FOR CARE. ANY NEWBORN THAT REQUIRES SURGICAL INTERVENTIONS DUE TO A CONGENITAL ANOMALY IS TRANSFERRED TO INDIANAPOLIS. OUR PRIMARY GOAL IS TO CARE FOR THIS VULNERABLE POPULATION IN OUR TECHNOLOGICALLY ADVANCED UNIT SO THAT WE CAN DECREASE ANY UNNECESSARY STRESS TO FAMILIES. ADDITIONALLY, WE HAVE A TRANSPORT TEAM WHO WILL GO TO SEVERAL SURROUNDING COUNTIES TO BRING INFANTS BACK TO UNION'S NICU FOR THE EXPERT MEDICAL AND NURSING CARE. LABOR AND DELIVERY WILL MOVE ALSO MOVE TO THE RENOVATED AREA ON JULY 9, 2012. THE NEW 23,300 SQUARE FOOT RENOVATIONS WILL INCREASE THE BIRTHING SUITES FROM THE CURRENT 5 BEDS TO 8. THE TRIAGE AREA WILL EXPAND FROM 3 BEDS TO 9, WITH THE CESAREAN BIRTHING AREA ACQUIRING AN ADDITIONAL ROOM FOR A TOTAL OF TWO. IN 2011 THERE WERE 1600 BIRTHS AND APPROXIMATELY THE SAME NUMBER OF OUTPATIENTS. WE PROVIDE ALL OPTIONS FOR THE PREGNANT WOMAN TO CHOOSE IN HOW SHE WOULD LIKE TO BIRTH HER NEWBORN--FROM HIGH TOUCH WITH NO PAIN MEDICATION TO HIGH TECH WHERE SHE CAN HAVE AN EPIDURAL. THE NEW BIRTHING SUITES WILL HAVE SHOWERS WHERE ONE CAN USE HYDROTHERAPY FOR ANY LABORING DISCOMFORT. WE MAKE EVERY EFFORT TO KEEP MOTHER AND NEWBORN TOGETHER FROM BIRTH TO DISCHARGE AND INITIATE BREAST FEEDING WITHIN THE FIRST HOUR OF LIFE. THERE ARE LACTATION CONSULTANTS TO ASSIST WITH BREAST FEEDING DURING THE HOSPITALIZATION AND A "STORK SHOP" WHERE ELECTRIC BREAST PUMPS, BRAS, AND SUPPLIES CAN BE PURCHASED. PRENATAL CLASSES ARE ALSO OFFERED TO THOSE NEWLY PREGNANT FAMILIES AND FOR ANYONE WHO NEEDS A REFRESHER.
  SCHEDULE H, PART VI, LINE 5: ST. ANN MEDICAL CLINIC FOUNDED IN SEPTEMBER 1997 TO PROVIDE COMPREHENSIVE OUTPATIENT MEDICAL CARE FOR THE POOR OF VIGO AND SURROUNDING COUNTIES. ST. ANN MEDICAL CLINIC IS A PROGRAM OF PROVIDENCE SELF SUFFICIENCY MINISTRIES. CLIENTS SERVED MUST BE FINANCIALLY AT OR BELOW THE 125% POVERTY LEVEL AS ESTABLISHED BY THE FEDERAL GUIDELINES, MUST HAVE NO INSURANCE AND NO PHYSICIAN, AND BE WITHOUT THE RESOURCES OF MEDICARE OR MEDICAID. UNION'S PHYSICIANS, NURSES AND OTHERS PROVIDE VOLUNTEER SERVICE AND LEADERSHIP WITH ONE OF OUR PHYSICIANS SERVING AS MEDICAL DIRECTOR, AND LEADERS SUCH AS THE UNION HOSPITAL FOUNDATION DIRECTOR, THE CHAIRMAN OF THE BOARD OF DIRECTORS AND THE HOSPITAL'S LEGAL COUNSEL SERVING ON ITS ADVISORY COMMITTEE. HOSPITAL PHYSICIANS AND STAFF PROVIDE THOUSANDS OF VOLUNTEER HOURS TO THE CLINIC EACH YEAR. BEGINNING IN 2007, UNION HEALTH SYSTEM PLACED A NURSE PRACTITIONER FULL TIME WITHIN THE CLINIC. IN ADDITION, UNION HOSPITAL UHI ANNUALLY PROVIDES MORE THAN $13,000 IN MONETARY SUPPORT AND NEARLY $150,000 IN IN-KIND SUPPORT IN THE FORM OF FOLLOWUP TESTING AND CARE. SINCE 1997, THE CLINIC HAS TALLIED 60,000 CLIENT VISITS WITH NEARLY 20,800 OF THOSE VISITS OCCURRING SINCE FISCAL YEAR 2007. THE CLINIC OPERATES WITH A STAFF OF 105 DEDICATED CORE VOLUNTEERS, INCLUDING DOCTORS, NURSE PRACTITIONERS, NURSES, PHARMACISTS AND CLERICAL SUPPORT. THE NUMBER OF UNDERSERVED POOR IN THE VIGO COUNTY AREA IS INCREASING RAPIDLY AS EVIDENCED BY THE INCREASING NUMBERS OF CLINIC VISITS AND DECREASING ECONOMIC OPPORTUNITIES. THE CLINIC HAS DECREASED VISITS TO THE ALREADY OVERLOADED HOSPITAL EMERGENCY ROOMS. FURTHERMORE INDIVIDUALS AND FAMILIES, WHO HAVE NO OTHER RESOURCES, WOULD TYPICALLY NOT SEEK MEDICAL CARE, THUS RESULTING IN HIGHER IN HIGHER INCIDENCES OF MORE SERIOUS MEDICAL CONDITIONS GOING UNTREATED, POORER QUALITY OF LIFE AND INCREASING STRESS ON THE FAMILY.
  SCHEDULE H,PART VI,LINE 5: UNION HOSPITAL CLARA FAIRBANKS CENTER FOR WOMEN CLARA FAIRBANKS CENTER FOR WOMEN PROVIDES QUALITY CARE AND STATE-OF-THE-ART TECHNOLOGY IN MAMMOGRAPHY SERVICES FOR ALL PATIENTS OF THE WABASH VALLEY AND SURROUNDING COUNTIES. WE NOW HAVE THREE LOCATIONS TO SERVE OUR PATIENTS: THE MAIN CENTER AT 1711 N. 6 1/2 ST., SUITE 300, HUX CANCER CENTER IN TERRE HAUTE, SECOND LOCATION IS SOUTH OF THE CITY AT THOMAS PLAZA, 5500 S. US HWY. 41, TERRE HAUTE, AND THE THIRD LOCATION AT UNION HOSPITAL CLINTON, 801 S. MAIN, CLINTON, IN. THE SERVICES PROVIDED INCLUDE: DIGITAL MAMMOGRAPHY, BREAST ULTRASOUND, STEREOTACTIC AND ULTRASOUND GUIDED BREAST BIOPSY PROCEDURES, BONE DENSITY SCANS, AND A BOUTIQUE TO SUPPLY SPECIAL GARMENTS FOR PATIENTS WHO HAVE UNDERGONE BREAST SURGERY. BECAUSE PERSONALIZED CARE IS AS VITAL A PART OF GUIDING A PATIENT THROUGH BREAST CARE, AS IT IS IMPORTANT TO BE SURE TO TREAT EACH PATIENT AS AN INDIVIDUAL NOT JUST A CANCER DIAGNOSIS; THE CENTER IDENTIFIED THE NEED FOR A PATIENT NAVIGATOR IN 2004. THE PATIENT NAVIGATOR HELPS GUIDE THE PATIENTS AND THEIR FAMILIES THROUGH THE SOMETIMES-OVERWHELMING PROCESS OF A BREAST CANCER DIAGNOSIS AND TREATMENT. SHE IS ABLE TO ACCOMPLISH THIS BY MAKING HERSELF AVAILABLE TO ANSWER QUESTIONS, SCHEDULE APPOINTMENTS AND COORDINATE REFERRALS. THE STAFF EDUCATES THE PATIENTS AND COMMUNITY ABOUT BREAST CARE, AVAILABLE GRANT DOLLARS, AND MAMMOGRAPHY SERVICES THROUGH DIRECT COMMUNICATION WITH THE CENTER, COMMUNITY HEALTH FAIRS AND PUBLIC SPEAKING. THE CLARA FAIRBANKS CENTER MEETS ALL STANDARDS SET FORTH BY THE HEALTHCARE FACILITIES ACCREDITATION PROGRAM (HFAP), FEDERAL DRUG ADMINISTRATION (FDA), AMERICAN COLLEGE OF RADIOLOGY (ACR), AND THE REQUIREMENTS SET FORTH BY THE INDIANA STATE DEPARTMENT OF HEALTH. THE CENTER IS THE LEADING MAMMOGRAPHY FACILITY IN THE WABASH VALLEY. SINCE 1998, THE CENTER HAS BEEN A MAJOR PARTICIPANT IN THE INDIANA BREAST AND CERVICAL CANCER PREVENTION PROGRAM (BCCP), A PROGRAM TO ASSIST INDIGENT WOMEN WITH FUNDING FOR MAMMOGRAPHY SERVICES. FOR THE LAST FIVE YEARS, THE CENTER HAS BEEN APPROVED FOR GRANT DOLLARS THROUGH THE INDIANA BREAST CANCER AWARENESS TRUST. IN 2010, THE CLARA FAIRBANKS CENTER PROVIDED OVER 17,000 MAMMOGRAPHY SERVICES (BREAST BIOPSIES, ULTRASOUNDS, AND MAMMOGRAMS). THIS SAME YEAR, THE CLARA FAIRBANKS CENTER FOR WOMEN DIAGNOSED 153 WOMEN WITH BREAST CANCER AND ANOTHER 41 THAT WERE HIGH RISK. THE WABASH VALLEY BREAST CANCER SURVIVOR ORGANIZATION GAVE DOLLARS IN THE AMOUNT OF $7,500.00. THIS HELPED WITH THE PURCHASE OF 7 LYMPHEDEMA GARMENTS (WHICH WERE NOT COVERED BY THE PATIENTS INSURANCE) AND ASSISTED 13 WOMEN WITH MAMMOGRAPHY SERVICES. THE BCCP GAVE FUNDS FOR APPROXIMATELY 86 MAMMOGRAPHY SERVICES. THROUGH A WABASH VALLEY KOMEN FOUNDATION GRANT IN THE AMOUNT OF $65,000 ANOTHER 203 WOMEN AND ONE MALE WERE ASSISTED WITH ADDITIONAL SERVICES (MOSTLY BREAST BIOPSY PROCEDURES AND DIAGNOSTIC MAMMOGRAPHY). SEVENTY-SIX WOMEN RECEIVED SCREENING MAMMOGRAMS FROM A $10,000 GRANT FROM INDIANA BREAST CANCER AWARENESS TRUST. THESE WERE WOMEN AND MEN WHO MIGHT NOT HAVE RECEIVED THESE SERVICES IF THIS FUNDING HAD NOT BEEN AVAILABLE. BREAST CANCER SHOWS NO AGE BOUNDARIES; EARLY DETECTION IS STILL THE BEST PREVENTION. WITH EARLIER DIAGNOSIS, THERE IS LESS TREATMENT COST AND BETTER PROGNOSIS FOR THE PATIENT. WHILE BCCP IS A WORTHWHILE PROGRAM TO ASSIST INDIGENT WOMEN WITH MAMMOGRAPHY SERVICES, IT ONLY SUPPLIES FUNDING FOR MAMMOGRAPHY SERVICES FOR WOMEN 40 YEARS AND OLDER. WE KNOW THAT BREAST CANCER HAS THE POTENTIAL TO GROW MORE RAPIDLY IN YOUNGER WOMEN: THEREFORE IT IS OF UTMOST IMPORTANCE TO DETECT THESE CANCERS AT THE FIRST POSSIBLE SIGN. SINCE THERE HAS BEEN AN INCREASED NEED FOR FUNDING TO INCLUDE SCREENING, DIAGNOSIS, AND TREATMENT FOR WOMEN UNDER THE AGE OF 40, CLARA FAIRBANKS WILL CONTINUE TO PARTNER WITH ORGANIZATIONS LIKE THE SUSAN G. KOMEN FOUNDATION. THE CENTER WILL LOOK FOR EVERY OPPORTUNITY TO REQUEST GRANTS TO HELP ASSIST NOT ONLY WOMEN BUT MEN FOR THESE SERVICES. THE CENTER WILL CONTINUE TO EDUCATE ABOUT THE IMPORTANCE OF EARLY DETECTION AND FURTHER ENHANCE THE HOSPITAL'S "TEAM APPROACH" FOR BREAST CANCER PATIENTS.
  SCHEDULE H, PART VI, LINE 5: FRANKLIN ELEMENTARY SCHOOL WHAT BEGAN IN 1983 AS AN INDIANA STATE UNIVERSITY GRADUATE STUDENT'S PROJECT TO LINK LOCAL BUSINESSES WITH ELEMENTARY SCHOOLS HAS BECOME A LONG-STANDING PARTNERSHIP TO ENCOURAGE HEALTHY LIFESTYLES IN ONE OF TERRE HAUTE'S POOREST ELEMENTARY SCHOOLS. THE PAIRING OF UNION HOSPITAL WITH BENJAMIN FRANKLIN ELEMENTARY SCHOOL IN TERRE HAUTE HAS PROVEN TO BE A "PERFECT PARTNERSHIP" IN MATCHING THE NEEDS OF STUDENTS WITH STAFF AND VOLUNTEERS FROM THE HOSPITAL. FRANKLIN SCHOOL IS LOCATED IN A POOR INNER-CITY NEIGHBORHOOD WHERE 98% OF STUDENTS QUALIFY FOR THE FEDERAL FREE BREAKFAST AND LUNCH PROGRAM. THE STUDENT POPULATION IS TRANSIENT; 90% OF STUDENTS WHO BEGIN ELEMENTARY SCHOOL AT FRANKLIN DO NOT FINISH ELEMENTARY SCHOOL AT THE SCHOOL DUE TO INSTABILITY IN THEIR HOME AND FAMILY LIVES. FOR MOST, GOOD NUTRITION, HYGIENE AND PHYSICAL FITNESS ARE NOT TAUGHT OR ENCOURAGED IN THE HOME. EACH YEAR UNION PROGRAM DIRECTORS MEET WITH THE PRINCIPAL AND TEACHERS FROM THE SCHOOL TO SET CRITERIA AND PLAN THE YEAR'S ACTIVITIES. ENGAGING THE CLASSROOM TEACHER IN THE PLANNING AND PREPARATION FOR THESE ACTIVITIES AND WORKING WITH THEM TO INCORPORATE GOOD HEALTH MESSAGES INTO THEIR CURRICULA IS VITAL TO THE PROGRAMS SUCCESS. IN 2011 UNION HOSPITAL OFFICIALS DEVELOPED THE UNION HOSPITAL HEALTHY ME PROGRAM FOR FRANKLIN STUDENTS. THE PROGRAM TESTS THE STUDENTS HEIGHT, WEIGHT, BLOOD PRESSURE, SIT-UP, SIT AND REACH, BAR HANG AND SHUTTLE RUN. THE RESULTS OF EACH TEST ARE RECORDED AND SENT TO THE HOMES OF EACH STUDENT. THIS PARTNERSHIP IS FAR FROM ONE-SIDED. FOR EACH HOLIDAY, STUDENTS FROM THE SCHOOL MAKE TRAY FAVORS FOR PATIENT MEAL TRAYS TO BRIGHTEN THEIR DAY. CAROLERS FROM THE SCHOOL AT CHRISTMAS PROVIDE CHEER TO PATIENTS AND STAFF. MORE THAN 350 STUDENTS PARTICIPATE EACH YEAR IN THESE ACTIVITIES. GIVEN THE TRANSIENT NATURE OF THIS POPULATION, IT IS DIFFICULT TO MEASURE THE LONG-TERM EFFECTS HOWEVER AT OVER THE YEARS THE HEALTH TESTING OF THE STUDENTS, 3-6 STUDENTS ARE IDENTIFIED WITH SIGNIFICANT HEALTH ISSUES SUCH AS HIGH BLOOD PRESSURE, HIGH BLOOD SUGAR, MALNOURISHMENT OR OBESITY. FOLLOW-UP IS DONE WITH FAMILIES TO ENCOURAGE FURTHER MEDICAL EVALUATION AND LINK THEM TO APPROPRIATE SOCIAL SERVICES. ANECDOTALLY, NURSES AND OTHER HEALTH PROFESSIONALS HAVE TOLD US OF THE INFLUENCE OUR STAFF HAD IN THEIR DECISION TO BECOME CARE PROVIDERS AS A RESULT OF HEARING THEM AT FRANKLIN SCHOOL. WHILE THE SCHOOL HAS HAD THREE PRINCIPLES IN THE LAST 15 YEARS, EACH ONE HAS KEPT THE PROGRAM GROWING AND VIABLE. AN AVERAGE OF $2,000 IS SPENT FROM THE MARKETING BUDGET EACH YEAR ON T-SHIRTS, PRINTING, RIBBONS, BUS TRANSPORTATION AND MEALS. STAFF DONATES ABOUT 60 HOURS EACH YEAR FOR THESE ACTIVITIES. TO HELP FIGHT CHILDHOOD OBESITY AND TO BETTER COMBAT HEART DISEASE THE FRANKLIN SCHOOL HEALTH PROGRAM UNDERWENT A MAJOR OVERHAUL IN 2011. THE NEW PROGRAM TITLED, UNION HOSPITAL HEALTHY ME AT FRANKLIN ELEMENTARY WILL BE A MORE FORMALIZED PROGRAM THAT WILL INCLUDE PRE AND POST HEALTH TESTING. BUILDING ON OUR ADOPTION OF THE PRESIDENTIAL FITNESS CHALLENGE IN FY 2010, THE HEALTHY ME PROGRAM INCLUDES FOLLOW-UP TESTING AT THE END OF THE SCHOOL YEAR. IF THE STUDENTS DO NOT EAT HEALTHY AND EXERCISE OUTSIDE OF SCHOOL, THE HEALTHY ME PROGRAM WILL BE LESS IMPACTFUL. THUS, THE NEW PROGRAM FEATURED THREE FAMILY DINNER NIGHTS, OFFERING A FREE MEAL AND EDUCATION FROM A UNION HOSPITAL NUTRITIONIST AND FITNESS CENTER SPECIALISTS. HEALTHY EATING ON A BUDGET AND AT-HOME-IN-HOME EXERCISE WAS STRESSED TO THE PARENTS.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2010

Additional Data


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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
2010
Open to Public Inspection
Name of the organization
UNION HOSPITAL INC
 
Employer identification number

35-0876396
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) IPACS INC
1606 N SEVENTH ST
TERRE HAUTE,IN47804
35-1720998 		CLINIC MANAGEMENT IN 298,863 2,051,568 UNION HOSPITAL
 
(2) UNION ASSOCIATED PHYSICIANS CLINIC INC
1606 N SEVENTH ST
TERRE HAUTE,IN47804
27-0581401 		PHYSICIAN GROUP IN -2,465,813 10,782,740 UNION HEALTH SYSTEM
 








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) UNION HOSPITAL FOUNDATION

1659 N SEVENTH ST

TERRE HAUTE,IN47804
35-1642823 		FUNDRAISING IN 501(C)(3) LINE 11C, III-FI UNION HOSPITAL
 
Yes
 
(2) UNION HOSPITAL HEALTH SERVICES INC

1606 N SEVENTH ST

TERRE HAUTE,IN47804
35-1642805 		HEALTH SERVICES IN 501(C)(3) LINE 9 N/A
 
No
(3) VISITING NURSE ASSOCIATION OF WABASH VALLEY INC

400 EIGHT AVE

TERRE HAUTE,IN47804
35-0869064 		CHARITABLE HOME HEALTH IN 501(C)(3) LINE 7 UNION HOSPITAL FOUNDATION
 
Yes
 
(4) CENTER FOR OCCUPATIONAL HEALTH

4001 WABASH AVE

TERRE HAUTE,IN47803
35-2118417 		OCCUPATIONAL HEALTH SERVICES IN 501(C)(3) LINE 7 UNION HOSPITAL
 
Yes
 
(5) UNION HEALTH SYSTEMS

1606 N SEVENTH ST

TERRE HAUTE,IN47804
27-0581133 		MANAGEMENT ORGANIZATION IN 501(C)(3) LINE 11B, II N/A
 
No




For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2010
Schedule R (Form 990) 2010
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












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












Schedule R (Form 990) 2010
Schedule R (Form 990) 2010
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
Yes
 
b Gift, grant, or capital contribution to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1b
 
No
c Gift, grant, or capital contribution from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1c
Yes
 
d Loans or loan guarantees to or for other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1d
 
No
e Loans or loan guarantees by other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1e
 
No
f Sale of assets to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1f
 
No
g Purchase of assets from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1g
 
No
h Exchange of assets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1h
 
No
i Lease of facilities, equipment, or other assets to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1i
Yes
 
j Lease of facilities, equipment, or other assets from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .
1j
 
No
k Performance of services or membership or fundraising solicitations for other organization(s) . . . . . . . . . . . . . . . . . . . . . .
1k
Yes
 
l Performance of services or membership or fundraising solicitations by other organization(s) . . . . . . . . . . . . . . . . . . . . . .
1l
 
No
m Sharing of facilities, equipment, mailing lists, or other assets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1m
 
No
n Sharing of paid employees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1n
Yes
 
o Reimbursement paid to other organization for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1o
 
No
p Reimbursement paid by other organization for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1p
Yes
 
q Other transfer of cash or property to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1q
 
No
r Other transfer of cash or property from other 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) UNION HOSPITAL FOUNDATION

 P 354,434  
(1)
(2)
(3)
(4)
(5)
(6)
Schedule R (Form 990) 2010
Schedule R (Form 990) 2010
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)
Are all
partners
section
501(c)(3)
organizations? 		(e)
Share of
end-of-year
assets 		(f)
Disproprtionate allocations? 		(g)
Code V—UBI
amount in box
20 of Schedule K-1
(Form 1065) 		(h)
General or
managing
partner?
Yes No Yes No Yes No






























Schedule R (Form 990) 2010
Schedule R (Form 990) 2010
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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