Department of the Treasury Internal Revenue Service
Public Charity Status and Public Support
Complete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.
Attach to Form 990 or Form 990-EZ. See separate instructions. Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public Inspection
Name of the organization
INDIANA RADIOLOGY PARTNERS INC
Employer identification number
20-1017034
Part I
Reason for Public Charity Status
(All organizations must complete this part.) See instructions.
The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)
1
2
3
4
5
section 170(b)(1)(A)(iv). (Complete Part II.)
6
7
8
9
receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of
its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses
acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)
10
11
e
By checking this box, I certify that the organization is not controlled directly or indirectly by one or more disqualified persons other than foundation managers and other than one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2).
f
If the organization received a written determination from the IRS that it is a Type I, Type II, or Type III supporting organization, check this box
..................................................
g
Since August 17, 2006, has the organization accepted any gift or contribution from any of the following persons?
(i) A person who directly or indirectly controls, either alone or together with persons described in (ii)
Yes
No
and (iii) below, the governing body of the 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) 2013
Schedule A (Form 990 or 990-EZ) 2013
Page 2
Part II
Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi) (Complete only if you checked the box on line 5, 7, or 8 of Part I or if the
organization failed to qualify under Part III. If the organization fails to
qualify under the tests listed below, please complete Part III.)
Section A. Public Support
Calendar year (or fiscal year beginning in)
(a) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....
2
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......
3
The value of services or facilities furnished by a governmental unit to the organization without charge..
4
Total. Add lines 1 through 3
5
The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included
on line 1 that exceeds 2% of the amount shown on line 11, column (f)..
6
Public support. Subtract line 5 from line 4.
Section B. Total Support
Calendar year
(or fiscal year beginning in)
(a) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(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
Gross receipts from related activities, etc. (see instructions)
..................
12
13
First five years.
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here.................................................
Section C. Computation of Public Support Percentage
14
Public support percentage for 2013 (line 6, column (f) divided by line 11, column (f))
.........
14
15
Public support percentage for 2012 Schedule A, Part II, line 14
...............
15
16a
33 1/3% support test—2013.
If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization
.......................
b
33 1/3% support test—2012.
If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization
.....................
17a
10%-facts-and-circumstances test—2013.
If the organization did not check a box on line 13, 16a, or 16b, and line 14
is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here. Explain
in Part IV how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization
.....................................................
b
10%-facts-and-circumstances test—2012.
If the organization did not check a box on line 13, 16a, 16b, or 17a, and line
15 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here.
Explain in Part IV how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported organization
................................................
18
Private foundation.
If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions
.....................................................
Schedule A (Form 990 or 990-EZ) 2013
Schedule A (Form 990 or 990-EZ) 2013
Page 3
Part III
Support Schedule for Organizations Described in Section 509(a)(2) (Complete only if you checked the box on line 9 of Part I or if the organization
failed to qualify under Part II. If the organization fails to qualify under
the tests listed below, please complete Part II.)
Section A. Public Support
Calendar year (or fiscal year beginning in)
(a) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
2
Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......
3
Gross receipts from activities that are not an unrelated trade or business under section 513..
4
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5
The value of services or facilities furnished by a governmental unit to the organization without charge..
6
Total. Add lines 1 through 5.
7a
Amounts included on lines 1, 2, and 3 received from disqualified persons...
b
Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
c
Add lines 7a and 7b..
8
Public support (Subtract line 7c from line 6.)
Section B. Total Support
Calendar year (or fiscal year beginning in)
(a) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(f) Total
9
Amounts from line 6...
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c
Add lines 10a and 10b.
11
Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
12
Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)
..
13
Total support. (Add lines 9, 10c, 11, and 12.)..
14
First five years.
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here.............................................
Section C. Computation of Public Support Percentage
15
Public support percentage for 2013 (line 8, column (f) divided by line 13, column (f))
.........
15
16
Public support percentage from 2012 Schedule A, Part III, line 15
...............
16
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2013 (line 10c, column (f) divided by line 13, column (f))
......
17
18
Investment income percentage from 2012 Schedule A, Part III, line 17
.............
18
19a
33 1/3% support tests—2013.
If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
........
b
33 1/3% support tests—2012.
If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
.....
20
Private foundation.
If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions
.....
Schedule A (Form 990 or 990-EZ) 2013
Schedule A (Form 990 or 990-EZ) 2013
Page 4
Part IV
Supplemental Information.
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) 2013
Additional Data
Software ID:
Software Version:
-
TIN:
SCHEDULE O (Form 990 or 990-EZ)
Department of the Treasury Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ
Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
Attach to Form 990 or 990-EZ.
Information about Schedule O (Form 990 or 990-EZ) and its instructions is at
www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public Inspection
Name of the organization
INDIANA RADIOLOGY PARTNERS INC
Employer identification number
20-1017034
Return Reference
Explanation
Part VI, Section A, Line 1b - Number of Voting Members that are Indepen.
Indiana Radiology Partners, Inc. is part of a multi-entity hospital system controlled by Indiana University Health, Inc., a 501(c)(3) tax-exempt organization whose board is comprised of voting members, of which substantially all are independent community members.
Part VI, Section A, Line 2 - Family or Business Relationships
John F. Fitzgerald, M.D. and John C. Kohne, M.D. serve on the Board of Managers of Health Venture Management, LLC. No additional compensation is provided to these individuals for their service.
Part VI, Section A, Line 3 - Delegation of Control over Management Duties
Randall J. Luckey serves as the Executive Director of Indiana Radiology Partners, Inc. ("Indiana Radiology Partners") and performs many managerial duties customarily performed by or under the direct supervision of an Officer or Key Employee. Randall J. Luckey is an employee of Indiana University School of Medicine ("IUSOM"). Indiana Radiology Partners reimburses IUSOM for a portion of Randall J. Luckey's salary for his service as Indiana Radiology Partners' Executive Director.
Part VI, Section A, Lines 6, 7a and 7b - Members or Stockholders
Line 6: The sole member of Indiana Radiology Partners, Inc. ("Indiana Radiology Partners") is Indiana University Health, Inc. ("IU Health"), a 501(c)(3) tax-exempt hospital. Line 7A: The control and management of the affairs of Indiana Radiology Partners is vested in a Board of Directors of eleven (11) directors. There are Appointed and Elected Directors. Such directors, each of whom have one vote, are selected as follows: Appointed Directors: - One (1) director shall be the IU Health Chief Medical Officer. - One (1) director shall be the Chairperson or Interim Chairperson of the Indiana University School of Medicine ("IUSOM") Department of Radiology. - One (1) director shall be the Geographic Chief/Medical Director of IU Health Methodist Hospital Radiology. - One (1) director shall be designated by IUSOM. - One (1) director shall be designated by Methodist Specialty Physicians, LLC. - One (1) director shall be designated by Indiana University Medical Group-Specialty Care. - Two (2) directors shall be appointed from the academic track radiologists by the Chairperson of the IUSOM Department of Radiology. Elected Directors: - Two (2) directors shall be elected by a majority vote of Clinical Radiologists. - One (1) director shall be elected by the Board of Directors from a list of candidates submitted to the Board by Indiana Radiology Partners' employed or contracted physicians who primarily work at Suburban area sites. Line 7B: Notwithstanding any other provisions of the Articles of Incorporation or any provision of the Corporation's Bylaws, the following matters require the approval of IU Health, as the sole member, prior to implementation, and IU Health shall not grant such approval without the agreement by the IUSOM Dean, which shall not be unreasonably withheld if such proposed action will not materially harm the IUSOM's educational or research mission: - Any amendment to the Articles of Incorporation or Bylaws of Indiana Radiology Partners; - Adoption or revision of the operating or capital budget of Indiana Radiology Partners and the plan of compensation for employed radiologists; - A merger or consolidation of Indiana Radiology Partners; - Any sale, lease, exchange, conveyance, mortgage, pledge or other disposition of a substantial portion of the property, assets or interests of Indiana Radiology Partners, other than pursuant to a budget approved by IU Health. - Any incurrence of debt by, or the creation of any lien upon the property or revenues of, Indiana Radiology Partners other than in the ordinary course of business or pursuant to a budget approved by IU Health.
Part VI, Section A, Line 11b - Review of Form 990
Indiana Radiology Partners, Inc. has established the following process for reviewing Form 990: The Form 990 and related schedules are reviewed by the COO. After the COO approves the Form 990 and related schedules, a finalized complete Form 990 is sent to each board member via e-mail prior to filing the form with the IRS. Each member is informed of the availability of the tax department to answer any questions.
Part VI, Section B, Lines 12, 13, and 14 - Policies
Indiana Radiology Partners, Inc. ("Indiana Radiology Partners") is part of the Indiana University Health, Inc. ("IU Health") system. As the sole member and controlling parent of Indiana Radiology Partners, IU Health and its board of directors have mandated that certain policies be followed to ensure greater standardization throughout the system. Thus, Indiana Radiology Partners' Board of Directors was not required to separately adopt a conflict of interest, whistleblower, document retention and destruction and joint venture policies because IU Health's Board of Directors had already adopted and required these policies to be followed by its subsidiaries.
Part VI, Section B, 12c - Conflict of Interest Policy
Indiana Radiology Partners, Inc. ("Indiana Radiology Partners") has a Conflict of Interest Policy, the purpose of which is to protect Indiana Radiology Partners' interests when it is contemplating entering into a transaction or arrangement that might benefit the private interest of an officer or director. Each director, principal officer and member of a committee with board-delegated powers is required to annually sign a statement which affirms that such person (1) has received a copy of the conflict of interest policy; (2) has read and understands the policy; (3) has agreed to comply with the policy; and (4) understands and acknowledges that the Corporation is a tax-exempt organization and that in order to maintain its federal tax exemption it must engage primarily in activities which accomplish one or more of its tax-exempt purposes. Periodic reviews of conflict of interest disclosures are conducted by the Board and General Counsel to ensure that Indiana Radiology Partners operates in a manner consistent with its tax-exempt purposes and that it does not engage in activities that could jeopardize its status as an organization exempt from federal income tax. These reviews, at a minimum, include the following subjects: (1) whether compensation arrangements and benefits are reasonable and are the result of arm's-length bargaining; (2) whether acquisitions of physician practices and other provider services result in inurement or impermissible private benefit; (3) whether partnership and joint venture arrangements and arrangements with management service organizations and physician hospital organizations conform to written policies, are properly recorded, reflect reasonable payments for goods and services, further the Corporation's tax-exempt purposes and do not result in inurement or impermissible private benefit; and (4) whether agreements to provide health care and agreements with other health care providers, employees, and third-party payors further the Corporation's tax-exempt purposes and do not result in inurement or impermissible private benefit. Key employees are subject to the Indiana University Health, Inc.'s conflict of interest policy. Each employee that is manager level or above, including officers and directors, is required to annually sign a statement which affirms that such person (1) has received a copy of the conflict of interest policy; (2) has read and understands the policy; (3) has agreed to comply with the policy; and (4) understands and acknowledges that the Corporation is a tax-exempt organization and that in order to maintain its federal tax exemption it must engage primarily in activities which accomplish one or more of its tax-exempt purposes. If an interest is disclosed, the form requires that the discloser's supervisor sign the form to indicate his or her knowledge and approval of the interest. The form is then submitted to Corporate Compliance for review. If the disclosure is by the President & CEO, it is reviewed by the Chairman of the Board of Directors for approval. If the disclosure is by a member of the Board of Directors, the General Counsel and Chief Compliance Officer reviews the disclosures and determines whether to consent. Breach of the Conflict of Interest Policy, including failure to complete and update the questionnaire, and failure to disclose an interest that should be disclosed, may subject an individual to disciplinary action, including dismissal
Part VI, Section C, Line 19 - Public Disclosure
Indiana Radiology Partners, Inc.'s ("IU Health Radiology") Articles of Incorporation are available to the public through the Indiana Secretary of State's web-site. IU Health Radiology's conflict of interest policy is described on Form 990, Schedule O. IU Health Radiology is a consolidated subsidiary in the consolidated financial statements for Indiana University Health, Inc. ("IU Health"). The consolidated financial statements for IU Health are available to the public through its bond filings.
Part XI, Line 9 - Other Changes in Net Assets or Fund Balances
During 2013, Indiana University Health, Inc. ("IU Health"), a related 501(c)(3) tax-exempt organization, made an equity transfer to Indiana Radiology Partners, Inc. ("Indiana Radiology Partners") of $9,419,207. Throughout the existence of Indiana Radiology Partners, IU Health has provided funds to support Indiana Radiology Partners' exempt purpose. Although there was never any intent for Indiana Radiology Partners to repay IU Health, these amounts were recorded as intercompany balances rather than equity transfers. During 2013, IU Health and Indiana Radiology Partners made adjustments to their books and records to reflect these intercompany balances as equity transfers for both book and tax purposes.
Part IX, Line 11g - Other Fees for Services
Line 11g includes amounts paid for the following: Shared Services/Professional Fees/Leased Employees - $24,039,274
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.