Department of the Treasury Internal Revenue Service
Public Charity Status and Public Support
Complete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.
Attach to Form 990 or Form 990-EZ. See separate instructions.
OMB No. 1545-0047
2012
Open to Public Inspection
Name of the organization
UOFL & JEWISH CARDIOVASCULAR INNOVATION INST
Employer identification number
20-1319658
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) 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)
(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.") ....
1,222,087
1,793,730
1,065,493
1,027,506
263,150
5,371,966
2
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......
0
3
The value of services or facilities furnished by a governmental unit to the organization without charge..
0
4
Total. Add lines 1 through 3
1,222,087
1,793,730
1,065,493
1,027,506
263,150
5,371,966
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)..
0
6
Public support. Subtract line 5 from line 4.
5,371,966
Section B. Total Support
Calendar year
(or fiscal year beginning in)
(a) 2008
(b) 2009
(c) 2010
(d) 2011
(e) 2012
(f) Total
7
Amounts from line 4..
1,222,087
1,793,730
1,065,493
1,027,506
263,150
5,371,966
8
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...
4,490
3,750
8,240
9
Net income from unrelated business activities, whether or not the business is regularly carried on..
0
10
Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)..
0
0
0
0
0
11
Total support (Add lines 7 through 10).
5,380,206
12
Gross receipts from related activities, etc. (see instructions)
..................
12
156,146
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 2012 (line 6, column (f) divided by line 11, column (f))
.........
14
99.840 %
15
Public support percentage for 2011 Schedule A, Part II, line 14
...............
15
99.860 %
16a
33 1/3% support test—2012.
If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization
.......................
b
33 1/3% support test—2011.
If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization
.....................
17a
10%-facts-and-circumstances test—2012.
If the organization did not check a box on line 13, 16a, or 16b, and line 14
is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here. Explain
in Part IV how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization
.....................................................
b
10%-facts-and-circumstances test—2011.
If the organization did not check a box on line 13, 16a, 16b, or 17a, and line
15 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here.
Explain in Part IV how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported organization
................................................
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) 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)
(a) 2008
(b) 2009
(c) 2010
(d) 2011
(e) 2012
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
2
Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......
3
Gross receipts from activities that are not an unrelated trade or business under section 513..
4
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5
The value of services or facilities furnished by a governmental unit to the organization without charge..
6
Total. Add lines 1 through 5.
7a
Amounts included on lines 1, 2, and 3 received from disqualified persons...
b
Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
c
Add lines 7a and 7b..
8
Public support (Subtract line 7c from line 6.)
Section B. Total Support
Calendar year (or fiscal year beginning in)
(a) 2008
(b) 2009
(c) 2010
(d) 2011
(e) 2012
(f) Total
9
Amounts from line 6...
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c
Add lines 10a and 10b.
11
Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
12
Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)
..
13
Total support. (Add lines 9, 10c, 11, and 12.)..
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 2012 (line 8, column (f) divided by line 13, column (f))
.........
15
16
Public support percentage from 2011 Schedule A, Part III, line 15
...............
16
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2012 (line 10c, column (f) divided by line 13, column (f))
......
17
18
Investment income percentage from 2011 Schedule A, Part III, line 17
.............
18
19a
33 1/3% support tests—2012.
If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
........
b
33 1/3% support tests—2011.
If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
.....
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) 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:
12000266
Software Version:
v2012.1.0
-
TIN:
SCHEDULE O (Form 990 or 990-EZ)
Department of the Treasury Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ
Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
Attach to Form 990 or 990-EZ.
OMB No. 1545-0047
2012
Open to Public Inspection
Name of the organization
UOFL & JEWISH CARDIOVASCULAR INNOVATION INST
Employer identification number
20-1319658
Identifier
Return Reference
Explanation
ORGANIZATION'S MISSION
FORM 990, PART III, LINE 1
OUR INVESTIGATORS ARE REGULARLY INVITED SPEAK ABOUT OUR ACCOMPLISHMENTS AT THE LOCAL, NATIONAL AND INTERNATIONAL LEVEL. OUR INTERNATIONAL RECOGNITION ALSO RESULTS IN FREQUENT VISITS BY INVESTIGATORS FROM NUMEROUS OTHER COUNTRIES. OUR HEART INNOVATIONS INCLUDE THE DEVELOPMENT OF NEXT-GENERATION CIRCULATORY ASSIST DEVICES KNOW AS VENTRICULAR ASSIST DEVICES. WE HAVE ALSO DEVELOPED NEXT GENERATION THERAPIES THAT PROVIDE A BIOLOGICAL SOLUTION TO HEART MUSCLE THAT HAS LOST ITS ABILITY TO PROVIDE ADEQUATE PERFUSION OF BLOOD TO THE PERIPHERAL CIRCULATION. OUR MOST NOTABLE ACCOMPLISHMENT HAS BEEN THE USE OF A PATIENT'S OWN TISSUE TO REBUILD THE SMALLEST BLOOD VESSELS OF THE HEART KNOWN AS THE MICROCIRCULATION. WE HAVE EXPANDED OUR EFFORTS IN WOMEN'S CARDIOVASCULAR DISEASE RECOGNIZES THAT CARDIOVASCULAR DISEASE IS THE NUMBER ONE KILLER OF WOMEN.
DESCRIPTION OF PROGRAM SERVICES
FORM 990, PART III, LINE 4A
THE TRANSLATION OF PRECLINICAL DATA TO HUMAN CLINICAL TRIALS IS ONE OF OUR MAJOR STRENGTHS. WE ALSO PARTICIPATE IN THE TRANSLATION OF SUCCESSFUL DEVICES AND THERAPIES TO WIDESPREAD USE IN THE MEDICAL COMMUNITY BASED ON OUR UNDERSTANDING OF THE FDA APPROVAL PROCESS AS WELL AS OUR ABILITY TO HELP IN THE COMMERCIALIZATION OF IDEAS. A SIGNIFICANT PART OF OUR MISSION IS TO ALSO HELP TRAIN MEDICAL PROFESSIONALS IN THE PROPER USE OF THESE HIGHLY COMPLEX NEW THERAPIES. TRAINING AND EDUCATION IS A CENTRAL ROLE OF THE INSTITUTE.
Classes of members or stockholders
Form 990, Part VI, Section A, Line 6
THE ORGANIZATION HAD TWO ORIGINAL MEMBERS CONSISTING OF THE UNIVERSITY OF LOUISVILLE AND JEWISH HOSPITAL & ST. MARY'S HEALTHCARE, INC (JHSMH). IN DECEMBER 2012, AS PART OF ITS MERGER WITH KENTUCKYONE HEALTHCARE, JHSMH TRANSFERRED ITS INTEREST IN THE ORGANIZATION TO THE JEWISH HERITAGE FUND FOR EXCELLENCE. BOTH MEMBERS CONTINUE TO HAVE EQUAL RIGHTS UNDER THE ORGANIZATION'S GOVERNING DOCUMENTS INCLUDING BUT NOT LIMITED TO THE RIGHT TO AMEND THE GOVERNING DOCUMENTS, ADOPT OR MODIFY THE ORGANIZATION'S BUSINESS PLANS, APPROVE THE INCURRENCE OF ANY LONG-TERM DEBT, APPROVE ANY MATERIAL MERGERS OR REORGANIZATIONS, DISPOSE OF ANY MATERIAL ASSETS, ESTABLISH ANY AFFILIATES, AND APPROVE THE NAME OR ANY NAME CHANGES TO THE ORGANIZATION.
Members or stockholders electing members of governing body
Form 990, Part VI, Section A, Line 7a
BOTH THE UNIVERSITY OF LOUISVILLE AND THE JEWISH HERITAGE FUND FOR EXCELLENCE HAVE EQUAL POWER TO APPOINT ONE OR MORE MEMBERS OF THE BOARD OF THE ORGANIZATION.
Review of form 990 by governing body
Form 990, Part VI, Section B, Line 11b
UNIVERSITY OF LOUISVILLE FINANCE PERSONNEL AND AN OUTSIDE FIRM PREPARED THE RETURN AND A COPY OF THE RETURN WAS PROVIDED TO ALL BOARD MEMBERS FOR REVIEW PRIOR TO FILING.
Conflict of interest policy
Form 990, Part VI, Section B, Line 12c
THE ORGANIZATION'S BYLAWS REQUIRE THAT ALL OFFICERS AND TRUSTEES AVOID CONFLICTS OF INTEREST AND OTHERWISE FULLY DISCLOSE TO THE ORGANIZATION ANY POTENTIAL OR ACTUAL CONFLICTS OF INTEREST SO THAT SUCH POTENTIAL CONFLICTS ARE DEALT WITH IN A MANNER THAT IS IN THE BEST INTEREST OF THE ORGANIZATION. OFFICERS AND TRUSTEES ARE REQUIRED TO FAMILIARIZE THEMSELVES WITH THE ORGANIZATION'S CONFLICTS OF INTEREST POLICY AND TO COMPLETE ANY AND ALL SUCH DISCLOSURE FORMS AS MAY BE DEEMED NECESSARY OR USEFUL BY THE ORGANIZATION OR ITS MEMBERS FOR IDENTIFYING POTENTIAL CONFLICTS OF INTEREST.
TAX RETURN DISCLOSURE
FORM 990, PART VI, LINE 18
COPIES OF THE ORGANIZATION'S FORM 1023 AVAILABLE UPON REQUEST. COPIES OF THE MOST RECENT FORMS 990 AND 990-T ARE AVAILABLE AT WWW.LOUISVILLE.EDU OR UPON REQUEST.
Governing documents, conflict of interest policy and financial statements available to the public
Form 990, Part VI, Section C, Line 19
GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.