Department of the Treasury Internal Revenue Service
Public Charity Status and Public Support
Complete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.
Attach to Form 990 or Form 990-EZ. See separate instructions.
OMB No. 1545-0047
2011
Open to Public Inspection
Name of the organization
IU HEALTH INC
Employer identification number
35-1693695
Part I
Reason for Public Charity Status
(All organizations must complete this part.) See instructions
The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)
1
2
3
4
5
section 170(b)(1)(A)(iv). (Complete Part II.)
6
7
8
9
receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of
its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses
acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)
10
11
e
By checking this box, I certify that the organization is not controlled directly or indirectly by one or more disqualified persons other than foundation managers and other than one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2).
f
If the organization received a written determination from the IRS that it is a Type I, Type II or Type III supporting organization, check this box
..................................................
g
Since August 17, 2006, has the organization accepted any gift or contribution from any of the following persons?
(i) a person who directly or indirectly controls, either alone or together with persons described in (ii)
Yes
No
and (iii) below, the governing body of the the supported organization?
................
11g(i)
No
(ii)
a family member of a person described in (i) above?
......................
11g(ii)
No
(iii)
a 35% controlled entity of a person described in (i) or (ii) above?
................
11g(iii)
No
h
Provide the following information about the supported organization(s).
(i) Name of supported organization
(ii) EIN
(iii) Type of organization (described on lines 1- 9 above or IRC section (see instructions))
(iv) Is the organization in col. (i) listed in your governing document?
(v) Did you notify the organization in col. (i) of your support?
(vi) Is the organization in col. (i) organized in the U.S.?
(vii) Amount of support?
Yes
No
Yes
No
Yes
No
(1)
INDIANA UNIVERSITY SCHOOL OF MEDICINE
356001673
6
Yes
Yes
Yes
0
(2)
HEALTH AND HOSPITAL CORPORATION
356005697
6
Yes
Yes
Yes
0
Total
0
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2011
Schedule A (Form 990 or 990-EZ) 2011
Page 2
Part II
Support Schedule for Organizations Described in IRC 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi) (Complete only if you checked the box on line 5, 7, or 8 of Part I or if the
organization failed to qualify under Part III. If the organization fails to
qualify under the tests listed below, please complete Part III.)
Section A. Public Support
Calendar year(or fiscal year beginning in)
(a) 2007
(b) 2008
(c) 2009
(d) 2010
(e) 2011
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....
2
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......
3
The value of services or facilities furnished by a governmental unit to the organization without charge..
4
Total. Add lines 1 through 3..
5
The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included
on line 1 that exceeds 2% of the amount shown on line 11, column (f)..
6
Public Support. Subtract line 5 from line 4.
Section B. Total Support
Calendar year(or fiscal year beginning in)
(a) 2007
(b) 2008
(c) 2009
(d) 2010
(e) 2011
(f) Total
7
Amounts from line 4..
8
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
9
Net income from unrelated business activities, whether or not the business is regularly carried on..
10
Other income. (Explain in Part IV.) Do not include gain or loss from the sale of capital assets..
11
Total support (Add lines 7 through 10).
12
Gross receipts from related activities, etc. (See instructions.)
..................
12
13
First Five Years
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here..........................................
Section C. Computation of Public Support Percentage
14
Public Support Percentage for 2010 (line 6 column (f) divided by line 11 column (f))
.........
14
15
Public Support Percentage for 2009 Schedule A, Part II, line 14
...............
15
16a
33 1/3% support test—2011.
If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization
......................
b
33 1/3% support test—2010.
If the organization did not check the box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization
.....................
17a
10%-facts-and-circumstances test—2011.
If the organization did not check a box on line 13, 16a, or 16b and line 14
is 10% or more, and if the organization meets the "facts and circumstances" test, check this box and stop here. Explain
in Part IV how the organization meets the "facts and circumstances" test. The organization qualifies as a publicly supported
organization
..................................................
b
10%-facts-and-circumstances test—2010.
If the organization did not check a box on line 13, 16a, 16b, or 17a and line
15 is 10% or more, and if the organization meets the "facts and circumstances" test, check this box and stop here.
Explain in Part IV how the organization meets the "facts and circumstances" test. The organization qualifies as a publicly supported organization
..............................................
18
Private Foundation
If the organization did not check a box on line 13, 16a, 16b, 17a or 17b, check this box and see
instructions
...................................................
Schedule A (Form 990 or 990-EZ) 2011
Schedule A (Form 990 or 990-EZ) 2011
Page 3
Part III
Support Schedule for Organizations Described in IRC 509(a)(2) (Complete only if you checked the box on line 9 of Part I or if the organization
failed to qualify under Part II. If the organization fails to qualify under
the tests listed below, please complete Part II.)
Section A. Public Support
Calendar year(or fiscal year beginning in)
(a) 2007
(b) 2008
(c) 2009
(d) 2010
(e) 2011
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
2
Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......
3
Gross receipts from activities that are not an unrelated trade or business under section 513..
4
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5
The value of services or facilities furnished by a governmental unit to the organization without charge..
6
Total. Add lines 1 through 5.
7a
Amounts included on lines 1, 2, and 3 received from disqualified persons...
b
Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
c
Add lines 7a and 7b..
8
Public Support (Subtract line 7c from line 6.)
Section B. Total Support
Calendar year (or fiscal year beginning in)
(a) 2007
(b) 2008
(c) 2009
(d) 2010
(e) 2011
(f) Total
9
Amounts from line 6...
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c
Add lines 10a and 10b.
11
Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
12
Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)
13
Total support (Add lines 9, 10c, 11 and 12.).
14
First Five Years
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here.............................................
Section C. Computation of Public Support Percentage
15
Public Support Percentage for 2011 (line 8 column (f) divided by line 13 column (f))
.........
15
16
Public support percentage from 2010 Schedule A, Part III, line 15
...............
16
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2011 (line 10c column (f) divided by line 13 column (f))
......
17
18
Investment income percentage from 2010 Schedule A, Part III, line 17
.............
18
19a
33 1/3% support tests—2011.
If the organization did not check the box on line 14, and line 15 is more than 33 1/3% and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
..........
b
33 1/3% support tests—2010.
If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
....
20
Private Foundation
If the organization did not check a box on line 14, 19a or 19b, check this box and see instructions
.....
Schedule A (Form 990 or 990-EZ) 2011
Schedule A (Form 990 or 990-EZ) 2011
Page 4
Part IV
Supplemental Information.
Supplemental Information. Complete this part to provide the explanation required by Part II, line 10; Part II, line 17a or 17b; or Part III, line 12. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
Explanation
Schedule A (Form 990 or 990-EZ) 2011
Additional Data
Software ID:
11000230
Software Version:
v2011.1.0
-
TIN:
SCHEDULE O (Form 990 or 990-EZ)
Department of the Treasury Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ
Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
Attach to Form 990 or 990-EZ.
OMB No. 1545-0047
2011
Open to Public Inspection
Name of the organization
IU HEALTH INC
Employer identification number
35-1693695
Identifier
Return Reference
Explanation
DELEGATED AUTHORITY TO EXECUTIVE COMMITTEE
FORM 990, PART VI, LINE 1A
THE EXECUTIVE COMMITTEE SHALL CONSIST OF NOT LESS THAN FIVE DIRECTORS AND SHALL HAVE AND EXERCISE THE AUTHORITY OF THE BOARD IN THE MANAGEMENT OF THE CORPORATION IN THE INTERIM PERIOD BETWEEN BOARD MEETINGS. THE EXECUTIVE COMMITTEE SHALL ENDEAVOR TO REGULARLY MEET ON A MONTHLY BASIS.
Classes of members or stockholders
Form 990, Part VI, Section A, Line 6
IU MEDICAL GROUP - PRIMARY CARE HAS TWO GOVERNING BODIES, THE BOARD OF MEMBERS AND THE BOARD OF DIRECTORS. THE MEMBERS OF IU MEDICAL GROUP - PRIMARY CARE GOVERNING BODY DO NOT ALL HAVE THE SAME VOTING RIGHTS. BELOW OUTLINES THE RIGHTS OF BOTH THE BOARD OF DIRECTORS AND THE BOARD OF MEMBERS. VOTING RIGHTS OF THE BOARD OF DIRECTORS: 1. THE BUSINESS, PROPERTY AND AFFAIRS OF THE CORPORATION SHALL BE MANAGED AND CONTROLLED UNDER THE DIRECTION OF THE BOARD OF DIRECTORS AS FROM TIME TO TIME CONSTITUTED (THE "BOARD"). 2. THE BOARD SHALL EXERCISE ALL THE POWERS OF THE CORPORATION, SUBJECT TO THE RESTRICTIONS IMPOSED BY LAW, THE ARTICLES OF INCORPORATION AND THE CODE OF BY-LAWS. VOTING RIGHTS OF THE BOARD OF MEMBERS: 1. RATIFICATION OF THE CLASS A DIRECTORS WHO ARE ELECTED BY THE DELEGATES; 2. ELECTION OF THE CLASS B DIRECTORS WHO REPRESENT THE INDIANAPOLIS METROPOLITAN AREA BUSINESS COMMUNITY; 3. REMOVAL OF THE PRESIDENT OF THE CORPORATION; 4. APPROVAL ON AN ANNUAL BASIS OF THE CERTIFIED PUBLIC ACCOUNTING FIRM THAT AUDITS THE CORPORATION'S FINANCIAL BOOKS AND RECORDS; 5. THE APPROVAL OF, AND ONE OR MORE MATERIAL CHANGES IN, THE MISSION STATEMENT OR THE LONG-TERM STRATEGIC BUSINESS PLAN OF THE CORPORATION; 6. APPROVAL OF THE ANNUAL BUDGET OF THE CORPORATION; 7. APPROVAL OF THE SALE, LEASE, EXCHANGE OR DISPOSITION OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF THE CORPORATION, OR THE MERGER, CONSOLIDATION OR STRATEGIC JOINT VENTURE OF THE CORPORATION WITH ANY OTHER ENTITY; AND 8. AMENDMENT, ALTERATION, OR REPEAL OF THE ARTICLES OF INCORPORATION OR THE CODE OF BY-LAWS OF THE CORPORATION.
Members or stockholders electing members of governing body
Form 990, Part VI, Section A, Line 7a
AS OUTLINED ABOVE, THE RIGHTS OF THE MEMBERS DO INCLUDE THE ELECTION OF MEMBERS TO THE GOVERNING BODY.
Decisions requiring approval by members or stockholders
Form 990, Part VI, Section A, Line 7b
THE ORGANIZATION HAS A GOVERNING BODY MADE UP OF MEMBERS CALLED THE BOARD OF MEMBERS. CERTAIN DECISIONS ARE SUBJECT TO THE APPROVAL OF THE BOARD OF MEMBERS, AS OUTLINED BELOW: 1. RATIFICATION OF THE CLASS A DIRECTORS WHO ARE ELECTED BY THE DELEGATES; 2. ELECTION OF THE CLASS B DIRECTORS WHO REPRESENT THE INDIANAPOLIS METROPOLITAN AREA BUSINESS COMMUNITY; 3. REMOVAL OF THE PRESIDENT OF THE CORPORATION; 4. APPROVAL ON AN ANNUAL BASIS OF THE CERTIFIED PUBLIC ACCOUNTING FIRM THAT AUDITS THE CORPORATION'S FINANCIAL BOOKS AND RECORDS; 5. THE APPROVAL OF, AND ONE OR MORE MATERIAL CHANGES IN, THE MISSION STATEMENT OR THE LONG-TERM STRATEGIC BUSINESS PLAN OF THE CORPORATION; 6. APPROVAL OF THE ANNUAL BUDGET OF THE CORPORATION; 7. APPROVAL OF THE SALE, LEASE, EXCHANGE OR DISPOSITION OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF THE CORPORATION, OR THE MERGER, CONSOLIDATION OR STRATEGIC JOINT VENTURE OF THE CORPORATION WITH ANY OTHER ENTITY; AND 8. AMENDMENT, ALTERATION, OR REPEAL OF THE ARTICLES OF INCORPORATION OR THE CODE OF BY-LAWS OF THE CORPORATION.
Review of form 990 by governing body
Form 990, Part VI, Section B, Line 11b
THE TAX RETURN IS PREPARED BY CROWE HORWATH LLP. THE FORM 990 IS REVIEWED BY THE CFO AND A COPY IS SENT TO EVERY VOTING MEMBER OF THE GOVERNING BOARD OF DIRECTORS PRIOR TO FILING WITH THE IRS.
Conflict of interest policy
Form 990, Part VI, Section B, Line 12c
IN ACCORDANCE WITH IU MEDICAL GROUP - PRIMARY CARE'S (IUMG-PC) CONFLICT OF INTEREST POLICY, ALL IUMG-PC PROVIDERS, EMPLOYEES, OFFICERS, AND MEMBERS OF THE BOARD OF MEMBERS, BOARD OF DIRECTORS, FINANCE COMMITTEE AND COMPENSATION COMMITTEE HAVE A DUTY TO DISCLOSE ALL FACTS MATERIAL FOR A REVIEW OF THE POTENTIAL CONFLICT. ANNUALLY, ALL OF IUMG-PC'S MEMBERS, OFFICERS, DIRECTORS AND BOARD COMMITTEE MEMBERS MUST COMPLETE A WRITTEN DISCLOSURE FORM, ALONG WITH THE DUTY TO UPDATE THE FORM AS NECESSARY IF ANY NEW INTERESTS OR CHANGES IN PREVIOUSLY REPORTED INTERESTS DEVELOP. ANY SITUATION THAT COULD GIVE RISE TO A POTENTIAL CONFLICT OF INTEREST IS REVIEWED BY A DISINTERESTED IUMG-PC OFFICER, OR THE OFFICERS AS A GROUP, OR THE IUMG-PC EXECUTIVE COMMITTEE OR THE BOARD OF DIRECTORS. THE REVIEW SHALL DETERMINE WHETHER IUMG-PC, WITH REASONABLE EFFORT, SHOULD OBTAIN A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT THAT WOULD NOT GIVE RISE TO A CONFLICT OF INTEREST. IF SUCH A TRANSACTION OR ARRANGEMENT CAN NOT REASONABLY BE ATTAINED, THEN THE REVIEWER SHALL DETERMINE WHETHER THE TRANSACTION OR ARRANGEMENT IS IN THE CORPORATION'S BEST INTEREST, AND IS FAIR AND REASONABLE TO IUMG-PC. IF AN ISSUE INVOLVING A POTENTIAL CONFLICT IS BROUGHT TO THE TABLE AT A BOARD MEETING, THE PERSON WITH THE POTENTIAL CONFLICT WOULD ABSTAIN FROM VOTING ON THE ISSUE.
Process used to establish compensation of top management official
Form 990, Part VI, Section B, Line 15a
ANNUALLY, THE COMPENSATION OF THE CEO IS REVIEWED BY THE IU MEDICAL GROUP-PRIMARY CARE COMPENSATION COMMITTEE. THE COMMITTEE IS COMPRISED OF MEMBERS FROM THE FINANCE COMMITTEE WHO ARE INDEPENDENT FROM THE MANAGEMENT OF IU MEDICAL GROUP-PRIMARY CARE. THE COMPENSATION COMMITTEE USES COMPENSATION STUDIES TO ENSURE THE COMPENSATION OF THE CEO IS REASONABLE. THE DECISIONS AND DELIBERATIONS ARE DOCUMENTED IN THE COMMITTEE MINUTES. THIS PROCESS WAS LAST UNDERTAKEN IN 2011.
Process used to establish compensation of other officers/key employees
Form 990, Part VI, Section B, Line 15b
ANNUALLY, THE COMPENSATION OF OTHER OFFICERS IS REVIEWED BY THE IU MEDICAL GROUP-PRIMARY CARE COMPENSATION COMMITTEE. THE COMMITTEE IS COMPRISED OF MEMBERS FROM THE FINANCE COMMITTEE WHO ARE INDEPENDENT FROM THE MANAGEMENT OF IU MEDICAL GROUP-PRIMARY CARE. THE COMPENSATION COMMITTEE USES COMPENSATION STUDIES TO ENSURE THE COMPENSATION IS REASONABLE. THE DECISIONS AND DELIBERATIONS ARE DOCUMENTED IN THE COMMITTEE MINUTES. THIS PROCESS WAS LAST UNDERTAKEN IN 2011.
Governing documents, conflict of interest policy and financial statements available to the public
Form 990, Part VI, Section C, Line 19
THE ORGANIZATION'S CONFLICT OF INTEREST POLICY, GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST.
Other changes in net assets or fund balances
Form 990, Part XI, Line 5
NET UNREALIZED GAINS (LOSSES) ON INVESTMENTS - -1044095; LOSS OF SALE OF FIXED ASSETS - -4600; OTHER ADJUSTMENTS - -80561;
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.