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
INDIANA UNIVERSITY HEALTH CARE ASSOCIATES INC
Employer identification number
35-1747218
Part I
Reason for Public Charity Status
(All organizations must complete this part.) See instructions
The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)
1
2
3
4
5
section 170(b)(1)(A)(iv). (Complete Part II.)
6
7
8
9
receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of
its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses
acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)
10
11
e
By checking this box, I certify that the organization is not controlled directly or indirectly by one or more disqualified persons other than foundation managers and other than one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2).
f
If the organization received a written determination from the IRS that it is a Type I, Type II or Type III supporting organization, check this box
..................................................
g
Since August 17, 2006, has the organization accepted any gift or contribution from any of the following persons?
(i) a person who directly or indirectly controls, either alone or together with persons described in (ii)
Yes
No
and (iii) below, the governing body of the the supported organization?
................
11g(i)
(ii)
a family member of a person described in (i) above?
......................
11g(ii)
(iii)
a 35% controlled entity of a person described in (i) or (ii) above?
................
11g(iii)
h
Provide the following information about the supported organization(s).
(i) Name of supported organization
(ii) EIN
(iii) Type of organization (described on lines 1- 9 above or IRC section (see instructions))
(iv) Is the organization in col. (i) listed in your governing document?
(v) Did you notify the organization in col. (i) of your support?
(vi) Is the organization in col. (i) organized in the U.S.?
(vii) Amount of support?
Yes
No
Yes
No
Yes
No
Total
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 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.") .
5,726,916
3,040,342
0
0
0
8,767,258
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......
28,583,649
21,794,831
60,461,533
217,100,267
311,003,051
638,943,331
3
Gross receipts from activities that are not an unrelated trade or business under section 513..
414,151
137,893
864,798
7,739,538
6,375,474
15,531,854
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.
34,724,716
24,973,066
61,326,331
224,839,805
317,378,525
663,242,443
7a
Amounts included on lines 1, 2, and 3 received from disqualified persons...
0
0
0
0
0
b
Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
0
0
3,093,972
27,666,033
45,828,532
76,588,537
c
Add lines 7a and 7b..
0
0
3,093,972
27,666,033
45,828,532
76,588,537
8
Public Support (Subtract line 7c from line 6.)
586,653,906
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...
34,724,716
24,973,066
61,326,331
224,839,805
317,378,525
663,242,443
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
487,287
1,087,676
3,817,378
2,619,461
1,260,522
9,272,324
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
0
0
0
17,437
0
17,437
c
Add lines 10a and 10b.
487,287
1,087,676
3,817,378
2,636,898
1,260,522
9,289,761
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.).
35,212,003
26,060,742
65,143,709
227,476,703
318,639,047
672,532,204
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
87.231 %
16
Public support percentage from 2010 Schedule A, Part III, line 15
...............
16
90.549 %
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2011 (line 10c column (f) divided by line 13 column (f))
......
17
1.381 %
18
Investment income percentage from 2010 Schedule A, Part III, line 17
.............
18
2.084 %
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:
Software Version:
-
TIN:
SCHEDULE O (Form 990 or 990-EZ)
Department of the Treasury Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ
Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
Attach to Form 990 or 990-EZ.
OMB No. 1545-0047
2011
Open to Public Inspection
Name of the organization
INDIANA UNIVERSITY HEALTH CARE ASSOCIATES INC
Employer identification number
35-1747218
Identifier
Return Reference
Explanation
Part VI, Section A - Governing Body and Management
Line 2 - Family or Business Relationships
John F. Fitzgerald, M.D. and Marvin G. Pember serve on the board of managers of Health Venture Management, LLC. No additional compensation is provided. John F. Fitzgerald, M.D. and Marvin G. Pember serve on the board of directors of Indiana University Health Plans, Inc. No additional compensation is provided. Samuel L. Odle and Michael R. Niemier, M.D. serve on the board of managers of Clarian Health West, LLC. Marvin G. Pember and Isadore Rivas each served on the board of managers of Clarian Health West, LLC during a portion of 2011. No additional compensation is provided. Samuel L. Odle, Marvin G. Pember, and Larry H. Stevens, M.D. serve on the board of managers of Clarian Health North, LLC. No additional compensation is provided. John F. Fitzgerald, M.D. and Charles M. Shufflebarger, M.D. serve on the board of directors of IUH Assurance, Ltd. and IU Health Risk Retention Group, Inc. No additional compensation is provided.
Part VI, Section A - Governing Body and Management
Lines 6, 7a and 7b - Members or Stockholders
Line 6: Indiana University Health Care Associates, Inc. ("IU Health Physicians") has two Members, which are designated as the Class A Member and the Class B Member. The Class A Member consists of those individuals who serve from time to time as the Trustees of Indiana University ("IU"). The Class B Member is Indiana University Health, Inc. ("IU Health"). Line 7a: The Board of Directors consists of: (a) two individuals appointed by IU as the Class A Member, (b) three individuals appointed by IU Health as the Class B Member, (c) four Associates appointed by IU as the Class A Member, and (d) four Associates appointed by IU Health as the Class B Member. A physician or any non-physician health care provider approved by IU Health Physicians may be an Associate of IU Health Physicians if he or she (a) has medical staff privileges (if applicable) and conducts a substantial practice activity at a hospital affiliated with IU Health, at William M. Wishard Hospital, Larue D. Carter Memorial Hospital or the Richard L. Roudebush Medical Center or at some other site authorized by the Corporation; (b) holds a faculty position with the Indiana University School of Medicine; and (c) is party to an employment agreement with IU Health Physicians or, if not party to an employment agreement, meets the written criteria for nonemployee Associate status approved by the Board and the members from time to time. Line 7b: Any decision by the Board of Directors to amend, supplement, or repeal all or any part of the provisions contained in the Articles of Incorporation must be duly approved by a vote of both Members.
Part VI, Section A - Governing Body and Management
Line 11b - Form 990 Provided to Governing Body
Indiana University Health Care Associates, Inc. ("IU Health Physicians") has established the following process for the review of the Form 990 and related schedules before it is filed: The Chief Financial Officer reviewed and approved the Form 990 and related schedules. After the review and approval from the Chief Financial Officer, a complete copy of the Form 990 and related schedules was made available to each board member on a secure intranet site. Each member was informed of the availability of the Tax Department to answer any questions.
Part VI, Section B - Policies
Lines 12, 13, 14, and 16a
Indiana University Health Care Associates, Inc. ("IU Health Physicians") is part of the Indiana University Health, Inc. ("IU Health") system. As a member of IU Health Physicians, IU Health and its Board of Directors have mandated that certain policies be followed to ensure greater standardization throughout the system. Thus, IU Health Physicians' Board of Directors was not required to separately adopt a conflict of interest, whistleblower, document retention and destruction and joint venture policies because IU Health's Board of Directors had already adopted and required these policies to be followed by its subsidiaries.
Part VI, Section B - Policies
Line 12c - Conflict of Interest Policy
Indiana University Health Care Associates, Inc. ("IU Health Physicians") has a Conflict of Interest Policy, the purpose of which is to protect IU Health Physician's interests when it is contemplating entering into a transaction or arrangement that might benefit the private interest of an officer, director, or employee. Each employee that is manager level or above, including officers and directors, is required to annually sign a statement which affirms that such person (1) has received a copy of the conflict of interest policy; (2) has read and understands the policy; (3) has agreed to comply with the policy; and (4) understands and acknowledges that the Corporation is a tax-exempt organization and that in order to maintain its federal tax exemption it must engage primarily in activities which accomplish one or more of its tax-exempt purposes. If an interest is disclosed, the form requires that the discloser's supervisor sign the form to indicate his/her knowledge and approval of the interest. The form is then submitted to Corporate Compliance for review. If the disclosure is by the CEO/President, it is reviewed by the board chairman for approval. If the disclosure is by a member of the board of directors, the General Counsel/Chief Compliance Officer reviews the disclosures and determines whether to consent. Board members with a conflict of interest cannot participate in any decision related to that conflict. Breach of the conflict of interest policy, including failure to complete and update the questionnaire and failure to disclose an interest that should be disclosed, may subject an individual to disciplinary action, including dismissal.
Part VI, Section B - Policies
Line 15 - Process for Determining Compensation
Indiana University Health Care Associates, Inc. ("IU Health Physicians") has the following process in place to determine the compensation for its CEO, CFO and other executives. IU Health Physicians engages an independent compensation consultant who utilizes a variety of methods and procedures to establish market ranges for the CEO, CFO, and other executives. The market ranges provided by the independent consultant is used by the executive Compensation Committee to review and establish the yearly pay increases for the CEO. The Compensation Committee reviews the market data for the CFO and other executives and delegates the annual pay increase decision to the CEO, who uses the market data to drive the annual pay increase decisions.
Part VI, Section B - Policies
Line 19 - Public Disclosure
Indiana University Health Care Associates, Inc.'s ("IU Health Physicians") Articles of Incorporation are available for public inspection through the Indiana Secretary of State's web-site. IU Health Physicians' conflict of interest procedures are disclosed on the Form 990, Schedule O.
Part VII, Section A - Governing Body and Management
Line 1a, Column (B) - Average hours per week
Richard F. Graffis, M.D. is the Executive Vice President and Chief Medical Officer for Indiana University Health, Inc. and devotes 55 hours per week. Marvin G. Pember is the Executive Vice President and Chief Financial Officer for Indiana University Health, Inc. and devotes 55 hours per week. Samuel L. Odle is the Executive Vice President and Chief Operating Officer for Indiana University Health, Inc. and devotes 55 hours per week. Isadore Rivas was the Vice President, Finance for Indiana University Health, Inc. and devoted 55 hours per week. Herbert E. Cushing, M.D. is the Chief Medical Officer of University Hospital for Indiana University Health, Inc. and devotes 15 hours per week. Arthur C. Coffey, M.D. is a staff physician for Indiana University Health, Inc. and devotes 55 hours per week.
Part XI - Reconciliation of Net Assets
Line 5 - Other Changes in Net Assets or Fund Balances
During 2011, Indiana University Health, Inc. ("IU Health"), a related 501(c)(3) tax-exempt organization, made an equity transfer to Indiana University Health Care Associates, Inc. ("IU Health Physicians") of $125,896,146 and The Indiana Clinic Support Services, LLC d/b/a Indiana University Health Physicians Support Services of -$994,278. Since IU Health Physicians joined the IU Health system, IU Health has provided funds to support IU Health Physicians' exempt purpose. Although there was never any intent for IU Health Physicians to repay IU Health, these amounts were recorded as intercompany balances rather than equity transfers. During 2011, IU Health and IU Health Physicians made adjustments to their books and records to reflect these intercompany balances as equity transfers for both book and tax purposes. Additionally during 2011, IU Health Physicians, Inc. recorded the following other changes in net assets or fund balances: Book/Tax Differences - Partnerships: 2,225 Change in Minimum Pension Liability: -488,296
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.