Form990
Click to see attachment
Department of the Treasury
Internal Revenue Service
Return of Organization Exempt From Income Tax
Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except black lung benefit trust or private foundation)

MediumBullet The organization may have to use a copy of this return to satisfy state reporting requirements.
OMB No. 1545-0047
2012
Open to Public Inspection
A For the 2012 calendar year, or tax year beginning 01-01-2012 , 2012, and ending 12-31-2012
BCheck if applicable:
CName of organization
INDIANA UNIVERSITY HEALTH BLOOMINGTON INC
 
Doing Business As
 
 
Number and street (or P.O. box if mail is not delivered to street address)
PO BOX 1149
Suite
Room/suite
City or town, state or country, and ZIP + 4
BLOOMINGTON, IN47403
D Employer identification number

35-1720796
E Telephone number

G Gross receipts $ 393,634,693
F Name and address of principal officer:
MARK E MOORE CEO
PO BOX 1149
BLOOMINGTON,IN474021149
I
Tax-exempt status: (   ) LeftBullet (insert no.) or
J
Website:MediumBullet
WWW.IUHEALTHBLOOMINGTON.ORG
H(a)
Is this a group return for
affiliates?
H(b)
Are all affiliates included?
If "No," attach a list. (see instructions)
H(c)
Group exemption number MediumBullet  
K Form of organization:
 
L Year of formation: 1988
M State of legal domicile: IN
Part I
Summary
Activities & Governance 1 Briefly describe the organization’s mission or most significant activities: INDIANA UNIVERSITY HEALTH BLOOMINGTON HOSPITAL'S MISSION IS TO IMPROVE THE HEALTH OF OUR PATIENTS AND COMMUNITY THROUGH INNOVATION AND EXCELLENCE IN CARE, EDUCATION, RESEARCH, AND SERVICE.
2 Check this box MediumBullet
3 Number of voting members of the governing body (Part VI, line 1a) ........ 3 19
4 Number of independent voting members of the governing body (Part VI, line 1b) ..... 4 13
5 Total number of individuals employed in calendar year 2011 (Part V, line 2a) ...... 5 3,299
6 Total number of volunteers (estimate if necessary) ............. 6 425
7a Total unrelated business revenue from Part VIII, column (C), line 12 ........ 7a 3,257,656
b Net unrelated business taxable income from Form 990-T, line 34 ......... 7b 1,011,656
Revenues Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 5,014,099 2,406,817
9 Program service revenue (Part VIII, line 2g) ......... 336,485,891 382,330,864
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 5,613,049 4,089,711
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 57,494 4,616,159
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)................... 347,170,533 393,443,551
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 97,826 102,310
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) 159,943,122 173,383,428
16a Professional fundraising fees (Part IX, column (A), line 11e)..... 0 0
b Total fundraising expenses (Part IX, column (D), line 25) MediumBullet0    
17 Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e).... 146,300,230 164,665,056
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 306,341,178 338,150,794
19 Revenue less expenses. Subtract line 18 from line 12....... 40,829,355 55,292,757
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............. 339,277,591 385,876,639
21 Total liabilities (Part X, line 26)............. 105,999,691 120,911,598
22 Net assets or fund balances. Subtract line 21 from line 20..... 233,277,900 264,965,041
Part II
Signature Block
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge.
Sign Here
JumboBullet
Signature of officer Date
JumboBullet
Type or print name and title
Paid Preparer Use Only
Print/Type preparer's name
 
Preparer's signature
Date
PTIN
Firm's name MediumBullet

Firm's EIN MediumBullet
Firm's address MediumBullet



Phone no.
May the IRS discuss this return with the preparer shown above? (see instructions) ............
For Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 11282Y
Form 990 (2012)
Form 990 (2012)
Page 2
Part III
Statement of Program Service Accomplishments
Check if Schedule O contains a response to any question in this Part III ...............
1
Briefly describe the organization’s mission: Indiana University Health Bloomington Hospital's mission is to improve the health of our patients and community through innovation and excellence in care, education, research, and service.
2
Did the organization undertake any significant program services during the year which were not listed on
the prior Form 990 or 990-EZ? ......................
If “Yes,” describe these new services on Schedule O.
3
Did the organization cease conducting, or make significant changes in how it conducts, any program services? ............................
If “Yes,” describe these changes on Schedule O.
4
Describe the organization’s program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.
4a (Code:   ) (Expenses $ 182,517,453 including grants of $ 0 ) (Revenue $ 261,187,094 )
Inpatient and outpatient ancillary medical services, including laboratory, radiology, and other imaging services, 24-hour emergency department and ambulance services, and a full range of cardiac services, among others.
4b (Code:   ) (Expenses $ 56,703,018 including grants of $ 0 ) (Revenue $ 78,917,325 )
Inpatient and outpatient surgical services: Indiana University Health Bloomington (IUHB) performed a total of 3,679 inpatient and 10,915 outpatient surgical procedures during 2012. Please see Schedule O for additional information concerning IUHB's program services.
4c (Code:   ) (Expenses $ 27,795,041 including grants of $ 0 ) (Revenue $ 38,684,189 )
Acute inpatient medical care, representing the services provided to a total of 12,846 adult and pediatric inpatients and 1,977 newborn infants during 2012. IUHB provides a range of complex medical care including orthopedic, post-surgical, cardiac, intensive care, and psychiatric services. Please see Schedule O for additional information concerning IUHB's program services.
4d Other program services (Describe in Schedule O.)
(Expenses $ 2,545,152 including grants of $ 102,310 ) (Revenue $ 3,542,256 )
4e Total program service expensesMediumBullet269,560,664
Form 990 (2012)
Form 990 (2012)
Page 3
Part IV
Checklist of Required Schedules
Yes
No
1
Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If “Yes,” complete Schedule AClick to see attachment........................
1
Yes
 
2
Is the organization required to complete Schedule B, Schedule of Contributors (see instructions)? Click to see attachment...
2
Yes
 
3
Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for public office? If “Yes,” complete Schedule C, Part IClick to see attachment..........
3
 
No
4
Section 501(c)(3) organizations. Did the organization engage in lobbying activities, or have a section 501(h) election in effect during the tax year? If “Yes,” complete Schedule C, Part IIClick to see attachment........
4
Yes
 
5
Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or similar amounts as defined in Revenue Procedure 98-19? If “Yes,” complete Schedule C,
Part IIIClick to see attachment............................
5
 
No
6
Did the organization maintain any donor advised funds or any similar funds or accounts for which donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts? If “Yes,” complete Schedule D, Part IClick to see attachment........................
6
 
No
7
Did the organization receive or hold a conservation easement, including easements to preserve open space,
the environment, historic land areas, or historic structures? If “Yes,” complete Schedule D, Part IIClick to see attachment...
7
 
No
8
Did the organization maintain collections of works of art, historical treasures, or other similar assets? If “Yes,” complete Schedule D, Part III Click to see attachment....................
8
 
No
9
Did the organization report an amount in Part X, line 21 for escrow or custodial account liability; serve as a custodian for amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or debt negotiation services? If “Yes,” complete Schedule D, Part IVClick to see attachment..............
9
 
No
10
Did the organization, directly or through a related organization, hold assets in temporarily restricted endowments, permanent endowments, or quasi-endowments? If “Yes,” complete Schedule D, Part VClick to see attachment......
10
Yes
 
11
If the organization’s answer to any of the following questions is "Yes," then complete Schedule D, Parts VI, VII, VIII, IX, or X as applicable.
a
Did the organization report an amount for land, buildings, and equipment in Part X, line 10?
If “Yes,” complete Schedule D, Part VI.Click to see attachment...................
11a
Yes
 
b
Did the organization report an amount for investments—other securities in Part X, line 12 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VIIClick to see attachment.......
11b
 
No
c
Did the organization report an amount for investments—program related in Part X, line 13 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VIIIClick to see attachment.......
11c
 
No
d
Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part IXClick to see attachment............
11d
 
No
e
Did the organization report an amount for other liabilities in Part X, line 25? If “Yes,” complete Schedule D, Part XClick to see attachment
11e
Yes
 
f
Did the organization’s separate or consolidated financial statements for the tax year include a footnote that addresses the organization’s liability for uncertain tax positions under FIN 48 (ASC 740)? If “Yes,” complete Schedule D, Part XClick to see attachment.........................
11f
 
No
12a
Did the organization obtain separate, independent audited financial statements for the tax year?
If “Yes,” complete Schedule D, Parts XI and XII Click to see attachment.................
12a
 
No
b
Was the organization included in consolidated, independent audited financial statements for the tax year? If “Yes,” and if the organization answered "No" to line 12a, then completing Schedule D, Parts XI and XII is optional Click to see attachment
12b
Yes
 
13
Is the organization a school described in section 170(b)(1)(A)(ii)? If “Yes,” complete Schedule E....
13
 
No
14a
Did the organization maintain an office, employees, or agents outside of the United States?.....
14a
 
No
b
Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business, investment, and program service activities outside the United States, or aggregate foreign investments valued at $100,000 or more? If “Yes,” complete Schedule F, Parts I and IV......... Click to see attachment
14b
Yes
 
15
Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or assistance to any organization or entity located outside the United States? If “Yes,” complete Schedule F, Parts II and IVClick to see attachment
15
 
No
16
Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or assistance to individuals located outside the United States? If “Yes,” complete Schedule F, Parts III and IV... Click to see attachment
16
 
No
17
Did the organization report a total of more than $15,000 of expenses for professional fundraising services on Part IX, column (A), lines 6 and 11e? If “Yes,” complete Schedule G, Part I (see instructions)....
17
 
No
18
Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VIII, lines 1c and 8a? If “Yes,” complete Schedule G, Part II............
18
 
No
19
Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a? If “Yes,” complete Schedule G, Part III...................
19
 
No
20a
Did the organization operate one or more hospital facilities? If “Yes,” complete Schedule H.... Click to see attachment
20a
Yes
 
b
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)
Form 990 (2012)
Page 4
Part IV
Checklist of Required Schedules (continued)
21
Did the organization report more than $5,000 of grants and other assistance to any government or organization in the United States on Part IX, column (A), line 1? If “Yes,” complete Schedule I, Parts I and II... Click to see attachment
21
Yes
 
22
Did the organization report more than $5,000 of grants and other assistance to individuals in the United States on Part IX, column (A), line 2? If “Yes,” complete Schedule I, Parts I and III........ Click to see attachment
22
 
No
23
Did the organization answer “Yes” to Part VII, Section A, line 3, 4, or 5 about compensation of the organization’s current and former officers, directors, trustees, key employees, and highest compensated employees? If “Yes,” complete Schedule J....................... Click to see attachment
23
Yes
 
24a
Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as of the last day of the year, that was issued after December 31, 2002? If “Yes,” answer lines 24b through 24d and complete Schedule K. If “No,” go to line 25................ Click to see attachment
24a
Yes
 
b
Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...
24b
 
No
c
Did the organization maintain an escrow account other than a refunding escrow at any time during the year
to defease any tax-exempt bonds?......................
24c
 
No
d
Did the organization act as an “on behalf of” issuer for bonds outstanding at any time during the year?...
24d
 
No
25a
Section 501(c)(3) and 501(c)(4) organizations. Did the organization engage in an excess benefit transaction with a disqualified person during the year? If “Yes,” complete Schedule L, Part I........ Click to see attachment
25a
 
No
b
Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and that the transaction has not been reported on any of the organization’s prior Forms 990 or 990-EZ? If “Yes,” complete Schedule L, Part I................... Click to see attachment
25b
 
No
26
Was a loan to or by a current or former officer, director, trustee, key employee, 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
26
 
No
27
Did the organization provide a grant or other assistance to an officer, director, trustee, key employee, substantial contributor or employee thereof, a grant selection committee member, or to a 35% controlled entity or family member of any of these persons? If “Yes,” complete Schedule L, Part III......... Click to see attachment
27
 
No
28
Was the organization a party to a business transaction with one of the following parties (see Schedule L, Part IV instructions for applicable filing thresholds, conditions, and exceptions):
a
A current or former officer, director, trustee, or key employee? If “Yes,” complete Schedule L, Part IV .......................... Click to see attachment
28a
 
No
b
A family member of a current or former officer, director, trustee, or key employee? If “Yes,”
complete Schedule L, Part IV..................... Click to see attachment
28b
Yes
 
c
An entity of which a current or former officer, director, trustee, or key employee (or a family member thereof) was an officer, director, trustee, or direct or indirect owner? If “Yes,” complete Schedule L, Part IV... Click to see attachment
28c
Yes
 
29
Did the organization receive more than $25,000 in non-cash contributions? If “Yes,” complete Schedule M..
29
 
No
30
Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? If “Yes,” complete Schedule M.............
30
 
No
31
Did the organization liquidate, terminate, or dissolve and cease operations? If “Yes,” complete Schedule N,
Part I...........................
31
 
No
32
Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If “Yes,” complete Schedule N, Part II......................
32
 
No
33
Did the organization own 100% of an entity disregarded as separate from the organization under Regulations sections 301.7701-2 and 301.7701-3? If “Yes,” complete Schedule R, Part I........ Click to see attachment
33
 
No
34
Was the organization related to any tax-exempt or taxable entity? If “Yes,” complete Schedule R, Part II, III, or IV, and Part V, line 1........................ Click to see attachment
34
Yes
 
35a
Did the organization have a controlled entity within the meaning of section 512(b)(13)?
35a
Yes
 
b
If ‘Yes’ to line 35a, did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)? If “Yes,” complete Schedule R, Part V, line 2... Click to see attachment
35b
Yes
 
36
Section 501(c)(3) organizations. Did the organization make any transfers to an exempt non-charitable related organization? If “Yes,” complete Schedule R, Part V, line 2............. Click to see attachment
36
 
No
37
Did the organization conduct more than 5% of its activities through an entity that is not a related organization and that is treated as a partnership for federal income tax purposes? If “Yes,” complete Schedule R, Part VIClick to see attachment
37
 
No
38
Did the organization complete Schedule O and provide explanations in Schedule O for Part VI, lines 11b and 19? Note. All Form 990 filers are required to complete Schedule O. ............
38
Yes
 
Form 990 (2012)
Form 990 (2012)
Page 5
Part V
Statements Regarding Other IRS Filings and Tax Compliance
Check if Schedule O contains a response to any question in this Part V ...............
Yes
No
1a
Enter the number reported in Box 3 of Form 1096 Enter -0- if not applicable ..
1a
317
b
Enter the number of Forms W-2G included in line 1a. Enter -0- if not applicable .
1b
0
c
Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners? ..................
1c
Yes
 
2a
Enter the number of employees reported on Form W-3, Transmittal of Wage and
Tax Statements, filed for the calendar year ending with or within the year covered by this return ..................
2a
3,299
b
If at least one is reported on line 2a, did the organization file all required federal employment tax returns?
Note. If the sum of lines 1a and 2a is greater than 250, you may be required to e-file (see instructions)
2b
Yes
 
3a
Did the organization have unrelated business gross income of $1,000 or more during the year?...
3a
Yes
 
b
If “Yes,” has it filed a Form 990-T for this year? If “No,” provide an explanation in Schedule O.....
3b
Yes
 
4a
At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a financial account in a foreign country (such as a bank account, securities account, or other financial account)?..........................
4a
 
No
b
If "Yes," enter the name of the foreign country: MediumBullet
See instructions for filing requirements for Form TD F 90-22.1, Report of Foreign Bank and Financial Accounts.
5a
Was the organization a party to a prohibited tax shelter transaction at any time during the tax year?..
5a
 
No
b
Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?
5b
 
No
c
If “Yes,” to line 5a or 5b, did the organization file Form 8886-T? ............
5c
 
 
6a
Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit any contributions that were not tax deductible as charitable contributions?...
6a
 
No
b
If “Yes,” did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible?........................
6b
 
 
7
Organizations that may receive deductible contributions under section 170(c).
a
Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and services provided to the payor?....................
7a
 
No
b
If “Yes,” did the organization notify the donor of the value of the goods or services provided?.....
7b
 
 
c
Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file Form 8282?...........................
7c
 
No
d
If “Yes,” indicate the number of Forms 8282 filed during the year ....
7d
 
e
Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?............................
7e
 
No
f
Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract?..
7f
 
No
g
If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required?............................
7g
 
 
h
If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C?..........................
7h
 
 
8
Sponsoring organizations maintaining donor advised funds and section 509(a)(3) supporting organizations. Did the supporting organization, or a donor advised fund maintained by a sponsoring organization, have excess business holdings at any time during the year?............
8
 
 
9
Sponsoring organizations maintaining donor advised funds.
a
Did the organization make any taxable distributions under section 4966?..........
9a
 
 
b
Did the organization make a distribution to a donor, donor advisor, or related person?.......
9b
 
 
10
Section 501(c)(7) organizations. Enter:
a
Initiation fees and capital contributions included on Part VIII, line 12 ...
10a
 
b
Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities
10b
 
11
Section 501(c)(12) organizations. Enter:
a
Gross income from members or shareholders .........
11a
 
b
Gross income from other sources (Do not net amounts due or paid to other sources against amounts due or received from them.) ..........
11b
 
12a
Section 4947(a)(1) non-exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041?
12a
 
 
b
If “Yes,” enter the amount of tax-exempt interest received or accrued during the year. ....................
12b
 
13
Section 501(c)(29) qualified nonprofit health insurance issuers.
a
Is the organization licensed to issue qualified health plans in more than one state?
Note. See the instructions for additional information the organization must report on Schedule O.
13a
 
 
b
Enter the amount of reserves the organization is required to maintain by the states in which the organization is licensed to issue qualified health plans ....
13b
 
c
Enter the amount of reserves on hand ............
13c
 
14a
Did the organization receive any payments for indoor tanning services during the tax year?.....
14a
 
No
b
If "Yes," has it filed a Form 720 to report these payments? If “No,” provide an explanation in Schedule O..
14b
 
 
Form 990 (2012)
Form 990 (2012)
Page 6
Part VI
Governance, Management, and Disclosure For each “Yes” response to lines 2 through 7b below, and for a “No” response to lines 8a, 8b, or 10b below, describe the circumstances, processes, or changes in Schedule O. See instructions.
Check if Schedule O contains a response to any question in this Part VI ...............
Section A. Governing Body and Management
Yes
No
1a
Enter the number of voting members of the governing body at the end of the tax year .....................
1a
19
If there are material differences in voting rights among members of the governing body, or if the governing body delegated broad authority to an executive committee or similar committee, explain in Schedule O.
b
Enter the number of voting members included in line 1a, above, who are independent ...................
1b
13
2
Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other officer, director, trustee, or key employee? .................
2
Yes
 
3
Did the organization delegate control over management duties customarily performed by or under the direct supervision of officers, directors or trustees, or key employees to a management company or other person? .
3
 
No
4
Did the organization make any significant changes to its governing documents since the prior Form 990 was filed? ...........................
4
 
No
5
Did the organization become aware during the year of a significant diversion of the organization’s assets? .
5
 
No
6
Did the organization have members or stockholders? ................
6
Yes
 
7a
Did the organization have members, stockholders, or other persons who had the power to elect or appoint one or more members of the governing body? ....................
7a
Yes
 
b
Are any governance decisions of the organization reserved to (or subject to approval by) members, stockholders, or persons other than the governing body? ...................
7b
Yes
 
8
Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:
a
The governing body? .........................
8a
Yes
 
b
Each committee with authority to act on behalf of the governing body? ............
8b
Yes
 
9
Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the organization’s mailing address? If “Yes,” provide the names and addresses in Schedule O.......
9
 
No
Section B. Policies (This Section B requests information about policies not required by the Internal Revenue Code.)
Yes
No
10a
Did the organization have local chapters, branches, or affiliates? ............
10a
 
No
b
If “Yes,” did the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with the organization's exempt purposes?
10b
 
 
11a
Has the organization provided a complete copy of this Form 990 to all members of its governing body before filing the form? ............................
11a
Yes
 
b
Describe in Schedule O the process, if any, used by the organization to review this Form 990. .....
12a
Did the organization have a written conflict of interest policy? If “No,” go to line 13.......
12a
Yes
 
b
Were officers, directors, or trustees, and key employees required to disclose annually interests that could give rise to conflicts? ..........................
12b
Yes
 
c
Did the organization regularly and consistently monitor and enforce compliance with the policy? If “Yes,” describe in Schedule O how this was done.......................
12c
Yes
 
13
Did the organization have a written whistleblower policy? ...............
13
Yes
 
14
Did the organization have a written document retention and destruction policy? .........
14
Yes
 
15
Did the process for determining compensation of the following persons include a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision?
a
The organization’s CEO, Executive Director, or top management official ...........
15a
Yes
 
b
Other officers or key employees of the organization ................
15b
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
 
b
If “Yes,” did the organization follow a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and take steps to safeguard the organization’s exempt status with respect to such arrangements? ............
16b
Yes
 
Section C. Disclosure
17
List the States with which a copy of this Form 990 is required to be filedMediumBullet
IN
18
Section 6104 requires an organization to make its Form 1023 (or 1024 if applicable), 990, and 990-T (501(c)(3)s only) available for public inspection. Indicate how you made these available. Check all that apply.
19
Describe in Schedule O whether (and if so, how), the organization made its governing documents, conflict of interest policy, and financial statements available to the public during the tax year.
20
State the name, physical address, and telephone number of the person who possesses the books and records of the organization:
MediumBulletJAMES J MYERS CFOBLOOMINGTON HOSP PO BOX 1149BLOOMINGTONIN474021149 (812) 353-9171
Form 990 (2012)
Form 990 (2012)
Page 7
Part VII
Compensation of Officers, Directors,Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors
Check if Schedule O contains a response to any question in this Part VII ...............
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees
1a Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the organization’s tax year.
RoundBullet List all of the organization’s current officers, directors, trustees (whether individuals or organizations), regardless of amount
of compensation. Enter -0- in columns (D), (E), and (F) if no compensation was paid.

RoundBullet List all of the organization’s current key employees, if any. See instructions for definition of "key employee."
RoundBullet List the organization’s five current highest compensated employees (other than an officer, director, trustee or key employee)
who received reportable compensation (Box 5 of Form W-2 and/or Box 7 of Form 1099-MISC) of more than $100,000 from the
organization and any related organizations.

RoundBullet List all of the organization’s former officers, key employees, or highest compensated employees who received more than $100,000
of reportable compensation from the organization and any related organizations.

RoundBullet List all of the organization’s former directors or trustees that received, in the capacity as a former director or trustee of the
organization, more than $10,000 of reportable compensation from the organization and any related organizations.

List persons in the following order: individual trustees or directors; institutional trustees; officers; key employees; highest
compensated employees; and former such persons.
Check this box if neither the organization nor any related organization compensated any current officer, director, or trustee.
(A)
Name and Title 		(B)
Average hours per week (list any hours for related organizations below dotted line) 		(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee) 		(D)
Reportable compensation from the organization (W- 2/1099-MISC) 		(E)
Reportable compensation from related organizations (W- 2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; Officer; Key Employee; Highest compensated employee; Former;
(1) Daniel J Peterson........................................................................
Chariman
 2.0
.......................   		X   X       0 0 0
(2) Moya L Andrews EdD........................................................................
Director
 2.0
.......................   		X           0 0 0
(3) Mark D Bradford........................................................................
Director
 2.0
.......................   		X           0 0 0
(4) Lynn H Coyne........................................................................
Director
 2.0
.......................   		X           0 0 0
(5) Allen W Dunn MD........................................................................
Director
 2.0
.......................   		X           0 0 0
(6) Daniel F Evans Jr........................................................................
Director
 2.0
.......................55.0 		X           0 1,413,834 865,442
(7) James V Faris MD........................................................................
Director
 2.0
.......................   		X           0 0 0
(8) Michael L Gentile........................................................................
Director
 2.0
.......................   		X           0 0 0
(9) Virgil W Hunt........................................................................
Director
 2.0
.......................   		X           0 0 0
(10) Chad A Johnson MD........................................................................
Director
 2.0
.......................   		X           0 0 0
(11) Christopher J Kroll........................................................................
Director
 2.0
.......................   		X           0 0 0
(12) Lee J Marchant........................................................................
Director
 2.0
.......................   		X           0 0 0
(13) Charles R McKeen........................................................................
Director
 2.0
.......................   		X           0 0 0
(14) Joyce B Polling........................................................................
Director/Secretary/Vice Chair
 2.0
.......................   		X   X       0 0 0
(15) Michael A Robbins........................................................................
Director
 2.0
.......................   		X           0 0 0
(16) Eleanor H Rogers RN........................................................................
Director
 2.0
.......................   		X           0 0 0
(17) Susan D Wier........................................................................
Director/Treasurer
 2.0
.......................   		X   X       0 0 0
Form 990 (2012)
Form 990 (2012)
Page 8
Part VII
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (continued)
(A)
Name and Title 		(B)
Average hours per week (list any hours for related organizations below dotted line) 		(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee) 		(D)
Reportable compensation from the organization (W- 2/1099-MISC) 		(E)
Reportable compensation from related organizations (W- 2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; Officer; Key Employee; Highest compensated employee; Former;
(18) Linda S Williamson........................................................................
Director
 2.0
.......................   		X           0 0 0
(19) Barbara A Wrenn........................................................................
Director
 2.0
.......................   		X           0 0 0
(20) Mark E Moore........................................................................
CEO
 50.0
.......................2.0 		    X       1,207,270 0 184,445
(21) James J Myers........................................................................
CFO
 50.0
.......................   		    X       288,411 0 87,033
(22) Steven D Deckard........................................................................
VP, HR
 50.0
.......................   		      X     245,971 0 58,100
(23) Kenneth E Marshall MD........................................................................
VP & CMO
 50.0
.......................   		      X     348,574 0 70,937
(24) Mark W McMath........................................................................
VP & CIO
 50.0
.......................   		      X     222,846 0 64,614
(25) Ruth Ann Morris RN........................................................................
VP & CNO
 50.0
.......................   		      X     278,000 0 96,359
(26) Larry Bailey........................................................................
Vice President
 10.0
.......................32.0 		      X     385,112 0 59,393
(27) Lee McKinley MD........................................................................
Physician
 50.0
.......................   		        X   295,346 0 61,027
(28) Amartyadeb Goswami MD........................................................................
Physician
 50.0
.......................   		        X   287,225 0 42,492
(29) Charles McCalla MD........................................................................
Physician
 50.0
.......................   		        X   269,230 0 55,725
(30) Mark Munroe MD........................................................................
Physician
 50.0
.......................   		        X   239,676 0 12,499
(31) A Perry Griffith MD........................................................................
Physician
 50.0
.......................   		        X   236,657 0 35,883
1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)............MediumBullet 4,304,318 1,413,834 1,693,949
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organizationMediumBullet127
Yes
No
3
Did the organization list any former officer, director or trustee, key employee, or highest compensated employee on line 1a? If “Yes,” complete Schedule J for such individual ..............
3
 
No
4
For any individual listed on line 1a, is the sum of reportable compensation and other compensation from the organization and related organizations greater than $150,000? If “Yes,” complete Schedule J for such individual...........................
4
Yes
 
5
Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual for services rendered to the organization? If “Yes,” complete Schedule J for such person ........
5
 
No
Section B. Independent Contractors
1
Complete this table for your five highest compensated independent contractors that received more than $100,000 of compensation from the organization. Report compensation for the calendar year ending with or within the organization’s tax year.
(A)
Name and business address 		(B)
Description of services 		(C)
Compensation
PREMIER HEALTHCARE LLC, PO BOX 550BLOOMINGTONIN474020550 E/R PHYSICIANS 3,494,209
MAYO MEDICAL LABS, PO BOX 9146MINNEAPOLISMN554809146 CLINICAL LABS 977,729
BORMA, PO Box 1149BLOOMINGTONIN474021149 Operating Room Mgmt 951,500
IU Cariovascular Surgeon Corp, 950 N Meridian StINDIANAPOLISIN46204 Physician Services 824,736
TOTAL RENAL CARE INC, PO BOX 8500-1607PHILADELPHIAPA191781607 DIALYSIS SERVICES 816,193
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization MediumBullet23
Form 990 (2012)
Form 990 (2012)
Page 9
Part VIII
Statement of Revenue
Check if Schedule O contains a response to any question in this Part VIII ..............
(A)
Total revenue 		(B)
Related or
exempt
function
revenue 		(C)
Unrelated
business
revenue 		(D)
Revenue
excluded from
tax under sections
512, 513, or 514
Contributions, Gifts, Grants and Other Similar Amounts 1a Federated campaigns..1a  
b Membership dues....1b  
c Fundraising events....1c  
d Related organizations...1d 474,481
e Government grants (contributions)1e 1,777,045
f All other contributions, gifts, grants, and
similar amounts not included above1f 		155,291
g Noncash contributions included in lines
1a-1f:$ 		 
h Total. Add lines 1a-1f.......MediumBullet 2,406,817
Program Service Revenue Business Code
2a Net Patient Service Revenue 900099 303,550,026 303,550,026    
b Reference Laboratory 621500 70,640,647 67,480,726 3,159,921  
c Income/(Loss) From Partnerships 900099 2,072,966 2,072,966    
d Shared Services 541900 1,394,054 1,394,054    
e EHR INCENTIVE 900099 3,928,609 3,928,609    
f All other program service revenue . 744,562 744,562    
g Total. Add lines 2a–2f........MediumBullet 382,330,864
Other Revenue 3 Investment income (including dividends, interest, and other similar amounts).......MediumBullet 522,362     522,362
4 Income from investment of tax-exempt bond proceeds..MediumBullet 0      
5 Royalties...........MediumBullet 0      
(i) Real (ii) Personal
6a Gross rents 880,459  
b Less: rental expenses 191,142  
c Rental income or (loss) 689,317 0
d Net rental income or (loss).......MediumBullet 689,317   59,674 629,643
(i) Securities (ii) Other
7a Gross amount from sales of assets other than inventory 3,567,349  
b Less: cost or other basis and sales expenses    
c Gain or (loss) 3,567,349  
d Net gain or (loss)..........MediumBullet 3,567,349     3,567,349
8a Gross income from fundraising events (not including
$  
of contributions reported on line 1c). See Part IV, line 18 ..
a  
b Less: direct expenses ...b  
c Net income or (loss) from fundraising events..MediumBullet 0    
9a Gross income from gaming activities.
See Part IV, line 19 ...
a  
b Less: direct expenses ...b  
c Net income or (loss) from gaming activities...MediumBullet 0      
10a Gross sales of inventory, less
returns and allowances .
a  
b Less: cost of goods sold ..b  
c Net income or (loss) from sales of inventory..MediumBullet 0      
Miscellaneous Revenue Business Code
11a Cafeteria/Food Service 722514 1,646,191     1,646,191
b PURCHASE DISCOUNTS 900099 728,640     728,640
c Child Care 624410 470,438   38,061 432,377
d All other revenue .... 1,081,573     1,081,573
e Total. Add lines 11a–11d ...... MediumBullet 3,926,842
12 Total revenue. See Instructions......MediumBullet 393,443,551 379,170,943 3,257,656 8,608,135
Form 990 (2012)
Form 990 (2012)
Page 10
Part IX
Statement of Functional Expenses
Section 501(c)(3) and 501(c)(4) organizations must complete all columns. All other organizations must complete column (A).Check if Schedule O contains a response to any question in this Part IX ...............
Do not include amounts reported on lines 6b,
7b, 8b, 9b, and 10b of Part VIII. 		(A)
Total expenses 		(B)
Program service expenses 		(C)
Management and general expenses 		(D)
Fundraising expenses
1 Grants and other assistance to governments and organizations in the United States. See Part IV, line 21 102,310 102,310
2 Grants and other assistance to individuals in the United States. See Part IV, line 22 0  
3 Grants and other assistance to governments, organizations, and individuals outside the United States. See Part IV, lines 15 and 16 0  
4 Benefits paid to or for members 0  
5 Compensation of current officers, directors, trustees, and key employees .... 3,597,065 2,111,003 1,486,062  
6 Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .... 0      
7 Other salaries and wages 124,181,602 102,302,263 21,879,339  
8 Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) .... 9,829,673 8,032,235 1,797,438  
9 Other employee benefits ....... 26,715,445 21,830,302 4,885,143  
10 Payroll taxes ........... 9,059,643 7,403,011 1,656,632  
11 Fees for services (non-employees):        
a Management ...... 1,946,510 1,877,396 69,114  
b Legal ......... 251,615   251,615  
c Accounting ........... 287,665   287,665  
d Lobbying ........... 13,065   13,065  
e Professional fundraising services. See Part IV, line 17 0  
f Investment management fees ...... 550,438   550,438  
g Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O) ........ 28,296,553 13,820,301 14,476,252  
12 Advertising and promotion .... 1,636,947 1,515,857 121,090  
13 Office expenses ....... 11,094,007 5,826,222 5,267,785  
14 Information technology ...... 5,570,123 338,136 5,231,987  
15 Royalties .. 0      
16 Occupancy ........... 6,323,022 2,811,832 3,511,190  
17 Travel ............ 816,095 621,282 194,813  
18 Payments of travel or entertainment expenses for any federal, state, or local public officials ...... 0      
19 Conferences, conventions, and meetings .... 0      
20 Interest ........... 1,886,549 1,826,828 59,721  
21 Payments to affiliates ....... 0      
22 Depreciation, depletion, and amortization ..... 17,827,328 14,567,451 3,259,877  
23 Insurance .............. 1,357,650 10,401 1,347,249  
24 Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a Drugs and Medical Supplies 49,397,350 49,397,350    
b Bad Debt 19,101,109 19,101,109    
c MEDICAID HAF FEES 13,300,996 13,300,996    
d UNRELATED BUSINESS INC TAX 7,491   7,491  
e All other expenses 5,000,543 2,764,379 2,236,164  
25 Total functional expenses. Add lines 1 through 24e 338,150,794 269,560,664 68,590,130 0
26 Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here MediumBullet if following SOP 98-2 (ASC 958-720).        
Form 990 (2012)
Form 990 (2012)
Page 11
Part X Balance Sheet Check if Schedule O contains a response to any question in this Part X ...............
(A)
Beginning of year 		(B)
End of year
Assets 1 Cash—non-interest-bearing ............. 39,582 1 20,538
2 Savings and temporary cash investments ......... 51,212,393 2 74,516,157
3 Pledges and grants receivable, net ........... 1,440,130 3 0
4 Accounts receivable, net ............. 39,026,874 4 40,270,826
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 .............. 5,420,169 8 5,373,660
9 Prepaid expenses and deferred charges .......... 4,771,573 9 4,794,621
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 378,010,474
b Less: accumulated depreciation ..... 10b 257,696,910 121,879,413 10c 120,313,564
11 Investments—publicly traded securities .......... 100,659,766 11 119,514,186
12 Investments—other securities. See Part IV, line 11 ..... 0 12 0
13 Investments—program-related. See Part IV, line 11 ..... 3,009,422 13 3,471,638
14 Intangible assets ............... 0 14 3,583,576
15 Other assets. See Part IV, line 11 ........... 11,818,269 15 14,017,873
16 Total assets. Add lines 1 through 15 (must equal line 34)...... 339,277,591 16 385,876,639
Liabilities 17 Accounts payable and accrued expenses ......... 29,855,671 17 35,525,268
18 Grants payable ................. 0 18 0
19 Deferred revenue ................ 27,894 19 13,826
20 Tax-exempt bond liabilities ............. 42,879,356 20 44,759,686
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 .. 3,425,814 23 3,113,941
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.................... 29,810,956 25 37,498,877
26 Total liabilities. Add lines 17 through 25......... 105,999,691 26 120,911,598
Net Assets or Fund Balance Organizations that follow SFAS 117 (ASC 958), check here MediumBullet and complete lines 27 through 29, and lines 33 and 34.
27 Unrestricted net assets .............. 229,706,716 27 260,860,194
28 Temporarily restricted net assets ........... 2,936,703 28 3,470,216
29 Permanently restricted net assets ........... 634,481 29 634,631
Organizations that do not follow SFAS 117 (ASC 958), check here MediumBullet and complete lines 30 through 34.
30 Capital stock or trust principal, or current funds ........   30  
31 Paid-in or capital surplus, or land, building or equipment fund .....   31  
32 Retained earnings, endowment, accumulated income, or other funds   32  
33 Total net assets or fund balances ........... 233,277,900 33 264,965,041
34 Total liabilities and net assets/fund balances ........ 339,277,591 34 385,876,639
Form 990 (2012)
Form 990 (2012)
Page 12
Part XI
Reconcilliation of Net Assets
Check if Schedule O contains a response to any question in this Part XI ...............
1
Total revenue (must equal Part VIII, column (A), line 12) ............
1
393,443,551
2
Total expenses (must equal Part IX, column (A), line 25) ............
2
338,150,794
3
Revenue less expenses. Subtract line 2 from line 1 ..............
3
55,292,757
4
Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) ..
4
233,277,900
5
Net unrealized gains (losses) on investments ...............
5
9,510,192
6
Donated services and use of facilities .................
6
 
7
Investment expenses .....................
7
 
8
Prior period adjustments .....................
8
 
9
Other changes in net assets or fund balances (explain in Schedule O) ........
9
-33,115,808
10
Net assets or fund balances at end of year. Combine lines 3 through 9 (must equal Part X, line 33, column (B))
10
264,965,041
Part XII
Financial Statements and Reporting
Check if Schedule O contains a response to any question in this Part XII ..............
Yes
No
1
Accounting method used to prepare the Form 990:  
If the organization changed its method of accounting from a prior year or checked "Other," explain in
Schedule O.
2a
Were the organization’s financial statements compiled or reviewed by an independent accountant?
2a
 
No
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were compiled or reviewed on a separate basis, consolidated basis, or both:
b
Were the organization’s financial statements audited by an independent accountant?
2b
Yes
 
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were audited on a separate basis, consolidated basis, or both:
c
If “Yes,” to line 2a or 2b, does the organization have a committee that assumes responsibility for oversight of the audit, review, or compilation of its financial statements and selection of an independent accountant?
2c
Yes
 
If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O.
3a
As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the Single Audit Act and OMB Circular A-133?
3a
Yes
 
b
If “Yes,” did the organization undergo the required audit or audits? If the organization did not undergo the required audit or audits, explain why in Schedule O and describe any steps taken to undergo such audits
3b
Yes
 
Form 990 (2012)
Form 990, Special Condition Description:
Special Condition Description
Additional Data


Software ID:  
Software Version:  
SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service
Public Charity Status and Public Support

Complete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.
right arrow Attach to Form 990 or Form 990-EZ. right arrow See separate instructions.
OMB No. 1545-0047
2012
Open to Public
Inspection
Name of the organization
INDIANA UNIVERSITY HEALTH BLOOMINGTON INC
 
Employer identification number

35-1720796
Part I
Reason for Public Charity Status (All organizations must complete this part.) See instructions.
The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)
1
2
3
4
5
section 170(b)(1)(A)(iv). (Complete Part II.)
6
7
8
9
receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of
its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses
acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)
10
11
e
f
g
(i) A person who directly or indirectly controls, either alone or together with persons described in (ii)
Yes
No
and (iii) below, the governing body of the supported organization? ................
11g(i)
 
 
(ii) A family member of a person described in (i) above? ......................
11g(ii)
 
 
(iii) A 35% controlled entity of a person described in (i) or (ii) above? ................
11g(iii)
 
 
h
Provide the following information about the supported organization(s).
(i) Name of supported organization (ii) EIN (iii) Type of organization (described on lines 1- 9 above or IRC section (see instructions)) (iv) Is the organization in col. (i) listed in your governing document? (v) Did you notify the organization in col. (i) of your support? (vi) Is the organization in col. (i) organized in the U.S.? (vii) Amount of monetary support
Yes No Yes No Yes No
Total                  

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990EZ.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2012
Schedule A (Form 990 or 990-EZ) 2012
Page 2
Part II
Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization fails to qualify under the tests listed below, please complete Part III.)
Section A. Public Support
Calendar year (or fiscal year beginning in) right arrow (a) 2008 (b) 2009 (c) 2010 (d) 2011 (e) 2012 (f) Total
1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....            
2 Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......            
3 The value of services or facilities furnished by a governmental unit to the organization without charge..            
4 Total. Add lines 1 through 3            
5 The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f)..            
6 Public support. Subtract line 5 from line 4.            
Section B. Total Support
Calendar year (or fiscal year beginning in) right arrow (a) 2008 (b) 2009 (c) 2010 (d) 2011 (e) 2012 (f) Total
7 Amounts from line 4..            
8 Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...            
9 Net income from unrelated business activities, whether or not the business is regularly carried on..            
10 Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)..            
11 Total support (Add lines 7 through 10).            
12
12
 
13
First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization, check this box and stop here........................................right arrow
Section C. Computation of Public Support Percentage
14
14
 
15
15
 
16a
b
17a
b
18
Private foundation. If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions ..................................................... right arrow
Schedule A (Form 990 or 990-EZ) 2012
Schedule A (Form 990 or 990-EZ) 2012
Page 3
Part III
Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 9 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)
Section A. Public Support
Calendar year (or fiscal year beginning in) right arrow (a) 2008 (b) 2009 (c) 2010 (d) 2011 (e) 2012 (f) Total
1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .            
2 Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......            
3 Gross receipts from activities that are not an unrelated trade or business under section 513..            
4 Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...            
5 The value of services or facilities furnished by a governmental unit to the organization without charge..            
6 Total. Add lines 1 through 5.            
7a Amounts included on lines 1, 2, and 3 received from disqualified persons...            
b Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.            
c Add lines 7a and 7b..            
8 Public support (Subtract line 7c from line 6.)            
Section B. Total Support
Calendar year (or fiscal year beginning in) right arrow (a) 2008 (b) 2009 (c) 2010 (d) 2011 (e) 2012 (f) Total
9 Amounts from line 6...            
10a Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..            
b Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.            
c Add lines 10a and 10b.            
11 Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.            
12 Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.) ..            
13 Total support. (Add lines 9, 10c, 11, and 12.)..            
14
Section C. Computation of Public Support Percentage
15
15
 
16
16
 
Section D. Computation of Investment Income Percentage
17
17
 
18
18
 
19a
b
20
Schedule A (Form 990 or 990-EZ) 2012
Schedule A (Form 990 or 990-EZ) 2012
Page 4
Part IV
Supplemental Information. Complete this part to provide the explanations required by Part II, line 10; Part II, line 17a or 17b; and Part III, line 12. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
 
Explanation
 
 
 
 
Schedule A (Form 990 or 990-EZ) 2012

Additional Data


Software ID:  
Software Version:  
Schedule B
(Form 990, 990-EZ,
or 990-PF)
Department of the Treasury
Internal Revenue Service
Schedule of Contributors
Arrow Bullet Attach to Form 990, 990-EZ, or 990-PF.
OMB No. 1545-0047
2012
Name of the organization
INDIANA UNIVERSITY HEALTH BLOOMINGTON INC
 
Employer identification number

35-1720796
Organization type (check one):
Filers of:
Section:
Form 990 or 990-EZ





Form 990-PF




Check if your organization is covered by the General Rule or a Special Rule.  
Note. Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.
General Rule
Special Rules
......................... Arrow Bullet   $    
Caution. An organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2 of its Form 990; or check the box 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 BLOOMINGTON INC
  		Employer identification number

35-1720796
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


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

     
 
   

$  


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

     
 
   

$  


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

     
 
   

$  


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

     
 
   

$  


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

     
 
   

$  


(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 BLOOMINGTON INC
  		Employer identification number

35-1720796
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 BLOOMINGTON INC
  		Employer identification number

35-1720796
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 (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
Schedule B (Form 990, 990-EZ, or 990-PF) (2012)

Additional Data


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

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

For Organizations Exempt From Income Tax Under section 501(c) and section 527
SchCMd Bullet Complete if the organization is described below.SchCMd Bullet Attach to Form 990 or Form 990-EZ.
SchCMd Bullet See separate instructions.
OMB No. 1545-0047
2012
Open to Public
Inspection
If the organization answered “Yes” to Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet Section 527 organizations: Complete Part I-A only.
If the organization answered “Yes” to Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)): Complete Part II-A. Do not complete Part II-B.
Round Bullet Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered “Yes” to Form 990, Part IV, Line 5 (Proxy Tax) or Form 990-EZ, Part V, line 35c (Proxy Tax), then
Round Bullet Section 501(c)(4), (5), or (6) organizations: Complete Part III.
Name of the organization
INDIANA UNIVERSITY HEALTH BLOOMINGTON INC
 
Employer identification number

35-1720796
Part I-A
Complete if the organization is exempt under section 501(c) or is a section 527 organization.

1
Provide a description of the organization’s direct and indirect political campaign activities in Part IV.
2
Political expenditures ....................................SchCMd Bullet
$  
3
Volunteer hours ........................................
 

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

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

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










For Paperwork Reduction Act Notice, see the instructions for Form 990 or 990-EZ.
Cat. No. 50084S
Schedule C (Form 990 or 990-EZ) 2012

Schedule C (Form 990 or 990-EZ) 2012
Page 2
Part II-A
Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).
A Check SchCMd Bulletexpenses, and share of excess lobbying expenditures).
B Check SchCMd Bullet
Limits on Lobbying Expenditures
(The term "expenditures" means amounts paid or incurred.) 		(a) Filing
organization's
totals 		(b) Affiliated group
totals
1a Total lobbying expenditures to influence public opinion (grass roots lobbying) ......    
b Total lobbying expenditures to influence a legislative body (direct lobbying) .......    
c Total lobbying expenditures (add lines 1a and 1b) ...................    
d Other exempt purpose expenditures ........................    
e Total exempt purpose expenditures (add lines 1c and 1d) ...............    
f Lobbying nontaxable amount. Enter the amount from the following table in both
columns.		    
  If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:    
  Not over $500,00020% of the amount on line 1e.    
  Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.    
  Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.    
  Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.    
  Over $17,000,000$1,000,000.    
       
g Grassroots nontaxable amount (enter 25% of line 1f) .................    
h Subtract line 1g from line 1a. If zero or less, enter -0-. ................    
i Subtract line 1f from line 1c. If zero or less, enter -0-. ................    
j If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting
section 4911 tax for this year? ......................................

4-Year Averaging Period Under Section 501(h)
(Some organizations that made a section 501(h) election do not have to complete all of the five
columns below. See the instructions for lines 2a through 2f on page 4.)
Lobbying Expenditures During 4-Year Averaging Period
  Calendar year (or fiscal year
beginning in) 		(a) 2009 (b) 2010 (c) 2011 (d) 2012 (e) Total
             
2a Lobbying nontaxable amount          
             
b Lobbying ceiling amount
(150% of line 2a, column(e)) 		         
             
c Total lobbying expenditures          
             
d Grassroots nontaxable amount          
             
e Grassroots ceiling amount
(150% of line 2d, column (e))		          
             
f Grassroots lobbying expenditures          
Schedule C (Form 990 or 990-EZ) 2012


Schedule C (Form 990 or 990-EZ) 2012
Page 3
Part II-B
Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).
For each “Yes” response to lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.
(a)
No
Yes
(b)
Amount
1
During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:
a
Volunteers? .........................................
 
 
b
Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ....
 
 
c
Media advertisements? ....................................
 
No
 
d
Mailings to members, legislators, or the public? .........................
 
No
 
e
Publications, or published or broadcast statements? .......................
 
No
 
f
Grants to other organizations for lobbying purposes? .......................
 
No
 
g
Direct contact with legislators, their staffs, government officials, or a legislative body? ........
 
No
 
h
Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ......
 
No
 
i
Other activities? ..........................
Yes
 
13,065
j
Total. Add lines 1c through 1i ...............................
13,065
2a
Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....
 
 
b
If "Yes," enter the amount of any tax incurred under section 4912 .................
 
c
If "Yes," enter the amount of any tax incurred by organization managers under section 4912 .....
 
d
If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? .......
 
 
Part III-A
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).
Yes
No
1
Were substantially all (90% or more) dues received nondeductible by members? ................
1
 
 
2
Did the organization make only in-house lobbying expenditures of $2,000 or less? ................
2
 
 
3
Did the organization agree to carry over lobbying and political expenditures from the prior year? ..........
3
 
 
Part III-B
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) and if either (a) BOTH Part III-A, lines 1 and 2, are answered “No” OR (b) Part III-A, line 3, is answered “Yes."
1
Dues, assessments and similar amounts from members .....................
1
 
2
Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political
expenses for which the section 527(f) tax was paid).
a
Current year .........................................
2a
 
b
Carryover from last year ....................................
2b
 
c
Total ............................................
2c
 
3
Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .
3
 
4
If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ................................
4
 
5
Taxable amount of lobbying and political expenditures (see instructions) ..............
5
 
Part IV
Supplemental Information
Complete this part to provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, line 5; Part II-A (affiliated group list); Part II-A, line 2; and Part ll-B, line 1. Also, complete this part for any additional information.
Identifier Return Reference Explanation
Schedule C, Part II-B Line 1i - Other Activities Indiana University Health Bloomington Hospital, Inc. ("IU Health Bloomington Hospital") paid institutional membership dues to the American Hospital Association ("AHA") and Indiana Hospital Association ("IHA") during 2012 in the amount of $34,858 and $82,534, respectively. Each membership organization notified IU Health Bloomington Hospital that a portion of the dues it paid were used for lobbying purposes. The AHA used 24.60%, or $8,575 of 2012 membership dues paid by IU Health Bloomington Hospital, for lobbying expenditures. The IHA used 5.44%, or $4,490 of the 2012 membership dues paid by IU Health Bloomington Hospital, for lobbying expenditures. The total membership dues paid to these organizations by IU Health Bloomington Hospital during 2012 that were attributable to lobbying expenditures was $13,065.
Schedule C (Form 990 or 990EZ) 2012

Additional Data


Software ID:  
Software Version:  

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

35-1720796
Part I
Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" to Form 990, Part IV, line 6.
(a) Donor advised funds (b) Funds and other accounts
1 Total number at end of year .........    
2 Aggregate contributions to (during year) ...    
3 Aggregate grants from (during year) .....    
4 Aggregate value at end of year ........    
5
Did the organization inform all donors and donor advisors in writing that the assets held in donor advised
funds are the organization's property, subject to the organization's exclusive legal control? ............
6
Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be
used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ...................................
Part II
Conservation Easements. Complete if the organization answered "Yes" to Form 990, Part IV, line 7.
1
Purpose(s) of conservation easements held by the organization (check all that apply).
2
Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.
Held at the End of the Year
a Total number of conservation easements ....................... 2a  
b Total acreage restricted by conservation easements .................. 2b  
c Number of conservation easements on a certified historic structure included in (a) ..... 2c  
d Number of conservation easements included in (c) acquired after 8/17/06, and not on a historic structure listed in the National Register .................... 2d  
3
Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the tax year SchDMd Bullet  
4
Number of states where property subject to conservation easement is located SchDMd Bullet  
5
Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and
enforcement of the conservation easements it holds? .............................
6
Staff and volunteer hours devoted to monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet  
7
Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet $  
8
Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i) and section 170(h)(4)(B)(ii)? .......................................
9
In Part XIII, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" to Form 990, Part IV, line 8.
1a
If the organization elected, as permitted under SFAS 116 (ASC 958), not to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide, in Part XIII, the text of the footnote to its financial statements that describes these items.
b
If the organization elected, as permitted under SFAS 116 (ASC 958), to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide the following amounts relating to these items:
(i)
Revenues included in Form 990, Part VIII, line 1 ........................SchDMd Bullet $  
(ii)
Assets included in Form 990, Part X ..............................SchDMd Bullet $  
2
If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under SFAS 116 (ASC 958) relating to these items:
a
Revenues included in Form 990, Part VIII, line 1 ..........................SchDMd Bullet $  
b
Assets included in Form 990, Part X ...............................SchDMd Bullet $  
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 52283D
Schedule D (Form 990) 2012

Schedule D (Form 990) 2012
Page 2
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)
3
Using the organization’s acquisition, accession, and other records, check any of the following that are a significant use of its collection items (check all that apply):
a
d
b
e
 
c
4
Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.
5
During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?........
Part IV
Escrow and Custodial Arrangements. Complete if the organization answered "Yes" to Form 990,
Part IV, line 9, or reported an amount on Form 990, Part X, line 21.
1a
Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................
b
If "Yes," explain the arrangement in Part XIII and complete the following table:
Amount
c Beginning balance ................................. 1c  
d Additions during the year .............................. 1d  
e Distributions during the year ............................. 1e  
f Ending balance ................................... 1f  
2a
Did the organization include an amount on Form 990, Part X, line 21? .....................
b
If “Yes,” explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII ........
Part V
Endowment Funds. Complete if the organization answered "Yes" to Form 990, Part IV, line 10.
(a)Current year (b)Prior year b (c)Two years back (d)Three years back (e)Four years back
1a Beginning of year balance .... 3,571,184 4,313,701 4,108,745 3,703,110 3,703,110
b Contributions ........ 533,663   204,956 405,635  
c Net investment earnings, gains, and losses          
d Grants or scholarships .....          
e Other expenditures for facilities
and programs ........ 		  742,517      
f Administrative expenses ....          
g End of year balance ...... 4,104,847 3,571,184 4,313,701 4,108,745 3,703,110
2
Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:
a
Board designated or quasi-endowment SchDMd Bullet  
b
Permanent endowment SchDMd Bullet15.461 %
c
Temporarily restricted endowment SchDMd Bullet84.539 %
The percentages in lines 2a, 2b, and 2c should equal 100%.
3a
Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes
No
(i) unrelated organizations ........................
3a(i)
 
No
(ii) related organizations ........................
3a(ii)
Yes
 
b
If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? .........
3b
Yes
 
4
Describe in Part XIII the intended uses of the organization's endowment funds.
Part VI
Land, Buildings, and Equipment. See Form 990, Part X, line 10.
Description of property (a) Cost or other basis (investment) (b)Cost or other basis (other) (c) Accumulated depreciation (d) Book value
1a Land .................   19,606,797 19,606,797
b Buildings ................   152,468,133 93,241,074 59,227,059
c Leasehold improvements ............   6,197,948 4,346,351 1,851,597
d Equipment ................   190,796,891 155,719,345 35,077,546
e Other .................   8,940,705 4,390,140 4,550,565
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......SchDMdBullet 120,313,564
Schedule D (Form 990) 2012

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








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








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








Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........Small Bullet  
Part X
Other Liabilities. See Form 990, Part X, line 25.
1.(a) Description of liability (b) Book value
Federal income taxes 0
Due to Third-Party Payors 6,314,431
Pension and Other Retirement Liabilities 30,802,918
Accrued Malpractice Liability 381,528






Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)Small Bullet 37,498,877
2. Fin 48 (ASC 740) Footnote. In Part XIII, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC 740). Check here if the text of the footnote has been provided in Part XIII .....................................................
Schedule D (Form 990) 2012

Schedule D (Form 990) 2012
Page 4
Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return
1 Total revenue, gains, and other support per audited financial statements ....... 1  
2 Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a Net unrealized gains on investments .......... 2a  
b Donated services and use of facilities ......... 2b  
c Recoveries of prior year grants ........... 2c  
d Other (Describe in Part XIII.) ............ 2d  
e Add lines 2a through 2d ..................... 2e  
3 Subtract line 2e from line 1..................... 3  
4 Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b . 4a  
b Other (Describe in Part XIII.) ........... 4b  
c Add lines 4a and 4b....................... 4c  
5 Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ...... 5  
Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return
1 Total expenses and losses per audited financial statements ........... 1  
2 Amounts included on line 1 but not on Form 990, Part IX, line 25:
a Donated services and use of facilities .......... 2a  
b Prior year adjustments .............. 2b  
c Other losses ................ 2c  
d Other (Describe in Part XIII.) ............ 2d  
e Add lines 2a through 2d...................... 2e  
3 Subtract line 2e from line 1..................... 3  
4 Amounts included on Form 990, Part IX, line 25, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b .. 4a  
b Other (Describe in Part XIII.) ............ 4b  
c Add lines 4a and 4b....................... 4c  
5 Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ...... 5  
Part XIII
Supplemental Information
Complete this part to provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b;
Part V, line 4; Part X, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.
Identifier Return Reference Explanation
Schedule D, Part V Endowment Funds Line 4 Intended Uses of Organizations Endowment Funds Temporarily and permanently restricted net assets are generally restricted for indigent and other patient care services, medical education and research programs, and medical supplies and equipment.
ASC 740-10 FOOTNOTE FROM FINANCIAL STATEMENTS SCHEDULE D, PART X, LINE 2 INDIANA UNIVERSITY HEALTH BLOOMINGTON, INC. IS A SUBSIDIARY IN THE CONSOLIDATED FINANCIAL STATEMENTS OF INDIANA UNIVERSITY HEALTH, INC. INDIANA UNIVERSITY HEALTH, INC. ADOPTED FIN 48 (NOW ASC 740-10) IN 2007. NO DISCLOSURES WERE REQUIRED IN 2012 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


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Software Version:  




SCHEDULE F(Form 990)
Department of the Treasury
Internal Revenue Service
Statement of Activities Outside the United States
Right pointing arrow large image Complete if the organization answered "Yes" to Form 990,Part IV, line 14b, 15, or 16.Right pointing arrow large image Attach to Form 990. Right pointing arrow large image See separate instructions.
OMB No. 1545-0047
2012
Open to Public Inspection
Name of the organization
INDIANA UNIVERSITY HEALTH BLOOMINGTON INC
 
Employer identification number

35-1720796
Part I
General Information on Activities Outside the United States. Complete if the organization answered “Yes” to Form 990, Part IV, line 14b.
1
For grantmakers. Does the organization maintain records to substantiate the amount of the grants or
assistance, the grantees’ eligibility for the grants or assistance, and the selection criteria used to award
the grants or assistance? ...................................
2
For grantmakers. Describe in Part V the organization’s procedures for monitoring the use of grant funds outside
the United States.
3
Activites per Region. (The following Part I, line 3 table can be duplicated if additional space is needed.)
(a) Region (b) Number of offices in the region (c) Number of employees, agents, and independent contractors in region (d) Activities conducted in region (by type) (e.g., fundraising, program services, investments, grants to recipients located in the region) (e) If activity listed in (d) is a program service, describe specific type of
service(s) in region		 (f) Total expenditures
for and investments
in region
Central America and the Caribbean     Investments   5,171,803
           
           
           
           
           
           
           
           
           
           
           
           
           
           
           
           
3a Sub-total .....     5,171,803
b Total from continuation sheets to Part I ...      
c Totals (add lines 3a and 3b)     5,171,803
For Paperwork Reduction Act Notice, see the Instructions for Form 990.Cat. No. 50082W Schedule F (Form 990) 2012
Schedule F (Form 990) 2012
Page 2
Part II
Grants and Other Assistance to Organizations or Entities Outside the United States. Complete if the organization answered “Yes” to Form 990, Part IV, line 15, for any recipient who received more than $5,000. Part II can be duplicated if additional space is needed.
1 (a) Name of organization (b) IRS code section
and EIN (if applicable)		 (c) Region (d) Purpose of
grant 		(e) Amount of
cash grant 		(f) Manner of
cash
disbursement 		(g) Amount of
of non-cash
assistance 		(h) Description
of non-cash
assistance 		(i) Method of
valuation
(book, FMV,
appraisal, other)
             
             
             
             
             
             
             
             
             
             
             
             
             
             
             
             
2 Enter total number of recipient organizations listed above that are recognized as charities by the foreign country, recognized as tax-exempt by the IRS, or for which the grantee or counsel has provided a section 501(c)(3) equivalency letter ....MediumBullet
 
3
Enter total number of other organizations or entities .......................MediumBullet
 
Schedule F (Form 990) 2012
Schedule F (Form 990) 2012Page 3
Part III
Grants and Other Assistance to Individuals Outside the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 16.
Part III can be duplicated if additional space is needed.
(a) Type of grant or assistance (b) Region (c) Number of recipients (d) Amount of
cash grant 		(e) Manner of cash
disbursement 		(f) Amount of
non-cash
assistance 		(g) Description
of non-cash
assistance 		(h) Method of
valuation
(book, FMV,
appraisal, other)
               
               
               
               
               
               
               
               
               
               
               
               
               
               
               
               
               
               
Schedule F (Form 990) 2012
Schedule F (Form 990) 2012
Page 4
Part IV
Foreign Forms
1 Was the organization a U.S. transferor of property to a foreign corporation during the tax year? If “Yes,”the organization may be required to file Form 926, Return by a U.S. Transferor of Property to a Foreign Corporation (see Instructions for Form 926)......................................
2 Did the organization have an interest in a foreign trust during the tax year? If “Yes,” the organizationmay be required to file Form 3520, Annual Return to Report Transactions with Foreign Trusts and Receipt of Certain Foreign Gifts, and/or Form 3520-A, Annual Information Return of Foreign Trust With a U.S. Owner (see Instructions for Forms 3520 and 3520-A).......................................
3 Did the organization have an ownership interest in a foreign corporation during the tax year? If "Yes," the organization may be required to file Form 5471, Information Return of U.S. Persons with Respect to Certain Foreign Corporations. (see Instructions for Form 5471)..............................
4 Was the organization a direct or indirect shareholder of a passive foreign investment company or a qualified electing fund during the tax year? If "Yes," the organization may be required to file Form 8621, Return by a Shareholder of a Passive Foreign Investment Company or Qualified Electing Fund. (see Instructions for Form 8621)
5 Did the organization have an ownership interest in a foreign partnership during the tax year? If "Yes," the organization may be required to file Form 8865, Return of U.S. Persons with Respect to Certain Foreign Partnerships. (see Instructions for Form 8865)....................................
6 Did the organization have any operations in or related to any boycotting countries during the tax year? If "Yes," the organization may be required to file Form 5713, International Boycott Report (see Instructions for Form 5713)................................................
Schedule F (Form 990) 2012
Schedule F (Form 990) 2012
Page 5
Part V
Supplemental Information
Complete this part to provide the information required by Part I, line 2 (monitoring of funds); Part I, line 3, column (f) (accounting method; amounts of investments vs. expenditures per region); Part II, line 1 (accounting method); Part III (accounting method); and Part III, column (c) (estimated number of recipients), as applicable. Also complete this part to provide any additional information (see instructions).
Identifier ReturnReference Explanation
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
Schedule F (Form 990) 2012
Additional Data


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Software Version:  



SCHEDULE H (Form 990)
Department of the Treasury
Internal Revenue Service
Hospitals
MediumBullet Complete if the organization answered "Yes" to Form 990, Part IV, question 20.
MediumBullet Attach to Form 990. MediumBullet See separate instructions.
OMB No. 1545-0047
2012
Open to Public Inspection
Name of the organization
INDIANA UNIVERSITY HEALTH BLOOMINGTON INC
 
Employer identification number

35-1720796
Part I
Financial Assistance and Certain Other Community Benefits at Cost
Yes
No
1a
Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a ...
1a
Yes
 
b
If "Yes," was it a written policy? .......................
1b
Yes
 
2
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.
3
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.
a
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:
3a
Yes
 
%
b
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: .........
3b
Yes
 
%
c
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.
4
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"? ..............

4

Yes

 
5a
Did the organization budget amounts for free or discounted care provided under its financial assistance policy during the tax year? ............................

5a

Yes

 
b
If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? ......
5b
Yes
 
c
If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care? ..............
5c
 
No
6a
Did the organization prepare a community benefit report during the tax year? ..........
6a
Yes
 
b
If "Yes," did the organization make it available to the public? ..............
6b
Yes
 
Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.
7
Financial Assistance and Certain Other Community Benefits at Cost
Financial Assistance and
Means-Tested
Government Programs
 (a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community benefit expense (d) Direct offsetting revenue (e) Net community benefit expense (f) Percent of total expense
a Financial Assistance at cost
(from Worksheet 1) .. 		  13,057 15,421,785 0 15,421,785 4.830 %
b Medicaid (from Worksheet 3,
column a) .... 		  43,791 45,002,038 33,117,196 11,884,842 3.730 %
c Costs of other means-tested
government programs (from
Worksheet 3, column b) . 		  4,064 3,383,351 2,857,598 525,753 0.160 %
d Total Financial Assistance
and Means-Tested
Government Programs . 		  60,912 63,807,174 35,974,794 27,832,380 8.720 %
Other Benefits
 28 122,439 1,296,272 742 1,295,530 0.410 %
e Community health
improvement services and
community benefit operations
(from Worksheet 4) ..
f Health professions education
(from Worksheet 5) .. 		3 3,539 430,299 4,400 425,899 0.130 %
g Subsidized health services
(from Worksheet 6) .. 		2 14,109 22,012,528 15,749,063 6,263,465 1.960 %
h Research (from Worksheet 7)            
i Cash and in-kind
contributions for community
benefit (from Worksheet 8) 		3 27,800 411,065 0 411,065 0.130 %
j Total. Other Benefits .. 36 167,887 24,150,164 15,754,205 8,395,959 2.630 %
k Total. Add lines 7d and 7j . 36 228,799 87,957,338 51,728,999 36,228,339 11.350 %
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.
(a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community building expense (d) Direct offsetting
revenue 		(e) Net community building expense (f) Percent of total expense
1 Physical improvements and housing            
2 Economic development            
3 Community support 1 775 0 0 0 0 %
4 Environmental improvements            
5 Leadership development and training for community members            
6 Coalition building 1 150 0 0 0 0 %
7 Community health improvement advocacy 1 365 7,842 0 7,842  
8 Workforce development 1 15 1,465 0 1,465  
9 Other            
10 Total 4 1,305 9,307 0 9,307 0 %
Part III
Bad Debt, Medicare, & Collection Practices
Section A. Bad Debt Expense
Yes
No
1
Did the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................
1
 
No
2
Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......
2
19,101,109
3
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. ......
3
 
4
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
5
Enter total revenue received from Medicare (including DSH and IME).....
5
73,819,258
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
92,505,159
7
Subtract line 6 from line 5. This is the surplus (or shortfall)........
7
-18,685,901
8
Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:
Section C. Collection Practices
9a
Did the organization have a written debt collection policy during the tax year? ..........
9a
Yes
 
b
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.......................

9b

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 %
1S IN Surgery Ctr LLC
  		outpatient surgery 45.000 %   55.000 %
2S IN Radiolog Assoc
  		radiological services 50.000 %   50.000 %
3Bloomington Endo Ctr
  		gastrointestional treatment 51.000 %   49.000 %
4
5
6
7
8
9
10
11
12
13
Schedule H (Form 990) 2012
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?1
Name, address, and primary website address 		Licensed Hospital General-Medical-Surgical Children's Hospital Teaching Hospital Critical Hospital Research Facility ER-24Hours ER-Other Other (Describe) Facility reporting group
1 Indiana University Health Bloomington
601 West Second Street
Bloomington,IN47403
www.IUHEALTHBLOOMINGTON.ORG 		X X         X      
Schedule H (Form 990) 2012
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)
INDIANA UNIVERSITY HEALTH BLOOMINGTON
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) 1
Yes No
Community Health Needs Assessment (Lines 1 through 8c are optional for tax years begining on or before March 23, 2012)
1 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.................... 1    
If “Yes,” indicate what the CHNA report describes (check all that apply):
a
b
c
d
e
f
g
h
i
j
2 Indicate the tax year the hospital facility last conducted a CHNA: 20  
3 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 .................... 3    
4 Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI................................ 4    
5 Did the hospital facility make its CHNA report widely available to the public? ............. 5    
If “Yes,” indicate how the CHNA report was made widely available (check all that apply):
a
b
c
6 If the hospital facility addressed needs identified in its most recently conducted CHNA, indicate how (check all that apply to date):
a
b
c
d
e
f
g
h
i
7 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 ........ 7    
8a 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)? ........................... 8a    
b If "Yes" to line 8a, did the organization file Form 4720 to report the section 4959 excise tax? ...... 8b    
c 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
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: 200.%
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: 200.%
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
b
c
d
e
f
g
h
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
b
c
d
e
f
g
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
b
c
d
e
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
b
c
d
e
Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part VFacility Information (continued)

18 Indicate which efforts the hospital facility made before initiating any of the actions listed in line 17 (check all that apply):
a
b
c
d
e
Policy Relating to Emergency Medical Care
Yes No
19 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?.......... 19 Yes  
If “No,” indicate why:
a
b
c
d
Charges to Individuals Eligible for Assistance under the FAP (FAP-Eligible Individuals)
20 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.
a
b
c
d
21 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? ............................ 21   No
If “Yes,” explain in Part VI.
22 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? ......................... 22   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2012
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?7
Name and address Type of Facility (describe)
1 IUH BLOOMINGTON HOSP COMM HEALTH SVCS
333 EAST MILLER DRIVE
BLOOMINGTON,IN47401 		COMMUNITY HEALTH SERVICES
2 IUH BLOOMINGTON HOSP HOME MEDICAL EQUIP
1355 WEST BLOOMFIELD ROAD SUITE 4
BLOOMINGTON,IN47403 		DURABLE MEDICAL EQUIPMENT SUPL
3 IUH BLOOMINGTON HOSP HOME HEALTH SVCS
333 EAST MILLER DRIVE
BLOOMINGTON,IN47401 		HOME HEALTH AGENCY
4 IUH BLOOMINGTON HOSPITAL HOSPICE
619 WEST FIRST STREET
BLOOMINGTON,IN47403 		HOSPICE
5 IUH BLOOMINGTON HOSP CTR OCCUP HEALTH
3443 WEST THIRD STREET
BLOOMINGTON,IN47404 		OCCUPATIONAL HEALTH PROGRAM
6 IUH BLOOMINGTON HOSP PROMPTCARE WEST
3443 WEST THIRD STREET
BLOOMINGTON,IN47404 		URGENT CARE CENTER
7 IUH BLOOMINGTON HOSP PROMPTCARE EAST
326 SOUTH WOODCREST DRIVE
BLOOMINGTON,IN47401 		URGENT CARE CLINIC
8
9
10
Schedule H (Form 990) 2012
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 3C   INDIANA UNIVERSITY HEALTH BLOOMINGTON HOSPITAL MAKES PARTIAL FINANCIAL ASSISTANCE DETERMINATIONS BASED UPON PATIENTS' LIQUID ASSET AND INCOME LEVELS. THE HOSPITAL CALCULATES A PATIENT'S TOTAL AVAILABLE FUNDS BY ADDING ANNUAL INCOME AND LIQUID ASSETS, AND THEN SUBTRACTING 200% OF THE FEDERAL POVERTY GUIDELINES FOR THE FAMILY SIZE. THE DIFFERENCE BETWEEN THE BILLED CHARGES AND THE TOTAL AVAILABLE FUNDS TO PAY THE HOSPITAL IS ADJUSTED OFF TO FINANCIAL ASSISTANCE. ALL PATIENTS QUALIFYING FOR FINANCIAL ASSISTANCE RECEIVE A FINANCIAL ASSISTANCE DISCOUNT THAT IS AT LEAST AS LARGE AS THE AVERAGE OF THE THREE LARGEST NEGOTIATED COMMERCIAL DISCOUNT RATES.
PART I, LINE 6A   INDIANA UNIVERSITY HEALTH BLOOMINGTON HOSPITAL REPORTS ITS COMMUNITY BENEFIT INVESTMENTS AND INITIATIVE HIGHLIGHTS IN TWO SEPARATE REPORTS. FIRST, THE HOSPITAL PREPARES A SEPARATE COMMUNITY BENEFIT REPORT THAT ONLY REFLECTS COMMUNITY BENEFIT ACTIVITIES OCCURRING UNDER ITS TAX IDENTIFICATION NUMBER. IN ADDITION, THE INDIANA UNIVERSITY HEALTH STATEWIDE SYSTEM PUBLISHES AN ANNUAL COMMUNITY BENEFIT REPORT THAT ENCOMPASSES THE COMMUNITY BENEFIT ACTIVITIES OF ALL OF ITS STATEWIDE FACILITIES.
PART I, LINE 7G   IN ACCORDANCE WITH THE INSTRUCTIONS, INDIANA UNIVERSITY HEALTH BLOOMINGTON HOSPITAL IDENTIFIED SUBSIDIZED HEALTH SERVICES AS SERVICES THAT WERE PROVIDED AT A FINANCIAL LOSS AND WOULD NO LONGER BE OFFERED IN THE COMMUNITY IF THE HOSPITAL DISCONTINUED THE SERVICE. THE HOSPITAL DID NOT INCLUDE ANY COSTS ATTRIBUTABLE TO A PHYSICIAN CLINIC AS SUBSIDIZED HEALTH SERVICES.
PART I, LINE 7, COLUMN (F)   IN CALCULATING THE PERCENTAGE OF TOTAL EXPENSE REPORTED IN COLUMN (F), TOTAL EXPENSES AS REPORTED ON FORM 990, PART IX, LINE 25, COLUMN (A) WERE REDUCED BY $19,101,109, THE AMOUNT OF BAD DEBT EXPENSE INCLUDED ON THAT LINE.
PART I, LINE 7   INDIANA UNIVERSITY HEALTH BLOOMINGTON HOSPITAL USED A HOSPITAL-WIDE COST-TO-CHARGE RATIO TO CALCULATE THE COST OF PROVIDING SERVICES TO CHARITY CARE PATIENTS. DEPARTMENT-SPECIFIC COST-TO-CHARGE RATIOS FROM THE HOSPITAL'S MEDICARE COST REPORT WERE USED TO CALCULATE THE COST OF MEDICAID SERVICES, HEALTHY INDIANA PLAN SERVICES, AND SUBSIDIZED HEALTH SERVICES. ACTUAL DIRECT COSTS PLUS AN INDIRECT COST FACTOR FROM THE MEDICARE COST REPORT WAS USED TO CALCULATE THE COST OF COMMUNITY HEALTH IMPROVEMENT SERVICES, HEALTH PROFESSIONS EDUCATION, AND CONTRIBUTIONS TO COMMUNITY GROUPS.
PART II   INDIANA UNIVERSITY HEALTH BLOOMINGTON HOSPITAL PROVIDES FINANCIAL AND IN-KIND SUPPORT TO COMMUNITY AGENCIES AND PROGRAMS THAT BENEFIT THE WELL-BEING OF THE COMMUNITY. THIS COMMUNITY SUPPORT IS PROVIDED TO SUCH PROGRAMS AS THE MONROE COUNTY EMERGENCY MANAGEMENT DISASTER PREPAREDNESS EFFORTS. IU HEALTH BLOOMINGTON HOSPITAL ALSO IMPROVES THE HEALTH OF ITS COMMUNITY THROUGH COLLABORATIONS AND PARTNERSHIPS SUCH AS THE ACTIVE LIVING COALITION AND THE ACTIVE AGING COALITION. THE ACTIVE LIVING COALITION IS COMPRISED OF INDIVIDUALS AND ORGANIZATIONS REPRESENTING COMMUNITY SECTORS OF HEALTH CARE, EDUCATION, CITY GOVERNMENT, COUNTY GOVERNMENT, BUSINESS, AND SERVICE ORGANIZATIONS WHO ARE ADDRESSING THE PUBLIC HEALTH ISSUE OF PHYSICAL INACTIVITY. THE COALITION STRIVES TO INCREASE THE NUMBER OF PEOPLE WHO ENGAGE IN A HEALTHY, PHYSICALLY ACTIVE LIFESTYLE THROUGH COLLABORATIVE EFFORTS ON COMMUNITY EVENTS, RESEARCH, NETWORKING AND PROGRAMMING THAT LEADS TO INCREASED PHYSICAL ACTIVITY OPPORTUNITIES FOR ALL WHO RESIDE IN MONROE COUNTY. THIS PROGRAM IS OFFERED AT NO CHARGE TO THE PARTICIPANTS WHO ARE REFERRED BY THEIR HEALTHCARE PRACTITIONER. THE ACTIVE AGING COALITION IS A GRASSROOTS NETWORKING ORGANIZATION CONSISTING OF SENIORS AND THE BUSINESSES AND NON-PROFIT ORGANIZATIONS WHO SERVE THEM. THE GOAL OF THE COALITION IS TO IDENTIFY SPECIFIC AREAS OF NEED IMPACTING SENIORS AND CREATE FOCUS GROUPS TO WORK ON THESE AREAS. FINALLY, IU HEALTH BLOOMINGTON HOSPITAL IMPROVES LONG-TERM ACCESS TO HEALTHCARE IN THE COMMUNITY BY WORKING WITH EDUCATIONAL INSTITUTIONS TO HOST CAREER DAYS AND PLACE STUDENTS IN JOB SHADOWING OPPORTUNITIES IN ITS FACILITY.
PART III, LINE 4   Below is the footnote to the organizations financial statements that describes how the organization determines the provision for uncollectible patient accounts: Summary of Significant Accounting Policies Accounts Receivable and Allowance for Uncollectible Accounts "The Indiana University Health System does not require collateral or other security for the delivery of health care services from its patients, substantially all of whom are residents of the state of Indiana. However, assignment of benefit payments payable under patients health insurance programs and plans (e.g., Medicare, Medicaid, health maintenance organizations, and commercial insurance policies) is routinely obtained, consistent with industry practice. The provision for uncollected patient accounts, for all payors, is recognized when services are provided based upon managements assessment of historical and expected net collections, taking into consideration business and economic conditions, changes and trends in health care coverage, and other collection indicators. Periodically, management assesses the adequacy of the allowance for uncollectible accounts based upon accounts receivable payor composition and aging, the significance of individual payors to outstanding accounts receivable balances, and historical write-off experience by payor category, as adjusted for collection indicators. The results of this review are then used to make any modifications to the provision for uncollected patient accounts and the allowance for uncollectible accounts. In addition, the Indiana University Health System follows established guidelines for placing certain past due patient balances with collection agencies. Patient accounts that are uncollected, including those placed with collection agencies, are initially charged against the allowance for uncollectible accounts in accordance with collection policies of the Indiana University Health System and, in certain cases, are reclassified to charity care if deemed to otherwise meet financial assistance policies of the Indiana University Health System." Methodology used in determining the amount reported on line 2 as bad debt: Indiana University Health Bloomington Hospital considers an account as bad debt when it has unsuccessfully exhausted its internal collections efforts. Rationale for including bad debt as community benefit: IU Health Bloomington Hospital provides health care services through various programs that are designed, among other matters, to enhance the health of the community and improve the health of low-income patients. In addition, the Hospital provides services intended to benefit the poor and underserved, including those persons who cannot afford health insurance because of inadequate resources and are uninsured or underinsured.
PART III, LINE 8   DEPARTMENT-SPECIFIC COST-TO-CHARGE RATIOS FROM THE HOSPITAL'S MEDICARE COST REPORT WERE USED TO CALCULATE THE COST OF MEDICARE SERVICES. THE MEDICARE COSTS OF SERVICES INCLUDED IN PART I AS "SUBSIDIZED HEALTH SERVICES" WERE THEN REMOVED TO ENSURE THAT COSTS WERE NOT DOUBLE COUNTED ON SCHEDULE H. IN ACCORDANCE WITH THE SCHEDULE H INSTRUCTIONS, IU HEALTH BLOOMINGTON HOSPITAL ONLY INCLUDED THE ALLOWABLE COSTS AND NET MEDICARE COLLECTIONS THAT WERE REPORTED IN THE HOSPITAL'S MEDICARE COST REPORT. THEREFORE, THIS FIGURE EXCLUDED SUBSTANTIAL MEDICARE SHORTFALLS THAT RESULTED FROM PROVIDING AMBULANCE, CLINICAL LABORATORY, THERAPY, AND MEDICARE PART C SERVICES. THE HOSPITAL BELIEVES THAT ITS ENTIRE MEDICARE SHORTFALL SHOULD BE CONSIDERED A COMMUNITY BENEFIT. IN ACCORDANCE WITH ITS MISSION, THE HOSPITAL PROVIDES NECESSARY HEALTHCARE SERVICES TO ALL PATIENTS REGARDLESS OF THEIR INSURANCE STATUS OR ABILITY TO PAY. SERVICES ARE PROVIDED TO MEDICARE PATIENTS EVEN THOUGH THE HOSPITAL UNDERSTANDS THAT THE RESULTING REIMBURSEMENT WILL NOT BE ENOUGH TO COVER THE FULL COST OF PROVIDING THESE SERVICES. MEDICARE BENEFICIARIES BENEFIT FROM THE HOSPITAL PROVIDING THESE SERVICES AT A FINANCIAL LOSS, AND THE HOSPITAL FEELS THAT THIS BENEFIT SHOULD BE INCLUDED IN REPORTS PROVIDED TO THE COMMUNITY.
PART III, LINE 9B   ACCOUNTS THAT ARE APPROVED FOR FINANCIAL ASSISTANCE ARE IMMEDIATELY WRITTEN-OFF AND ALL COLLECTION EFFORTS ARE CEASED.
PART V, SECTION B, LINE 11   INDIANA UNIVERSITY HEALTH BLOOMINGTON HOSPITAL MAKES PARTIAL FINANCIAL ASSISTANCE DETERMINATIONS BASED UPON PATIENTS' LIQUID ASSET AND INCOME LEVELS. THE HOSPITAL CALCULATES A PATIENT'S TOTAL AVAILABLE FUNDS BY ADDING ANNUAL INCOME AND LIQUID ASSETS, AND THEN SUBTRACTING 200% OF THE FEDERAL POVERTY GUIDELINES FOR THE FAMILY SIZE. THE DIFFERENCE BETWEEN THE BILLED CHARGES AND THE TOTAL AVAILABLE FUNDS TO PAY THE HOSPITAL IS ADJUSTED OFF TO FINANCIAL ASSISTANCE. ALL PATIENTS QUALIFYING FOR FINANCIAL ASSISTANCE RECEIVE A FINANCIAL ASSISTANCE DISCOUNT THAT IS AT LEAST AS LARGE AS THE AVERAGE OF THE THREE LARGEST NEGOTIATED COMMERCIAL DISCOUNT RATES.
PART V, SECTION B, LINE 14G   THE HOSPITAL INCLUDED A SUMMARY OF THE FINANCIAL ASSISTANCE APPLICATION PROCESS ON ALL BILLS SENT TO PATIENTS. THIS PROCESS SUMMARY WAS ALSO POSTED IN HOSPITAL REGISTRATION AREAS. THESE NOTIFICATIONS CONTAINED THE TELEPHONE NUMBERS OF INDIVIDUALS TO CONTACT TO LEARN MORE ABOUT THE FINANCIAL ASSISTANCE PROCESS AND TO OBTAIN A COPY OF THE FINANCIAL ASSISTANCE APPLICATION.
PART VI, LINE 2 - NEEDS ASSESSMENT   INDIANA UNIVERSITY HEALTH BLOOMINGTON HOSPITAL UTILIZES A VARIETY OF TOOLS TO ASSESS THE HEALTH CARE NEEDS OF ITS SERVICE AREA. THESE TECHNIQUES INCLUDE ANALYZING DATA FROM ADMISSION AND DIAGNOSIS CODES, REVIEWING EMERGENCY DEPARTMENT STATISTICS, AND PARTNERING WITH LOCAL AGENCIES SUCH AS THE HEALTH DEPARTMENT, UNITED WAY, INDIANA UNIVERSITY, AND CITY OF BLOOMINGTON PARKS AND RECREATION. THE HOSPITAL USES THE RESULTS OF ITS NEEDS ASSESSMENT TO TARGET ITS COMMUNITY BENEFIT ACTIVITIES.
PART VI, LINE 3 - PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE   Indiana University Health Bloomington Hospital employs an Individual Solutions team of case workers and financial assistance representatives to educate patients about governmental assistance programs and the Hospitals internal financial assistance program. Uninsured patients are screened for eligibility for financial assistance, and, if eligible, the Individual Solutions team reaches out to the patients with education on the appropriate assistance program. This education takes place via room visits to uninsured inpatient patients and discussions in the emergency department with uninsured outpatient patients. The Individual Solutions team also screens Medicare patients for their ability to qualify for financial assistance either through Medicaid or the Hospitals charity care policy. The Individual Solutions team assists patients in completing the Medicaid, Healthy Indiana Plan, and charity care application paperwork and serves as their advocates throughout the application process. This advocacy can extend as far as attending a courtroom hearing in support of a patients Medicaid eligibility appeal if his or her application is originally denied by the State. The Hospital also notifies patients of financial assistance programs at other points during the revenue cycle. For example, Hospital staff alert patients to financial assistance programs during pre-hospitalization charge estimate requests and post-hospitalization billing inquiries. The Hospital goes to extraordinary measures to educate and assist patients regarding the financial assistance programs that are potentially available to them. Indiana University Health Bloomington Hospital has also funded an extensive outreach program to raise awareness of and enrollment in Indianas state sponsored health insurance program (the Healthy Indiana Plan). The Hospital utilizes the knowledge and expertise of its Individual Solutions team to promote the Healthy Indiana Plan (HIP) within our service area. The Hospital promotes this program through direct mailings, newspaper advertisements, HIP enrollment events, and other events within the community. The Individual Solutions team members meet with patients that need assistance completing Healthy Indiana Plan applications and are available to answer any questions that may arise during the application process. This tremendous outreach initiative demonstrates the Hospitals commitment to educating its patient base about the financial assistance programs that are available within the community.
PART VI, LINE 4 - COMMUNITY INFORMATION   Indiana University Health Bloomington Hospital is located in Monroe County and serves as a regional referral center for its ten county service area. Monroe County is located in south central Indiana and has a population of 137,974 (based on 2010 census). The other nine counties in the Hospitals service area are comprised of primarily rural communities. Bloomington is the largest town in Monroe County with a population of 69,247. The largest ethnic population in Monroe County is white (87.8%), followed by the Asian (5.2%), Black (3.3%), two or more race groups (2.5%) and American Indian/Alaska Native (0.3%). Hispanics make up 2.9% of the population, with Non-Hispanics equaling 97.1%. Monroe County has a lower-than-average median household income of $36,061 and a higher-than-average poverty rate of 21.9 percent. Lack of income serves as a barrier to accessing nutritious food, physical activities and transportation to such resources. This situation is exacerbated in the more rural areas of Monroe County where there are few public transportation options. However, the county is resource-rich with a vibrant health care and social assistance network, extensive parks and recreation programs and facilities and home to Indiana Universitys main campus.
PART VI, LINE 5 - PROMOTION OF COMMUNITY HEALTH   INDIANA UNIVERSITY HEALTH BLOOMINGTON HOSPITAL IS INVOLVED IN MULTIPLE INITIATIVES TO INCREASE ACCESS TO CARE WITHIN ITS COMMUNITY. THE HOSPITAL CURRENTLY OPERATES TWO PRIMARY CARE OFFICES THAT HELP ADDRESS THE PRIMARY CARE SHORTAGE AND ACCESS TO CARE ISSUES PRESENT IN THE COMMUNITY. THE HOSPITAL RECENTLY BEGAN PLANS FOR A THIRD PRIMARY CARE FACILITY TO PROVIDE FOR THE HEALTHCARE NEEDS OF MONROE COUNTY. THE HOSPITAL ALSO FINANCIALLY SUPPORTS THE LOCAL VOLUNTEERS IN MEDICINE UNINSURED CLINIC BY PROVIDING FREE TESTING SERVICES, STAFF SUPPORT, AND BOARD LEADERSHIP. FURTHERMORE, THE HOSPITAL PROVIDES SUPPORT TO COMMUNITY MEMBERS UNDERGOING CANCER TREATMENT BY PROVIDING AN EDUCATIONAL RESOURCE AND SUPPORT CENTER (OLCOTT CENTER) THAT IS FREE OF CHARGE TO THE COMMUNITY. FINALLY, THE HOSPITAL SERVES AS THE SPONSORING AGENCY FOR THE WIC PROGRAM OF MONROE AND GREENE COUNTIES, THE MONROE COUNTY PUBLIC HEALTH CLINIC, AND THE POSITIVE LINK HIV AND AIDS AWARENESS AND CARE COORDINATION PROGRAM.
PART VI, LINE 6 - AFFILIATED HEALTH CARE SYSTEM ROLES   INDIANA UNIVERSITY HEALTH IS A COMPREHENSIVE HEALTHCARE SYSTEM COMPRISED OF NUMEROUS HOSPITALS, PHYSICIANS PRACTICES, AND OTHER HEALTHCARE FACILITIES ACROSS THE STATE. BY COORDINATING CARE ACROSS A FULL CONTINUUM OF SERVICES, THE SYSTEM IS ABLE TO PROVIDE PREEMINENT CARE TO THE RESIDENTS OF INDIANA. ALTHOUGH EACH HOSPITAL IN THE SYSTEM PREPARES ITS OWN COMMUNITY BENEFIT PLAN RELATIVE TO ITS RESPECTIVE COMMUNITY, IU HEALTH CONSIDERS ITS COMMUNITY BENEFIT PLAN AS AN IMPORTANT PART OF AN OVERALL VISION FOR STRENGTHENING THE STATE'S HEALTHCARE SAFETY NET.
Part VI, Line 7 State Filing of Community Benefit Report IN
Schedule H (Form 990) 2012
Additional Data


Software ID:  
Software Version:  
Schedule I
(Form 990)
Department of the Treasury
Internal Revenue Service
Grants and Other Assistance to Organizations,
Governments and Individuals in the United States
Complete if the organization answered "Yes," to Form 990, Part IV, line 21 or 22.
lBullet Attach to Form 990
OMB No. 1545-0047
2012
Open to Public
Inspection
Name of the organization
INDIANA UNIVERSITY HEALTH BLOOMINGTON INC
 
Employer identification number
35-1720796
Part I
General Information on Grants and Assistance
1
Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ....................................
2
Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.
Part II
Grants and Other Assistance to Governments and Organizations in the United States. Complete if the organization answered "Yes" to
Form 990, Part IV, line 21, for any recipient that received more than $5,000. 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 (e) Amount of non-cash
assistance		 (f) Method of valuation
(book, FMV, appraisal,
other)		 (g) Description of
non-cash assistance		 (h) Purpose of grant
or assistance
(1) American Heart Association
PO Box 4002902
Des Moines,IA50340 		13-5613797 501(c)(3) 20,000       S13 Bloominton GRFW/S12 Bloomington Gala
(2) The Greater Bloomington Chamber of Commerce
PO Box 1302
Bloomington,IN47402 		35-0183215 501(c)(6) 14,234       Event Sponsorship
(3) Health Foundation of Greater Indianapolis
429 E Vermont St Ste 300
Indianapolis,IN46202 		35-6203550 501(C)(3) 10,000       Indiana Aids Fund
(4) Wonderlab Museum of Science Health & Tech
308 West 4th St
Bloomington,IN47404 		35-1956521 501(c)(3) 6,500       Thermal Imaging Camera
















2
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................ Bullet Image
3
3
Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image
1
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50055P
Schedule I (Form 990) 2012

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		 (d)Amount of
non-cash assistance		 (e)Method of valuation (book,
FMV, appraisal, other)		 (f)Description of non-cash assistance












Part IV
Supplemental Information.
Complete this part to provide the information required in Part I, line 2, Part III, column (b), and any other additional information.
Identifier Return Reference Explanation
Description of Organization's Procedures for Monitoring the Use of Grants Form 990, Schedule I, Part I, Line 2 Through its own active involvement in the programs it helps to support or underwrite, Indiana University Health Bloomington is aware at all times of the programs activities.
Schedule I (Form 990) 2012


Additional Data


Software ID:  
Software Version:  


Schedule J
(Form 990)
Department of the Treasury
Internal Revenue Service
Compensation Information
For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet Complete if the organization answered "Yes" to Form 990,
Part IV, question 23.
SchJMediumBullet Attach to Form 990. SchJMediumBullet See separate instructions.
OMB No. 1545-0047
2012
Open to Public Inspection
Name of the organization
INDIANA UNIVERSITY HEALTH BLOOMINGTON INC
 
Employer identification number

35-1720796
Part I
Questions Regarding Compensation
Yes
No
1a
Check the appropiate box(es) if the organization provided any of the following to or for a person listed in Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.
b
If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all of the expenses described above? If "No," complete Part III to explain....
1b
 
 
2
Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all officers,
directors, trustees, and the CEO/Executive Director, regarding the items checked in line 1a? .......
2
 
 
3
Indicate which, if any, of the following the filing organization used to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.
4
During the year, did any person listed in Form 990, Part VII, Section A, line 1a with respect to the filing organization or a related organization:
a
Receive a severance payment or change-of-control payment? ................
4a
 
No
b
Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........
4b
Yes
 
c
Participate in, or receive payment from, an equity-based compensation arrangement? .........
4c
 
No
If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.
Only 501(c)(3) and 501(c)(4) organizations only must complete lines 5-9.
5
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:
a
The organization? ...........................
5a
 
No
b
Any related organization? .........................
5b
 
No
If "Yes," to line 5a or 5b, describe in Part III.
6
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:
a
The organization? ...........................
6a
 
No
b
Any related organization? .........................
6b
 
No
If "Yes," to line 6a or 6b, describe in Part III.
7
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization provide any non-fixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............
7
Yes
 
8
Were any amounts reported in Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III .............................
8
 
No
9
If "Yes" to line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................
9
 
 
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50053T
Schedule J (Form 990) 2012

Schedule J (Form 990) 2012
Page 2
Part II
Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed.
For each individual whose compensation must be reported in Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions, on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.
Note. The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and (E) amounts for that individual.
(A) Name and Title (B) Breakdown of W-2 and/or 1099-MISC compensation (C) Retirement and other deferred compensation (D) Nontaxable
benefits		 (E) Total of columns
(B)(i)-(D) 		(F) Compensation
reported as deferred
in prior Form 990
(i) Base compensation (ii) Bonus & incentive compensation (iii) Other reportable compensation
(1)Daniel F Evans JrDirector (i)
(ii)		 0
1,043,576 		0
313,408 		0
56,850 		0
838,555 		0
26,887 		0
2,279,276 		0
0
(2)Mark E MooreCEO (i)
(ii)		 459,108
0 		46,282
0 		701,880
0 		159,532
0 		24,913
0 		1,391,715
0 		683,191
0
(3)James J MyersCFO (i)
(ii)		 246,994
0 		23,333
0 		18,084
0 		85,581
0 		1,452
0 		375,444
0 		0
0
(4)Steven D DeckardVP, HR (i)
(ii)		 170,163
0 		14,369
0 		61,439
0 		40,413
0 		17,687
0 		304,071
0 		47,544
0
(5)Kenneth E Marshall MDVP & CMO (i)
(ii)		 322,022
0 		26,000
0 		552
0 		44,359
0 		26,578
0 		419,511
0 		0
0
(6)Mark W McMathVP & CIO (i)
(ii)		 198,827
0 		16,997
0 		7,022
0 		37,101
0 		27,513
0 		287,460
0 		0
0
(7)Ruth Ann Morris RNVP & CNO (i)
(ii)		 247,020
0 		20,782
0 		10,198
0 		75,177
0 		21,182
0 		374,359
0 		0
0
(8)Lee McKinley MDPhysician (i)
(ii)		 287,461
0 		0
0 		7,885
0 		43,419
0 		17,608
0 		356,373
0 		0
0
(9)Amartyadeb Goswami MDPhysician (i)
(ii)		 286,673
0 		0
0 		552
0 		11,250
0 		31,242
0 		329,717
0 		0
0
(10)Charles McCalla MDPhysician (i)
(ii)		 239,878
0 		0
0 		29,352
0 		38,285
0 		17,440
0 		324,955
0 		0
0
(11)Mark Munroe MDPhysician (i)
(ii)		 221,322
0 		0
0 		18,354
0 		11,142
0 		1,357
0 		252,175
0 		0
0
(12)A Perry Griffith MDPhysician (i)
(ii)		 236,105
0 		0
0 		552
0 		11,250
0 		24,633
0 		272,540
0 		0
0
(13)Larry BaileyVice President (i)
(ii)		 211,391
0 		27,428
0 		146,293
0 		33,068
0 		26,325
0 		444,505
0 		136,243
0
Schedule J (Form 990) 2012

Schedule J (Form 990) 2012
Page 3
Part III
Supplemental Information
Complete this part to provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II.
Also complete this part for any additional information.
Identifier Return Reference Explanation
Supplemental Nonqualified Retirement Plan Schedule J, Part I, Line 4B As part of the executive compensation plan recommended to Indiana University Health Bloomington, Inc. by a professional compensation consulting firm, the hospital offers eligible senior executives the opportunity to participate in a non-qualified 457(F) deferred compensation plan. Following are the participants in the plan and amounts contributed by employer 2012. Mark E. Moore, CEO $117,874 James J. Myers, CFO $ 40,938 Steven D. Deckard, VP, HR $ 7,685 Kenneth E. Marshall, M.D., VP & CMO $ 33,109 Mark W. McMath, VP & CIO $ 26,287 Ruth Ann Morris, R.N., VP & CNO $ 26,347 Larry Bailey, Vice President $ 21,818 Following are the amounts deferred by employees for 2012: Mark E. Moore, CEO $ 0 James J. Myers, CFO $ 16,500 Steven D. Deckard, VP, HR $ 7,000 Kenneth E. Marshall, M.D., VP & CMO $ 0 Mark W. McMath, VP & CIO $ 6,470 Ruth Ann Morris, R.N., VP & CNO $ 7,150 Larry Bailey, Vice President $ 0 THE FOLLOWING PARTICIPANTS VESTED AS OF 12/31/12 AND CHOSE TO RECEIVE A DISTRIBUTION OF THE FOLLOWING AMOUNT: Mark E. Moore, CEO $683,191 Steven D. Deckard, VP, HR $ 47,544 Larry Bailey, Vice President $136,243 Daniel F. Evans Jr. participates in an Indiana University Health, Inc. supplemental executive retirement plan, provisions of which are designed to retain 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 amount of this benefit has been included in column c, deferred compensation, representing the current year increase in the accrued benefit and/or current year contributions. No amount was actually paid to the executive during the year.
NON-FIXED PAYMENTS TO OFFICERS AND KEY EMPLOYEES SCHEDULE J, PART I, LINE 7 According to the hospitals executive compensation plan, annual goals will be set for each member of the senior leadership group, and the degree of successful completion determined following the end of the year will determine that leaders annual bonus, if any. Any payouts will be in the form of a lump sum and will not affect the leaders base pay. The leader may elect to defer any of all of the bonus compensation through the hospitals 457(f) plan, subject to any plan restrictions if required. The amount of the merit payment for the CEO shall be determined by the compensation committee; all other senior leaders payments shall be recommended by the CEO to the compensation committee for approval prior to any award.
Schedule J (Form 990) 2012

Additional Data


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Schedule K
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Information on Tax Exempt Bonds
SchKMediumBullet Complete if the organization answered "Yes" to Form 990, Part IV, line 24a. Provide descriptions,
explanations, and any additional information in Part VI.
SchKMediumBullet Attach to Form 990. SchKMediumBullet See separate instructions.
OMB No. 1545-0047
2012
Open to Public
Inspection
Name of the organization
INDIANA UNIVERSITY HEALTH BLOOMINGTON INC
 
Employer identification number
35-1720796
Part I
Bond Issues
(a) Issuer name (b) Issuer EIN (c) CUSIP # (d) Date issued (e) Issue price (f) Description of purpose (g) Defeased (h) On
behalf of
issuer 		(i) Pool
financing
Yes No Yes No Yes No
A HOSPITAL AUTHORITY OF MONROE COUNTY INDIANA
  		000000000 000000000 02-16-2006 19,962,132 TAX-EXEMPT EQUIP LOANS (SEE PT VI)   X   X   X
Part II
Proceeds
A B C D
1 Amount of bonds retired . . . . . . . . . . . . . . 0      
2 Amount of bonds legally defeased . . . . . . . . . . . 0      
3 Total proceeds of issue . . . . . . . . . . . . . . 19,962,132      
4 Gross proceeds in reserve funds . . . . . . . . . . . . 0      
5 Capitalized interest from proceeds . . . . . . . . . . . 0      
6 Proceeds in refunding escrows . . . . . . . . . . . . 0      
7 Issuance costs from proceeds . . . . . . . . . . . . 0      
8 Credit enhancement from proceeds . . . . . . . . . . . 0      
9 Working capital expenditures from proceeds . . . . . . . . . 0      
10 Capital expenditures from proceeds . . . . . . . . . . . 19,962,132      
11 Other spent proceeds . . . . . . . . . . . . . . 0      
12 Other unspent proceeds . . . . . . . . . . . . . . 0      
13 Year of substantial completion . . . . . . . . . . . . 2006
Yes No Yes No Yes No Yes No
14 Were the bonds issued as part of a current refunding issue? . . . . .   X            
15 Were the bonds issued as part of an advance refunding issue? . . . . .   X            
16 Has the final allocation of proceeds been made? . . . . . . . . X              
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? . . . . . . . . . . . . . . X              
Part III
Private Business Use
A B C D
Yes No Yes No Yes No Yes No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? . . . . . . .   X            
2 Are there any lease arrangements that may result in private business use of bond-financed property? . . . . . . . . .   X            
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50193E
Schedule K (Form 990) 2012
Schedule K (Form 990) 2012
Page 2
Part III
Private Business Use (Continued)
A B C D
Yes No Yes No Yes No Yes No
3a Are there any management or service contracts that may result in private business use of bond-financed property? . . . . . . . . . . . .   X            
b If "Yes" to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property? . . . . . . . . . . . . . . . .                
c Are there any research agreements that may result in private business use of bond-financed property? . . . . . . . . . . . . . . .   X            
d If "Yes" to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property? .                
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government . . SchKMediumBullet 0%   %   %   %
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government . . . . . . . SchKMediumBullet   %   %   %   %
6 Total of lines 4 and 5 . . . . . . . . . . . . . . .   %   %   %   %
7 Does the bond issue meet the private security or payment test? . . . . .   X            
8a Has there been a sale or disposition of any of the bond financed property to a nongovernmental person other than a 501(c)(3) organization since the bonds were issued?. . . . . . . . . . . . . . . . .   X            
b If “Yes” to line 8a, enter the percentage of bond-financed property sold or disposed of.   %   %   %   %
c If “Yes” to line 8a, was any remedial action taken pursuant to Regulations sections 1.141-12 and 1.145-2? . . . . . . . . . . . . .   X            
9 Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under
Regulations sections 1.141-12 and 1.145-2?
X              
Part IV
Arbitrage
A B C D
Yes No Yes No Yes No Yes No
1 Has the issuer filed Form 8038-T? . . . . .   X            
2 If "No" to line 1, did the following apply? . . . .
a Rebate not due yet? . . . . . . . .                
b Exception to rebate? . . . . . . . .                
c No rebate due? . . . . . . . . . .
               
If you checked "No rebate due" in line 2c, provide in Part VI the date the rebate computation was performed
3 Is the bond issue a variable rate issue? . . . . X              
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?   X            
b Name of provider . . . . . . . . . 0
  		 
  		 
  		 
 
c Term of hedge . . . . . . . . . .        
d Was the hedge superintegrated? . . . . . .                
e Was a hedge terminated? . . . . . . .                
Schedule K (Form 990) 2012
Schedule K (Form 990) 2012
Page 3
Part IV
Arbitrage (Continued)
A B C D
Yes No Yes No Yes No Yes No
5a Were gross proceeds invested in a guaranteed investment contract (GIC)? . . . . . . . . .                
b Name of provider . . . . . . . . . 0
  		 
  		 
  		 
 
c Term of GIC . . . . . . . . . .        
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? . . . . .                
6 Were any gross proceeds invested beyond an available temporary period? . . . . . . . .   X            
7 Has the organization established written procedures to monitor the requirements of section 148? . . . X              
Part V
Procedures To Undertake Corrective Action
A B C D
Yes No Yes No Yes No Yes No
1 Has the organization established written procedures to ensure that violations of federal tax requirements are timely identified and corrected through the voluntary closing agreement program if self-remediation is not available under applicable regulations? X              
Part VI
Supplemental Information. Complete this part to provide additional information for responses to questions on Schedule K (see instructions).
Identifier Return Reference Explanation
TAX-EXEMPT EQUIPMENT LOANS (MASTER LEASE AND SUBLEASE AGREEMENT) 0 Part I, Column (f) These funds, which were used entirely for the puchase of medical and hospital IT equipment, were orginally received in three separate draws: $14,252,734 on 02/16/2006; $3,256,179 on 06/07/2006; and $2,453,219 on 12/28/2006 (Total = $19,962,132). The equipment financed with these tax-exempt loans was separated into three categories: $5,566,946 assets with a 5-year usefuld life; $2,403,488 assets with an 8-year useful life; and $11,991,698 asssets with a 10-year useful life (Total - $19,962,132). The interest rate spread to the BMA Index used to calculate the variable-rate interest cost is 0.98% for the 5-year loan, 1.09% for the 8-year loan, and 1.21% for the 10-year loan. As of 12/31/2012 the unpaid balances on the three loan categories are as follows: $0 on the 5-year loan, $512,175 on the 8-year loan, and $5,014,199 on the 10-year loan (Total = 5,526,374).
Schedule K (Form 990) 2012

Additional Data


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Schedule L
(Form 990 or 990-EZ)
Department of the Treasury
Internal Revenue Service
Transactions with Interested Persons
MediumBullet Complete if the organization answered
"Yes" on Form 990, Part IV, lines 25a, 25b, 26, 27, 28a, 28b, or 28c,
or Form 990-EZ, Part V, 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 BLOOMINGTON INC
 
Employer identification number

35-1720796
Part I
Excess Benefit Transactions (section 501(c)(3) and section 501(c)(4) organizations only).
Complete if the organization answered "Yes" on Form 990, Part IV, line 25a or 25b, or Form 990-EZ, Part V, line 40b.
1(a) Name of disqualified person (b) Relationship between disqualified person and organization (c) Description of transaction (d) Corrected?
Yes No





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

Part II
Loans to and/or From Interested Persons.
Complete if the organization answered "Yes" on Form 990-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?
To From Yes No Yes No Yes No
Total ......Small Bullet $  
Part III
Grants or Assistance Benefitting Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 27.
(a) Name of interested person (b) Relationship between interested person and the organization (c) Amount of 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
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?
Yes No
(1) BORMA SEE SCHEDULE L, PART V 951,500 MEDICAL SERVICES PROVIDER   No
(2) PREMIER HEALTHCARE SEE SCHEDULE L, PART V 3,494,209 MEDICAL SERVICES PROVIDER   No
(3) OLD NATIONAL BANK SEE SCHEDULE L, PART V 3,160,445 GENERAL BANKING TRANSACTIONS   No
(4) BLOOMINGTON ANESTHESIOLOGISTS PC SEE SCHEDULE L, PART V 759,800 MEDICAL SERVICES PROVIDER   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 INVOLVING INTERESTED PERSONS FORM 990, SCHEDULE L, PART IV Charles R. McKeen, M.D. an IUHB Director, is also a member of a medical practice, Bloomington Operating Room Management Associates (BORMA), with whom the hospital contracts for surgical management and medical services. IUHB paid the medical group BORMA, but not Dr. McKeen directly, a total of $951,500. James V. Faris, M.D. an IUHB Director, is also a member and partial owner of a large Bloomington medical practice, Premier Healthcare, LLC, with whom the hospital contracts for a wide variety of medical services, including but not limited to cardiology and hospitalist coverage. IUHB paid Premier healthcare, but not Dr. Faris directly, a total of $3,494,209. Mark D. Bradford, an IUHB director, is president of Old National Bank, IUHB's primary bank. Old National Bank financed $2,866,528 of IUHB patient accounts receivable during 2012, in addition to providing customary commercial banking services. Fees paid to Old National Bank in 2012 were $293,917. Chad A. Johnson, M.D. and Allen W. Dunn, M.D., both of whom are IUHB Directors, are also members of a medical practice, Bloomington Anesthesiologists, P.C., with whom the hospital contracts for medical services. IUHB paid the medical group Bloomington Anesthesiologists, P.C., but not Dr. Johnson or Dr. Dunn directly, a total of $759,800.
Schedule L (Form 990 or 990-EZ) 2012

Additional Data


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Software Version:  




SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
MediumBullet Attach to Form 990 or 990-EZ.
OMB No. 1545-0047
2012
Open to Public
Inspection
Name of the organization
INDIANA UNIVERSITY HEALTH BLOOMINGTON INC
 
Employer identification number

35-1720796
Identifier Return Reference Explanation
DESCRIPTION OF OTHER PROGRAM SERVICES FORM 990, PART III, LINE 4D INDIANA UNIVERSITY HEALTH BLOOMINGTON'S PRIMARY REASON FOR EXISTENCE IS TO PROVIDE HIGH-QUALITY MEDICAL CARE FOR ITS COMMUNITY. TO ACCOMPLISH THIS END, THE HOSPITAL HAS INCURRED SIGNIFICANT EXPENSE TO ACQUIRE THE BEST MEDICAL SUPPLIES AND EQUIPMENT AVAILABLE. MEDICAL SERVICES, BOTH INPATIENT AND OUTPATIENT, ARE SUBJECT TO ONGOING IMPROVEMENT AND EXPANSION IN RESPONSE TO THE CHANGING NEEDS OF THE COMMUNITY. AS THE ONLY FULL-SERVICE MEDICAL/SURGICAL HOSPITAL IN MONROE COUNTY, IUHB PROVIDES SERVICES TO A LARGE POPULATION. RESIDENTS OF OWEN, BROWN, GREENE, AND LAWRENCE COUNTIES ARE ALSO SIGNIFICANT USERS OF THE HOSPITAL'S SERVICES. DURING THE FISCAL YEAR ENDING DECEMBER 31, 2012, IUHB DISCHARGED A TOTAL OF 12,846 ADULT AND PEDIATRIC INPATIENTS, AS WELL AS 1,977 NEWBORN INFANTS. IN ADDITION, APPROXIMATELY 916,000 MEDICAL PROCEDURES WERE PERFORMED FOR HOSPITAL OUTPATIENTS. SINCE ITS INCEPTION, IUHB HAS PROVIDED MEDICAL CARE TO ANY AND ALL PATIENTS PRESENTING THEMSELVES FOR SERVICE, REGARDLESS OF THEIR ABILITY TO PAY. THE VALUE OF FREE CARE PROVIDED TO PATIENTS WHO QUALIFIED FOR HOSPITAL CHARITY DURING FISCAL YEAR 2012 WAS $42,805,713; THE HOSPITAL IS ALSO A FULL PARTICIPANT IN PROVIDING CARE TO MEDICARE AND MEDICAID PATIENTS, AT REIMBURSABLE AMOUNTS FAR LOWER THAN ITS NORMAL CHARGES. DURING 2012, THE HOSPITAL WAS EXTREMELY SUCCESSFUL IN ENROLLING MEMBERS OF ITS COMMUNITY BOTH IN THE MEDICAID PROGRAM AND IN THE MORE RECENTLY CREATED STATE HEALTH CARE PROGRAM KNOWN AS THE HEALTHY INDIANA PLAN (HIP). ALTHOUGH REIMBURSEMENTTO THE HOSPITAL UNDER THESE PROGRAMS IS EXTREMELY LOW IN COMPARISON TO GROSS PATIENT CHARGES, THE ENROLLMENT ASSISTANCE PROVIDED TO INDIVIDUALS SHOULD BE VIEWED AS A COMMUNITY BENEFIT SINCE SUCCESSFUL ENROLLEES ARE THEN COVERED FOR MOST OTHER ESSENTIAL MEDICAL SERVICES FROM OTHER PROVIDERS THAN JUST THE HOSPITAL ITSELF. IN ORDER TO PROMOTE GOOD HEALTH CARE AND TO EMPHASIZE THE IMPORTANCE OF PREVENTIVE MEDICINE, THE HOSPITAL OFFERS FREE LECTURES PRESENTED BY KNOWLEDGEABLE PROFESSIONALS TO THE BLOOMINGTON COMMUNITY. HISTORICALLY, THESE LECTURES, WHICH ARE HELD BOTH AT THE HOSPITAL AND THROUGHOUT THE SERVICE AREA, HAVE BEEN WELL ATTENDED AND WELL RECEIVED BY THE RESIDENTS OF MONROE AND SURROUNDING COUNTIES. TOPICS COVERED BY THESE FREE SEMINARS INCLUDE NUTRITION, DIABETES, OBESITY, AND CANCER PREVENTION, TO NAME ONLY A FEW. IN ADDITION TO PROVIDING EDUCATIONAL SESSIONS FOR SENIORS, THE HOSPITAL HAS ALSO DEVELOPED ITS SENIORITY PLUS PLAN, DESIGNED TO PROVIDE A FULL RANGE OF FREE SERVICE AND ADVICE TO THIS GROUP IN ADDITION TO EXTENSIVE DISCOUNT PROGRAMS THAT HAVE BEEN ARRANGED BY HOSPITAL STAFF ON BEHALF OF SENIORITY PLUS MEMBERS. IUHB IS ACTIVELY INVOLVED IN EDUCATION FOR STUDENTS ENROLLED IN VARIOUS POST-SECONDARY VOCATIONAL AND ACADEMIC PROGRAMS, INCLUDING, BUT NOT LIMITED TO, NURSING, RESPIRATORY THERAPY, CLINICAL INFORMATICS, SURGICAL TECHNOLOGY, EMERGENCY MEDICAL RESPONSE, CLINICAL ENGINEERING, PHARMACY, LABORATORY, AND FOOD AND NUTRITION SERVICES. ALSO TO FURTHER ITS EDUCATIONAL GOALS, THE HOSPITAL OFFERS CAREER COUNSELING TO LOCAL HIGH SCHOOLS AND JUNIOR HIGH SCHOOLS, EVEN PROVIDING A HEALTH CARE CAREER CAMP FOR STUDENTS DURING THE SUMMER MONTHS. THROUGH THIS PROCESS, THE HOSPITAL HOPES TO INFORM YOUNG PEOPLE OF LITTLE KNOWN WAYS IN WHICH ONE MAY SERVE WITHIN THE MEDICAL COMMUNITY. THROUGHOUT THE YEAR, IUHB HAS PROVIDED THE COMFORT OF VARIOUS COUNSELING AND SUPPORT GROUPS AT NO CHARGE TO ALL THOSE WHO NEED AND DESIRE THIS SERVICE, ADDRESSING SUCH ISSUES AS SMOKING CESSATION, DIABETES MANAGEMENT, AND COPING WITH THE LOSS OF A LOVED ONE. THE HOSPITAL HAS ALSO CONTRIBUTED TO THE SAFETY AND WELL BEING OF THE CHILDREN IN ITS COMMUNITY BY PROVIDING CAR SEAT SAFETY CHECKS, BICYCLE HELMETS, SUNSCREEN, AND LEAD TESTING, ALL WITHOUT CHARGE TO THE BENEFICIARIES. FAMILY OR BUSINESS RELATIONSHIPS FORM 990, Part VI, QUESTION 2 Chad A. Johnson, M.D. and Allen W. Dunn, M.D. have a business relationships as members of a medical practice, Bloomington Anesthesiologists, P.C.
Description of Classes of Members or Stockholders Form 990, Part VI, Question 6 INDIANA UNIVERSITY HEALTH, INC. (EIN 35-1955872) IS THE SOLE MEMBER OF INDIANA UNIVERSITY HEALTH BLOOMINGTON, INC.
Description of Classes of Persons and the Nature of Their Rights Form 990, Part VI, Question 7a ANY AMENDMENT THAT WOULD IN ANY WAY RELATE TO THE NUMBER OF DIRECTORS OF HOSPITAL, THE SOURCE OF THEIR APPOINTMENTS, THE PROVISION WITH RESPECT TO SUPERMAJORITY VOTING, THE PROVISIONS REGARDING THE COUNCIL'S COMMITTEE INVOLVEMENT OR PROVISIONS WITH RESPECT TO THE REMOVAL OF SUCH DIRECTORS, SHALL REQUIRE THE PRIOR APPROVAL OF INDIANA UNIVERSITY HEALTH, INC.
Descr Classes of Persons, Decisions Requiring Appr & Type of Voting Rights Form 990, Part VI, Question 7b NO ACTION OF THE HOSPITAL'S BOARD OR OF ANY OFFICER OR AGENT OF THE HOSPITAL REGARDING ANY MATTERS THAT ARE SUBJECT TO INDIANA UNIVERSITY HEALTH, INC.'S RESERVED POWERS SHALL HAVE ANY FORCE OR EFFECT WITHOUT PRIOR NOTICE TO AND THE WRITTEN APPROVAL OF INDIANA UNIVERSITY HEALTH, INC. RESERVED POWERS REFERENCED ABOVE INCLUDE, BUT ARE NOT LIMITED TO, ANY ACTION THAT WOULD ALTER OPERATING AND CAPITAL BUDGETS, CHANGE THE CURRENT CORPORATE ENTITY STRUCTURE, OR CHANGE THE ARTICLES OF INCORPORATION.
Describe the Process used by Management &/or Governing Body to Review 990 Form 990, Part VI, Question 11b BEGINNING IN 2012, FOR THE TAX YEAR ENDED 12/31/2011, INDIANA UNIVERSITY HEALTH BLOOMINGTON PROVIDED A CONFIDENTIAL AND SECURE WEB SITE ACCESSIBLE TO MEMBERS OF ITS BOARD OF DIRECTORS, ON WHICH A COMPLETE COPY OF ITS IRS FORM 990, AS ULTIMATELY FILED WITH THE IRS, WAS POSTED FOR VIEWING BEFORE IT WAS FILED. DURING THE TAX RETURN POSTING PERIOD, DIRECTORS WERE ENCOURAGED TO SUBMIT QUESTIONS OR SUGGESTIONS TO THE HOSPITAL'S CFO.
Description of Process to Monitor Transactions for Conflicts of Interest Form 990, Part VI, Question 12c FOLLOWING THE ANNUAL SUBMISSION OF ALL RELEVANT PERSON'S CONFLICT OF INTEREST FORMS, THE HOSPITAL AUDIT AND COMPLIANCE COMMITTEE MEETS TO REVIEW ALL RESPONSES AND TO DETERMINE WHETHER ANY OF THE POTENTIAL CONFLICTS THAT HAVE BEEN DOCUMENTED WOULD PREVENT ANYONE'S SERVING ON THE BOARD OF DIRECTORS, OR CONTINUING AS A KEY EMPLOYEE. FOLLOWING ARE KEY EXCERPTS TAKEN FROM THE HOSPITAL'S 2012 CONFLICT OF INTEREST POLICY: 1) ALL BOARD MEMBERS, EX-OFFICIO BOARD MEMBERS, COMMITTEE MEMBERS OR SENIOR MANAGEMENT TEAM MEMBERS SHOULD ACT IN GOOD FAITH AND IN THE BEST INTERESTS OF INDIANA UNIVERSITY HEALTH BLOOMINGTON, INC. 2) ANY MEMBER HAVING AN EXISTING OR POTENTIAL INTEREST IN A CONTRACT OR OTHER TRANSACTION PRESENTED TO THE BOARD OF DIRECTORS OR A COMMITTEE THEREOF FOR DELIBERATION, AUTHORIZATION, APPROVAL, OR RATIFICATION, OR ANY PERSON WHO REASONABLY BELIEVES SUCH AN INTEREST EXISTS IN A MEMBER SHALL MAKE A PROMPT, FULL, AND FRANK DISCLOSURE OF THE INTEREST TO THE BOARD OR COMMITTEE AT THE EARLIEST POSSIBLE MEETING OF THE BOARD OR COMMITTEE. 3) A CONFLICT OCCURS WHEN A MEMBER HAS A DIRECT OR INDIRECT PROFESSIONAL OR PERSONAL INTEREST THAT COMPETES WITH THE INTERESTS OF THE HOSPITAL. THE POLCY REQUIRES (A) REGULAR ANNUAL STATEMENTS FROM MEMBERS THAT DISCLOSE EXISTING AND POTENTIAL CONFLICTS OF INTEREST, AND (B) CORRECTIVE AND DISCIPLINARY ACTION WITH RESPECT TO THE TRANSGRESSIONS OF SUCH POLICIES.
Offices & Positions for Which Process was Used, & Year Process was Begun Form 990, Part VI, Question 15a BEGINNING IN 2003 AND EFFECTIVE FOR EVERY SUCCEEDING YEAR, INCLUDING THE YEAR ENDED 12/31/2012, INDIANA UNIVERSITY HEALTH BLOOMINGTON HAS HAD A FORMAL WRITTEN POLICY DEFINING COMPENSATION TO ITS CEO, CFO, AND ALL OTHER KEY EXECUTIVE EMPLOYEES (THIS GROUP IS REFERRED TO INTERNALLY AS THE SLG.) THE COMPENSATION COMMITTEE IS COMPRISED OF INDEPENDENT MEMBERS AND IS RESPONSIBLE FOR REVIEWING AND APPROVING ANY CHANGES TO EXECUTIVE COMPENSATION AND/OR BENEFITS ON AN ANNUAL BASIS. ANY CHANGES ARE TO BE REASONABLE, MARKET COMPETITIVE, AND BASED ON MARKET INFORMATION SUPPLIED BY INDEPENDENT CONSULTANTS EMPLOYED BY THE COMPENSATION COMMITTEE AND NOT BY THE ADMINISTRATIVE STAFF. CONSULTANTS SHALL REPORT THEIR FINDINGS DIRECTLY TO THE COMPENSATION COMMITTEE. MEMBERS OF THE ADMINISTRATIVE STAFF SHALL NOT BE PRESENT WHILE DISCUSSIONS ARE HELD TO DETERMINE THE LEVEL OF COMPENSATION AND BENEFITS FOR THE SLG. MINUTES OF COMPENSATION COMMITTEE PROCEEDINGS SHALL BE KEPT, REFLECTING THE COMMITTEE'S INDEPENDENCE, ANY IDENTIFIED CONFLICTS OF INTEREST, WHAT DECISIONS WERE MADE, AND WHAT INDIVIDUALS WERE PRESENT. SALARY ADJUSTMENTS AND/OR BENEFIT CHANGES FOR ANY SLG MEMBER MUST BE APPROVED BY THE COMMITTEE PRIOR TO IMPLEMENTATION. ALL SUCH APPROVED CHANGES WILL BE DISCLOSED TO THE FULL BOARD OF DIRECTORS AT THE NEXT REGULARLY SCHEDULED MEETING. THE POLICY HERE DESCRIBED WAS USED TO EVALUATE SLG SALARIES DURING THE YEAR ENDED 12/31/2012.
Offices & Positions for Which Process was Used, & Year Process was Begun Form 990, Part VI, Question 15b THE COMPENSATION AND BENEFITS OF ALL KEY EXECUTIVE POSITIONS ARE SUBJECT TO THE SAME PROCESS AS DESCRIBED IN THE EXPLANATION FOR FORM 990, PART VI, LINE 15A. THE PROCESS WAS MOST RECENTLY USED IN 2012 TO EVALUATE THE SENIOR LEADERSHIP POSITIONS.
Avail of Gov Docs, Conflict of Interest Policy, & Fin Stmts to Gen Public Form 990, Part VI, Question 19 INDIANA UNIVERSITY HEALTH BLOOMINGTON, INC. ASKS THAT ANYONE REQUESTING A COPY OF ITS IRS FORM 990 COME TO ITS ADMINISTRATIVE OFFICE TO ACCESS THAT COPY. REQUESTS TO SEE THE RETURN CAN BE SUBMITTED VIA THE HOSPITAL'S INTERNET WEB SITE OR BY TELEPHONING THE GENERAL SWITCHBOARD NUMBER FOR THE HOSPITAL. STAFF ATTEMPTS TO ALWAYS RESPOND TO ALL REQUESTS WITHIN 24 HOURS, REGARDLESS OF THE MEANS OF TRANSMISSION. COMPLIANCE POLICIES, SUCH AS THOSE DEFINING CONFLICTS OF INTEREST ARE AVAILABLE TO HOSPITAL EMPLOYEES VIA AN EXTENSIVE INTRANET SITE. ANYONE OUTSIDE THE HOSPITAL MAY REQUEST A COPY VIA THE PUBLIC INTERNET SITE OR BY TELEPHONE. FINANCIAL STATEMENTS, TOO, ARE AVAILABLE FOR VIEWING UPON REQUEST, BUT MUST BE OBTAINED IN PERSON FROM THE HOSPITAL'S ADMINISTRATIVE OFFICES.
Other Changes in Net Assets Form 990, Part XI, Question 9 During 2012, Indiana University Health Bloomington, Inc. recorded the following other changes in net assets or fund balances: Change in Pension Obligation: $ (8,280,906) Additional Paid In Capita/Net Asset Transfers: $(25,368,570) Unrealized Increase In Foundation Net Assets: $ 533,663 Rounding: $ 5 _____________ Total Other Changes in Net Assets $(33,115,808)
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2012

Additional Data


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

OMB No. 1545-0047
2012
Open to Public Inspection
Name of the organization
INDIANA UNIVERSITY HEALTH BLOOMINGTON INC
 
Employer identification number

35-1720796
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










Part II
Identification of Related Tax-Exempt Organizations (Complete if the organization answered "Yes" to Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.)
(a)
Name, address, and EIN of related organization


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

 		(d)
Exempt Code section


 		(e)
Public charity status
(if section 501(c)(3))

 		(f)
Direct controlling
entity

 		(g)
Section 512(b)(13) controlled entity?
Yes No
(1) Clarian Transplant Institute Inc

950 N Meridian St Ste 800

Indianapolis,IN46204
13-4350599 		Healthcare IN 501(c)(3) 9 IUH
 
Yes
 
(2) IU Health Ball Memorial Physicians Inc

950 N Meridian St Ste 800

Indianapolis,IN46204
35-1925641 		Healthcare IN 501(c)(3) 9 IUHBMH
 
Yes
 
(3) IU Helth Bedford Inc

2900 W 16th St

Bedford,IN47421
23-7042323 		Healthcare IN 501(c)(3) 3 IUH
 
Yes
 
(4) IU Health Blackford Hospital Inc

950 N Meridian St Ste 800

Indianapolis,IN46204
01-0646166 		Healthcare IN 501(c)(3) 3 IUHBMH
 
Yes
 
(5) IU Health BMH Foundation Inc

950 N Meridian St Ste 800

Indianapolis,IN46204
31-1111784 		Fundraising IN 501(c)(3) 11, I IUHBMH
 
Yes
 
(6) IU Health Care Associates Inc

950 N Meridian St Ste 800

Indianapolis,IN46204
35-1747218 		Healthcare IN 501(c)(3) 9 IUH
 
Yes
 
(7) IU Health LaPorte Hospital Inc

PO Box 250

LaPorte,IN46352
35-1125434 		Healthcare IN 501(c)(3) 3 IUH
 
Yes
 
(8) IU Health LaPorte Physicians Inc

PO Box 250

LaPorte,IN46352
31-1070868 		Healthcare IN 501(c)(3) 3 IUHLH
 
Yes
 
(9) IU Health Morgan Hospital Inc

2209 John R Wooden Dr

Martinsville,IN46151
27-3533027 		Healthcare IN 501(c)(3) 3 IUH
 
Yes
 
(10) IU Health North Hospital Inc

950 N Meridian St Ste 800

Indianapolis,IN46204
35-1932442 		Healthcare IN 501(c)(3) 3 IUH
 
Yes
 
(11) IU Health Paoli Hosp Foundation Inc

PO Box 499

Paoli,IN47454
31-0992486 		Fundraising IN 501(c)(3) 11, III-O IUHP
 
Yes
 
(12) Goshen Health System Inc

200 High Park Ave

Goshen,IN46527
35-1974765 		Healthcare IN 501(c)(3) 11, I IUH
 
Yes
 
(13) IU Health PaoliInc

PO Box 499

Paoli,IN47454
35-2090919 		Healthcare IN 501(c)(3) 3 IUHB
 
Yes
 
(14) IU Health Tipton HospitalInc

1000 S Main St

Tipton,IN46072
26-2772226 		Healthcare IN 501(c)(3) 3 IUH
 
Yes
 
(15) IU Health West Hospital Inc

950 N Meridian St Ste 800

Indianapolis,IN46204
35-1814660 		Healthcare IN 501(c)(3) 3 IUH
 
Yes
 
(16) IU Health White Memorial Hospital Inc

720 S Sixth St

Monticello,IN47960
27-3532963 		Healthcare IN 501(c)(3) 3 IUH
 
Yes
 
(17) IU Health White Memorial Foundation

PO Box 952

Monticello,IN47960
35-1671806 		Fundraising IN 501(c)(3) 11, III-O IUHWMH
 
Yes
 
(18) IU Medical Group Foundation Inc

340 W 10th St No FS5100

Indianapolis,IN46202
20-1093251 		Fundraising IN 501(c)(3) 11, II NA
 
 
No
(19) Methodist Health Foundation Inc

1800 N Capital Ave

Indianapolis,IN46202
35-6043086 		Fundraising IN 501(c)(3) 11, I IUH
 
Yes
 
(20) Methodist Health Group Inc

950 N Meridian St Ste 800

Indianapolis,IN46204
35-0876390 		Healthcare IN 501(c)(3) 11, III-FI NA
 
 
No
(21) Methodist Medical Group Inc

950 N Meridian St Ste 800

Indianapolis,IN46204
35-1945384 		Healthcare IN 501(c)(3) 3 IUH
 
Yes
 
(22) Methodist Occup Health Centers Inc

950 N Meridian St Ste 800

Indianapolis,IN46204
35-1844176 		Healthcare IN 501(c)(3) 3 IUH
 
Yes
 
(23) Goshen Hospital Association Inc

200 High Park Ave

Goshen,IN46527
35-6001540 		Healthcare IN 501(c)(3) 3 GHS
 
Yes
 
(24) Methodist Research Institute Inc

950 N Meridian St Ste 800

Indianapolis,IN46204
35-2023710 		Healthcare IN 501(c)(3) 11, I IUH
 
Yes
 
(25) MH Healthcare Inc

950 N Meridian St Ste 800

Indianapolis,IN46204
35-1766531 		Healthcare IN 501(c)(3) 3 MMG
 
Yes
 
(26) Morgan Co Mem Hosp Foundation Inc

2209 John R Wooden Dr

Martinsville,IN46151
35-2035162 		Fundraising IN 501(c)(3) 11, II IUHMH
 
Yes
 
(27) Morgan Co Mem Hosp Guild Inc

2209 John R Wooden Dr

Martinsville,IN46151
31-0886844 		Fundraising IN 501(c)(3) 11, III-FI IUHMH
 
Yes
 
(28) Morgan Health Services Inc

1949 Hospital Dr

Martinsville,IN46151
35-1968564 		Healthcare IN 501(c)(3) 3 IUHMH
 
Yes
 
(29) University Family Physicians Inc

950 N Meridian St Ste 800

Indianapolis,IN46204
23-7427350 		Healthcare IN 501(c)(3) 9 IUHCA
 
Yes
 
(30) Rehabilitation Hospital of Indiana Inc

4141 Shore Dr

Indianapolis,IN46254
35-1786005 		Healthcare IN 501(c)(3) 3 MHH
 
Yes
 
(31) RHI Foundation Inc

4141 Shore Dr

Indianapolis,IN46254
35-1932349 		Fundraising IN 501(c)(3) 11 - I RHI
 
Yes
 
(32) Local Council of Women Of Bloomington

PO Box 1149

Bloomington,IN47402
35-0992711 		Non-Profit IN 501(c)(3) 7 NA
 
Yes
 
(33) Bloomington Hospital Auxiliary Inc

PO Box 1149

Bloomington,IN47402
35-6041676 		Volunteers IN 501(c)(4)   IUHB
 
Yes
 
(34) HealthLinc Inc

714 S Rogers St

Bloomington,IN47402
26-3571507 		Healthcare IN 501(c)(3) 9 IUHB
 
Yes
 
(35) Bloomington Hospital Foundation Inc

405 N Rogers Street

Bloomington,IN47404
35-1720795 		Fundraising IN 501(c)(3) 7 IUHB
 
Yes
 
(36) Indiana Radiology Partners Inc

950 N MERIDIAN ST STE 800

INDIANAPOLIS,IN46204
20-1017034 		Healthcare IN 501(c)(3) 3 IUH
 
Yes
 
(37) Indiana University Health Inc

950 N Meridian St Ste 800

Indianapolis,IN46204
35-1955872 		Healthcare IN 501(c)(3) 3 NA
 
 
No
(38) IU Health Arnett Foundation Inc

950 N Meridian St Ste 800

Indianapolis,IN46204
35-6079797 		Fundraising IN 501(c)(3) 11, I IUHA
 
Yes
 
(39) IU Health Arnett Inc

950 N Meridian St Ste 800

Indianapolis,IN46204
26-3162145 		Healthcare IN 501(c)(3) 3 IUH
 
Yes
 
(40) IU Health Ball Memorial Hospital Inc

950 N Meridian St Ste 800

Indianapolis,IN46204
35-0867958 		Healthcare IN 501(c)(3) 3 IUH
 
Yes
 
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2012
Schedule R (Form 990) 2012
Page 2
Part III
Identification of Related Organizations Taxable as a Partnership (Complete if the organization answered "Yes" to Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year.)
(a)
Name, address, and EIN of
related organization



 		(b)
Primary activity




 		(c)
Legal
domicile
(state or foreign
country)


 		(d)
Direct controlling
entity



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

(f)
Share of total income




 		(g)
Share of end-of-year
assets



 		(h)
Disproprtionate allocations?




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



 		(k)
Percentage
ownership
Yes No Yes No
(1) Ball Outpatient Sugery Center LLC

3000 Riverchase Galleria Ste 500
Birmingham,AL35244
27-0275794 		Healthcare IN BOSCH
  		N/A       No     No  
(2) Eagle Highlands Surgery Center LLC

3000 Riverchase Galleria Ste 500
Birmingham,AL35244
35-2259204 		Healthcare IN EHSCH
  		N/A       No     No  
(3) EHSC Holdings LLC

3000 Riverchase Galleria Ste 500
Birmingham,AL35244
45-4147879 		Healthcare IN IUH
  		N/A       No     No  
(4) Health Venture Management LLC

950 N Meridian St Ste 800
Indianapolis,IN46204
20-5740218 		Management IN IUH
  		N/A       No     No  
(5) IEC Holdings LLC

3000 Riverchase Galleria Ste 500
Birmingham,AL35244
45-4148032 		Healthcare IN IUH
  		N/A       No     No  
(6) Indiana Endoscopy Centers LLC

3000 Riverchase Galleria Ste 500
Birmingham,AL35244
20-8398421 		Healthcare IN IECH
  		N/A       No     No  
(7) BSC Holdings LLC

3000 Riverchase Galleria Ste 500
Birmingham,AL35244
45-2314634 		Healthcare IN IUH
  		N/A       No     No  
(8) Mid-America Surgery Center LLC

2401 W University Ave
Muncie,IN47303
35-2002953 		Healthcare IN CDHV
  		N/A       No     No  
(9) ROC Surgery LLC

3000 Riverchase Galleria Ste 500
Birmingham,AL35244
27-1497960 		Healthcare IN ROCSH
  		N/A       No     No  
(10) ROCS Holdings LLC

3000 Riverchase Galleria Ste 500
Birmingham,AL35244
45-4148369 		Healthcare IN IUH
  		N/A       No     No  
(11) Senate Street Surgery Center LLC

3000 Riverchase Galleria Ste 500
Birmingham,AL35244
42-1709357 		Healthcare IN SSSCH
  		N/A       No     No  
(12) Beltway Sugery Centers LLC

3000 Riverchase Galleria Ste 500
Birmingham,AL35244
35-2072586 		Healthcare IN BSCH
  		N/A       No     No  
(13) SSSC Holdings LLC

3000 Riverchase Galleria Ste 500
Birmingham,AL35244
45-4148167 		Healthcare IN IUH
  		N/A       No     No  
(14) Cardinal Health Alliance LLC

2401 W University Ave
Muncie,IN47303
35-1966281 		Managed Care IN IUHBMH
  		N/A       No     No  
(15) Bloomington Endoscopy Centers LLC

PO BOX 1149
BLOOMINGTON,IN47402
35-2117943 		HEALTHCARE IN IUHB
  		RELATED 428,088 2,858,481   No 0   No 51.000 %
(16) BMH Outpatient Sugery Services LLC

2401 W University Ave
Muncie,IN47303
20-4567998 		Healthcare IN IUHBMH
  		N/A       No     No  
(17) BOSC Holdings LLC

3000 Riverchase Galleria Ste 500
Birmingham,AL35244
45-4147343 		Healthcare IN IUH
  		N/A       No     No  
(18) Cardinal Health Initiatives LLC

950 N Meridian St Ste 800
Indianapolis,IN46204
30-0102702 		Purchasing IN IUHBMH
  		N/A       No     No  
(19) CHV Fund I LLC

950 N Meridian St Ste 800
Indianapolis,IN46204
26-2523206 		Venture Capital IN IUH
  		N/A       No     No  
(20) CHV Fund Management LLC

950 N Meridian St Ste 800
Indianapolis,IN46204
26-2523151 		Venture Capital IN CHV
  		N/A       No     No  
(21) Clarian Health Network LLC

950 N Meridian St Ste 800
Indianapolis,IN46204
35-2055030 		Healthcare IN IUH
  		N/A       No     No  
Part IV
Identification of Related Organizations Taxable as a Corporation or Trust (Complete if the organization answered "Yes" to Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.)
(a)
Name, address, and EIN of
related organization
 		(b)
Primary activity
 		(c)
Legal
domicile
(state or foreign
country)
 		(d)
Direct controlling
entity
 		(e)
Type of entity
(C corp, S corp,
or trust) 		(f)
Share of total income
 		(g)
Share of end-of-year
assets
 		(h)
Percentage
ownership
 		(i)
Section 512(b)(13) controlled entity?
Yes No
(1) BMH Medical Pavilion Association Inc

2525 W University Ave
Muncie,IN47303
35-1858408 		Condo Management IN IUHBMH
  		C       Yes  
(2) IU Health Southern IN Physicians Inc

PO Box 1149
Bloomington,IN47402
35-1913875 		Healthcare IN IUHB
  		C 48,233,681 14,648,559 100.000 % Yes  
(3) IUH Assurance Ltd

720 W Bay Rd PO Box 69
Grand Cayman    
CJ
98-0395429 		Insurance CJ IUH
  		C       Yes  
(4) Occ-Health Revenue Systems Inc

950 N Meridian St Ste 800
Indianapolis,IN46204
20-3308057 		Workers Comp PPO IN MOHC
  		C       Yes  
(5) Parkmor Drug Inc

1501 S Main St
Goshen,IN46526
13-1394980 		Pharmacy Sales IN GHS
  		C       Yes  
(6) PILR Inc

200 High Park Ave
Goshen,IN46526
20-4294750 		Development IN GHS
  		C       Yes  
(7) Radiation Oncology Resources Inc

200 High Park Ave
Goshen,IN46526
26-2008424 		Healthcare IN GHS
  		C       Yes  
(8) SCANS Inc

950 N Meridian St Ste 800
Indianapolis,IN46204
45-3080392 		Healthcare IN CHVF1
  		C       Yes  
(9) Univresity Health Management Inc

950 N Meridian St Ste 800
Indianapolis,IN46204
27-2891143 		Management IN CHV
  		C       Yes  
(10) University Health Mgmt (China) Inc

950 N Meridian St Ste 800
Indianapolis,IN46204
27-3891311 		Management IN CHV
  		C       Yes  
(11) Proteuo Fund LP

PO Box 31106 89 Nexus Way
Grand Cayman    
CJ
98-1075227 		Investments CJ IUH
  		C       Yes  
(12) Cardinal Health Ventures Inc

950 N Meridian St Ste 800
Indianapolis,IN46204
35-1611424 		Management IN IUHBMH
  		C       Yes  
(13) CHV Capital Inc

950 N Meridian St Ste 800
Indianapolis,IN46204
26-0752507 		Venture Capital IN IUH
  		C       Yes  
(14) IU Health ACO Inc

950 N Meridian St Ste 800
Indianapolis,IN46204
45-4421020 		Healthcare IN IUH
  		C       Yes  
(15) IU Health Board Designated Trust

400 Howard St
San Francisco,CA94105
30-6309021 		Investment IN IUH
  		T       Yes  
(16) IU Health NTGI S&P500 Fund CF

PO Box 804358
Chicago,IL60680
30-6298263 		Investment IN IUH
  		T       Yes  
(17) IU Health Plans Inc

1776 Meridian St Ste 300
Indianapolis,IN46202
26-2127080 		HMO IN IUH
  		C       Yes  
(18) IU Health Risk Purchasing Group Inc

151 Meeting St Ste 301
Charleston,SC29401
26-0202446 		Insurance IN IUH
  		C       Yes  
(19) IU Health Risk Retention Group Inc

151 N Meeting St Ste 301
Charleston,SC29401
20-1107674 		Insurance SC IUH
  		C       Yes  
Schedule R (Form 990) 2012
Schedule R (Form 990) 2012
Page 3
Part V
Transactions With Related Organizations (Complete if the organization answered "Yes" to Form 990, Part IV, line 34, 35b, or 36.)
Note. Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.
Yes
No
1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?
a Receipt of (i) interest (ii) annuities (iii) royalties or (iv) rent from a controlled entity . . . . . . . . . . . . . . . . . . . . . . .
1a
 
No
b Gift, grant, or capital contribution to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1b
Yes
 
c Gift, grant, or capital contribution from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1c
Yes
 
d Loans or loan guarantees to or for related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1d
 
No
e Loans or loan guarantees by related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1e
 
No
f Dividends from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1f
 
No
g Sale of assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1g
 
No
h Purchase of assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1h
 
No
i Exchange of assets with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1i
 
No
j Lease of facilities, equipment, or other assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1j
 
No
k Lease of facilities, equipment, or other assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .
1k
 
No
l Performance of services or membership or fundraising solicitations for related organization(s) . . . . . . . . . . . . . . . . . . . .
1l
Yes
 
m Performance of services or membership or fundraising solicitations by related organization(s) . . . . . . . . . . . . . . . . . . . .
1m
Yes
 
n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) . . . . . . . . . . . . . . . . . . . . .
1n
Yes
 
o Sharing of paid employees with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1o
Yes
 
p Reimbursement paid to related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1p
Yes
 
q Reimbursement paid by related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1q
Yes
 
r Other transfer of cash or property to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1r
 
No
s Other transfer of cash or property from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1s
 
No
2
If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.
(a)
Name of other organization 		(b)
Transaction
type (a-s) 		(c)
Amount involved 		(d)
Method of determining amount involved
(1) IU HEALTH SOUTHERN INDIANA PHYSICIANS

 B 25,368,570 FMV
(2) BLOOMINGTON HOSPITAL FOUNDATION

 C 474,481 FMV
(3) BLOOMINGTON HOSPITAL FOUNDATION

 M 337,628 FMV
(4) BLOOMINGTON HOSPITAL FOUNDATION

 N 617,992 FMV
(5) IU HEALTH PAOLI

 P 361,062 FMV
(6) IU HEALTH SOUTHERN INDIANA PHYSICIANS

 P 843,396 FMV
Schedule R (Form 990) 2012
Schedule R (Form 990) 2012
Page 4
Part VI
Unrelated Organizations Taxable as a Partnership (Complete if the organization answered "Yes" to Form 990, Part IV, line 37.)
Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.
(a)
Name, address, and EIN of entity 		(b)
Primary activity 		(c)
Legal domicile
(state or foreign
country) 		(d)
Predominant income (related, unrelated, excluded from tax under section 512-514)

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




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






























Schedule R (Form 990) 2012
Schedule R (Form 990) 2012
Page 5
Part VII
Supplemental Information
Complete this part to provide additional information for responses to questions on Schedule R (see instructions).
Identifier Return Reference Explanation

Additional Data


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