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
RHI FOUNDATION INC
Employer identification number
35-1932349
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)
No
(ii)
A family member of a person described in (i) above?
......................
11g(ii)
No
(iii)
A 35% controlled entity of a person described in (i) or (ii) above?
................
11g(iii)
No
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
(A)
REHABILITATION HOSPITAL OF INDIANA
351786005
3
Yes
Yes
Yes
6,779
Total
6,779
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:
13000248
Software Version:
2013v3.1
-
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
RHI FOUNDATION INC
Employer identification number
35-1932349
Return Reference
Explanation
Form 990, Part III, Line 3, Significant changes in program services
THE SMALL BUSINESS TECHNOLOGY TRANSFER (STTR) PROJECT WAS A COOPERATIVE RESEARCH AND DEVELOPMENT EFFORT BETWEEN INVENTIVE SOFTWARE SOLUTIONS AND THE RHI FOUNDATION RESEARCH DEPARTMENT. THE PURPOSE OF THE STTR PROJECT WAS TO BE CONDUCTED JOINTLY BY CREATING AN INTERNET BASED EVALUATION SYSTEM FOR POST ACUTE ACQUIRED BRAIN INJURY. THE STTR PROJECT CONCLUDED IN MAY 2012.
FORM 990, PART V, LINE 2A, NUMBER OF EMPLOYEES REPORTED ON FORM W-3
THE EMPLOYEE REPORTED HERE WAS PAID BY REHABILITATION HOSPITAL OF INDIANA, A RELATED TAX-EXEMPT ORGANIZATION, FOR SERVICES PROVIDED SOLELY TO RHI FOUNDATION.
Form 990, Part VI, Sec A, Line 1a, Delegate broad authority to a committee
THE EXECUTIVE COMMITTEE SHALL CONSIST OF NOT LESS THAN FOUR (4) NOT MORE THAN TEN (10) MEMBERS, ALL OF WHOM MUST BE MEMBERS OF THE FOUNDATION'S BOARD OF DIRECTOR. MEMBERS OF THE EXECUTIVE COMMITTEE SHALL BE APPOINTED BY THE BOARD OF DIRECTORS. WHEN ACTION IS TAKEN BY THE EXECUTIVE COMMITTEE, IT WILL BE REPORTED TO THE BOARD OF DIRECTORS AT ITS NEXT MEETING. THE EXECUTIVE COMMITTEE SHALL HAVE POWER TO TRANSACT ALL REGULAR BUSINESS OF THE FOUNDATION DURING THE PERIOD BETWEEN MEETINGS OF THE BOARD OF DIRECTORS SUBJECT TO ANY PRIOR LIMITATION IMPOSED BY THE BOARD OF DIRECTORS AND SUBJECT TO ANY LIMITATIONS IMPOSED BY LAW.
Form 990, Part VI, Sec A, Line 6, Classes of members or stockholders
REHABILITATION HOSPITAL OF INDIANA IS THE SOLE CORPORATE MEMBER OF THE RHI FOUNDATION. THE SOLE CORPORATE MEMBER WILL FILL ANY VACANCIES ON THE RHI FOUNDATION BOARD OF DIRECTORS. IN ADDITION, SOME DECISIONS OF THE GOVERNING BODY REQUIRE THE APPROVAL OF ITS SOLE CORPORATE MEMBER.
Form 990, Part VI, Sec A, Line 7a, Members or stockholders electing members of governing body
MEMBERS OF THE BOARD OF DIRECTORS ARE ELECTED AN AN ANNUAL OR SPECIAL MEETING OF THE CORPORATE MEMBER, REHABILITATION HOSPITAL OF INDIANA. IN ADDITION, THE CORPORATE MEMBER, AFTER CONFERRING WITH THE BOARD OF DIRECTORS, ANNUALLY APPOINTS THE EXECUTIVE DIRECTOR.
Form 990, Part VI, Sec A, Line 7b, Decisions requiring approval by members or stockholders
THE FOLLOWING MATTERS REQUIRE THE APPROVAL OF THE CORPORATE MEMBER, REHABILITATION HOSPITAL OF INDIANA: 1. APPROVE, INTERPRET AND CHANGE ANY STATEMENT OF MISSION, PHILOSOPHY, ROLE AND PURPOSE OF THE FOUNDATION. 2. APPROVE AND AMEND THE BYLAWS OR THE ARTICLES OF INCORPORATION OF THE FOUNDATION. 3. FIX THE NUMBER OF DIRECTORS OF THE FOUNDATION. 4. APPROVE THE MERGER, DISSOLUTION, CONSOLIDATION OR REORGANIZATION OF THE FOUNDATION. 5. APPROVE THE FORMATION OF OTHER ENTITIES BY THE FOUNDATION. 6. APPROVE THE ACQUISITION, SALE, LEASE, TRANSFER OR OTHER ALIENATION OF PROPERTY OF THE FOUNDATION, OTHER THAN IN THE USUAL AND REGULAR COURSE OF THE FOUNDATION'S BUSINESS, WHEN SUCH ACQUISITION, SALE, LEASE, TRANSFER OR OTHER ALIENATION IS ABOVE SPECIFIED FINANCIAL LEVELS SET IN ACCORDANCE WITH POLICIES ESTABLISHED FROM TIME TO TIME BY THE CORPORATE MEMBER. 7. APPROVE CAPITAL AND OPERATING BUDGETS OF THE FOUNDATION. 8. APPROVE DEBT INCURRED BY THE FOUNDATION WHICH IS IN EXCESS OF SUCH LIMITS AS ARE ESTABLISHED BY THE CORPORATE MEMBER. 9. APPROVE THE DISPOSITION OF THE ASSETS OF THE FOUNDATION AT THE TIME OF ITS DISSOLUTION. 10. ESTABLISH POLICY CONCERNING QUALITY OF CARE AND SERVICES OR ESTABLISH POLICY AND PROCEDURES CONCERNING FINANCE AND RESOURCES FOR THE FOUNDATION, WHICH ARE INCONSISTENT WITH POLICIES ESTABLISHED BY THE CORPORATE MEMBER. 11. APPROVE THE LONG-RANGE FINANCIAL AND STRATEGIC PLANS FOR THE FOUNDATION. 12. APPROVE AN INTERNAL AUDITING PROGRAM FOR THE FOUNDATION WHICH IS CONSISTENT WITH THE INTERNAL AUDITING PROGRAM ESTABLISHED BY THE CORPORATE MEMBER. 13. APPOINT AND REMOVE THE EXECUTIVE DIRECTOR OF THE FOUNDATION, PROVIDED, HOWEVER, THAT THE CORPORATE MEMBER SHALL CONFER WITH THE BOARD OF DIRECTORS CONCERNING THE APPOINTMENT OF REMOVAL OF THE EXECUTIVE DIRECTOR. 14. APPROVE THE CRITERIA AND THE PROCESS FOR THE EVALUATION OF THE EXECUTIVE DIRECTOR OF THE FOUNDATION. 15. TAKE ANY ACTION WHICH WOULD BE INCONSISTENT WITH THE GOVERNING DOCUMENTS OR POLICIES OF THE CORPORATE MEMBER.
Form 990, Part VI, Sec B, Line 11b, Review of form 990 by governing body
A DETAILED REVIEW IS PERFOMED BY MANAGEMENT AND A REPRESENTATIVE FROM MAJORITY OWNER MEMBER ORGANIZATION OF REHABILITATION HOSPITAL OF INDIANA (A RELATED TAX-EXEMPT ORGANIZATION). THEN A FINAL DRAFT IS SENT TO THE BOARD OF DIRECTORS PRIOR TO FILING WITH THE IRS.
Form 990, Part VI, Sec B, Line 12c, Conflict of interest policy
ALL BOARD MEMBERS ARE REQUIRED TO COMPLETE A CONFLICT OF INTEREST FORM ANNUALLY. THE EXECUTIVE DIRECTOR OF THE FOUNDATION AND THE CHAIRMAN OF THE BOARD REVIEW THE CONFLICT OF INTEREST FORMS. IF A BOARD MEMBER HAS A CONFLICT REGARDING AN ISSUE AT HAND, THEN THAT MEMBER WOULD REMOVE THEMSELVES FROM BOTH THE DISCUSSION AND VOTING ON THE CONFLICTED ITEM. IN THE EVENT THE BOARD MEMBER FAILING TO REMOVE THEMSELVES FROM THE CONFLICTING ISSUE, THE BOARD MEMBER WOULD BE ASKED TO RECUSE THEMSELVES FROM THE DISCUSSION AND VOTE.
FORM 990, PART VI, LINE 15B, PROCESS USED TO ESTABLISH COMPENSATION OF OTHER OFFICERS/KEY EMPLOYEES
THE FOUNDATION DOES NOT HAVE ANY OTHER COMPENSATED OFFICERS OR KEY EMPLOYEES. THEREFORE, THIS QUESTION HAS BEEN ANSWERED "NO" IN ACCORDANCE WITH THE FORM 990 INSTRUCTIONS.
Form 990, Part VI, Sec C, Line 19, Required documents available to the public
FINANCIAL STATEMENTS, GOVERNING DOCUMENTS, AND CONFLICT OF INTEREST POLICIES ARE NOT REQUIRED DISCLOSURES PURSUANT TO INTERNAL REVENUE CODE (IRC) SECTION 6104. AS SUCH, THESE DOCUMENTS ARE NOT AVAILABLE TO THE PUBLIC AT THIS TIME.
Form 990, Part IX, Line 11g, Other Expenses
CONSULTING - TOTAL EXPENSE: 166674, PROGRAM SERVICE EXPENSE: 166674, MANAGEMENT AND GENERAL EXPENSES: , FUNDRAISING EXPENSES: ;
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.