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
2012
Open to Public Inspection
A For the 2012 calendar year, or tax year beginning 01-01-2012 , 2012, and ending 12-31-2012
BCheck if applicable:
CName of organization
METHODIST OCCUPATIONAL HEALTH CENTERS INC
 
Doing Business As
IU HEALTH OCCUPATIONAL SERVICES
 
Number and street (or P.O. box if mail is not delivered to street address)
950 N MERIDIAN STREET SUITE 800
Suite
Room/suite
City or town, state or country, and ZIP + 4
INDIANAPOLIS, IN46204
D Employer identification number

35-1844176
E Telephone number

G Gross receipts $ 28,400,659
F Name and address of principal officer:
CLARK DAY
950 N MERIDIAN ST STE 800
INDIANAPOLIS,IN46204
I
Tax-exempt status: (   ) LeftBullet (insert no.) or
J
Website:MediumBullet
WWW.IUHEALTH.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: 1991
M State of legal domicile: IN
Part I
Summary
Activities & Governance 1 Briefly describe the organization’s mission or most significant activities: Provide occupational health services in prevention, treatment, and rehabilitation.
2 Check this box MediumBullet
3 Number of voting members of the governing body (Part VI, line 1a) ........ 3 3
4 Number of independent voting members of the governing body (Part VI, line 1b) ..... 4 0
5 Total number of individuals employed in calendar year 2011 (Part V, line 2a) ...... 5 372
6 Total number of volunteers (estimate if necessary) ............. 6 0
7a Total unrelated business revenue from Part VIII, column (C), line 12 ........ 7a 12,828
b Net unrelated business taxable income from Form 990-T, line 34 ......... 7b 253
Revenues Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 0 0
9 Program service revenue (Part VIII, line 2g) ......... 26,866,637 27,814,721
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 9,508 -253,993
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 33,024 573,247
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)................... 26,909,169 28,133,975
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 50 0
14 Benefits paid to or for members (Part IX, column (A), line 4)..... 0 0
15 Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10) 16,831,999 16,630,394
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–24e).... 10,306,729 10,881,704
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 27,138,778 27,512,098
19 Revenue less expenses. Subtract line 18 from line 12....... -229,609 621,877
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............. 11,310,039 10,684,538
21 Total liabilities (Part X, line 26)............. 2,903,678 1,656,300
22 Net assets or fund balances. Subtract line 21 from line 20..... 8,406,361 9,028,238
Part II
Signature Block
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge.
Sign Here
JumboBullet
Signature of officer Date
JumboBullet
Type or print name and title
Paid Preparer Use Only
Print/Type preparer's name
 
Preparer's signature
Date
PTIN
Firm's name MediumBullet

Firm's EIN MediumBullet
Firm's address MediumBullet



Phone no.
May the IRS discuss this return with the preparer shown above? (see instructions) ............
For Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 11282Y
Form 990 (2012)
Form 990 (2012)
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: Provide occupational health services in prevention, treatment, and rehabilitation.
2
Did the organization undertake any significant program services during the year which were not listed on
the prior Form 990 or 990-EZ? ......................
If “Yes,” describe these new services on Schedule O.
3
Did the organization cease conducting, or make significant changes in how it conducts, any program services? ............................
If “Yes,” describe these changes on Schedule O.
4
Describe the organization’s program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations 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 $ 22,048,832 including grants of $ 0 ) (Revenue $ 27,814,721 )
Methodist Occupational Health Centers, Inc. ("MOHC") provides a full range of occupational health services in prevention, treatment and rehabilitation. Prevention: MOHC performs a wide variety of pre-placement physical examinations specific to the job for which the individual is being considered, and in accordance with the Americans with Disabilities Act, in matching potential job applicants with the essential functions of their jobs. This assistance is critical to employers as they comply with the Americans with Disabilities Act. The Organization also offers a nationally certified drug screening program which is operated in compliance with guidelines established by the National Institute for Drug Abuse. Further, the Organization provides on-site medical monitoring examination protocol development, e.g., assisting companies with their compliance under Occupational Safety and Health Administration guidelines, ergonomic compliance assistance, and assistance in compliance with the Americans with Disabilities Act reasonable accommodation guidelines. Additionally, the Organization provides industrial hygiene services to assist in analyzing noise levels, indoor air quality, and other mandated surveillance programs under the authorization of the Occupational Safety and Health Administration. Treatment: MOHC specializes in the treatment of workers' compensation injuries and offers services complementary to the basic treatment of an injury, such as hand surgery, physiatry, orthopedic, neurology, and ophthalmology, as well as in-house pharmacy services. The concept of the Organization's treatment plan is centered on the early intervention/early return to work concept. Through early intervention and a variety of treatment and rehabilitative modalities, patients are assured better treatment outcomes, and the most expeditious return to work, thus saving the employers tremendous expense in lost productivity, overtime, training costs, etc. Rehabilitation: MOHC provides both physical and occupational therapy on-site at each location. The therapists are trained in rehabilitation of work related injuries and are supervised by the Organization's occupational health physicians. The focus of the therapist is to return the injured worker to the job. During physical therapy rehabilitation, the injured worker is taught proper techniques to avoid re-injury. The Occupational Therapy Department specializes in hand rehabilitation, utilizing various exercises and splints that assist in expediting the recovery process. Relationship of Activities to the Accomplishment of the Exempt Purpose: MOHC meets the occupational health care needs of employers in the areas of prevention, treatment, and rehabilitation. These services are delivered with an emphasis on cost containment through early intervention and expert case management. All of MOHC's clinics are equipped to conduct basic injury care, physical examinations, and the following ancillary services: X-ray, collection of specimens for laboratory analysis, pulmonary function testing, audiometry, electrocardiogram (EKG), and vision screening. Certain services are contracted in the treatment process. Hand surgery, neurology, physiatry, orthopedics, and ophthalmology are all contracted with individual physicians and/or specialty groups who provide their services on MOHC's premises to assure streamlined communication with the physician and the employer/insurance carrier, thereby providing coordinated care for the patient producing better clinical outcomes. MOHC is committed to cost containment for its employer clients and/or their insurance carriers. Since the Organization specializes in occupational health, approximately ninety-nine percent (99%) of the fees for all cases are paid either through the employers' workers' compensation insurance or directly by the employers. Due to the unique field in the medical continuum, occupational health providers charge the fees for care to the employers' workers' compensation insurance or the employers. The employees are not directly responsible for payment for their care. Thus, the need to provide charity care by the Organization itself is virtually nonexistent. The Organization will refer patients, when medically indicated, to the Indiana University Health, Inc. health care system where charity care is provided, should it be necessary. MOHC is involved in educational programs, specifically with the MOHC Training Institute. The Organization acts as the clinical practicum site for the physical/occupational therapy schools in Central Indiana. MOHC's staff also provides lectures to local nursing schools (Indiana University School of Nursing) in the field of occupational health. Methodist MOHC also provides clinical rotations and internships for health related courses of education to a variety of educational programs within Indiana including: Indiana University, University of Indianapolis, Ivy Tech, Indiana Business College, Kaplan, and ITT Technical Institute. The Organization is deeply committed to occupational health training and preventive health care. Thus, the MOHC Training Institute provides over 100 annual programs to the community on the prevention and treatment of occupational health injuries. MOHC has created a clinical database of the treatment of occupational health injuries and conducts clinical outcomes research with the aim of adding to the body of clinical knowledge to improve the care and outcomes of the prevention and treatment of occupational injuries. MOHC also supports community non-profits by providing certain services to non-profits at below cost or at no cost. For example, Department of Transportation Commercial Drivers License physical exams are provided at no charge to church bus drivers who drive church members to church activities.
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 expensesMediumBullet22,048,832
Form 990 (2012)
Form 990 (2012)
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 (see instructions)? ...
2
 
No
3
Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for public office? If “Yes,” complete Schedule C, Part I..........
3
 
No
4
Section 501(c)(3) organizations. Did the organization engage in lobbying activities, or have a section 501(h) election in effect during the tax year? If “Yes,” complete Schedule C, Part II........
4
 
No
5
Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or similar amounts as defined in Revenue Procedure 98-19? If “Yes,” complete Schedule C,
Part III............................
5
 
No
6
Did the organization maintain any donor advised funds or any similar funds or accounts for which donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts? If “Yes,” complete Schedule D, Part IClick to see attachment........................
6
 
No
7
Did the organization receive or hold a conservation easement, including easements to preserve open space,
the environment, historic land areas, or historic structures? If “Yes,” complete Schedule D, Part IIClick to see attachment...
7
 
No
8
Did the organization maintain collections of works of art, historical treasures, or other similar assets? If “Yes,” complete Schedule D, Part III Click to see attachment....................
8
 
No
9
Did the organization report an amount in Part X, line 21 for escrow or custodial account liability; serve as a custodian for amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or debt negotiation services? If “Yes,” complete Schedule D, Part IVClick to see attachment..............
9
 
No
10
Did the organization, directly or through a related organization, hold assets in temporarily restricted endowments, permanent endowments, or quasi-endowments? If “Yes,” complete Schedule D, Part VClick to see attachment......
10
 
No
11
If the organization’s answer to any of the following questions is "Yes," then complete Schedule D, Parts VI, VII, VIII, IX, or X as applicable.
a
Did the organization report an amount for land, buildings, and equipment in Part X, line 10?
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 VIIClick 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 VIIIClick 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 IXClick to see attachment............
11d
Yes
 
e
Did the organization report an amount for other liabilities in Part X, line 25? If “Yes,” complete Schedule D, Part XClick 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 XClick to see attachment.........................
11f
 
No
12a
Did the organization obtain separate, independent audited financial statements for the tax year?
If “Yes,” complete Schedule D, Parts XI and XII 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 and XII is optional Click to see attachment
12b
Yes
 
13
Is the organization a school described in section 170(b)(1)(A)(ii)? If “Yes,” complete Schedule E....
13
 
No
14a
Did the organization maintain an office, employees, or agents outside of the United States?.....
14a
 
No
b
Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business, investment, and program service activities outside the United States, or aggregate foreign investments valued at $100,000 or more? If “Yes,” complete Schedule F, Parts I and IV.........
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 United States? If “Yes,” complete Schedule F, Parts II and IV
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 United States? If “Yes,” complete Schedule F, Parts III and IV...
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 (see instructions)....
17
 
No
18
Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VIII, lines 1c and 8a? If “Yes,” complete Schedule G, Part II............
18
 
No
19
Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a? If “Yes,” complete Schedule G, Part III...................
19
 
No
20a
Did the organization operate one or more hospital facilities? If “Yes,” complete Schedule H....
20a
 
No
b
If “Yes” to line 20a, did the organization attach a copy of its audited financial statements to this return?
20b
 
 
Form 990 (2012)
Form 990 (2012)
Page 4
Part IV
Checklist of Required Schedules (continued)
21
Did the organization report more than $5,000 of grants and other assistance to any government or organization in the United States on Part IX, column (A), line 1? If “Yes,” complete Schedule I, Parts I and II...
21
 
No
22
Did the organization report more than $5,000 of grants and other assistance to individuals in the United States on Part IX, column (A), line 2? If “Yes,” complete Schedule I, Parts I and III........
22
 
No
23
Did the organization answer “Yes” to Part VII, Section A, line 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 lines 24b through 24d and complete Schedule K. If “No,” go to line 25................
24a
 
No
b
Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...
24b
 
 
c
Did the organization maintain an escrow account other than a refunding escrow at any time during the year
to defease any tax-exempt bonds?......................
24c
 
 
d
Did the organization act as an “on behalf of” issuer for bonds outstanding at any time during the year?...
24d
 
 
25a
Section 501(c)(3) and 501(c)(4) organizations. Did the organization engage in an excess benefit transaction with a disqualified person during the year? If “Yes,” complete Schedule L, Part I........
25a
 
No
b
Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and that the transaction has not been reported on any of the organization’s prior Forms 990 or 990-EZ? If “Yes,” complete Schedule L, Part I...................
25b
 
No
26
Was a loan to or by a current or former officer, director, trustee, key employee, highest compensated employee, or disqualified person outstanding as of the end of the organization’s tax year? If “Yes,” complete Schedule L,
Part II..........................
26
 
No
27
Did the organization provide a grant or other assistance to an officer, director, trustee, key employee, substantial contributor or employee thereof, a grant selection committee member, or to a 35% controlled entity or family member of any of these persons? If “Yes,” complete Schedule L, Part III.........
27
 
No
28
Was the organization a party to a business transaction with one of the following parties (see Schedule L, Part IV instructions for applicable filing thresholds, conditions, and exceptions):
a
A current or former officer, director, trustee, or key employee? If “Yes,” complete Schedule L, Part IV ..........................
28a
 
No
b
A family member of a current or former officer, director, trustee, or key employee? If “Yes,”
complete Schedule L, Part IV.....................
28b
 
No
c
An entity of which a current or former officer, director, trustee, or key employee (or a family member thereof) was an officer, director, trustee, or direct or indirect owner? If “Yes,” complete Schedule L, Part IV...
28c
 
No
29
Did the organization receive more than $25,000 in non-cash contributions? If “Yes,” complete Schedule M..
29
 
No
30
Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? If “Yes,” complete Schedule M.............
30
 
No
31
Did the organization liquidate, terminate, or dissolve and cease operations? If “Yes,” complete Schedule N,
Part I...........................
31
 
No
32
Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If “Yes,” complete Schedule N, Part II......................
32
 
No
33
Did the organization own 100% of an entity disregarded as separate from the organization under Regulations sections 301.7701-2 and 301.7701-3? If “Yes,” complete Schedule R, Part I........ Click to see attachment
33
Yes
 
34
Was the organization related to any tax-exempt or taxable entity? If “Yes,” complete Schedule R, Part II, III, or IV, and Part V, line 1........................ Click to see attachment
34
Yes
 
35a
Did the organization have a controlled entity within the meaning of section 512(b)(13)?
35a
Yes
 
b
If ‘Yes’ to line 35a, did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)? If “Yes,” complete Schedule R, Part V, line 2... Click to see attachment
35b
Yes
 
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 11b and 19? Note. All Form 990 filers are required to complete Schedule O. ............
38
Yes
 
Form 990 (2012)
Form 990 (2012)
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
32
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
372
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, securities account, or other financial 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 as charitable contributions?...
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. See the instructions for additional information the organization must report on Schedule O.
13a
 
 
b
Enter the 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 amount of reserves on hand ............
13c
 
14a
Did the organization receive any payments for indoor tanning services during the tax year?.....
14a
 
No
b
If "Yes," has it filed a Form 720 to report these payments? If “No,” provide an explanation in Schedule O..
14b
 
 
Form 990 (2012)
Form 990 (2012)
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
3
If there are material differences in voting rights among members of the governing body, or if the governing body delegated broad authority to an executive committee or similar committee, explain in Schedule O.
b
Enter the number of voting members included in line 1a, above, who are independent ...................
1b
0
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
Yes
 
3
Did the organization delegate control over management duties customarily performed by or under the direct supervision of officers, directors or trustees, or key employees to a management company or other person? .
3
 
No
4
Did the organization make any significant changes to its governing documents since the prior Form 990 was filed? ...........................
4
 
No
5
Did the organization become aware during the year of a significant diversion of the organization’s assets? .
5
 
No
6
Did the organization have members or stockholders? ................
6
Yes
 
7a
Did the organization have members, stockholders, or other persons who had the power to elect or appoint one or more members of the governing body? ....................
7a
Yes
 
b
Are any governance decisions of the organization reserved to (or subject to approval by) members, stockholders, or persons other than the governing body? ...................
7b
Yes
 
8
Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:
a
The governing body? .........................
8a
Yes
 
b
Each committee with authority to act on behalf of the governing body? ............
8b
Yes
 
9
Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the organization’s mailing address? If “Yes,” provide the names and addresses in Schedule O.......
9
 
No
Section B. Policies (This Section B requests information about policies not required by the Internal Revenue Code.)
Yes
No
10a
Did the organization have local chapters, branches, or affiliates? ............
10a
 
No
b
If “Yes,” did the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with the organization's exempt purposes?
10b
 
 
11a
Has the organization provided a complete 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 this Form 990. .....
12a
Did the organization have a written conflict of interest policy? If “No,” go to line 13.......
12a
Yes
 
b
Were officers, directors, or trustees, and key employees required to disclose annually interests that could give rise to conflicts? ..........................
12b
Yes
 
c
Did the organization regularly and consistently monitor and enforce compliance with the policy? If “Yes,” describe in Schedule O how this was done.......................
12c
Yes
 
13
Did the organization have a written whistleblower policy? ...............
13
Yes
 
14
Did the organization have a written document retention and destruction policy? .........
14
Yes
 
15
Did the process for determining compensation of the following persons include a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision?
a
The organization’s CEO, Executive Director, or top management official ...........
15a
Yes
 
b
Other officers or key employees of the organization ................
15b
 
No
If "Yes" to line 15a or 15b, describe the process in Schedule O (see instructions).
16a
Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a taxable entity during the year? ......................
16a
 
No
b
If “Yes,” did the organization follow a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and take steps to safeguard the organization’s exempt status with respect to such arrangements? ............
16b
 
 
Section C. Disclosure
17
List the States with which a copy of this Form 990 is required to be filedMediumBullet
IN
18
Section 6104 requires an organization to make its Form 1023 (or 1024 if applicable), 990, and 990-T (501(c)(3)s only) available for public inspection. Indicate how you made these available. Check all that apply.
19
Describe in Schedule O whether (and if so, how), the organization made its governing documents, conflict of interest policy, and financial statements available to the public during the tax year.
20
State the name, physical address, and telephone number of the person who possesses the books and records of the organization:
MediumBulletBROC BUDDE950 N MERIDIAN STREET SUITE 800INDIANAPOLISIN46204 (317) 962-4575
Form 990 (2012)
Form 990 (2012)
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. 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 organization compensated any current officer, director, or trustee.
(A)
Name and Title 		(B)
Average hours per week (list any hours for related organizations below dotted line) 		(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee) 		(D)
Reportable compensation from the organization (W- 2/1099-MISC) 		(E)
Reportable compensation from related organizations (W- 2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; Officer; Key Employee; Highest compensated employee; Former;
(1) RONALD L STIVER........................................................................
CHAIRMAN
 2.0
.......................55.0 		X   X       0 433,079 102,659
(2) THOMAS W BRINK........................................................................
DIRECTOR/PRESIDENT
 55.0
.......................0.0 		X   X       159,511 0 21,245
(3) G DEAN RAINBOLT........................................................................
DIRECTOR/VICE PRESIDENT
 2.0
.......................25.0 		X   X       0 124,059 19,913
(4) ISADORE RIVAS........................................................................
DIRECTOR (01/01 - 10/30)
 2.0
.......................55.0 		X           0 323,333 20,980
(5) NORMAN G TABLER JR........................................................................
SECRETARY
 2.0
.......................55.0 		    X       0 584,258 639,156
(6) DAVID S KATZ MD........................................................................
MEDICAL DIRECTOR - CLINIC
 55.0
.......................0.0 		        X   262,422 0 41,086
(7) IMTIAZ M AHMAD MD........................................................................
MEDICAL DIRECTOR - CLINIC
 55.0
.......................0.0 		        X   220,851 0 46,769
(8) MICHAEL C PATELLOS MD........................................................................
MEDICAL DIRECTOR - CORPORATE
 55.0
.......................0.0 		        X   202,959 0 46,645
(9) CRAIG S NADELSON DO........................................................................
MEDICAL DIRECTOR - CLINIC
 55.0
.......................0.0 		        X   198,798 0 43,385
(10) SAJIV D ALEX MD........................................................................
MEDICAL DIRECTOR - CLINIC
 55.0
.......................0.0 		        X   196,181 0 43,372














Form 990 (2012)
Form 990 (2012)
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 (list any hours for related organizations below dotted line) 		(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee) 		(D)
Reportable compensation from the organization (W- 2/1099-MISC) 		(E)
Reportable compensation from related organizations (W- 2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; Officer; Key Employee; Highest compensated employee; Former;


























1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)............MediumBullet 1,240,722 1,464,729 1,025,210
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organizationMediumBullet17
Yes
No
3
Did the organization list any former officer, director or trustee, key employee, or highest compensated employee on line 1a? If “Yes,” complete Schedule J for such individual ..............
3
 
No
4
For any individual listed on line 1a, is the sum of reportable compensation and other compensation from the organization and related organizations greater than $150,000? If “Yes,” complete Schedule J for such individual...........................
4
Yes
 
5
Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual for services rendered to the organization? If “Yes,” complete Schedule J for such person ........
5
 
No
Section B. Independent Contractors
1
Complete this table for your five highest compensated independent contractors that received more than $100,000 of compensation from the organization. Report compensation for the calendar year ending with or within the organization’s tax year.
(A)
Name and business address 		(B)
Description of services 		(C)
Compensation
SOUTH BEND MEDICAL FOUNDATION INC, PO BOX 2030MISHAWAKAIN46546 LABORATORY 513,109
INDIANA UNIVERSITY, PO BOX 66271INDIANAPOLISIN46266 MEDICAL 282,296
HOWARD REGIONAL HEALTH SYSTEM, 3500 S LAFOUNTAINKOKOMOIN46902 MEDICAL 265,932
UNIVERSITY PHYSIATRIC ASSOCIATES I, 541 N CLINIC DRINDIANAPOLISIN46202 MEDICAL 265,375
THOMAS A BRADY SPORTS MEDICINE CEN, 201 PENNSYLVANIA PKWY 325INDIANAPOLISIN46280 MEDICAL 215,522
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization MediumBullet8
Form 990 (2012)
Form 990 (2012)
Page 9
Part VIII
Statement of Revenue
Check if Schedule O contains a response to any question in this Part VIII ..............
(A)
Total revenue 		(B)
Related or
exempt
function
revenue 		(C)
Unrelated
business
revenue 		(D)
Revenue
excluded from
tax under sections
512, 513, or 514
Contributions, Gifts, Grants and Other Similar Amounts 1a Federated campaigns..1a  
b Membership dues....1b  
c Fundraising events....1c  
d Related organizations...1d  
e Government grants (contributions)1e  
f All other contributions, gifts, grants, and
similar amounts not included above1f 		 
g Noncash contributions included in lines
1a-1f:$ 		 
h Total. Add lines 1a-1f.......MediumBullet 0
Program Service Revenue Business Code
2a NET PATIENT SERVICE REVENUE 621110 25,141,806 25,141,806 0 0
b SHARED SERVICES 900099 2,672,915 2,660,087 12,828 0
c
d
e
f All other program service revenue .        
g Total. Add lines 2a–2f........MediumBullet 27,814,721
Other Revenue 3 Investment income (including dividends, interest, and other similar amounts).......MediumBullet 12,691     12,691
4 Income from investment of tax-exempt bond proceeds..MediumBullet 0      
5 Royalties...........MediumBullet 0      
(i) Real (ii) Personal
6a Gross rents    
b Less: rental expenses    
c Rental income or (loss) 0 0
d Net rental income or (loss).......MediumBullet 0      
(i) Securities (ii) Other
7a Gross amount from sales of assets other than inventory    
b Less: cost or other basis and sales expenses   266,684
c Gain or (loss)   -266,684
d Net gain or (loss)..........MediumBullet -266,684     -266,684
8a Gross income from fundraising events (not including
$  
of contributions reported on line 1c). See Part IV, line 18 ..
a  
b Less: direct expenses ...b  
c Net income or (loss) from fundraising events..MediumBullet 0    
9a Gross income from gaming activities.
See Part IV, line 19 ...
a  
b Less: direct expenses ...b  
c Net income or (loss) from gaming activities...MediumBullet 0      
10a Gross sales of inventory, less
returns and allowances .
a  
b Less: cost of goods sold ..b  
c Net income or (loss) from sales of inventory..MediumBullet 0      
Miscellaneous Revenue Business Code
11a ALL OTHER REVENUE 900099 573,247 0 0 573,247
b            
c            
d All other revenue ....        
e Total. Add lines 11a–11d ...... MediumBullet 573,247
12 Total revenue. See Instructions......MediumBullet 28,133,975 27,801,893 12,828 319,254
Form 990 (2012)
Form 990 (2012)
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).Check if Schedule O contains a response to any question in this Part IX ...............
Do not include amounts reported on lines 6b,
7b, 8b, 9b, and 10b of Part VIII. 		(A)
Total expenses 		(B)
Program service expenses 		(C)
Management and general expenses 		(D)
Fundraising expenses
1 Grants and other assistance to governments and organizations in the United States. See Part IV, line 21 0  
2 Grants and other assistance to individuals in the United States. See Part IV, line 22 0  
3 Grants and other assistance to governments, organizations, and individuals outside the United States. See Part IV, lines 15 and 16 0  
4 Benefits paid to or for members 0  
5 Compensation of current officers, directors, trustees, and key employees .... 180,756   180,756  
6 Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .... 0      
7 Other salaries and wages 13,136,398 11,303,052 1,833,346  
8 Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) .... 746,857 612,607 134,250  
9 Other employee benefits ....... 1,642,984 1,315,810 327,174  
10 Payroll taxes ........... 923,399 791,165 132,234  
11 Fees for services (non-employees):        
a Management ...... 0      
b Legal ......... 13,282   13,282  
c Accounting ........... 2,085   2,085  
d Lobbying ........... 0      
e Professional fundraising services. See Part IV, line 17 0  
f Investment management fees ...... 0      
g Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O) ........ 5,488,226 3,382,212 2,106,014  
12 Advertising and promotion .... 18,862 3,967 14,895  
13 Office expenses ....... 739,068 485,946 253,122  
14 Information technology ...... 210,339 156,420 53,919  
15 Royalties .. 0      
16 Occupancy ........... 1,311,675 1,139,120 172,555  
17 Travel ............ 144,029 103,213 40,816  
18 Payments of travel or entertainment expenses for any federal, state, or local public officials ...... 0      
19 Conferences, conventions, and meetings .... 4,356 4,296 60  
20 Interest ........... 13,178 11,939 1,239  
21 Payments to affiliates ....... 0      
22 Depreciation, depletion, and amortization ..... 290,887 187,477 103,410  
23 Insurance .............. 154,006 105,014 48,992  
24 Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a DRUGS AND MEDICAL SUPPLIES 2,119,055 2,119,055    
b BAD DEBT 256,100 256,100    
c RECRUITMENT 7,321 7,321    
d NONCAPITALIZED EQUIPMENT 2,187 2,187    
e All other expenses 107,048 61,931 45,117  
25 Total functional expenses. Add lines 1 through 24e 27,512,098 22,048,832 5,463,266 0
26 Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here MediumBullet if following SOP 98-2 (ASC 958-720).        
Form 990 (2012)
Form 990 (2012)
Page 11
Part X Balance Sheet Check if Schedule O contains a response to any question in this Part X ...............
(A)
Beginning of year 		(B)
End of year
Assets 1 Cash—non-interest-bearing ............. 1,380 1 1,530
2 Savings and temporary cash investments ......... 0 2 0
3 Pledges and grants receivable, net ........... 0 3 0
4 Accounts receivable, net ............. 4,070,340 4 3,458,318
5 Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
Schedule L ..................
0 5 0
6 Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations of section 501(c)(9) voluntary employees' beneficiary organizations (see instructions) Complete Part II of Schedule L
0 6 0
7 Notes and loans receivable, net ............. 0 7 0
8 Inventories for sale or use .............. 0 8 0
9 Prepaid expenses and deferred charges .......... 187,330 9 211,995
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 5,927,528
b Less: accumulated depreciation ..... 10b 4,543,551 1,598,033 10c 1,383,977
11 Investments—publicly traded securities .......... 0 11 0
12 Investments—other securities. See Part IV, line 11 ..... 0 12 0
13 Investments—program-related. See Part IV, line 11 ..... 0 13 0
14 Intangible assets ............... 0 14 0
15 Other assets. See Part IV, line 11 ........... 5,452,956 15 5,628,718
16 Total assets. Add lines 1 through 15 (must equal line 34)...... 11,310,039 16 10,684,538
Liabilities 17 Accounts payable and accrued expenses ......... 2,625,486 17 1,404,291
18 Grants payable ................. 0 18 0
19 Deferred revenue ................ 0 19 0
20 Tax-exempt bond liabilities ............. 0 20 0
21 Escrow or custodial account liability. Complete Part IV of Schedule D.. 0 21 0
22 Loans and other payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
persons. Complete Part II of Schedule L.......... 0 22 0
23 Secured mortgages and notes payable to unrelated third parties .. 183,890 23 164,182
24 Unsecured notes and loans payable to unrelated third parties .... 0 24 0
25 Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D.................... 94,302 25 87,827
26 Total liabilities. Add lines 17 through 25......... 2,903,678 26 1,656,300
Net Assets or Fund Balance Organizations that follow SFAS 117 (ASC 958), check here MediumBullet and complete lines 27 through 29, and lines 33 and 34.
27 Unrestricted net assets .............. 8,406,361 27 9,028,238
28 Temporarily restricted net assets ........... 0 28 0
29 Permanently restricted net assets ........... 0 29 0
Organizations that do not follow SFAS 117 (ASC 958), 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 ........... 8,406,361 33 9,028,238
34 Total liabilities and net assets/fund balances ........ 11,310,039 34 10,684,538
Form 990 (2012)
Form 990 (2012)
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
28,133,975
2
Total expenses (must equal Part IX, column (A), line 25) ............
2
27,512,098
3
Revenue less expenses. Subtract line 2 from line 1 ..............
3
621,877
4
Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) ..
4
8,406,361
5
Net unrealized gains (losses) on investments ...............
5
0
6
Donated services and use of facilities .................
6
0
7
Investment expenses .....................
7
0
8
Prior period adjustments .....................
8
0
9
Other changes in net assets or fund balances (explain in Schedule O) ........
9
0
10
Net assets or fund balances at end of year. Combine lines 3 through 9 (must equal Part X, line 33, column (B))
10
9,028,238
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
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were compiled or reviewed on a separate basis, consolidated basis, or both:
b
Were the organization’s financial statements audited by an independent accountant?
2b
Yes
 
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were audited on a separate basis, consolidated basis, or both:
c
If “Yes,” to line 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?
2c
Yes
 
If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O.
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 (2012)
Form 990, Special Condition Description:
Special Condition Description
Additional Data


Software ID:  
Software Version:  
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
2012
Open to Public
Inspection
Name of the organization
METHODIST OCCUPATIONAL HEALTH CENTERS INC
 
Employer identification number

35-1844176
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 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 monetary support
Yes No Yes No Yes No
Total                  

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990EZ.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2012
Schedule A (Form 990 or 990-EZ) 2012
Page 2
Part II
Support Schedule for Organizations Described in Sections 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) right arrow (a) 2008 (b) 2009 (c) 2010 (d) 2011 (e) 2012 (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) right arrow (a) 2008 (b) 2009 (c) 2010 (d) 2011 (e) 2012 (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. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)..            
11 Total support (Add lines 7 through 10).            
12
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........................................right arrow
Section C. Computation of Public Support Percentage
14
14
 
15
15
 
16a
b
17a
b
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 ..................................................... right arrow
Schedule A (Form 990 or 990-EZ) 2012
Schedule A (Form 990 or 990-EZ) 2012
Page 3
Part III
Support Schedule for Organizations Described in Section 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) right arrow (a) 2008 (b) 2009 (c) 2010 (d) 2011 (e) 2012 (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) right arrow (a) 2008 (b) 2009 (c) 2010 (d) 2011 (e) 2012 (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) 2012
Schedule A (Form 990 or 990-EZ) 2012
Page 4
Part IV
Supplemental Information. Complete this part to provide the explanations required by Part II, line 10; Part II, line 17a or 17b; and 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) 2012

Additional Data


Software ID:  
Software Version:  
SCHEDULE D
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Financial Statements
SchDMd Bullet Complete if the organization answered "Yes," to Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b
SchDMd Bullet Attach to Form 990. SchDMd Bullet See separate instructions.
OMB No. 1545-0047
2012
Open to Public Inspection
Name of the organization
METHODIST OCCUPATIONAL HEALTH CENTERS INC
 
Employer identification number

35-1844176
Part I
Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" to Form 990, Part IV, line 6.
(a) Donor advised funds (b) Funds and other accounts
1 Total number at end of year .........    
2 Aggregate contributions to (during year) ...    
3 Aggregate grants from (during year) .....    
4 Aggregate value at end of year ........    
5
Did the organization inform all donors and donor advisors in writing that the assets held in donor advised
funds are the organization's property, subject to the organization's exclusive legal control? ............
6
Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be
used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ...................................
Part II
Conservation Easements. Complete if the organization answered "Yes" to Form 990, Part IV, line 7.
1
Purpose(s) of conservation easements held by the organization (check all that apply).
2
Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.
Held at the End of the Year
a Total number of conservation easements ....................... 2a  
b Total acreage restricted by conservation easements .................. 2b  
c Number of conservation easements on a certified historic structure included in (a) ..... 2c  
d Number of conservation easements included in (c) acquired after 8/17/06, and not on a historic structure listed in the National Register .................... 2d  
3
Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the tax year SchDMd Bullet  
4
Number of states where property subject to conservation easement is located SchDMd Bullet  
5
Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and
enforcement of the conservation easements it holds? .............................
6
Staff and volunteer hours devoted to monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet  
7
Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet $  
8
Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i) and section 170(h)(4)(B)(ii)? .......................................
9
In Part XIII, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" to Form 990, Part IV, line 8.
1a
If the organization elected, as permitted under SFAS 116 (ASC 958), not to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide, in Part XIII, the text of the footnote to its financial statements that describes these items.
b
If the organization elected, as permitted under SFAS 116 (ASC 958), to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide the following amounts relating to these items:
(i)
Revenues included in Form 990, Part VIII, line 1 ........................SchDMd Bullet $  
(ii)
Assets included in Form 990, Part X ..............................SchDMd Bullet $  
2
If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under SFAS 116 (ASC 958) relating to these items:
a
Revenues included in Form 990, Part VIII, line 1 ..........................SchDMd Bullet $  
b
Assets included in Form 990, Part X ...............................SchDMd Bullet $  
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 52283D
Schedule D (Form 990) 2012

Schedule D (Form 990) 2012
Page 2
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)
3
Using the organization’s acquisition, 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 XIII.
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 XIII 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 XIII. Check here if the explanation has been provided in Part XIII ........
Part V
Endowment Funds. Complete if the organization answered "Yes" to Form 990, Part IV, line 10.
(a)Current year (b)Prior year b (c)Two years back (d)Three years back (e)Four years back
1a Beginning of year balance ....          
b Contributions ........          
c Net investment earnings, gains, and losses          
d Grants or scholarships .....          
e Other expenditures for facilities
and programs ........ 		         
f Administrative expenses ....          
g End of year balance ......          
2
Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:
a
Board designated or quasi-endowment SchDMd Bullet  
b
Permanent endowment SchDMd Bullet  
c
Temporarily restricted endowment SchDMd Bullet  
The percentages in lines 2a, 2b, and 2c should equal 100%.
3a
Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes
No
(i) unrelated organizations ........................
3a(i)
 
 
(ii) related organizations ........................
3a(ii)
 
 
b
If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? .........
3b
 
 
4
Describe in Part XIII the intended uses of the organization's endowment funds.
Part VI
Land, Buildings, and Equipment. See Form 990, Part X, line 10.
Description of property (a) Cost or other basis (investment) (b)Cost or other basis (other) (c) Accumulated depreciation (d) Book value
1a Land .................      
b Buildings ................   534,323 194,943 339,380
c Leasehold improvements ............   2,004,501 1,637,978 366,523
d Equipment ................   3,081,871 2,446,186 635,685
e Other .................   306,833 264,444 42,389
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......SchDMdBullet 1,383,977
Schedule D (Form 990) 2012

Schedule D (Form 990) 2012
Page 3
Part VII
Investments—Other Securities. See Form 990, Part X, line 12.
(a) Description of security or category
(including name of security)		 (b)Book value (c) Method of valuation:
Cost or end-of-year market value
(1)Financial derivatives    
(2)Closely-held equity interests    
Other








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








Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)Small Bullet  
Part IX
Other Assets. See Form 990, Part X, line 15.
(a) Description (b) Book value
(1) INTERCOMPANY RECEIVABLES (NET) 5,628,718








Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........Small Bullet 5,628,718
Part X
Other Liabilities. See Form 990, Part X, line 25.
1.(a) Description of liability (b) Book value
Federal income taxes 0
PENSION AND OTHER RETIREMENT LIABILITIES 87,827








Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)Small Bullet 87,827
2. Fin 48 (ASC 740) Footnote. In Part XIII, 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 (ASC 740). Check here if the text of the footnote has been provided in Part XIII .....................................................
Schedule D (Form 990) 2012

Schedule D (Form 990) 2012
Page 4
Part XI 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 XIII.) ............ 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 XIII.) ........... 4b  
c Add lines 4a and 4b....................... 4c  
5 Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ...... 5  
Part XII 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 XIII.) ............ 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 XIII.) ............ 4b  
c Add lines 4a and 4b....................... 4c  
5 Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ...... 5  
Part XIII
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, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.
Identifier Return Reference Explanation
Schedule D, Part X - Other Liabilities Line 2 - FIN 48 (ASC 740) Footnote Methodist Occupational Health Centers, Inc. is a subsidiary in the consolidated financial statements of Indiana University Health, Inc. ("IU Health"). IU Health adopted FIN 48 in 2007. No disclosures were required in 2012 under GAAP as IU Health does not have any material tax contingencies that required disclosures in the footnotes.
Schedule D (Form 990) 2012

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
2012
Open to Public Inspection
Name of the organization
METHODIST OCCUPATIONAL HEALTH CENTERS INC
 
Employer identification number

35-1844176
Part I
Questions Regarding Compensation
Yes
No
1a
Check the appropiate box(es) if the organization provided any of the following to or for a person listed in Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.
b
If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all of the expenses described above? If "No," complete Part III to explain....
1b
 
 
2
Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all officers,
directors, trustees, and the CEO/Executive Director, regarding the items checked in line 1a? .......
2
 
 
3
Indicate which, if any, of the following the filing organization used to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.
4
During the year, did any person listed in Form 990, Part VII, Section A, line 1a with respect to the filing organization or a related organization:
a
Receive a severance payment or change-of-control payment? ................
4a
Yes
 
b
Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........
4b
Yes
 
c
Participate in, or receive payment from, an equity-based compensation arrangement? .........
4c
 
No
If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.
Only 501(c)(3) and 501(c)(4) organizations only must complete lines 5-9.
5
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:
a
The organization? ...........................
5a
 
No
b
Any related organization? .........................
5b
 
No
If "Yes," to line 5a or 5b, describe in Part III.
6
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:
a
The organization? ...........................
6a
 
No
b
Any related organization? .........................
6b
 
No
If "Yes," to line 6a or 6b, describe in Part III.
7
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization provide any non-fixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............
7
 
No
8
Were any amounts reported in Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III .............................
8
 
No
9
If "Yes" to line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................
9
 
 
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50053T
Schedule J (Form 990) 2012

Schedule J (Form 990) 2012
Page 2
Part II
Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed.
For each individual whose compensation must be reported in Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions, on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.
Note. The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and (E) amounts for that individual.
(A) Name and Title (B) Breakdown of W-2 and/or 1099-MISC compensation (C) Retirement and other deferred compensation (D) Nontaxable
benefits		 (E) Total of columns
(B)(i)-(D) 		(F) Compensation
reported as deferred
in prior Form 990
(i) Base compensation (ii) Bonus & incentive compensation (iii) Other reportable compensation
(1)RONALD L STIVERCHAIRMAN (i)
(ii)		 0
327,538 		0
89,603 		0
15,938 		0
80,410 		0
22,249 		0
535,738 		0
0
(2)THOMAS W BRINKDIRECTOR/PRESIDENT (i)
(ii)		 154,720
0 		0
0 		4,791
0 		12,795
0 		8,450
0 		180,756
0 		0
0
(3)ISADORE RIVASDIRECTOR (01/01 - 10/30) (i)
(ii)		 0
102,842 		0
8,250 		0
212,241 		0
2,063 		0
18,917 		0
344,313 		0
0
(4)NORMAN G TABLER JRSECRETARY (i)
(ii)		 0
361,474 		0
117,125 		0
105,659 		0
620,101 		0
19,055 		0
1,223,414 		0
0
(5)DAVID S KATZ MDMEDICAL DIRECTOR - CLINIC (i)
(ii)		 260,660
0 		0
0 		1,762
0 		21,020
0 		20,066
0 		303,508
0 		0
0
(6)IMTIAZ M AHMAD MDMEDICAL DIRECTOR - CLINIC (i)
(ii)		 219,953
0 		0
0 		898
0 		20,670
0 		26,099
0 		267,620
0 		0
0
(7)MICHAEL C PATELLOS MDMEDICAL DIRECTOR - CORPORATE (i)
(ii)		 201,993
0 		0
0 		966
0 		18,933
0 		27,712
0 		249,604
0 		0
0
(8)CRAIG S NADELSON DOMEDICAL DIRECTOR - CLINIC (i)
(ii)		 198,429
0 		0
0 		369
0 		18,446
0 		24,939
0 		242,183
0 		0
0
(9)SAJIV D ALEX MDMEDICAL DIRECTOR - CLINIC (i)
(ii)		 195,273
0 		0
0 		908
0 		17,911
0 		25,461
0 		239,553
0 		0
0
Schedule J (Form 990) 2012

Schedule J (Form 990) 2012
Page 3
Part III
Supplemental Information
Complete this part to provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II.
Also complete this part for any additional information.
Identifier Return Reference Explanation
Schedule J, Part I - Questions Regarding Compensation Line 4a - Severance or Change-of-Control Payments Isadore Rivas received 2012 severance of $169,616 from Indiana University Health, Inc. This amount is included in column b (iii), other reportable compensation. Norman G. Tabler, Jr. entered into a severance agreement in 2012 with Indiana University Health, Inc. Included in column C, other deferred compensation is $599,081 of deferred compensation and benefits.
Schedule J, Part I - Questions Regarding Compensation Line 4b - Supplemental Nonqualified Retirement Plan Ronald L. Stiver, and Norman G. Tabler, Jr. participate in a supplemental executive retirement plan of Indiana University Health, Inc., the provisions of which are designed to retain these critical employees. The plan provides for an additional retirement benefit for service through normal retirement or other key dates. If the executive leaves prior to retirement or other key dates, the benefit may be forfeited or reduced. Ronald L. Stiver has an amount included in column c, deferred compensation, representing the current year increase in the accrued benefit and/or current contributions. No amount was actually paid to this executive during the year. For Norman G. Tabler, Jr., $54,935, is included in column b(iii), other reportable compensation, representing the amount received under their respective supplemental executive retirement plan.
Schedule J (Form 990) 2012

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
2012
Open to Public
Inspection
Name of the organization
METHODIST OCCUPATIONAL HEALTH CENTERS INC
 
Employer identification number

35-1844176
Identifier Return Reference Explanation
Part VI, Section A - Governing Body and Management Line 1b - Number of Voting Members that are Independent Methodist Occupational Health Centers, Inc. is part of a multi-entity hospital system controlled by Indiana University Health, Inc., a 501(c)(3) exempt organization whose board is comprised of voting members, of which substantially all are independent community members.
Part VI, Section A - Governing Body and Management Line 2 - Family or Business Relationships Thomas W. Brink and G. Dean Rainbolt serve as Officers and on the Board of Directors of Occ-Health Revenue Systems, Inc. No additional compensation is provided.
Part VI, Section A - Governing Body and Management Lines 6, 7A, and 7B - Members or Stockholders Line 6: The sole member of Methodist Occupational Health Centers, Inc. ("MOHC") is Indiana University Health, Inc. ("IU Health"), a 501(c)(3) tax-exempt hospital. Line 7A: The control and management of the affairs of MOHC is vested in a Board of Directors of not less than three (3) nor more than nine (9) Directors whom are elected by IU Health, as the sole member of the organization. Line 7B: Notwithstanding any other provisions of the Articles of Incorporation or any provision of MOHC's Bylaws, the following matters require the approval of IU Health, as the sole member, prior to implementation: - Any amendment of the Articles of Incorporation or Bylaws of MOHC; - Adoption or revision of any operating or capital budget of MOHC; - A merger or consolidation of MOHC; - Any sale, lease, exchange, conveyance, mortgage, pledge or other disposition of a substantial portion of the property, assets or interests of MOHC, other than pursuant to a budget approved by IU Health, as sole member; - Any incurrence of debt by, or the creation of any lien upon the property or revenues of, MOHC other than in the ordinary course of business or pursuant to a budget approved by IU Health, as sole member. Notwithstanding any other provisions of the Articles of Incorporation, or any provision of MOHC's Bylaws, IU Health, as the sole member, shall have the power to direct the Board of MOHC to do any of the following: - Transfer property of MOHC in amounts sufficient to pay the principal and interest of any obligation of IU Health, as sole member; and - Take such actions as are required in order for MOHC to comply with the covenants contained in any financing document to which IU Health, as sole member, is a party or under which IU Health is bound.
Part VI, Section A - Governing Body and Management Line 11b - Review of Form 990 Methodist Occupational Health Centers, Inc. has established the following process for reviewing Form 990: The Form 990 and related schedules are reviewed by the Vice President. After the Vice President approves the Form 990 and related schedules, a finalized complete Form 990 is made available to each board member on a protected intranet site prior to filing the form with the IRS. Each member is informed of the availability of the tax department to answer any questions.
Part VI, Section B - Policies Lines 12, 13, and 14 Methodist Occupational Health Centers Inc. ("MOHC") is part of the Indiana University Health, Inc. ("IU Health") system. As the sole member and controlling parent of MOHC, IU Health and its board of directors have mandated that certain policies be followed to ensure greater standardization throughout the system. Thus, MOHC's Board of Directors was not required to separately adopt a conflict of interest, whistleblower, document retention and destruction and joint venture policies because IU Health's Board of Directors had already adopted and required these policies to be followed by its subsidiaries.
Part VI, Section B - Policies Line 12c - Conflict of Interest Policy Methodist Occupational Health Centers, Inc. has a Conflict of Interest Policy, the purpose of which is, to protect Methodist Occupational Health Centers, Inc's interests when it is contemplating entering into a transaction or arrangement that might benefit the private interest of an officer or director. Each employee, including those employed by related entities, officer and member of the board of 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 board of directors or committee meets to discuss the interest to determine if a conflict exists. If a conflict is found to exist, the chairperson of the board or committee shall, if appropriate, appoint a disinterested person or committee to investigate alternatives to the proposed transaction or arrangement. After exercising due diligence, the board of directors or committee shall determine whether or not to move forward with any arrangement that gives rise to the conflict. If there are any violations of the Conflict of Interest policy, a hearing is held to determine if appropriate disciplinary and corrective action needs to be taken. Board members with a conflict of interest cannot participate in any decision related to that conflict.
Part VI, Section B - Policies Line 15a - Process for Determining Compensation Methodist Occupational Health Centers, Inc. ("MOHC") has a process in place to determine the compensation for its President. MOHC uses an independent compensation consultant who utilizes a variety of methods and procedures to obtain reasonable compensation ranges for comparable officer and employee positions. The independent compensation consultant provides MOHC with recommended compensation ranges for its President, which is then used as a guide for setting compensation by the Board of Directors. This process was last performed for the President in 2002. Since that time, the President has received increases commensurate with general employee wage increases. Compensation changes, including general employee wage increases, of the President are subject to the review and approval of the Board of Directors. The Board's decisions are documented in the Board's minutes.
Part VI, Section B - Policies Line 19 - Public Disclosure Methodist Occupational Health Centers, Inc.'s ("MOHC") Articles of Incorporation are available to the public through the Indiana Secretary of State's web-site. MOHC's conflict of interest policy is described on Form 990, Schedule O. MOHC is a consolidated subsidiary in the consolidated financial statements for Indiana University Health, Inc. ("IU Health"). The consolidated financial statements for IU Health are available to the public through its bond filings.
Part IX - Statement of Functional Expenses Line 11g - Other Fees for Services Line 11g includes amounts paid for the following: Shared Services - $5,488,226
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2012

Additional Data


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

OMB No. 1545-0047
2012
Open to Public Inspection
Name of the organization
METHODIST OCCUPATIONAL HEALTH CENTERS INC
 
Employer identification number

35-1844176
Part I
Identification of Disregarded Entities (Complete if the organization answered "Yes" to Form 990, Part IV, line 33.)
(a)
Name, address, and EIN (if applicable) 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) M-URGENT CARE LLC
950 N MERIDIAN ST STE 800
INDIANAPOLIS,IN46204
27-1972484 		HEALTHCARE IN 315,811 0 MOHC
 
(2) WORKPLACE HEALTH SERVICES LLC
950 N MERIDIAN ST STE 800
INDIANAPOLIS,IN46204
20-0994452 		HEALTHCARE IN 9,851,241 1,425,112 MOHC
 








Part II
Identification of Related Tax-Exempt Organizations (Complete if the organization answered "Yes" to 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 entity?
Yes No
(1) CLARIAN TRANSPLANT INSTITUTE INC

950 N MERIDIAN ST STE 800

INDIANAPOLIS,IN46204
13-4350599 		HEALTHCARE IN 501(C)(3) 9 IUH
 
Yes
 
(2) GOSHEN HEALTH SYSTEM INC

200 HIGH PARK AVE

GOSHEN,IN46527
35-1974765 		HEALTHCARE IN 501(C)(3) 11 I IUH
 
Yes
 
(3) GOSHEN HOSPITAL ASSOCIATION INC

200 HIGH PARK AVE

GOSHEN,IN46527
35-6001540 		HEALTHCARE IN 501(C)(3) 3 GHS
 
Yes
 
(4) HEALTHLINC INC

714 S ROGERS ST

BLOOMINGTON,IN47402
26-3571507 		HEALTHCARE IN 501(C)(3) 9 IUHB
 
Yes
 
(5) INDIANA RADIOLOGY PARTNERS INC

950 N MERIDIAN ST STE 800

INDIANAPOLIS,IN46204
20-1017034 		HEALTHCARE IN 501(C)(3) 3 IUH
 
Yes
 
(6) INDIANA UNIVERSITY HEALTH INC

950 N MERIDIAN ST STE 800

INDIANAPOLIS,IN46204
35-1955872 		HEALTHCARE IN 501(C)(3) 3 NA
 
 
No
(7) IU HEALTH ARNETT FOUNDATION INC

950 N MERIDIAN ST STE 800

INDIANAPOLIS,IN46204
35-6079797 		FUNDRAISING IN 501(C)(3) 11 I IUHA
 
Yes
 
(8) IU HEALTH ARNETT INC

950 N MERIDIAN ST STE 800

INDIANAPOLIS,IN46204
26-3162145 		HEALTHCARE IN 501(C)(3) 3 IUH
 
Yes
 
(9) IU HEALTH BALL MEMORIAL HOSPITAL INC

950 N MERIDIAN ST STE 800

INDIANAPOLIS,IN46204
35-0867958 		HEALTHCARE IN 501(C)(3) 3 IUH
 
Yes
 
(10) IU HEALTH BALL MEMORIAL PHYSICIANS INC

950 N MERIDIAN ST STE 800

INDIANAPOLIS,IN46204
35-1925641 		HEALTHCARE IN 501(C)(3) 9 IUHBMH
 
Yes
 
(11) IU HEALTH BEDFORD INC

2900 W 16TH ST

BEDFORD,IN47421
23-7042323 		HEALTHCARE IN 501(C)(3) 3 IUH
 
Yes
 
(12) IU HEALTH BLACKFORD HOSPITAL INC

950 N MERIDIAN ST STE 800

INDIANAPOLIS,IN46204
01-0646166 		HEALTHCARE IN 501(C)(3) 3 IUHBMH
 
Yes
 
(13) IU HEALTH BLOOMINGTON INC

PO BOX 1149

BLOOMINGTON,IN47403
35-1720796 		HEALTHCARE IN 501(C)(3) 3 IUH
 
Yes
 
(14) IU HEALTH BMH FOUNDATION INC

950 N MERIDIAN ST STE 800

INDIANAPOLIS,IN46204
31-1111784 		FUNDRAISING IN 501(C)(3) 11 I IUHMBH
 
Yes
 
(15) IU HEALTH CARE ASSOCIATES INC

950 N MERIDIAN ST STE 800

INDIANAPOLIS,IN46204
35-1747218 		HEALTHCARE IN 501(C)(3) 9 IUH
 
Yes
 
(16) IU HEALTH LAPORTE HOSPITAL INC

PO BOX 250

LAPORTE,IN46352
35-1125434 		HEALTHCARE IN 501(C)(3) 3 IUH
 
Yes
 
(17) IU HEALTH LAPORTE PHYSICIANS INC

PO BOX 250

LAPORTE,IN46352
31-1070868 		HEALTHCARE IN 501(C)(3) 3 IUHLH
 
Yes
 
(18) IU HEALTH MORGAN HOSPITAL INC

2209 JOHN R WOODEN DR

MARTINSVILLE,IN46151
27-3533027 		HEALTHCARE IN 501(C)(3) 3 IUH
 
Yes
 
(19) IU HEALTH NORTH HOSPITAL INC

950 N MERIDIAN ST STE 800

INDIANAPOLIS,IN46204
35-1932442 		HEALTHCARE IN 501(C)(3) 3 IUH
 
Yes
 
(20) IU HEALTH PAOLI HOSP FOUNDATION INC

PO BOX 499

PAOLI,IN47454
31-0992486 		FUNDRAISING IN 501(C)(3) 11 III-O IUHP
 
Yes
 
(21) IU HEALTH PAOLI INC

PO BOX 499

PAOLI,IN47454
35-2090919 		HEALTHCARE IN 501(C)(3) 3 IUHB
 
Yes
 
(22) IU HEALTH TIPTON HOSPITAL INC

1000 S MAIN ST

TIPTON,IN46072
26-2772226 		HEALTHCARE IN 501(C)(3) 3 IUH
 
Yes
 
(23) IU HEALTH WEST HOSPITAL INC

950 N MERIDIAN ST STE 800

INDIANAPOLIS,IN46204
35-1814660 		HEALTHCARE IN 501(C)(3) 3 IUH
 
Yes
 
(24) IU HEALTH WHITE MEMORIAL HOSPITAL INC

720 S SIXTH ST

MONTICELLO,IN47960
27-3532963 		HEALTHCARE IN 501(C)(3) 3 IUH
 
Yes
 
(25) IU MEDICAL GROUP FOUNDATION INC

340 W 10TH ST NO FS5100

INDIANAPOLIS,IN46202
20-1093251 		FUNDRAISING IN 501(C)(3) 11 II NA
 
 
No
(26) METHODIST HEALTH FOUNDATION INC

1800 N CAPITOL AVE

INDIANAPOLIS,IN46202
35-6043086 		FUNDRAISING IN 501(C)(3) 11 I IUH
 
Yes
 
(27) METHODIST HEALTH GROUP INC

950 N MERIDIAN ST STE 800

INDIANAPOLIS,IN46204
35-0876390 		HEALTHCARE IN 501(C)(3) 11 III-FI NA
 
 
No
(28) METHODIST MEDICAL GROUP INC

950 N MERIDIAN ST STE 800

INDIANAPOLIS,IN46204
35-1945384 		HEALTHCARE IN 501(C)(3) 3 IUH
 
Yes
 
(29) METHODIST RESEARCH INSTITUTE INC

950 N MERIDIAN ST STE 800

INDIANAPOLIS,IN46204
35-2023710 		HEALTHCARE IN 501(C)(3) 11 I IUH
 
Yes
 
(30) MH HEALTHCARE INC

950 N MERIDIAN ST STE 800

INDIANAPOLIS,IN46204
35-1766531 		HEALTHCARE IN 501(C)(3) 3 MMG
 
Yes
 
(31) MORGAN CO MEM HOSP FOUNDATION INC

2209 JOHN R WOODEN DR

MARTINSVILLE,IN46151
35-2035162 		FUNDRAISING IN 501(C)(3) 11 II IUHMH
 
Yes
 
(32) MORGAN CO MEM HOSP GUILD INC

2209 JOHN R WOODEN DR

MARTINSVILLE,IN46151
31-0886844 		FUNDRAISING IN 501(C)(3) 11 III-FI IUHMH
 
Yes
 
(33) MORGAN HEALTH SERVICES INC

1949 HOSPITAL DR

MARTINSVILLE,IN46151
35-1968564 		HEALTHCARE IN 501(C)(3) 3 IUHMH
 
Yes
 
(34) IU HEALTH WHITE MEMORIAL FOUNDATION

PO BOX 952

MONTICELLO,IN47960
35-1671806 		FUNDRAISING IN 501(C)(3) 11 III-O IUHWMH
 
Yes
 
(35) UNIVERSITY FAMILY PHYSICIANS INC

950 N MERIDIAN ST STE 800

INDIANAPOLIS,IN46204
23-7427350 		HEALTHCARE IN 501(C)(3) 9 IUHCA
 
Yes
 
(36) REHABILITATION HOSPITAL OF INDIANA INC

4141 SHORE DR

INDIANAPOLIS,IN46254
35-1786005 		HEALTHCARE IN 501(C)(3) 3 MHH
 
Yes
 
(37) RHI FOUNDATION INC

4141 SHORE DR

INDIANAPOLIS,IN46254
35-1932349 		FUNDRAISING IN 501(C)(3) 11 I RHI
 
Yes
 
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2012
Schedule R (Form 990) 2012
Page 2
Part III
Identification of Related Organizations Taxable as a Partnership (Complete if the organization answered "Yes" to Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year.)
(a)
Name, address, and EIN of
related organization



 		(b)
Primary activity




 		(c)
Legal
domicile
(state or foreign
country)


 		(d)
Direct controlling
entity



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

(f)
Share of total income




 		(g)
Share of end-of-year
assets



 		(h)
Disproprtionate allocations?




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



 		(k)
Percentage
ownership
Yes No Yes No
(1) BALL OUTPATIENT SURGERY CENTER LLC

3000 RIVERCHASE GALLERIA STE 500
BIRMINGHAM,AL35244
27-0275794 		HEALTHCARE IN BOSCH
  		N/A 0 0   No 0   No 0 %
(2) BELTWAY SURGERY CENTERS LLC

3000 RIVERCHASE GALLERIA STE 500
BIRMINGHAM,AL35244
35-2072586 		HEALTHCARE IN BSCH
  		N/A 0 0   No 0   No 0 %
(3) BLOOMINGTON ENDOSCOPY CENTERS LLC

PO BOX 1149
BLOOMINGTON,IN47402
35-2117943 		HEALTHCARE IN IUHB
  		N/A 0 0   No 0   No 0 %
(4) BMH OUTPATIENT SURGERY SERVICES LLC

2401 W UNIVERSITY AVE
MUNCIE,IN47303
20-4567998 		HEALTHCARE IN IUHBMH
  		N/A 0 0   No 0   No 0 %
(5) BOSC HOLDINGS LLC

3000 RIVERCHASE GALLERIA STE 500
BIRMINGHAM,AL35244
45-4147343 		HEALTHCARE IN IUH
  		N/A 0 0   No 0   No 0 %
(6) CARDINAL HEALTH INITIATIVES LLC

950 N MERIDIAN ST STE 800
INDIANAPOLIS,IN46204
30-0102702 		PURCHASING IN IUHBMH
  		N/A 0 0   No 0   No 0 %
(7) CHV FUND I LLC

950 N MERIDIAN ST STE 800
INDIANAPOLIS,IN46204
26-2523206 		VENTURE CAPITAL IN IUH
  		N/A 0 0   No 0   No 0 %
(8) CHV FUND MANAGEMENT LLC

950 N MERIDIAN ST STE 800
INDIANAPOLIS,IN46204
26-2523151 		VENTURE CAPITAL IN CHV
  		N/A 0 0   No 0   No 0 %
(9) CLARIAN HEALTH NETWORK LLC

950 N MERIDIAN ST STE 800
INDIANAPOLIS,IN46204
35-2055030 		HEALTHCARE IN IUH
  		N/A 0 0   No 0   No 0 %
(10) EAGLE HIGHLANDS SURGERY CENTER LLC

3000 RIVERCAHSE GALLERIA STE 500
BIRMINGHAM,AL35244
35-2259204 		HEALTHCARE IN EHSCH
  		N/A 0 0   No 0   No 0 %
(11) EHSC HOLDINGS LLC

3000 RIVERCHASE GALLERIA STE 500
BIRMINGHAM,AL35244
45-4147879 		HEALTHCARE IN IUH
  		N/A 0 0   No 0   No 0 %
(12) HEALTH VENTURE MANAGEMENT LLC

950 N MERIDIAN ST STE 800
INDIANAPOLIS,IN46204
20-5740218 		MANAGEMENT IN IUH
  		N/A 0 0   No 0   No 0 %
(13) IEC HOLDINGS LLC

3000 RIVERCHASE GALLERIA STE 500
BIRMINGHAM,AL35244
45-4148032 		HEALTHCARE IN IUH
  		N/A 0 0   No 0   No 0 %
(14) INDIANA ENDOSCOPY CENTERS LLC

3000 RIVERCHASE GALLERIA STE 500
BIRMINGHAM,AL35244
20-8398421 		HEALTHCARE IN IECH
  		N/A 0 0   No 0   No 0 %
(15) BSC HOLDINGS LLC

3000 RIVERCHASE GALLERIA STE 500
BIRMINGHAM,AL35244
45-2314634 		HEALTHCARE IN IUH
  		N/A 0 0   No 0   No 0 %
(16) MID-AMERICA SURGERY CENTER LLC

2401 W UNIVERSITY AVE
MUNCIE,IN47303
35-2002953 		HEALTHCARE IN CDHV
  		N/A 0 0   No 0   No 0 %
(17) ROC SURGERY LLC

3000 RIVERCHASE GALLERIA STE 500
BIRMINGHAM,AL35244
27-1497960 		HEALTHCARE IN ROCSH
  		N/A 0 0   No 0   No 0 %
(18) ROCS HOLDINGS LLC

3000 RIVERCHASE GALLERIA STE 500
BIRMINGHAM,AL35244
45-4148369 		HEALTHCARE IN IUH
  		N/A 0 0   No 0   No 0 %
(19) SENATE STREET SURGERY CENTER LLC

3000 RIVERCHASE GALLERIA STE 500
BIRMINGHAM,AL35244
42-1709357 		HEALTHCARE IN SSSCH
  		N/A 0 0   No 0   No 0 %
(20) SSSC HOLDINGS LLC

3000 RIVERCHASE GALLERIA STE 500
BIRMINGHAM,AL35244
45-4148167 		HEALTHCARE IN IUH
  		N/A 0 0   No 0   No 0 %
(21) CARDINAL HEALTH ALLIANCE LLC

2401 W UNIVERSITY AVE
MUNCIE,IN47303
35-1966281 		MANAGED CARE IN IUH
  		N/A 0 0   No 0   No 0 %
Part IV
Identification of Related Organizations Taxable as a Corporation or Trust (Complete if the organization answered "Yes" to 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
 		(i)
Section 512(b)(13) controlled entity?
Yes No
(1) BMH MEDICAL PAVILION ASSOCIATION INC

2525 W UNIVERSITY AVE
MUNCIE,IN47303
35-1858408 		CONDO MANAGEMENT IN IUHBMH
  		C 0 0 0 % Yes  
(2) CARDINAL HEALTH VENTURES INC

950 N MERIDIAN ST STE 800
INDIANAPOLIS,IN46204
35-1611424 		MANAGEMENT IN IUHBMH
  		C 0 0 0 % Yes  
(3) CHV CAPITAL INC

950 N MERIDIAN ST STE 800
INDIANAPOLIS,IN46204
26-0752507 		VENTURE CAPITAL IN IUH
  		C 0 0 0 % Yes  
(4) IU HEALTH ACO INC

950 N MERIDIAN ST STE 800
INDIANAPOLIS,IN46204
45-4421020 		HEALTHCARE IN IUH
  		C 0 0 0 % Yes  
(5) IU HEALTH BOARD DESIGNATED TRUST

400 HOWARD ST
SAN FRANCISCO,CA94105
30-6309021 		INVESTMENTS IN IUH
  		T 0 0 0 % Yes  
(6) IU HEALTH NTGI S&P500 FUND CF

PO BOX 804358
CHICAGO,IL60680
30-6298263 		INVESTMENTS IN IUH
  		T 0 0 0 % Yes  
(7) IU HEALTH PLANS INC

1776 MERIDIAN ST STE 300
INDIANAPOLIS,IN46202
26-2127080 		HMO IN IUH
  		C 0 0 0 % Yes  
(8) IU HEALTH RISK PURCHASING GROUP INC

151 MEETING ST STE 301
CHARLESTON,SC29401
26-0202446 		INSURANCE IN IUH
  		C 0 0 0 % Yes  
(9) IUH HEALTH RISK RETENTION GROUP INC

151 MEETING ST STE 301
CHARLESTON,SC29401
20-1107674 		INSURANCE SC IUH
  		C 0 0 0 % Yes  
(10) IU HEALTH SOUTHERN IN PHYSICIANS INC

PO BOX 1149
BLOOMINGTON,IN47402
35-1913875 		HEALTHCARE IN IUHB
  		C 0 0 0 % Yes  
(11) IUH ASSURANCE LTD

PO BOX 69
SOLARIS AVE.,GRAND CAYMAN  
CJ
98-0395429 		INSURANCE CJ IUH
  		C 0 0 0 % Yes  
(12) OCC-HEALTH REVENUE SYSTEMS INC

950 N MERIDIAN ST STE 800
INDIANAPOLIS,IN46204
20-3308057 		WORK COMP PPO IN MOHC
  		C 86,171 1,259 100.000 % Yes  
(13) PARKMOR DRUG INC

1501 S MAIN ST
GOSHEN,IN46526
13-1394980 		PHARMACY SALES IN GHS
  		C 0 0 0 % Yes  
(14) PILR INC

200 HIGH PARK AVE
GOSHEN,IN46526
20-4294750 		DEVELOPMENT IN GHS
  		C 0 0 0 % Yes  
(15) RADIATION ONCOLOGY RESOURCES INC

200 HIGH PARK AVE
GOSHEN,IN46526
26-2008424 		HEALTHCARE IN GHS
  		C 0 0 0 % Yes  
(16) SCANS INC

950 N MERIDIAN ST STE 800
INDIANAPOLIS,IN46204
45-3080392 		HEALTHCARE IN CHVF1
  		C 0 0 0 % Yes  
(17) UNIVERSITY HEALTH MANAGEMENT INC

950 N MERIDIAN ST STE 800
INDIANAPOLIS,IN46204
27-2891143 		MANAGEMENT IN CHV
  		C 0 0 0 % Yes  
(18) UNIVERSITY HEALTH MGMT (CHINA) INC

950 N MERIDIAN ST STE 800
INDIANAPOLIS,IN46204
27-3891311 		MANAGEMENT IN CHV
  		C 0 0 0 % Yes  
(19) PROTEUO FUND LP

 
 
98-1075227 		INVESTMENTS CJ IUH
  		C 0 0 0 % Yes  
Schedule R (Form 990) 2012
Schedule R (Form 990) 2012
Page 3
Part V
Transactions With Related Organizations (Complete if the organization answered "Yes" to Form 990, Part IV, line 34, 35b, or 36.)
Note. Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.
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 or (iv) rent from a controlled entity . . . . . . . . . . . . . . . . . . . . . . .
1a
 
No
b Gift, grant, or capital contribution to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1b
 
No
c Gift, grant, or capital contribution from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1c
 
No
d Loans or loan guarantees to or for related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1d
 
No
e Loans or loan guarantees by related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1e
 
No
f Dividends from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1f
 
 
g Sale of assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1g
 
No
h Purchase of assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1h
 
No
i Exchange of assets with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1i
 
No
j Lease of facilities, equipment, or other assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1j
 
No
k Lease of facilities, equipment, or other assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .
1k
Yes
 
l Performance of services or membership or fundraising solicitations for related organization(s) . . . . . . . . . . . . . . . . . . . .
1l
Yes
 
m Performance of services or membership or fundraising solicitations by related organization(s) . . . . . . . . . . . . . . . . . . . .
1m
Yes
 
n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) . . . . . . . . . . . . . . . . . . . . .
1n
 
No
o Sharing of paid employees with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1o
Yes
 
p Reimbursement paid to related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1p
 
No
q Reimbursement paid by related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1q
 
No
r Other transfer of cash or property to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1r
Yes
 
s Other transfer of cash or property from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1s
 
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-s) 		(c)
Amount involved 		(d)
Method of determining amount involved
(1) IU HEALTH ARNETT INC

 K 74,061 FMV
(2) IU HEALTH ARNETT INC

 L 319,887 FMV
(3) IU HEALTH BALL MEMORIAL HOSPITAL INC

 L 290,539 FMV
(4) IU HEALTH CARE ASSOCIATES INC

 L 169,288 FMV
(5) IU HEALTH NORTH HOSPITAL INC

 L 113,961 FMV
(6) IU HEALTH WEST HOSPITAL INC

 L 106,353 FMV
(7) IU HEALTH BALL MEMORIAL HOSPITAL INC

 M 89,604 FMV
(8) INDIANA RADIOLOGY PARTNERS INC

 M 200,565 FMV
(9) IU HEALTH RISK RETENTION GROUP INC

 R 134,027 FMV
Schedule R (Form 990) 2012
Schedule R (Form 990) 2012
Page 4
Part VI
Unrelated Organizations Taxable as a Partnership (Complete if the organization answered "Yes" to Form 990, Part IV, line 37.)
Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.
(a)
Name, address, and EIN of entity 		(b)
Primary activity 		(c)
Legal domicile
(state or foreign
country) 		(d)
Predominant income (related, unrelated, excluded from tax under section 512-514)

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




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






























Schedule R (Form 990) 2012
Schedule R (Form 990) 2012
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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