TY 2012 Form 990

- TIN:

Form990

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)

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: Address change Name change Initial return Terminated Amended return Application pending

CName of organization
Indiana University Health LaPorte Hospital

Doing Business As

Number and street (or P.O. box if mail is not delivered to street address)
PO Box 250 1007 Lincolnway
Suite

Room/suite

City or town, state or country, and ZIP + 4
LaPorte, IN46352

D Employer identification number

35-1125434

E Telephone number

G Gross receipts $ 311,495,097

F Name and address of principal officer:
Robert Petrina
PO Box 250 1007 Lincolnway
LaPorte,IN46352

Tax-exempt status: 501(c)(3) 501(c) ( ) LeftBullet

(insert no.) 4947(a)(1) or 527

Website:

www.iuhealth.org/laporte

H(a)

Is this a group return for
affiliates? Yes No

H(b)

Are all affiliates included?

Yes No

If "No," attach a list. (see instructions)

H(c)

Group exemption number MediumBullet

K Form of organization: Corporation Trust Association Other MediumBullet

L Year of formation: 1966

M State of legal domicile: IN

Part I

Summary

1	Briefly describe the organization’s mission or most significant activities: To improve the health of our patients and communities.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	14
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	11
5	Total number of individuals employed in calendar year 2011 (Part V, line 2a) ......	5	1,791
6	Total number of volunteers (estimate if necessary) .............	6	346
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	115,193
b	Net unrelated business taxable income from Form 990-T, line 34 .........	7b	68,840

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	5,115,472	899,339
9	Program service revenue (Part VIII, line 2g) .........	205,485,071	229,999,268
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	1,283,687	5,213,378
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	2,230,524	2,284,689
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)...................	214,114,754	238,396,674
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	306,255	245,165
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)	89,242,090	88,238,527
16a	Professional fundraising fees (Part IX, column (A), line 11e).....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 0
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	104,748,691	121,530,748
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	194,297,036	210,014,440
19	Revenue less expenses. Subtract line 18 from line 12.......	19,817,718	28,382,234
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	227,329,586	238,466,912
21	Total liabilities (Part X, line 26).............	75,600,793	74,043,507
22	Net assets or fund balances. Subtract line 21 from line 20.....	151,728,793	164,423,405

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

	Signature of officer	Date

	Type or print name and title

Paid Preparer Use Only

Print/Type preparer's name

Preparer's signature

Date

Check if
self-employed

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) ............YesNo

For Paperwork Reduction Act Notice, see the separate instructions.

Cat. No. 11282Y

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 ...............

Briefly describe the organization’s mission: TO IMPROVE THE HEALTH OF OUR PATIENTS AND COMMUNITIES.

Did the organization undertake any significant program services during the year which were not listed on
the prior Form 990 or 990-EZ? ...................... Yes No

If “Yes,” describe these new services on Schedule O.

Did the organization cease conducting, or make significant changes in how it conducts, any program services? ............................ Yes No

If “Yes,” describe these changes on Schedule O.

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 $ 149,394,724 including grants of $ 45,578 ) (Revenue $ 227,497,302 )
	Patient Care: Indiana University Health LaPorte Hospital (IUHLPH) is composed of a 227-Bed Community Hospital and is associated with Indiana University Health Starke Hospital, Indiana University LaPorte Physicians, LaPorte Hospital Auxiliary, and the philanthropic arm, The Foundation. IUHLPH was the first hospital in Northern Indiana to achieve Magnet Recognition for exemplary nursing leadership and quality patient care. In addition to the Magnet recognition, IUHLPH continues to set standards in a number of quality and service categories. The organization has been recognized twice by US News & World Report as one of the nation's best hospitals for both geriatric care and the treatment of respiratory disorders. In committing itself to the community, IUHLPH offers a variety of programs to the community that reach far beyond traditional medical care. Through the school systems, civic groups, churches, health fairs and community partners, IUHLPH makes significant contributions to support and improve the quality of life in LaPorte and its surrounding areas.

4b	(Code: ) (Expenses $ 2,351,820 including grants of $ 199,587 ) (Revenue $ 3,604,962 )
	Subsidized Health Services: IU Health LaPorte Hospital (IUHLPH) has provided many opportunities to the community to help heighten awareness of health education. Lectures, presentations, wellness screenings, health fairs, support groups and other programs were provided to accomplish the awareness goal. Three of the largest offered programs were the clinic services at the Community Health Center, LaPorte County Dental Clinic and the Visiting Nurses Association. The Community Health Center (CHC) provides medical assistance to individuals residing in LaPorte County who have low income or no health insurance. Some of the services offered at the health center include prescription drug assistance, physical exams, gynecological exams and lab and diagnostic services though LaPorte Hospital. During 2012, the Community Health Center received 5,675 visits and provided more than $475,600 in gross revenue and revenue of $90,487 in services. Also, over $976,704 in pharmaceutical drugs was given away through the indigent drug program. The second largest program was the clinic services provided at the LaPorte county Dental Clinic (CDC). The CDC guarantees that both children and adults with low income and no dental insurance have access to quality dental care. Services provided through the dental clinic include dental exams, teeth cleanings, fillings, tooth extractions, dentures, partials and more. The CDC provided more than $1,432,000 in gross revenue, net revenue of $347,387 worth of services, and received a total of 6,056 visits during 2012. Both the Community Health Center and the LaPorte County Dental Clinic are supported in part by the Foundation. IUHLPH also provides the Visiting Nurses Association (VNA) which extends to LaPorte, Starke, Porter and St. Joseph counties. The VNA provides home-based health services for those recuperating from an illness or learning to cope with chronic disease and disability. The VNA Home Care provided more than $5,011,000 in gross revenue, net revenue of $3,167,087 worth of services, and had 38,918 home visits in 2012. The VNA also offers a wide variety of other services in the communities such as foot care clinics, nail clipping and skin assessments, flu/pneumonia shot sites to name a few.

4c	(Code: ) (Expenses $ 2,214,003 including grants of $ ) (Revenue $ 58,451 )
	IUHLPH is proud to collaborate with local partners to utilize resources to benefit the residents of the community and improve their overall quality of life. In committing itself to the community, IUHLPH offers a variety of programs to the community that reach far beyond traditional medical care. Through the school systems, civic groups, churches, health fairs, and community partners, IUHLPH makes significant contributions to support and improve the quality of life in LaPorte and surrounding areas.

4d	Other program services (Describe in Schedule O.)
	(Expenses $ 24,634,989 including grants of $ ) (Revenue $ 373,614 )
4e	Total program service expenses178,595,536

Form 990 (2012)

Page 3

Part IV

Checklist of Required Schedules

Yes

Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If “Yes,” complete Schedule A Click to see attachment

........................

Yes

Is the organization required to complete Schedule B, Schedule of Contributors (see instructions)? Click to see attachment

...

Yes

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..........

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........

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............................

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 I Click to see attachment

........................

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 II Click to see attachment

...

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

....................

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 IV Click to see attachment

..............

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 V Click to see attachment

......

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.

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

Did the organization report an amount for investments—other securities in Part X, line 12 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VII Click to see attachment

.......

11b

Did the organization report an amount for investments—program related in Part X, line 13 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VIII Click to see attachment

.......

11c

Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part IX Click to see attachment

............

11d

Did the organization report an amount for other liabilities in Part X, line 25? If “Yes,” complete Schedule D, Part X Click to see attachment

11e

Yes

Did the organization’s separate or consolidated financial statements for the tax year include a footnote that addresses the organization’s liability for uncertain tax positions under FIN 48 (ASC 740)? If “Yes,” complete Schedule D, Part X Click to see attachment

.........................

11f

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

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

Is the organization a school described in section 170(b)(1)(A)(ii)? If “Yes,” complete Schedule E....

14a

Did the organization maintain an office, employees, or agents outside of the United States?.....

14a

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

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

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...

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)....

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............

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...................

20a

Did the organization operate one or more hospital facilities? If “Yes,” complete Schedule H.... Click to see attachment

20a

Yes

If “Yes” to line 20a, did the organization attach a copy of its audited financial statements to this return? Click to see list of attachments

20b

Yes

Form 990 (2012)

Page 4

Part IV

Checklist of Required Schedules (continued)

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... Click to see attachment

Yes

Did the organization report more than $5,000 of grants and other assistance to individuals in the United States on Part IX, column (A), line 2? If “Yes,” complete Schedule I, Parts I and III........ Click to see attachment

Yes

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

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

Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...

24b

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

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........ Click to see attachment

25a

Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and that the transaction has not been reported on any of the organization’s prior Forms 990 or 990-EZ? If “Yes,” complete Schedule L, Part I................... Click to see attachment

25b

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.......................... Click to see attachment

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......... Click to see attachment

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 current or former officer, director, trustee, or key employee? If “Yes,” complete Schedule L, Part IV .......................... Click to see attachment

28a

A family member of a current or former officer, director, trustee, or key employee? If “Yes,”
complete Schedule L, Part IV..................... Click to see attachment

28b

Yes

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... Click to see attachment

28c

Did the organization receive more than $25,000 in non-cash contributions? If “Yes,” complete Schedule M.. Click to see attachment

Yes

Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? If “Yes,” complete Schedule M............. Click to see attachment

Did the organization liquidate, terminate, or dissolve and cease operations? If “Yes,” complete Schedule N,
Part I...........................

Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If “Yes,” complete Schedule N, Part II......................

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

Yes

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

Yes

35a

Did the organization have a controlled entity within the meaning of section 512(b)(13)?

35a

Yes

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

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

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 VI Click to see attachment

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. ............

Yes

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

Enter the number reported in Box 3 of Form 1096 Enter -0- if not applicable ..

259

Enter the number of Forms W-2G included in line 1a. Enter -0- if not applicable .

Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners? ..................

Yes

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 ..................

1,791

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)

Yes

Did the organization have unrelated business gross income of $1,000 or more during the year?...

Yes

If “Yes,” has it filed a Form 990-T for this year? If “No,” provide an explanation in Schedule O.....

Yes

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)?..........................

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.

Was the organization a party to a prohibited tax shelter transaction at any time during the tax year?..

Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?

If “Yes,” to line 5a or 5b, did the organization file Form 8886-T? ............

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?...

If “Yes,” did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible?........................

Organizations that may receive deductible contributions under section 170(c).

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?....................

If “Yes,” did the organization notify the donor of the value of the goods or services provided?.....

Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file Form 8282?...........................

If “Yes,” indicate the number of Forms 8282 filed during the year ....

Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?............................

Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract?..

If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required?............................

If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C?..........................

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?............

Sponsoring organizations maintaining donor advised funds.

Did the organization make any taxable distributions under section 4966?..........

Did the organization make a distribution to a donor, donor advisor, or related person?.......

Section 501(c)(7) organizations. Enter:

Initiation fees and capital contributions included on Part VIII, line 12 ...

10a

Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities

10b

Section 501(c)(12) organizations. Enter:

Gross income from members or shareholders .........

11a

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

If “Yes,” enter the amount of tax-exempt interest received or accrued during the year. ....................

12b

Section 501(c)(29) qualified nonprofit health insurance issuers.

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

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

Enter the amount of reserves on hand ............

13c

14a

Did the organization receive any payments for indoor tanning services during the tax year?.....

14a

If "Yes," has it filed a Form 720 to report these payments? If “No,” provide an explanation in Schedule O..

14b

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

Enter the number of voting members of the governing body at the end of the tax year .....................

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.

Enter the number of voting members included in line 1a, above, who are independent ...................

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? .................

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? .

Did the organization make any significant changes to its governing documents since the prior Form 990 was filed? ...........................

Did the organization become aware during the year of a significant diversion of the organization’s assets? .

Did the organization have members or stockholders? ................

Yes

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? ....................

Yes

Are any governance decisions of the organization reserved to (or subject to approval by) members, stockholders, or persons other than the governing body? ...................

Yes

Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:

The governing body? .........................

Yes

Each committee with authority to act on behalf of the governing body? ............

Yes

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.......

Section B. Policies (This Section B requests information about policies not required by the Internal Revenue Code.)

Yes

10a

Did the organization have local chapters, branches, or affiliates? ............

10a

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

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

Were officers, directors, or trustees, and key employees required to disclose annually interests that could give rise to conflicts? ..........................

12b

Yes

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

Did the organization have a written whistleblower policy? ...............

Yes

Did the organization have a written document retention and destruction policy? .........

Yes

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?

The organization’s CEO, Executive Director, or top management official ...........

15a

Yes

Other officers or key employees of the organization ................

15b

Yes

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

Yes

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

Yes

Section C. Disclosure

List the States with which a copy of this Form 990 is required to be filed MediumBullet

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.

Own website Another's website Upon request Other (explain in Schedule O)

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.

State the name, physical address, and telephone number of the person who possesses the books and records of the organization:
MediumBullet

ROBERT PETRINAPO BOX 250 1007 LINCOLNWAYLAPORTEIN46352 (219) 326-1234

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.

List all of the organization’s current key employees, if any. See instructions for definition of "key employee."

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.

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.

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
(A) Name and Title
(1) DR JEFFREY ANDERSON........................................................................ BOARD MEMBER	2.0 .......................0.0	X			0	0	0
(2) LAUREN ARNOLD........................................................................ BOARD MEMBER	2.0 .......................0.0	X			0	0	0
(3) DIANA CORLEY........................................................................ BOARD MEMBER	2.0 .......................0.0	X			0	0	0
(4) JAMES DWORKIN........................................................................ BOARD MEMBER PHD	2.0 .......................0.0	X			0	0	0
(5) DR BRIAN MOORE........................................................................ BOARD MEMBER PHYSICIAN	2.0 .......................0.0	X			0	363,552	14,453
(6) DR MARTIN MURPHY........................................................................ BOARD MEMBER / PAST PRESIDENT	2.0 .......................0.0	X			57,855	318,294	9,001
(7) D DRUMMOND OSBORN........................................................................ BOARD MEMBER / VICE CHAIR	2.0 .......................0.0	X	X		0	0	0
(8) SCOTT SIEFKER........................................................................ BOARD MEMBER / SECRETARY	2.0 .......................0.0	X	X		0	0	0
(9) MICHELE THOMPSON........................................................................ BOARD MEMBER	2.0 .......................0.0	X			0	0	0
(10) G THOR THORDARSON........................................................................ PRESIDENT/CEO	35.0 .......................5.0	X	X		425,566	0	13,563
(11) PAUL WILKINS........................................................................ BOARD MEMBER / CHAIRPERSON	2.0 .......................0.0	X	X		0	0	0
(12) MARK KOSIOR........................................................................ BOARD MEMBER	2.0 .......................0.0	X			0	0	0
(13) MEL LUCAS........................................................................ BOARD MEMBER	2.0 .......................0.0	X			0	0	0
(14) FRAN MILO........................................................................ BOARD MEMBER	2.0 .......................0.0	X			0	0	0
(15) MARK RAFALSKI........................................................................ COO/CFO	35.0 .......................5.0		X		276,518	0	13,053
(16) CONNIE FORD........................................................................ VP HUMAN RESOURCES	40.0 .......................0.0			X	190,723	0	14,202
(17) LINDA SATKOSKI........................................................................ CEO Starke / COO	40.0 .......................0.0			X	325,824	0	14,721

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)				(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
(A) Name and Title
(18) STEPHANIE SMITH........................................................................ ADMIN REV CYCLE; CFO/FORMER	40.0 .......................0.0	X			124,322	0	9,650
(19) DAVID W HYATT........................................................................ CEO STARKE (from 6/12)	40.0 .......................0.0	X			152,370	0	6,806
(20) DR NADEEM KAMRAN........................................................................ PHYSICIAN	40.0 .......................0.0		X		354,985	0	16,194
(21) DR VINAY TUMULURI........................................................................ PHYSICIAN	40.0 .......................0.0		X		454,278	0	14,006
(22) DR SONALI SHUKLA........................................................................ PHYSICIAN	40.0 .......................0.0		X		317,558	0	9,346
(23) DAVID D HOUGH........................................................................ PHYSICIAN	40.0 .......................0.0		X		365,296	0	10,926
(24) SYED M SHAN UL ISLA........................................................................ PHYSICIAN	40.0 .......................0.0		X		362,350	0	8,728
(25) ANITA IVANKOVIG........................................................................ FORMER VP NURSING	40.0 .......................0.0			X	178,037	0	993

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)............	3,585,682	681,846	155,642

Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organization MediumBullet

Yes

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 ..............

Yes

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...........................

Yes

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 ........

Section B. Independent Contractors

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
Anesthesia Associates of La Porte, 800 Lincolnway Ste 301LA PORTEIN46350	Medical Services	2,803,084
AIMS of Indiana, 7290 E 102 PlaceCROWN POINTIN46307	Medical Services	2,117,580
Maple City Emergency Physicians, PO Box 793TRAVERSE CITYMI49685	Medical Services	679,282
South Bend Medical Foundation, PO Box 2030MISHAWAKAIN46546	Lab Services	811,679
Firstcare Rehab Hospital LLC, 1595 S CALUMET RD ST 1CHESTERTONIN46304	Medical Services	638,452
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 32

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
1a	Federated campaigns..1a
b	Membership dues....1b
c	Fundraising events....1c
d	Related organizations...1d		601,386
e	Government grants (contributions)1e		297,953

f	All other contributions, gifts, grants, and similar amounts not included above1f

g	Noncash contributions included in lines 1a-1f:$		257,366
h	Total. Add lines 1a-1f.......			899,339
			Business Code
2a	NET PATIENT REVENUE		621500	228,405,800	228,405,800
b	SALE OF DRUGS TO AFFILIATE		446110	644,949	644,949
c	UBI REFERENCE LAB		621500	41,322		41,322
d	ELECTRONIC MEDICAL RECORD ARRA		900099	833,326	833,326
e	INVESTMENTS IN PARTNERSHIPS		900099	73,871		73,871
f	All other program service revenue .
g	Total. Add lines 2a–2f........			229,999,268
3	Investment income (including dividends, interest, and other similar amounts).......			1,023,895			1,023,895
4	Income from investment of tax-exempt bond proceeds..			0
5	Royalties...........			0
		(i) Real	(ii) Personal
6a	Gross rents	2,104,424
b	Less: rental expenses	2,259,583
c	Rental income or (loss)	-155,159	0
d	Net rental income or (loss).......			-155,159			-155,159
		(i) Securities	(ii) Other
7a	Gross amount from sales of assets other than inventory	70,460,630	4,567,693
b	Less: cost or other basis and sales expenses	66,263,103	4,575,737
c	Gain or (loss)	4,197,527	-8,044
d	Net gain or (loss)..........			4,189,483			4,189,483
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..			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...			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..			0
Miscellaneous Revenue			Business Code
11a	CAFETERIA		722210	904,787			904,787
b	WELLNESS RESOURCE CENTER		900099	271,300	271,300
c	MEDICAL RECORDS FEES		900099	53,723	53,723
d	All other revenue ....			1,210,038	1,210,038
e	Total. Add lines 11a–11d ......			2,439,848
12	Total revenue. See Instructions......			238,396,674	231,419,136	115,193	5,963,006

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	169,587	169,587
2	Grants and other assistance to individuals in the United States. See Part IV, line 22	75,578	75,578
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 ....	1,804,203		1,804,203
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ....	133,972		133,972
7	Other salaries and wages	65,542,841	53,984,813	11,558,028
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	2,868,925	2,295,140	573,785
9	Other employee benefits .......	12,695,271	10,147,101	2,548,170
10	Payroll taxes ...........	5,193,315	4,154,652	1,038,663
11	Fees for services (non-employees):
a	Management ......	0
b	Legal .........	488,452		488,452
c	Accounting ...........	1,087,420		1,087,420
d	Lobbying ...........	0
e	Professional fundraising services. See Part IV, line 17	0
f	Investment management fees ......	84,954		84,954
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O) ........	27,130,835	21,704,668	5,426,167
12	Advertising and promotion ....	1,151,981	921,585	230,396
13	Office expenses .......	4,362,922	3,490,338	872,584
14	Information technology ......	3,941,471	3,153,177	788,294
15	Royalties ..	0
16	Occupancy ...........	4,485,660	3,588,528	897,132
17	Travel ............	392,797	314,238	78,559
18	Payments of travel or entertainment expenses for any federal, state, or local public officials ......	0
19	Conferences, conventions, and meetings ....	0
20	Interest ...........	1,589,863	1,271,890	317,973
21	Payments to affiliates .......	0
22	Depreciation, depletion, and amortization .....	15,785,519	12,628,415	3,157,104
23	Insurance ..............	0
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	MEDICAL SUPPLIES	27,881,850	27,881,850
b	BAD DEBT EXPENSE	23,144,494	23,144,494
c	MEDICAID ASSESSMENT FEE	9,005,041	9,005,041
d	UBI TAX	166,938		166,938
e	All other expenses	830,551	664,441	166,110
25	Total functional expenses. Add lines 1 through 24e	210,014,440	178,595,536	31,418,904	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 if following SOP 98-2 (ASC 958-720).

Form 990 (2012)

Page 11


				(A) Beginning of year		(B) End of year
1	Cashnon-interest-bearing .............			0	1	0
2	Savings and temporary cash investments .........			11,954,525	2	22,661,567
3	Pledges and grants receivable, net ...........			0	3	0
4	Accounts receivable, net .............			33,776,164	4	32,847,811
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 ..............			4,684,789	8	4,469,689
9	Prepaid expenses and deferred charges ..........			1,575,983	9	1,914,189
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	230,778,007
b	Less: accumulated depreciation .....	10b	138,799,763	98,669,209	10c	91,978,244
11	Investments—publicly traded securities ..........			65,604,279	11	73,703,274
12	Investments—other securities. See Part IV, line 11 .....			0	12	0
13	Investments—program-related. See Part IV, line 11 .....			6,306,070	13	6,148,120
14	Intangible assets ...............			4,726,742	14	4,726,742
15	Other assets. See Part IV, line 11 ...........			31,825	15	17,276
16	Total assets. Add lines 1 through 15 (must equal line 34)......			227,329,586	16	238,466,912
17	Accounts payable and accrued expenses .........			18,136,306	17	17,923,737
18	Grants payable .................			0	18	0
19	Deferred revenue ................			183,076	19	212,711
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 ..			3,056,597	23	1,605,339
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....................			54,224,814	25	54,301,720
26	Total liabilities. Add lines 17 through 25.........			75,600,793	26	74,043,507
	Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets ..............			151,613,463	27	164,256,993
28	Temporarily restricted net assets ...........			115,330	28	166,412
29	Permanently restricted net assets ...........			0	29	0
	Organizations that do not follow SFAS 117 (ASC 958), check here 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 ...........			151,728,793	33	164,423,405
34	Total liabilities and net assets/fund balances ........			227,329,586	34	238,466,912

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 ...............

Total revenue (must equal Part VIII, column (A), line 12) ............

238,396,674

Total expenses (must equal Part IX, column (A), line 25) ............

210,014,440

Revenue less expenses. Subtract line 2 from line 1 ..............

28,382,234

Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) ..

151,728,793

Net unrealized gains (losses) on investments ...............

2,651,620

Donated services and use of facilities .................

Investment expenses .....................

Prior period adjustments .....................

Other changes in net assets or fund balances (explain in Schedule O) ........

-18,339,242

Net assets or fund balances at end of year. Combine lines 3 through 9 (must equal Part X, line 33, column (B))

164,423,405

Part XII

Financial Statements and Reporting

Check if Schedule O contains a response to any question in this Part XII ..............

Yes

Accounting method used to prepare the Form 990: Cash Accrual Other
If the organization changed its method of accounting from a prior year or checked "Other," explain in
Schedule O.

Were the organization’s financial statements compiled or reviewed by an independent accountant?

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:

Separate basis Consolidated basis Both consolidated and separate basis

Were the organization’s financial statements audited by an independent accountant?

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:

Separate basis Consolidated basis Both consolidated and separate basis

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?

Yes

If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O.

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?

Yes

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

Yes

Form 990 (2012)

Form 990, Special Condition Description:

Special Condition Description

Additional Data

Software ID:
Software Version:

- TIN:

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.

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

Indiana University Health LaPorte Hospital

Employer identification number

35-1125434

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.)

A church, convention of churches, or association of churches described in section 170(b)(1)(A)(i).

A school described in section 170(b)(1)(A)(ii). (Attach Schedule E.)

A hospital or a cooperative hospital service organization described in section 170(b)(1)(A)(iii).

A medical research organization operated in conjunction with a hospital described in section 170(b)(1)(A)(iii). Enter the hospital's name, city, and state:

An organization operated for the benefit of a college or university owned or operated by a governmental unit described in

section 170(b)(1)(A)(iv). (Complete Part II.)

A federal, state, or local government or governmental unit described in section 170(b)(1)(A)(v).

An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in section 170(b)(1)(A)(vi). (Complete Part II.)

A community trust described in section 170(b)(1)(A)(vi). (Complete Part II.)

An organization that normally receives: (1) more than 331/3% of its support from contributions, membership fees, and gross

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.)

An organization organized and operated exclusively to test for public safety. See section 509(a)(4).

An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section 509(a)(3). Check the box that describes the type of supporting organization and complete lines 11e through 11h.

Type I

Type II

Type III - Functionally integrated

Type III - Non-functionally integrated

By checking this box, I certify that the organization is not controlled directly or indirectly by one or more disqualified persons other than foundation managers and other than one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2).

If the organization received a written determination from the IRS that it is a Type I, Type II, or Type III supporting organization, check this box ..................................................

Since August 17, 2006, has the organization accepted any gift or contribution from any of the
following persons?

(i) A person who directly or indirectly controls, either alone or together with persons described in (ii)

Yes

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)

Provide the following information about the supported organization(s).

(i) Name of supported organization	(ii) EIN	(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
(i) Name of supported organization	(ii) EIN	Yes	No	Yes	No	Yes	No	(vii) Amount of monetary support


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

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)		(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)		(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).

Gross receipts from related activities, etc. (see instructions) ..................

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

Public support percentage for 2012 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2011 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2012. If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization ....................... right arrow

33 1/3% support test—2011. If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization ..................... right arrow

17a

10%-facts-and-circumstances test—2012. If the organization did not check a box on line 13, 16a, or 16b, and line 14
is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here. Explain
in Part IV how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization ..................................................... right arrow

10%-facts-and-circumstances test—2011. If the organization did not check a box on line 13, 16a, 16b, or 17a, and line
15 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here.
Explain in Part IV how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly
supported organization ................................................ right arrow

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

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)		(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)		(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.)..

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

Public support percentage for 2012 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2011 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2012 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2011 Schedule A, Part III, line 17 .............

19a

33 1/3% support tests—2012. If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization ........ right arrow

33 1/3% support tests—2011. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization ..... right arrow

Private foundation. If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions ..... right arrow

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:

- TIN:

Schedule B
(Form 990, 990-EZ,
or 990-PF)

Department of the Treasury
Internal Revenue Service

Schedule of Contributors

Attach to Form 990, 990-EZ, or 990-PF.

OMB No. 1545-0047

2012

Name of the organization

Indiana University Health LaPorte Hospital

Employer identification number

35-1125434

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

4947(a)(1) nonexempt charitable trust not treated as a private foundation

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

4947(a)(1) nonexempt charitable trust treated as a private foundation

501(c)(3) taxable private foundation

Check if your organization is covered by the General Rule or a Special Rule.
Note. Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.

General Rule

For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, $5,000 or more (in money or
property) from any one contributor. Complete Parts I and II.

Special Rules

For a section 501(c)(3) organization filing Form 990 or 990-EZ that met the 33¹/3% support test of the regulations
under sections 509(a)(1) and 170(b)(1)(A)(vi) and received from any one contributor, during the year, a contribution of the
greater of (1) $5,000 or (2) 2% of the amount on (i) Form 990, Part VIII, line 1h, or (ii) Form 990-EZ, line 1. Complete Parts I and II.

For a section 501(c)(7), (8), or (10) organization filing Form 990 or 990-EZ that received from any one contributor,
during the year, total contributions of more than $1,000 for use exclusively for religious, charitable,
scientific, literary, or educational purposes, or the prevention of cruelty to children or animals. Complete Parts I, II, and
III.

For a section 501(c)(7), (8), or (10) organization filing Form 990 or 990-EZ that received from any one contributor,
during the year, contributions for use exclusively for religious, charitable, etc., purposes, but these contributions did
not total to more than $1,000. If this box is checked, enter here the total contributions that were received during
the year for an exclusively religious, charitable, etc., purpose. Do not complete any of the parts unless the General Rule
applies to this organization because it received nonexclusively religious, charitable, etc., contributions of $5,000 or more
during the year ......................... Arrow Bullet

Caution. An organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2 of its Form 990; or check the box on line H of its
Form 990-EZ or on Part I, line 2 of its Form 990-PF, to certify that it does not meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).

For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.

Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2012)

Schedule B (Form 990, 990-EZ, or 990-PF) (2012)

Page 2

Name of organization Indiana University Health LaPorte Hospital

Part I	Contributors (see instructions). Use duplicate copies of Part I if additional space is needed.
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
RESTRICTED	RESTRICTED RESTRICTED RESTRICTED RESTRICTED, RESTRICTED RESTRICTED	$RESTRICTED	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2012)

Schedule B (Form 990, 990-EZ, or 990-PF) (2012)

Page 3

Name of organization Indiana University Health LaPorte Hospital

Part II	Noncash Property (see instructions). Use duplicate copies of Part II if additional space is needed.
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
Schedule B (Form 990, 990-EZ, or 990-PF) (2012)

Schedule B (Form 990, 990-EZ, or 990-PF) (2012)

Page 4

Name of organization
Indiana University Health LaPorte Hospital

Employer identification number

35-1125434

Part III

Exclusively religious, charitable, etc., individual contributions to section 501(c)(7), (8), or (10) organizations
that total more than $1,000 for the year. Complete columns (a) through (e) and the following line entry.
For organizations completing Part III, enter the total of exclusively religious, charitable, etc.,
contributions of $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet

$
Use duplicate copies of Part III if additional space is needed.

(a) No.
from
Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a) No.
from
Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a) No.
from
Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a) No.
from
Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

Schedule B (Form 990, 990-EZ, or 990-PF) (2012)

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

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

Indiana University Health LaPorte Hospital

Employer identification number

35-1125434

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 ........

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? ............

Yes No

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? ...................................

Yes No

Part II

Conservation Easements. Complete if the organization answered "Yes" to Form 990, Part IV, line 7.

Purpose(s) of conservation easements held by the organization (check all that apply).

Preservation of land for public use (e.g., recreation or education) Preservation of an historically important land area

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

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.


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

Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the tax year SchDMd Bullet

Number of states where property subject to conservation easement is located SchDMd Bullet

Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and
enforcement of the conservation easements it holds? .............................

Yes No

Staff and volunteer hours devoted to monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet

Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet

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)? .......................................

Yes No

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.

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.

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

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:

Revenues included in Form 990, Part VIII, line 1 .......................... SchDMd Bullet

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

Page 2

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)

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):

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.

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?........

Yes No

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.

Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................

Yes No

If "Yes," explain the arrangement in Part XIII and complete the following table:


c	Beginning balance .................................	1c
d	Additions during the year ..............................	1d
e	Distributions during the year .............................	1e
f	Ending balance ...................................	1f

Did the organization include an amount on Form 990, Part X, line 21? .....................

Yes No

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 ......

Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:

Board designated or quasi-endowment SchDMd Bullet

Permanent endowment SchDMd Bullet

Temporarily restricted endowment SchDMd Bullet

The percentages in lines 2a, 2b, and 2c should equal 100%.

Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes

(i) unrelated organizations ........................

3a(i)

(ii) related organizations ........................

3a(ii)

If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? .........

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		(b)Cost or other basis (other)	(c) Accumulated depreciation	(d) Book value
1a	Land .................	5,835,616		5,835,616
b	Buildings ................	49,468,390	31,490,435	17,977,955
c	Leasehold improvements ............	78,521,654	44,423,326	34,098,328
d	Equipment ................	96,339,591	62,886,002	33,453,589
e	Other .................	612,756	0	612,756
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......				91,978,244

Schedule D (Form 990) 2012

Page 3

Part VII

InvestmentsOther 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.)

Part VIII

InvestmentsProgram 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.)

Part IX

Other Assets. See Form 990, Part X, line 15.

(a) Description				(b) Book value









Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........

Part X

Other Liabilities. See Form 990, Part X, line 25.

1.(a) Description of liability		(b) Book value
Federal income taxes		0
DUE TO IU HEALTH CORPORATE		36,383,959
ESTIMATED 3RD PARTY SETTLEMENTS		4,227,880
TAIL LIABILITY		258,118
DUE TO PENSION		13,414,488
DUE TO DEFERRED COMP PLAN		17,275




Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)		54,301,720
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

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
FIN 48 Footnote from Financial Statements	Schedule D, Part XIV	Indiana University Health La Porte Hospital is a subsidiary in the consolidated financial statements of Indiana University Health, Inc. Indiana University Health, Inc. adopted FIN 48 in 2007. No disclosures were required under GAAP as Indiana University Health, Inc. does not have any material tax contingencies that required disclosures in the footnotes.

Schedule D (Form 990) 2012

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE H (Form 990)

Department of the Treasury
Internal Revenue Service

Hospitals

Complete if the organization answered "Yes" to Form 990, Part IV, question 20.
MediumBullet

Attach to Form 990. MediumBullet

See separate instructions.

OMB No. 1545-0047

2012

Open to Public Inspection

Name of the organization

Indiana University Health LaPorte Hospital

Employer identification number

35-1125434

Part I

Financial Assistance and Certain Other Community Benefits at Cost

Yes

Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a ...

Yes

If "Yes," was it a written policy? .......................

Yes

If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.

Applied uniformly to all hospital facilities Applied uniformly to most hospital facilities Generally tailored to individual hospital facilities

Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.

Did the organization use Federal Poverty Guidelines (FPG) as a factor in determining eligibility for providing free care?

If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:

Yes

100% 150% 200% Other %

Did the organization use FPG as a factor in determining eligibility for providing discounted care? If "Yes," indicate

which of the following was the family income limit for eligibility for discounted care: .........

Yes

200% 250% 300% 350% 400% Other %

If the organization used factors other than FPG in determining eligibility, describe in Part VI the income based criteria for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, as a factor in determining eligibility for free or discounted care.

Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? ..............

Yes

Did the organization budget amounts for free or discounted care provided under its financial assistance policy during the tax year? ............................

Yes

If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? ......

Yes

If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care? ..............

Did the organization prepare a community benefit report during the tax year? ..........

Yes

If "Yes," did the organization make it available to the public? ..............

Yes

Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.

Financial Assistance and Certain Other Community Benefits at Cost

Financial Assistance and Means-Tested Government Programs		(c) Total community benefit expense	(d) Direct offsetting revenue	(e) Net community benefit expense	(f) Percent of total expense
a	Financial Assistance at cost (from Worksheet 1) ..	4,784,572		4,784,572	2.560 %
b	Medicaid (from Worksheet 3, column a) ....	31,810,878	34,058,050	-2,247,172
c	Costs of other means-tested government programs (from Worksheet 3, column b) .
d	Total Financial Assistance and Means-Tested Government Programs .	36,595,450	34,058,050	2,537,400	2.560 %
Other Benefits		602,131	58,451	543,680	0.290 %
e	Community health improvement services and community benefit operations (from Worksheet 4) ..	602,131	58,451	543,680	0.290 %
f	Health professions education (from Worksheet 5) ..	857,933		857,933	0.460 %
g	Subsidized health services (from Worksheet 6) ..	699,793		699,793	0.370 %
h	Research (from Worksheet 7)	324,005		324,005	0.170 %
i	Cash and in-kind contributions for community benefit (from Worksheet 8)	486,707		486,707	0.260 %
j	Total. Other Benefits ..	2,970,569	58,451	2,912,118	1.550 %
k	Total. Add lines 7d and 7j .	39,566,019	34,116,501	5,449,518	4.110 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2012

Schedule H (Form 990) 2012

Page

Part II

Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.

		(c) Total community building expense	(d) Direct offsetting revenue	(e) Net community building expense	(f) Percent of total expense
1	Physical improvements and housing	12,547	0	12,547	0.010 %
2	Economic development	14,520	0	14,520	0.010 %
3	Community support	1,999	0	1,999	0 %
4	Environmental improvements
5	Leadership development and training for community members	7,106	0	7,106	0 %
6	Coalition building
7	Community health improvement advocacy	172	0	172	0 %
8	Workforce development	52,692		52,693	0.030 %
9	Other
10	Total	89,036	0	89,037	0.050 %

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

Did the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................

Yes

Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......

6,550,634

Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit. ......

4,784,572

Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.

Section B. Medicare

Enter total revenue received from Medicare (including DSH and IME).....

48,731,595

Enter Medicare allowable costs of care relating to payments on line 5.....

63,954,537

Subtract line 6 from line 5. This is the surplus (or shortfall)........

-15,222,942

Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:

Cost accounting system Cost to charge ratio Other

Section C. Collection Practices

Did the organization have a written debt collection policy during the tax year? ..........

Yes

If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI.......................

Yes

Part IV

Management Companies and Joint Ventures(owned 10% or more by officers, directors, trustees, key employees, and physicians—see instructions)

(a) Name of entity	(b) Description of primary activity of entity	(c) Organization's profit % or stock ownership %	(d) Officers, directors, trustees, or key employees' profit % or stock ownership %	(e) Physicians' profit % or stock ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13

Schedule H (Form 990) 2012

Page

Part VFacility Information

Section A. Hospital Facilities (list in order of size from largest to smallest—see instructions) How many hospital facilities did the organization operate during the tax year?2 Name, address, and primary website address						Facility reporting group
1	IU Health LaPorte Hospital PO BOX 250 1007 LINCOLNWAY LaPorte,IN46352	X	X	X	X	A
2	IU Health Starke Hospital 102 E CULVER RD Knox,IN46534	X	X		X	A

Schedule H (Form 990) 2012

Page

Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)

	A
Name of hospital facility or facility reporting group

For single facility filers only: line Number of Hospital Facility (from Schedule H, Part V, Section A)

Yes

Community Health Needs Assessment (Lines 1 through 8c are optional for tax years begining on or before March 23, 2012)

During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 9....................

If “Yes,” indicate what the CHNA report describes (check all that apply):

A definition of the community served by the hospital facility

Demographics of the community

Existing health care facilities and resources within the community that are available to respond to the health needs of the community

How data was obtained

The health needs of the community

Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups

The process for identifying and prioritizing community health needs and services to meet the community health needs

The process for consulting with persons representing the community’s interests

Information gaps that limit the hospital facility’s ability to assess the community’s health needs

Other (describe in Part VI)

Indicate the tax year the hospital facility last conducted a CHNA: 20

In conducting its most recent CHNA, did the hospital facility take into account input from representatives of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted ....................

Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI................................

Did the hospital facility make its CHNA report widely available to the public? .............

If “Yes,” indicate how the CHNA report was made widely available (check all that apply):

Hospital facility’s website

Available upon request from the hospital facility

Other (describe in Part VI)

If the hospital facility addressed needs identified in its most recently conducted CHNA, indicate how (check all that apply to date):

Adoption of an implementation strategy that addresses each of the community health needs identified through the CHNA

Execution of the implementation strategy

Participation in the development of a community-wide plan

Participation in the execution of a community-wide plan

Inclusion of a community benefit section in operational plans

Adoption of a budget for provision of services that address the needs identified in the CHNA

Prioritization of health needs in its community

Prioritization of services that the hospital facility will undertake to meet health needs in its community

Other (describe in Part VI)

Did the hospital facility address all of the needs identified in its most recently conducted CHNA? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs ........

Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)? ...........................

If "Yes" to line 8a, did the organization file Form 4720 to report the section 4959 excise tax? ......

If "Yes" to line 8b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $

Schedule H (Form 990) 2012

Page

Part VFacility Information (continued)

Financial Assistance Policy			Yes	No
9	Did the hospital facility have in place during the tax year a written financial assistance policy that:
	Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care?	9	Yes
10	Used federal poverty guidelines (FPG) to determine eligibility for providing free care?...........	10	Yes
	If "Yes," indicate the FPG family income limit for eligibility for free care: 100% If "No," explain in Part VI the criteria the hospital facility used.
11	Used FPG to determine eligibility for providing discounted care?.................	11	Yes
	If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 400.% If "No," explain in Part VI the criteria the hospital facility used.
12	Explained the basis for calculating amounts charged to patients?.................	12	Yes
	If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a	Income level
b	Asset level
c	Medical indigency
d	Insurance status
e	Uninsured discount
f	Medicaid/Medicare
g	State regulation
h	Other (describe in Part VI)
13	Explained the method for applying for financial assistance?...................	13	Yes
14	Included measures to publicize the policy within the community served by the hospital facility?.......	14	Yes
	If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a	The policy was posted on the hospital facility’s website
b	The policy was attached to billing invoices
c	The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d	The policy was posted in the hospital facility’s admissions offices
e	The policy was provided, in writing, to patients on admission to the hospital facility
f	The policy was available upon request
g	Other (describe in Part VI)
Billing and Collections
15	Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?.......	15	Yes
16	Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a	Reporting to credit agency
b	Lawsuits
c	Liens on residences
d	Body attachments
e	Other similar actions (describe in Part VI)
17	Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?..........	17		No
	If “Yes,” check all actions in which the hospital facility or a third party engaged:
a	Reporting to credit agency
b	Lawsuits
c	Liens on residences
d	Body attachments
e	Other similar actions (describe in Part VI)

Schedule H (Form 990) 2012

Page

Part VFacility Information (continued)

Indicate which efforts the hospital facility made before initiating any of the actions listed in line 17 (check all that apply):

Notified individuals of the financial assistance policy on admission

Notified individuals of the financial assistance policy prior to discharge

Notified individuals of the financial assistance policy in communications with the patients regarding the patients’ bills

Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy

Other (describe in Part VI)

Policy Relating to Emergency Medical Care

Yes

Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?..........

Yes

If “No,” indicate why:

The hospital facility did not provide care for any emergency medical conditions

The hospital facility’s policy was not in writing

The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)

Other (describe in Part VI)

Charges to Individuals Eligible for Assistance under the FAP (FAP-Eligible Individuals)

Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.

The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged

The hospital facility used the average of its three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged

The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged

Other (describe in Part VI)

During the tax year, did the hospital facility charge any FAP-eligible individuals to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care? ............................

If “Yes,” explain in Part VI.

During the tax year, did the hospital facility charge any FAP-eligible individuals an amount equal to the gross charge for any service provided to that individual? .........................

If “Yes,” explain in Part VI.

Schedule H (Form 990) 2012

Page

Part VFacility Information (continued)

Section C. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility (list in order of size, from largest to smallest) How many non-hospital health care facilities did the organization operate during the tax year?12
Name and address		Type of Facility (describe)
1	IU Health Lakeshore Surgicare LLC 3111 Village Pointe Chesterton,IN46304	Surgicenter
2	Rehab at the Crossing 1203 Washington Street LaPorte,IN46350	Physical Therapy Services
3	Heart and Vascular Institute 901 Lincolnway LaPorte,IN46350	Cardiac Rehab
4	Lifeworks 3777 N Frontage Road Michigan City,IN46360	Physical Therapy, Diagnostic Imaging, and CVL Diagnostics
5	VNA 901 S Woodland Michigan City,IN46360	Home Health
6	Community Health and Dental Centers 400 Teegarden Street LaPorte,IN46350	Community Health Center
7	Lifeplex Diagnostic Imaging 2855 Miller Drive Plymouth,IN46563	Diagnostic Imaging
8	Legacy Building 1300 State Street LaPorte,IN46350	Neuro Sleep
9	Founders Square 15105 State Street LaPorte,IN46350	Pediatric Rehab, Lab
10	New Carlisle Wellness & Rehab 8988 E US HWY 20 New Carlisle,IN46552	Physical Therapy
11	Westville Wellness & Rehab 156 N Flynn Road LaPorte,IN46350	Physical Therapy Services
12	Michiana Hematology Oncology 1668 S US 421 Westville,IN46391	Lab

Schedule H (Form 990) 2012

Page

Part VI

Supplemental Information

Complete this part to provide the following information.

1	Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II; Part III, lines 4, 8, and 9b; Part V, Section A; and Part V, Section B, lines 1j, 3, 4, 5c, 6i, 7, 10, 11, 12h, 14g, 16e, 17e, 18e, 19c, 19d, 20d, 21, and 22.
2	Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any needs assessments reported in Part V, Section B.
3	Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4	Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5	Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6	Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7	State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.
8	Facility reporting group(s). If applicable, for each hospital facility in a facility reporting group provide the descriptions required for Part V, Section B, lines 1j, 3, 4, 5c, 6i, 7, 10, 11, 12h, 14g, 16e, 17e, 18e, 19c, 19d, 20d, 21, and 22.

Identifier	ReturnReference	Explanation
Part I, Line 6a		INDIANA UNIVERSITY HEALTH LAPORTE HOSPITAL'S (IUHLH) COMMUNITY BENEFIT REPORT IS INCLUDED IN INDIANA UNIVERSITY HEALTH, INC.'S ANNUAL BENEFIT REPORT DISTRIBUTED TO NUMEROUS COMMUNITY MEMBERS.
Part I, Line 7, column (f)		$23,144,494 IS THE AMOUNT OF BAD DEBT EXPENSE THAT WAS EXCLUDED FROM THE CALCULATION OF COMMUNITY BENEFIT EXPENSE PERCENTAGE REPORTED ON PART I, LINE 7, COLUMN F.
Part I, Line 7		THE COST TO CHARGE RATIO THAT WAS CALCULATED IN PART I, LINE 7, WAS USED IN CALCULATING THE EXPENSE AT COST FOR THE APPROPRIATE CATEGORIES.
Part II - Community Building Activities		IUHLH PROVIDES SEVERAL KEY ACTIVITIES WITHIN THIS CATEGORY, MOST NOTABLY, PROJECT SEARCH. IUHLH PARTICIPATES IN PROJECT SEARCH OF INDIANA, WHICH IS A TRANSITION PROGRAM FOR HIGH SCHOOL STUDENTS WITH DISABILITIES THAT PROVIDES SKILLS, TRAINING AND WORK EXPERIENCE. IUHLH IS THE FIRST AND PRESENTLY THE ONLY EMPLOYER IN LAPORTE COUNTY TO PARTICIPATE IN THE NATIONWIDE PROGRAM. THE PROJECT SEARCH PARTNERSHIP WITH IUHLH ENABLES STUDENTS WITH DISABILITIES TO NOT ONLY DEVELOP AN UNDERSTANDING OF THE REAL WORLD OF WORK, BUT TO ALSO DEVELOP THE SKILLS NECESSARY TO SUCCESSFULLY PURSUE FUTURE EMPLOYMENT OPPORTUNITIES.
Part III, Line 4		BAD DEBT EXPENSE FOR 2012 TOTALS $23,144,494 BUT WAS RECORDED AT COST AS $6,843,827 . COST TO CHARGE RATIO WAS THE METHOD OF CHOICE FOR THE 2012 DATA INPUT. IUHLH'S BAD DEBT EXPENSE (AT COST) CALCULATION WAS ARRIVED AT BY MULTIPLYING THE COST TO CHARGE RATIO BY THE TOTAL BAD DEBT EXPENSE THAT THE ORGANIZATION INCURRED.
Part III, Line 8		THE MEDICARE SHORTFALL REPORTED ON SCHEDULE H, PART III LINE 8 IS CALCULATED IN ACCORDANCE WITH THE FORM 990 INSTRUCTIONS, USING ALLOWABLE COST PER MEDICARE COST REPORT. ALLOWABLE COSTS FOR MEDICARE COST REPORT PURPOSES ARE NOT REFLECTIVE OF ALL COSTS ASSOCIATED WITH IU HEALTH LAPORTE HOSPITALS PARTICIPATION IN MEDICARE PROGRAMS. FOR EXAMPLE, THE MEDICARE COST REPORT EXCLUDES CERTAIN COSTS SUCH AS BILLED PHYSICIANS SERVICES, COST OF MEDICARE PARTS C & D, FEE SCHEDULE REIMBURSED SERVICES, AND DURABLE MEDICAL EQUIPMENT SERVICES. INCLUSION OF ALL COSTS ASSOCIATED WITH IU HEALTH LAPORTE HOSPITALS PARTICIPATION IN MEDICARE PROGRAMS WOULD SIGNIFICANTLY INCREASE THE MEDICARE SHORTFALL REPORTED ON SCHEDULE H, PART III, LINE 8. IUHLH'S MEDICARE SHORTFALL IS ATTRIBUTABLE TO REIMBURSEMENTS THAT ARE LESS THAN THE COST OF PROVIDING PATIENT CARE AND SERVICES TO MEDICARE BENEFICIARIES AND DOES NOT INCLUDE ANY AMOUNT THAT RESULTS FROM INEFFICIENCIES OR POOR MANAGEMENT. IUHLH ACCEPTS ALL MEDICARE PATIENTS KNOWING THAT THERE MAY BE SHORTFALLS; THEREFORE IT HAS TAKEN THE POSITION THAT THE SHORTFALL SHOULD BE COUNTED AS PART OF THE COMMUNITY BENEFIT. ADDITIONALLY, IT IS IMPLIED IN THE INTERNAL REVENUE SERVICE REVENUE RULING 69-545 THAT TREATING MEDICARE PATIENTS IS A COMMUNITY BENEFIT. REVENUE RULING 69-545, WHICH ESTABLISHED THE COMMUNITY BENEFIT STANDARD FOR NON-PROFIT HOSPITALS, STATES THAT IF A HOSPITAL SERVES PATIENTS WITH GOVERNMENTAL BENEFIT, INCLUDING MEDICARE, THEN THIS IS AN INDICATION THAT THE HOSPITAL OPERATES TO PROMOTE THE HEALTH OF THE COMMUNITY.
Part III, Line 9b		PROCEDURE ON COLLECTION PRACTICES (EXCERPT FROM FINANCIAL ASSISTANCE POLICY FOR IUHLH): 1. Patients must request assistance, complete, and sign a Financial Assistance application. 2. Upon receipt of the Financial Assistance application, the Financial Counselor will first determine if the guarantor qualifies for Financial Assistance. If the guarantor qualifies for Financial Assistance, they will be notified and the account adjusted per the write off/adjustment. 3. If the guarantor does not qualify for Financial Assistance but qualifies for Limited Means, a reduction in liability will be made to the account and the guarantor will be notified via mail. At the guarantor's request, payment arrangements will be made for the remaining balance. 4. If the guarantor does not qualify for Financial Assistance or Limited Means assistance and has been determined to be Uninsured, a discount will be made to the account and the guarantor will be notified via mail. At the guarantor's request, payment arrangements will be made on the remaining balance. 5. For guarantors who do not qualify for Financial Assistance or Limited Means assistance exceeding the household income threshold refer to the Over 400% FPL Policy. 6. Accounts that are to be considered will continue to age through our collection process, including referral to an outside reporting collection agency unless a Financial Counselor determines grounds for a suspension. Refer to the Financial Assistance Suspension Policy. 7. Patient complaints/dissatisfaction may be turned over to our Reconsideration Team (Financial Counselors) for the determination of a possible reconsideration. Refer to the Financial Assistance Reconsideration Policy.
Part V, Section B, Line 3		IU Health System collaborated with other organizations and agencies in conducting the needs assessment for the IU Health La Porte Hospital Community. These Collaborating organizations are listed on page 9 of the CHNA. To gather qualitative data for its CHNA, the approach consisted of a multi-component approach to identify and verify community health needs for the service area. We hosted multiple one and a half to two hour community conversation focus groups with public health officials and community leaders in attendance to discuss the healthcare needs for the service area and what role IU Health La Porte could play in addressing the identified needs. In addition, we surveyed the community at large through the hospital's website, with special emphasis to garner input from low income, uninsured or minority groups. Refer to pages 30 & 31 for list of participants.
Part V, Section B, Line 4		IU HEALTH LAPORTE HOSPITAL CONDUCTED THEIR NEEDS ASSESSMENT WITH IU HEALTH STARKE HOSPITAL AND IU HEALTH STARKE HOSPITAL IN TURN CONDUCTED THEIR NEEDS ASSESSMENT WITH IU HEALTH LAPORTE HOSPITAL.
Part V, Section B, Line 7		IU HEALTH LAPORTE & STARKE ADDRESS ALL OF THE NEEDS IDENTIFIED IN THE MOST RECENTLY CONDUCTED NEEDS ASSESSMENT. THIS WAS DONE VIA THE STRATEGIC PLAN AND ADDRESSED COMMUNITY HEALTH AND WELLNESS WITH 3 MAJOR GOALS IN 2009-2011: 1) ENHANCE EFFECTIVE COMMUNICATION THROUGH INCREASED EDUCATION AND AWARENESS, 2) ENCOURAGE WELLNESS AND PREVENTION, 3) ENHANCE ACCESS TO HEALTH CARE FOR UNINSURED AND UNDERINSURED AND THOSE WITH UNMET NEEDS. ACTION PLANS INCLUDED EDUCATION, HEALTH FAIRS, FREE PUBLIC SCREENINGS, ETC. IN 2012-2014, THE ACTION PLANS INCLUDE COMMUNITY FOCUSED WELLNESS AND HEALTH EDUCATION. THE PHILANTHROPY MISSION SUPPORTS THESE INITIATIVES WITH FUNDS. THIS YEAR WE ARE FOCUSING ON EDUCATION PARTICIPATION (SMOKING CESSATION, HEALTHY EATING, ETC.), SCREENINGS (DIABETES, OSTEOPOROSIS, ETC.), WELLNESS PARTICIPANTS (PHYSICAL ACTIVITIES VIA FITNESS FRIDAYS, ETC.) AND WE WILL INCREASE THE NUMBER OF COMMUNITY BENEFIT DOLLARS AND VOLUNTEER HOURS TO MAKE THESE HAPPEN.
Part VI, Line 2 - Needs Assessment		THE 2012 IU HEALTH LA PORTE CHNA HAS FOUR MAIN OBJECTIVES: 1) DEVELOP A COMPREHENSIVE PROFILE OF HEALTH STATUS, QUALITY OF CARE, AND CARE MANAGEMENT INDICATORS OVERALL AND BY COUNTY FOR THOSE RESIDING WITHIN THE IU HEALTH LA PORTE SERVICE AREA, SPECIFICALLY WITHIN THE PRIMARY SERVICE AREA (PSA) OF LA PORTE COUNTY, INDIANA, 2) IDENTIFY THE PRIORITY HEALTH NEEDS (PUBLIC HEALTH AND HEALTHCARE) WITHIN THE IU HEALTH LA PORTE PSA, 3) SERVE AS A FOUNDATION FOR DEVELOPING SUBSEQUENT DETAILED RECOMMENDATIONS ON IMPLEMENTATION STRATEGIES THAT CAN BE UTILIZED BY HEALTHCARE PROVIDERS, COMMUNITIES, AND POLICY MAKERS IN ORDER TO IMPROVE THE HEALTH STATUS OF THE IU HEALTH LA PORTE COMMUNITY AND 4) SUPPLY PUBLIC ACCESS TO THE CHNA RESULTS IN ORDER TO INFORM THE COMMUNITY AND PROVIDE ASSISTANCE TO THOSE INVESTED IN THE TRANSFORMATION TO THE COMMUNITY'S HEALTHCARE NETWORK.
Part VI, Line 3 - Patient Education of Eligibility for Assistance		Brochures are distributed through Financial Counselors who are available for those in need of financial assistance. The hospital has a Community Health Center which provides education and assistance via "Covering Kids and Families" along with many other programs and events.
Part VI, Line 4 - Community Information		LA PORTE COUNTY: POPULATION: 111,268 WHITE: 85% BLACK: 11% THERE ARE 6,601 HISPANICS AND IT'S PROJECTED TO GROW TO 7,906 BY 2017. ACCORDING TO THOMSON REUTER'S HEALTHVIEW PLUS SURVEY, 20.8% OF HOUSEHOLDS HAD DIFFICULTY PAYING FOR HEALTH CARE SERVICES AND THE UNINSURED RATE IS 12%. LA PORTE COUNTY WAS RANKED 65 OUT OF 92 IN 2012 ACCORDING TO WWW.COUNTYHEALTHRANKINGS.COM OBESITY IS A MAJOR RISK FACTOR FOR CV DISEASE, CERTAIN TYPES OF CANCER AND TYPE 2 DIABETES. LA PORTE COUNTY'S OBESITY RATE IS 29.1% AND DIAGNOSED DIABETES IS 10.9% (ACCORDING TO THE CDC).
Part VI, Line 5 - Promotion of Community Health		Through community outreach activities, screenings, health fairs and the CHNA.
Part VI, Line 6 - Affiliated Health Care System Roles		IUHLH HAS BEEN AFFILIATED WITH INDIANA UNIVERSITY HEALTH, INC. (IUH) SINCE 1998. THIS PARTNERSHIP ENABLES IUHLH TO OPERATE AUTONOMOUSLY THROUGH A LOCAL BOARD WHILE RECEIVING THE NEEDED CAPITAL THROUGH IUH. THIS PARTNERSHIP HAS PROVEN SUCCESSFUL THROUGH SEVERAL DIFFERENT PROGRAMS. THROUGH THE IU HEALTH NAME, OUR COMMUNITY HEALTH RESOURCE CENTER, HEALTHQUARTERS, CAN TAP INTO MANY DATABASES FOR THE PUBLIC. RESEARCH CAN BE DONE FREE OF CHARGE THROUGH NUMEROUS MEMBERSHIP SITES BY COMMUNITY MEMBERS LOOKING TO GATHER HEALTH INFORMATION.
Part VI, Line 7 - State filing of community benefit report		Indiana

Schedule H (Form 990) 2012

Additional Data

Software ID:
Software Version:

- TIN:

Schedule I
(Form 990)

Department of the Treasury
Internal Revenue Service

Grants and Other Assistance to Organizations,
Governments and Individuals in the United States

Complete if the organization answered "Yes," to Form 990, Part IV, line 21 or 22.
lBullet

Attach to Form 990

OMB No. 1545-0047

2012

Open to Public
Inspection

Name of the organization
Indiana University Health LaPorte Hospital

Employer identification number
35-1125434

Part I

General Information on Grants and Assistance

Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ....................................

Yes No

Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.

Part II

Grants and Other Assistance to Governments and Organizations in the United States. Complete if the organization answered "Yes" to
Form 990, Part IV, line 21, for any recipient that received more than $5,000. Part II can be duplicated if additional space is needed.

(a) Name and address of organization or government	(b) EIN	(c) IRC Code section if applicable	(d) Amount of cash grant	(h) Purpose of grant or assistance
(1) Purdue University North Central 1401 S US Hwy 421 Westville,IN46391	35-6002041	501(c)(3)	25,000	Promote community health/wellness
(2) Unity Foundation of LaPorte County PO Box 527 Michigan City,IN46360	35-1658674	501(c)(3)	12,500	Greater LaPorte Economic Dev. Corp & Michigan City Develop. Corp.
(3) INDIANA UNIVERSITY MEDICAL FOUNDATION PO Box 660245 Indianapolis,IN46266	35-6001673	501(c)(3)	15,000	To support medical education
(4) LaPorte County Symphony Orchestra PO Box 563 LaPorte,IN46350	23-7878110	501(c)(3)	15,000	To promote cancer services
(5) Harmony House - Casa Program 1005 Michigan Ave LaPorte,IN46350	35-2073521	501(c)(3)	10,000	Promote community health/wellness
(6) LAPORTE COUNTY COUNCIL ON AGING 800 MICHIGAN AVE LAPORTE,IN46350	23-7314112	501(C)(3)	25,000	PROMOTE COMM. HEALTH/WELLNESS
(7) Komen Northern Indiana PO Box 4157 South Bend,IN46634	56-2583632	501(c)(3)	15,000	Promote Community health/wellness
(8) Notre Dame Sports Properties 113 Joyce Center South Bend,IN46556	35-2122791		17,500	Promote Community health/wellness

Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................ Bullet Image

Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50055P

Schedule I (Form 990) 2012

Page 2

Part III

Grants and Other Assistance to Individuals in the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 22.
Part III can be duplicated if additional space is needed.

(a)Type of grant or assistance	(b)Number of recipients	(c)Amount of cash grant
(1) Critical Occupation Scholarships	7	45,578
(2) IU HEALTH LAPORTE PHYSICIAN LEGACY AWARD	3	15,000

Part IV

Supplemental Information.

Complete this part to provide the information required in Part I, line 2, Part III, column (b), and any other additional information.

Identifier	Return Reference	Explanation
Description of Organization's Procedures for Monitoring the Use of Grants	Schedule I, Part IV	Educational Scholarships are awarded to individuals for further education for occupations that have a critical need within the hospital system. Educational Scholarships awarded were $45,578 in total. Seven individuals received scholarships in excess of $5,000. Legacy Scholarships are awarded from IU HEALTH LAPORTE PHYSICIAN in 2012 total amount awarded to two individuals was $30,000. ALTHOUGH THE ORGANIZATION DOES NOT MONITOR THE USE OF GRANTS ONCE THEY HAVE BEEN DISBURSED, THROUGH DUE DILIGENCE, THE RECIPIENTS HAVE BEEN DETERMINED TO BE REPUTABLE ORGANIZATIONS WHO USE THE FUNDS FOR THEIR INTENDED CHARITABLE PURPOSE.

Schedule I (Form 990) 2012

Additional Data

Software ID:
Software Version:

- TIN:

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

Indiana University Health LaPorte Hospital

Employer identification number

35-1125434

Part I

Questions Regarding Compensation

Yes

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.

First-class or charter travel Housing allowance or residence for personal use

Travel for companions Payments for business use of personal residence

Tax idemnification and gross-up payments Health or social club dues or initiation fees

Discretionary spending account Personal services (e.g., maid, chauffeur, chef)

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....

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? .......

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.

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

Form 990 of other organizations Approval by the board or compensation committee

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:

Receive a severance payment or change-of-control payment? ................

Yes

Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........

Yes

Participate in, or receive payment from, an equity-based compensation arrangement? .........

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.

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:

The organization? ...........................

Any related organization? .........................

If "Yes," to line 5a or 5b, describe in Part III.

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:

The organization? ...........................

Any related organization? .........................

If "Yes," to line 6a or 6b, describe in Part III.

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 ............

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 .............................

If "Yes" to line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50053T

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
(A) Name and Title		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable 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
(1)DR BRIAN MOOREBOARD MEMBER PHYSICIAN	(i) (ii)	0 321,300	0 17,511	0 24,741	0 5,000	0 9,453	0 378,005	0 0
(2)DR MARTIN MURPHYBOARD MEMBER / PAST PRESIDENT	(i) (ii)	57,855 246,290	0 40,751	0 31,253	0 5,000	0 4,001	57,855 327,295	0 0
(3)G THOR THORDARSONPRESIDENT/CEO	(i) (ii)	399,756 0	200 0	25,610 0	5,000 0	8,563 0	439,129 0	0 0
(4)MARK RAFALSKICOO/CFO	(i) (ii)	255,733 0	200 0	20,585 0	5,000 0	8,053 0	289,571 0	0 0
(5)CONNIE FORDVP HUMAN RESOURCES	(i) (ii)	177,227 0	200 0	13,296 0	3,900 0	10,302 0	204,925 0	0 0
(6)ANITA IVANKOVIGFORMER VP NURSING	(i) (ii)	7,140 0	0	170,897 0	0	993 0	179,030 0	18,095 0
(7)LINDA SATKOSKICEO Starke / COO	(i) (ii)	303,961 0	1,000 0	20,863 0	5,000 0	9,721 0	340,545 0	30,629 0
(8)DR NADEEM KAMRANPHYSICIAN	(i) (ii)	307,110 0	6,733 0	41,142 0	5,308 0	10,886 0	371,179 0	0 0
(9)DR VINAY TUMULURIPHYSICIAN	(i) (ii)	401,953 0	20,128 0	32,197 0	5,000 0	9,006 0	468,284 0	0 0
(10)DR SONALI SHUKLAPHYSICIAN	(i) (ii)	293,839 0	100 0	23,619 0	5,000 0	4,346 0	326,904 0	0 0
(11)DAVID D HOUGHPHYSICIAN	(i) (ii)	338,351 0	100 0	26,845 0	5,000 0	5,926 0	376,222 0	0 0
(12)SYED M SHAN UL ISLAPHYSICIAN	(i) (ii)	316,653 0	31,350 0	14,347 0	5,216 0	3,512 0	371,078 0	0 0
(13)DAVID W HYATTCEO STARKE (from 6/12)	(i) (ii)	125,610 0	0 0	26,760 0	3,086 0	3,720 0	159,176 0	0 0

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, Line 4A		Anita Ivankovig received severance in the amount of $159,610. Schedule J, Part I, Line 4B Certain executives participate in a supplemental retirement plan, 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. The Executives that participated in this program are as follows: Dr. Brian Moore; Dr. Martin Murphy; G. Thor Thordarson; Mark Rafalski; Connie Ford; Stephanie Smith; Linda Satkoski; David Hyatt; Vinay Tumuluri; David Hough; Nadeem Kamran; and Sonali Shukla.

Schedule J (Form 990) 2012

Additional Data

Software ID:
Software Version:

- TIN:

Schedule L
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Transactions with Interested Persons

Complete if the organization answered
"Yes" on Form 990, Part IV, lines 25a, 25b, 26, 27, 28a, 28b, or 28c,
or Form 990-EZ, Part V, line 38a or 40b.
MediumBullet

Attach to Form 990 or Form 990-EZ. MediumBullet

See separate instructions.

OMB No. 1545-0047

2012

Open to Public Inspection

Name of the organization

Indiana University Health LaPorte Hospital

Employer identification number

35-1125434

Part I

Excess Benefit Transactions (section 501(c)(3) and section 501(c)(4) organizations only).
Complete if the organization answered "Yes" on Form 990, Part IV, line 25a or 25b, or Form 990-EZ, Part V, line 40b.

1(a) Name of disqualified person	(c) Description of transaction	(d) Corrected?
1(a) Name of disqualified person	(c) Description of transaction	Yes	No

Enter the amount of tax incurred by organization managers or disqualified persons during the year under section 4958. ........................... Bullet Image

Enter the amount of tax, if any, on line 2, above, reimbursed by the organization ....... Bullet Image

Part II

Loans to and/or From Interested Persons.
Complete if the organization answered "Yes" on Form 990-EZ, Part V, line 38a, or Form 990, Part IV, line 26; or if the organization reported an amount on Form 990, Part X, line 5, 6, or 22

(a) Name of interested person	(b) Relationship with organization	(c) Purpose of loan	(d) Loan to or from the organization?		(e)Original principal amount	(f)Balance due	(g) In default?		(h) Approved by board or committee?		(i)Written agreement?
(a) Name of interested person	(b) Relationship with organization	(c) Purpose of loan	To	From	(e)Original principal amount	(f)Balance due	Yes	No	Yes	No	Yes	No






Total ...... $

Part III

Grants or Assistance Benefitting Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 27.

(a) Name of interested person	(b) Relationship between interested person and the organization	(c) Amount of assistance	(d) Type of assistance	(e) Purpose of assistance

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 50056A

Schedule L (Form 990 or 990-EZ) 2012

Page 2

Part IV

Business Transactions Involving Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 28a, 28b, or 28c.

(a) Name of interested person	(b) Relationship between interested person and the organization	(c) Amount of transaction	(d) Description of transaction	(e) Sharing of organization's revenues?
(a) Name of interested person		(c) Amount of transaction	(d) Description of transaction	Yes	No
(1) KIM FORD	SEE PART V	67,014	COMPENSATION		No

Part V

Supplemental Information
Complete this part to provide additional information for responses to questions on Schedule L (see instructions).

Identifier	Return Reference	Explanation
BUSINESS TRANSACTIONS WITH INTERESTED PERSONS	SCHEDULE L, PART IV, LINE 1, COLUMN B	RELATIONSHIP: KIM FORD IS THE DAUGHTER-IN-LAW OF CONNIE FORD, KEY EMPLOYEE OF IUHLH.

Schedule L (Form 990 or 990-EZ) 2012

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE M
(Form 990)

Department of the Treasury

Internal Revenue Service

Noncash Contributions

Complete if the organizations answered "Yes" on Form 990, Part IV, lines 29 or 30.
Right pointing arrow large image

Attach to Form 990.

OMB No. 1545-0047

2012

Open to Public Inspection

Name of the organization

Indiana University Health LaPorte Hospital

Employer identification number

35-1125434

Part I

Types of Property

	(a) Check if applicable	(b) Number of contributions or items contributed	(c) Noncash contribution amounts reported on Form 990, Part VIII, line 1g	(d) Method of determining noncash contribution amounts
1 Art—Works of art ....
2 Art—Historical treasures .
3 Art—Fractional interests ..
4 Books and publications ..
5 Clothing and household goods .......
6 Cars and other vehicles ..
7 Boats and planes ....
8 Intellectual property ...
9 Securities—Publicly traded .
10 Securities—Closely held stock .
11 Securities—Partnership, LLC, or trust interests ....
12 Securities—Miscellaneous ..
13 Qualified conservation contribution—Historic structures .....
14 Qualified conservation contribution—Other ...
15 Real estate—Residential .
16 Real estate—Commercial ..
17 Real estate—Other ...
18 Collectibles .....
19 Food inventory ...
20 Drugs and medical supplies .
21 Taxidermy ......
22 Historical artifacts ....
23 Scientific specimens ..
24 Archeological artifacts ...
25 Other ( EQUIPMENT )	X	13	134,858	OTHER
26 Other ( CHC OPER & ACCESS TO HC )	X	1	122,508	OTHER
27 Other ( )
28 Other ( )

Number of Forms 8283 received by the organization during the tax year for contributions
for which the organization completed Form 8283, Part IV, Donee Acknowledgement ...

Yes

30a

During the year, did the organization receive by contribution any property reported in Part I, lines 1-28 that it

must hold for at least three years from the date of the initial contribution, and which is not required to be used

for exempt purposes for the entire holding period? ..................

30a

If "Yes," describe the arrangement in Part II.

Does the organization have a gift acceptance policy that requires the review of any non-standard contributions?

Yes

32a

Does the organization hire or use third parties or related organizations to solicit, process, or sell noncash

contributions? ..........................

32a

Yes

If "Yes," describe in Part II.

If the organization did not report an amount in column (c) for a type of property for which column (a) is checked,

describe in Part II.

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 51227J

Schedule M (Form 990) (2012)

Page 2

Part II

Supplemental Information. Complete this part to provide the information required by Part I, lines 30b,
32b, and 33, and whether the organization is reporting in Part I, column (b), the number of contributions, the number of items received, or a combination of both. Also complete this part for any additional information.

Identifier	Return Reference	Explanation
LaPorte Hospital Foundation & Community Dental Center	Schedule M, Non-Cash Contributions	LaPorte Hospital Foundation is our related organization that solicits, receives & processes donor designated gifts. The LaPorte Hospital Foundation will purchase hospital clinical, dietary, patient safety, homecare, hospice types of equipment with unrestricted donor dollars. The equipment selected by the LaPorte Hospital Foundation for purchase are based on the Strategic initiatives of the Hospital. Twice a year, the LaPorte Hospital Foundation will transfer the equipment to the hospital's general ledger. The equipment then becomes an asset of LaPorte Hospital and is depreciated on the hospital's general ledger.

Schedule M (Form 990) (2012)

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
MediumBullet

Attach to Form 990 or 990-EZ.

OMB No. 1545-0047

2012

Open to Public
Inspection

Name of the organization

Indiana University Health LaPorte Hospital

Employer identification number

35-1125434

Identifier	Return Reference	Explanation
Other Program Services	Form 990, Part III, Line 4d	Through Indiana University Health La Porte Hospital's pledge for charitable care, community health improvement, community education and research, as well as our commitment to direct charitable support for area programs, we are dedicated to improving the health of our community. We are constantly interacting with our communities to identify and meet the needs to keep people healthy.
Description of Classes of Members or Stockholders	Form 990, Part VI, Lines 6, 7a & 7b	INDIANA UNIVERSITY HEALTH LAPORTE HOSPITAL (IUHLH) HAS A SOLE MEMBER, INDIANA UNIVERSITY HEALTH, INC. (IUH) LIMITED APPROVAL POWERS - IUH SHALL HAVE THE FOLLOWING LIMITED APPROVAL POWERS FOR MATTERS RELATING TO IUHLH: -AMENDMENTS TO ARTICLES OF INCORPORATION AND BYLAWS; -AFFILIATIONS, MERGERS, CONSOLIDATIONS AND JOINT VENTURES; -JOINT APPOINTMENT/RETENTION OF CEO; -RATIFICATION OF LOCALLY APPOINTED DIRECTORS; -RATIFICATION OF CAPITAL AND OPERATING BUDGETS; -RATIFICATION OF STRATEGIC PLANS AND AMENDMENTS THERETO; -ENCUMBRANCE, SALE OR CONVEYANCE OF ASSETS IN EXCESS OF 5% OF IUHLH'S NET BOOK VALUE; -ISSUANCE OR GUARANTEE OF DEBT IN EXCESS OF 5% OF IUHLH'S NET BOOK VALUE; -AUTHORIZATION OF CAPITAL BUDGET DEVIATIONS (NORMAL) IN EXCESS OF 10% OF IUHLH'S ANNUAL CAPITAL BUDGET; -AUTHORIZATION OF CAPITAL BUDGET DEVIATIONS (SPECIAL PROJECTS) IN EXCESS OF 10% OF THE PROJECT BUDGET; -AUTHORIZATION OF OPERATING BUDGET DEVIATIONS IN EXCESS OF 10% OF IUHLH'S BUDGETED NET INCOME; AND -AUTHORIZATION OF UNBUDGETED ASSET TRANSFERS IN EXCESS OF 3.75% OF IUHLH'S BUDGETED NET INCOME. IN THE EVENT IUH AND IUHLH FAIL TO REACH AGREEMENT ON ANY OF THE FOREGOING MATTERS, IUH AGREES TO GIVE DUE CONSIDERATION TO IUHLH'S CONCERNS BEFORE MAKING ANY FINAL DECISION REGARDING THESE MATTERS. IUH ADDITIONAL LIMITED POWERS - IF IUHLH FAILS TO MEET THE PERFORMANCE STANDARDS SET FORTH ABOVE, IUH MAY EXERCISE THE FOLLOWING ADDITIONAL LIMITED POWERS (THE "ADDITIONAL LIMITED POWERS") WITH RESPECT TO IUHLH: -APPOINTMENT AND REMOVAL OF MEMBERS OF THE BOARD OF DIRECTORS; -APPOINTMENT/RETENTION OF CEO; -ADOPTION OF CAPITAL AND OPERATING BUDGETS; -ADOPTION OF STRATEGIC PLANS AND AMENDMENTS THERETO; AND -ENCUMBRANCE, SALE OR CONVEYANCE OF ASSETS IN EXCESS OF 3.75% OF IUHLH'S NET BOOK VALUE.
Describe the Process used by Management &/or Governing Body to Review 990	Form 990, Part VI, Line 11a	AFTER THE RETURN IS PREPARED BY OUTSIDE PUBLIC ACCOUNTANTS, THE 990 IS REVIEWED BY THE CFO. AFTER THE CFO 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. QUESTIONS.
Description of Process to Monitor Transactions for Conflicts of Interest	Form 990, Part VI, Line 12c	Every employee is required to complete a questionnaire. If, after completion of the questionnaire a situation arises, or may reasonably be expected to arise, the member must supplement a Questionnaire in writing. The completed questionnaires for key employees, physicians, officers, directors and trustees are forwarded to Administration where they are logged and tracked for compliance. The conflict of interest forms are routed to legal for review. Legal prepares a review summary of board members which is sent in writing to the Chairman of the Board with a copy to the CEO. Legal indicates in that report whether there are any conflicts which would prohibit service on the board. Assuming there are no conflicts prohibiting service, legal sends a summary of potential conflicts which could result in a board member not being able to participate in a discussion on certain issues. For example, a surgeon not participating in issues involving a recruiting agreement for a competitor, etc. This summary of board conflicts is also reviewed by the legal department with the full board at the first meeting of the year. As for managers and physicians, legal sends a report to the CEO with the conflicts and a copy to the board chair. Legal also reviews it personally with the CEO to resolve potential conflicts. Any person with a conflect will not be allowed to vote on the matter in question.
Offices & Positions for Which Process was Used, & Year Process was Begun	Form 990, Part VI, Line 15a	Our Human Resource department completes multiple salary surveys and market analysis regularly. The Human Resources department at the corporate offices gathers data and hire an outside firm, Hay Group, to perform independent analysis on executive and key positions. National, state, and local data is given to the firms. The outside firms perform independent analysis and forward their findings directly to the Chairperson of the Board of Directors, the Senior Vice President/Chief of Staff, and to our legal team. Legal presents the information to the Board of Directors and they make the final compensation decision for all executive and key positions. The process is documented in meeting minutes.
Offices & Positions for Which Process was Used, & Year Process was Begun	Form 990, Part VI, Line 15b	Our Human Resource department completes multiple salary surveys and market analysis regularly. Their findings are presented to the transactions and compensation committee for review and final approval.
Avail of Gov Docs, Conflict of Interest Policy, & Fin Stmts to Gen Public	Form 990, Part VI, Line 19	COPIES OF THE 990, GOVERNING DOCUMENTS, CONFLICT OF INTEREST STATEMENTS, BOARD OF DIRECTORS, AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC FROM ADMINISTRATION UPON REQUEST.
Other Changes in Net Assets or Fund Balance	Form 990, Part XI, Line 9	Elimination of Intercompany balances between Indiana University Health La Porte Hospital, Inc. and Indiana University Health Physicians, Inc. - (16,396,250) Year-end pension obligation - (1,942,992) Total - (18,339,242)

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:

- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

Complete if the organization answered "Yes" to Form 990, Part IV, line 33, 34, 35, 36, or 37.
MediumBullet

Attach to Form 990. MediumBullet

See separate instructions.

OMB No. 1545-0047

2012

Open to Public Inspection

Name of the organization

Indiana University Health LaPorte Hospital

Employer identification number

35-1125434

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) IU HEALTH STARKE HOSPITAL LLC 102 E CULVER ROAD KNOX,IN46534 27-0328204	HEALTHCARE	IN	25,371,469	15,584,656	NA
(2) IU HEALTH LAKESHORE SURGICARE LLC 3111 VILLAGE POINT CHESTERTON,IN46304 27-2041916	HEALTHCARE	IN	14,389,360	12,410,596	NA
(3) Northwest Rehab LLC 1007 Lincolnway LaPorte,IN46350 27-3458403	REHAB SVCS	IN	0	0	N/A

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?
(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	Yes	No
(1) IU Health LaPorte Physicians Inc PO Box 250 LAPORTE,IN46352 31-1070868	HEALTHCARE	IN	501(c)(3)	3	IUHLH	Yes
(2) Indiana University Health Inc 950 N Meridian St Ste 800 INDIANAPOLIS,IN46204 35-1955872	Healthcare	IN	501(c)(3)	3	NA		No
(3) IU Health Arnett Inc 950 N Meridian St Ste 800 Indianapolis,IN46204 26-3162145	Healthcare	IN	501(c)(3)	3	IU HEALTH	Yes
(4) Clarian Transplant Institute Inc 950 N Meridian St Ste 800 Indianapolis,IN46204 13-4350599	Healthcare	IN	501(c)(3)	9	IU HEALTH	Yes
(5) IU Health North Hospital Inc 950 N Meridian St Ste 800 Indianapolis,IN46204 35-1932442	Healthcare	IN	501(c)(3)	3	IU Health	Yes
(6) Methodist Health Foundation Inc 1800 North Capitol Avenue Indianapolis,IN46202 36-6043086	Fundraising	IN	501(c)(3)	11, TYPE I	IU HEALTH	Yes
(7) Methodist Health Group Inc 950 N Meridian St Ste 800 Indianapolis,IN46204 35-0876390	Healthcare	IN	501(c)(3)	11, III-FI	NA		No
(8) Methodist Medical Group Inc 950 N Meridian St Ste 800 Indianapolis,IN46204 35-1945384	healthcare	IN	501(c)(3)	3	IU HEALTH	Yes
(9) Methodist Occupational Health Ctrs Inc 950 N Meridian St Ste 800 Indianapolis,IN46204 35-1844176	healthcare	IN	501(c)(3)	3	IU HEALTH	Yes
(10) Methodist Research Institute Inc 950 N Meridian St Ste 800 Indianapolis,IN46204 35-2023710	healthcare	IN	501(c)(3)	11, TYPE I	IU HEALTH	Yes
(11) MH Healthcare Inc 950 N Meridian St Ste 800 Indianapolis,IN46204 35-1766531	Healthcare	IN	501(c)(3)	3	Meth Med Grp	Yes
(12) IU Health Bedford Inc 2900 West 16th Street Bedford,IN47421 23-7042323	Healthcare	IN	501(c)(3)	3	IU HEALTH	Yes
(13) Goshen Health System Inc 200 High Park Avenue Goshen,IN46527 35-1974765	Healthcare	IN	501(c)(3)	11, TYPE I	IU HEALTH	Yes
(14) Goshen Hospital Association Inc 200 High Park Avenue Goshen,IN46527 35-6001540	healthcare	IN	501(c)(3)	3	GOSH HLH SYS	Yes
(15) IU Health Tipton Hospital Inc 1000 S Main St Tipton,IN46072 26-2772226	Healthcare	IN	501(c)(3)	3	IU HEALTH	Yes
(16) IU Health Ball Memorial Hospital Inc 950 N Meridian St Ste 800 Indianapolis,IN46204 35-0867958	Healthcare	IN	501(c)(3)	3	IU HEALTH	Yes
(17) IU Health Blackford Hospital Inc 950 N Meridian St Ste 800 Indianapolis,IN46204 01-0646166	healthcare	IN	501(c)(3)	3	IUHBMH	Yes
(18) IU HEALTH PAOLI INC PO Box 499 Paoli,IN47454 35-2090919	healthcare	IN	501(c)(3)	3	IUHB	Yes
(19) IU HEALTH BLOOMINGTON INC PO BOX 1149 BLOOMINGTON,IN47403 35-1720796	HEALTHCARE	IN	501(c)(3)	3	IU HEALTH	Yes
(20) University Family Physicians Inc 950 N Meridian St Ste 800 Indianapolis,IN46204 23-7427350	healthcare	IN	501(c)(3)	9	IUHCA	Yes
(21) IU HEALTH BALL MEMORIAL PHYSICIANS 950 N Meridian St Ste 800 Indianapolis,IN46204 35-1925641	healthcare	IN	501(c)(3)	9	IUHBMH	Yes
(22) Indiana University Healthcare Associates 950 N Meridian St Ste 800 Indianapolis,IN46204 35-1747218	healthcare	IN	501(c)(3)	3	IU HEALTH	Yes
(23) IU HEALTH BMH FOUNDATION 950 N Meridian St Ste 800 Indianapolis,IN46204 31-1111784	fundraising	IN	501(c)(3)	11, TYPE I	IUHBMH	Yes
(24) Indiana Radiology partners Inc 950 N Meridian St Ste 800 Indianapolis,IN46204 20-1017034	Healthcare	IN	501(c)(3)	3	IU HEALTH	Yes
(25) IU Health West Hospital Inc 950 N MERIDIAN ST STE 800 INDIANAPOLIS,IN46204 35-1814660	HEALTHCARE	IN	501(c)(3)	3	IU HEALTH	Yes
(26) HEALTHLINC INC 714 S Rogers St Bloomington,IN47402 26-3571507	HEALTHCARE	IN	501(c)(3)	9	IUHB	Yes
(27) IU HEALTH MORGAN HOSPITAL INC 2209 JOHN R WOODEN DRIVE MARTINSVILLE,IN46151 27-3533027	HEALTHCARE	IN	501(c)(3)	3	IU HEALTH	Yes
(28) IU HEALTH WHITE MEMORIAL HOSPITAL INC 720 SOUTH SIXTH STREET MONTICELLO,IN47960 27-3532963	HEALTHCARE	IN	501(c)(3)	3	IU HEALTH	Yes
(29) IU Health Arnett Foundation 950 N Meridian St Ste 800 Indianapolis,IN46204 35-6079797	FUNDRAISING	IN	501(c)(3)	11, TYPE I	IUHA	Yes
(30) Morgan County Memorial Foundation Inc 2209 John R Wooden Drive Martinsville,IN46151 35-2035162	FUNDRAISING	IN	501(c)(3)	11, TYPE II	IUHMH	Yes
(31) Morgan Health Services Inc 1949 Hospital Drive Martinsville,IN46151 35-1968564	healthcare	IN	501(c)(3)	3	IUHMH	Yes
(32) IU Health White Memorial Foundation PO Box 952 Monticello,IN47960 35-1671806	FUNDRAISING	IN	501(c)(3)	11, III-O	IUHWMH	Yes
(33) IU Health Paoli Hospital Foundation Inc PO Box 499 Paoli,IN47454 31-0992486	Fundraising	IN	501(c)(3)	11, III-O	IUHP	Yes
(34) IU Medical Group Foundation Inc 340 W 10th St No FS5100 Indianapolis,IN46202 20-1093251	Fundraising	IN	501(c)(3)	11, TYPE II	NA		No
(35) Morgan County Memorial Hosp Guild Inc 2209 John R Wooden Dr Martinsville,IN46151 31-0886844	Fundraising	IN	501(c)(3)	11, III-FI	IUHMH	Yes
(36) LaPorte Hospital Foundation Inc PO Box 250 LaPorte,IN46352 31-0952775	Fundraising	IN	501(c)(3)	11, TYPE I	IUH LaPorte	Yes
(37) Rehabilitation Hospital of Indiana Inc 4141 Shore Dr Indianapolis,IN46254 35-1786005	Healthcare	IN	501(c)(3)	3	MHH	Yes
(38) RHI Foundation Inc 4141 Shore Dr Indianapolis,IN46254 35-1932349	Fundraising	IN	501(c)(3)	11 TYPE I	RHI	Yes

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50135Y

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 VUBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity		(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No
(1) BSC Holdings LLC 3000 Riverchase Galleria Ste 500 Birmingham,AL35244 45-2314634	Healthcare	IN	IUH	N/A					0
(2) Clarian Health Network LLC 950 N Meridian St Ste 800 Indianapolis,IN46204 35-2055030	Healthcare	IN	NA	N/A					0
(3) CHV Fund I LLC 950 N Meridian St Ste 800 Indianapolis,IN46204 26-2523206	VENTURE CAPITAL	IN	IUH	N/A					0
(4) Cardinal Health Alliance LLC 2401 W University Ave Muncie,IN47303 35-1966281	Managed Care	IN	IUHBMH	N/A					0
(5) Health Venture Management LLC 950 N Meridian St Ste 800 Indianapolis,IN46204 20-5740218	MANAGEMENT	IN	IUH	N/A					0
(6) Indiana Endoscopy Centers LLC 3000 Riverchase Galleria Suite 500 Birmingham,AL35244 20-8398421	Healthcare	IN	IECH	N/A					0
(7) Senate St Surgery Center LLC 3000 Riverchase Galleria Suite 500 Birmingham,AL35244 42-1709357	Healthcare	IN	SSSCH	N/A					0
(8) Ball Outpatient Sur Ctr LLC 3000 Riverchase Galleria Suite 500 Birmingham,AL35244 27-0275794	Healthcare	IN	IUH	N/A					0
(9) Cardinal Health Initiatives 2401 WEst University Avenue Muncie,IN47303 30-0102702	Purchasing	IN	IUHBMH	N/A					0
(10) Mid-America Surgery Center 2401 West University Avenue Muncie,IN47303 35-2002953	Healthcare	IN	CDHV	N/A					0
(11) BMH Outpatient Surg Svcs 2401 West University Avenue Muncie,IN47303 20-4567998	Healthcare	IN	IUHBMH	N/A					0
(12) CHV Fund Management LLC 950 N Meridian St Ste 800 Indianapolis,IN46204 26-2523151	VENTURE CAPITAL	IN	CHV	N/A					0
(13) ROC SURGERY LLC 3000 Riverchase Galleria Suite 500 Birmingham,AL35244 27-1497960	HEALTHCARE	IN	ROCSH	N/A					0
(14) EHSC Holdings LLC 3000 Riverchase Galleria Suite 500 Birmingham,AL35244 45-4147879	Healthcare	IN	IUH	N/A					0
(15) SSSC Holdings LLC 3000 Riverchase Galleria Suite 500 Birmingham,AL35244 45-4148167	Healthcare	IN	IUH	N/A					0
(16) IEC Holdings LLC 3000 Riverchase Galleria Suite 500 Birmingham,AL35244 45-4148032	Healthcare	IN	IUH	N/A					0
(17) ROCS Holdings LLC 3000 Riverchase Galleria Suite 500 Birmingham,AL35244 45-4148369	Healthcare	IN	IUH	N/A					0
(18) BOSC Holdings LLC 3000 Riverchase Galleria Suite 500 Birmingham,AL35244 45-4147343	Healthcare	IN	IUH	N/A					0
(19) Bloomington Endoscopy Centers LLC PO Box 1149 Bloomington,IN47402 35-2117943	Healthcare	IN	IUHB	N/A					0
(20) Beltway Surgery Centers LLC 3000 Riverchase Galleria Ste 500 Birmingham,AL35244 35-2072586	Healthcare	IN	BSCH	N/A					0
(21) Eagle Highlands Surgery Center LLC 3000 Riverchase Galleria Ste 500 Birmingham,AL35244 35-2259204	Healthcare	IN	EHSCH	N/A					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	(i) Section 512(b)(13) controlled entity?
(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	Yes	No
(1) IUH ASSURANCE LTD 720 West Bay Road PO Box 69 Grand Cayman CJ 98-0396429	INSURANCE	CJ	IUH	C			Yes
(2) IU HEALTH PLANS INC 1776 MERIDIAN STREET SUITE 300 INDIANAPOLIS,IN46202 26-2127080	HMO	IN	IUH	C			Yes
(3) CHV CAPITAL INC 950 N MERIDIAN STREET SUITE 800 INDIANAPOLIS,IN46204 26-0752507	VENTURE CAPITAL	IN	IUH	C			Yes
(4) IU HEALTH RISK PURCHASING GROUP INC 151 MEETING STREET SUITE 301 CHARLESTON,SC29401 26-0202446	INSURANCE	IN	IUH	C			Yes
(5) IU HEALTH RISK RETENTION GROUP INC 151 MEETING STREET SUITE 301 CHARLESTON,SC29401 20-1107674	INSURANCE	SC	IUH	C			Yes
(6) OCC-HEALTH REVENUE SYSTEMS INC 950 N MERIDIAN STREET SUITE 800 INDIANAPOLIS,IN46204 20-3308057	WORK COMP PPO	IN	MOHC	C			Yes
(7) PARKMOR DRUG INC 1501 SOUTH MAIN STREET GOSHEN,IN46526 13-1394980	PHARMACY SALES	IN	GHS	C			Yes
(8) BMH MEDICAL PAVILLION ASSOCIATION INC 2525 WEST UNIVERSITY AVENUE MUNCIE,IN47303 35-1858408	CONDO MANAGEMENT	IN	IUHBMH	C			Yes
(9) CARDINAL HEALTH VENTURES INC 950 N Meridian St Ste 800 Indianapolis,IN46204 35-1611424	MANAGEMENT	IN	IUHBMH	C			Yes
(10) PILR INC 200 HIGH PARK AVENUE GOSHEN,IN46526 20-4294750	DEVELOPMENT	IN	GHS	C			Yes
(11) IU HEALTH SOUTHERN INDIANA PHYS INC PO BOX 1149 BLOOMINGTON,IN47402 35-1913875	HEALTHCARE	IN	IUHB	C			Yes
(12) RADIATION ONCOLOGY RESOURCES INC 200 HIGH PARK AVENUE GOSHEN,IN46526 26-2008424	HEALTHCARE	IN	GHS	C			Yes
(13) UNIVERSITY HEALTH MANAGEMENT INC 950 N MERIDIAN STREET SUITE 800 INDIANAPOLIS,IN46204 27-2891143	MANAGEMENT	IN	CHV	C			Yes
(14) UNIVERSITY HEALTH MGMT (CHINA) INC 950 N MERIDIAN STREET SUITE 800 INDIANAPOLIS,IN46204 27-3891311	MANAGEMENT	IN	CHV	C			Yes
(15) Indiana University Health ACO Inc 950 N Meridian Street Suite 800 Indianapolis,IN46204 45-4421020	Healthcare	IN	IUH	C			Yes
(16) SCANS Inc 950 N Meridian Street Suite 800 Indianapolis,IN46204 45-3080392	Healthcare	IN	CHVF1	C			Yes
(17) IU Health Board Designated Trust 400 Howard St San Francisco,CA94105 30-6309021	Investments	IN	IUH	T			Yes
(18) IU Health NTGI S&P500 Fund CF PO Box 804358 Chicago,IL60680 30-6298263	Investments	IN	IUH	T			Yes
(19) Proteuo Fund LP PO Box 31106 89 Nexus Way Grand Cayman,CJ CJ 98-1075227	INVESTMENTS	CJ	IUH	C			Yes

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

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 . . . . . . . . . . . . . . . . . . . . . . .

b Gift, grant, or capital contribution to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

c Gift, grant, or capital contribution from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

d Loans or loan guarantees to or for related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

e Loans or loan guarantees by related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

f Dividends from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

g Sale of assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

h Purchase of assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

i Exchange of assets with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

j Lease of facilities, equipment, or other assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .

k Lease of facilities, equipment, or other assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .

l Performance of services or membership or fundraising solicitations for related organization(s) . . . . . . . . . . . . . . . . . . . .

m Performance of services or membership or fundraising solicitations by related organization(s) . . . . . . . . . . . . . . . . . . . .

n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) . . . . . . . . . . . . . . . . . . . . .

o Sharing of paid employees with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

p Reimbursement paid to related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

q Reimbursement paid by related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

r Other transfer of cash or property to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

s Other transfer of cash or property from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

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) INDIANA UNIVERSITY HEALTH LAPORTE PHYSICIANS	S	16,396,250	CASH TRANSFER
(2) LAPORTE HOSPITAL FOUNDATION	C	257,366	CASH & NON-CASH

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)	(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 VUBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?
(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	Yes	No	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No

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

Software ID:
Software Version: