Attach to Form 990 or Form 990-EZ.
Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
| (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 listed in your governing document? | (v) Amount of monetary support (see instructions) | (vi) Amount of other support (see instructions) | |
|---|---|---|---|---|---|---|
| Yes | No | |||||
| Total | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (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. | ||||||
Calendar year
(or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (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 VI.).. | ||||||
| 11 | Total support Add lines 7 through 10. | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") . | 1,491,141 | 1,199,996 | 0 | 0 | 0 | 2,691,137 |
| 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...... | 9,854,903 | 8,982,045 | 11,453,924 | 10,017,712 | 12,334,849 | 52,643,433 |
| 3 | Gross receipts from activities that are not an unrelated trade or business under section 513.. | 0 | 596,938 | 1,983 | 0 | 0 | 598,921 |
| 4 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf... | 0 | |||||
| 5 | The value of services or facilities furnished by a governmental unit to the organization without charge.. | 0 | |||||
| 6 | Total. Add lines 1 through 5. | 11,346,044 | 10,778,979 | 11,455,907 | 10,017,712 | 12,334,849 | 55,933,491 |
| 7a | Amounts included on lines 1, 2, and 3 received from disqualified persons... | 0 | |||||
| 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. | 1,715,928 | 1,785,630 | 2,845,129 | 2,928,102 | 3,198,907 | 12,473,696 |
| c | Add lines 7a and 7b.. | 1,715,928 | 1,785,630 | 2,845,129 | 2,928,102 | 3,198,907 | 12,473,696 |
| 8 | Public support (Subtract line 7c from line 6.) | 43,459,795 | |||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | 11,346,044 | 10,778,979 | 11,455,907 | 10,017,712 | 12,334,849 | 55,933,491 |
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | 0 | 0 | 0 | 0 | 0 | 0 |
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | 0 | |||||
| c | Add lines 10a and 10b. | 0 | 0 | 0 | 0 | 0 | 0 |
| 11 | Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on. | 0 | |||||
| 12 | Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.) .. | 0 | |||||
| 13 | Total support. (Add lines 9, 10c, 11, and 12.).. | 11,346,044 | 10,778,979 | 11,455,907 | 10,017,712 | 12,334,849 | 55,933,491 |
| Section A - Adjusted Net Income | (A) Prior Year |
(B) Current Year (optional) |
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| 1 | Net short-term capital gain | 1 | ||||
| 2 | Recoveries of prior-year distributions | 2 | ||||
| 3 | Other gross income (see instructions) | 3 | ||||
| 4 | Add lines 1 through 3 | 4 | ||||
| 5 | Depreciation and depletion | 5 | ||||
| 6 | Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions) | 6 | ||||
| 7 | Other expenses (see instructions) | 7 | ||||
| 8 | Adjusted Net Income (subtract lines 5, 6 and 7 from line 4) | 8 | ||||
| Section B - Minimum Asset Amount | (A) Prior Year |
(B) Current Year (optional) |
||||
| 1 | Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year): | 1 | ||||
| a | Average monthly value of securities | 1a | ||||
| b | Average monthly cash balances | 1b | ||||
| c | Fair market value of other non-exempt-use assets | 1c | ||||
| d | Total (add lines 1a, 1b, and 1c) | 1d | ||||
| e | Discount claimed for blockage or other factors (explain in detail in Part VI): | |||||
| 2 | Acquisition indebtedness applicable to non-exempt use assets | 2 | ||||
| 3 | Subtract line 2 from line 1d | 3 | ||||
| 4 | Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions). | 4 | ||||
| 5 | Net value of non-exempt-use assets (subtract line 4 from line 3) | 5 | ||||
| 6 | Multiply line 5 by .035 | 6 | ||||
| 7 | Recoveries of prior-year distributions | 7 | ||||
| 8 | Minimum Asset Amount (add line 7 to line 6) | 8 | ||||
| Section C - Distributable Amount | Current Year | |||||
| 1 | Adjusted net income for prior year (from Section A, line 8, Column A) | 1 | ||||
| 2 | Enter 85% of line 1 | 2 | ||||
| 3 | Minimum asset amount for prior year (from Section B, line 8, Column A) | 3 | ||||
| 4 | Enter greater of line 2 or line 3 | 4 | ||||
| 5 | Income tax imposed in prior year | 5 | ||||
| 6 | Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions) | 6 | ||||
| 7 | Check here if the current year is the organization's first as a non-functionally-integrated Type III supporting organization (see instructions) | |||||
| Section D - Distributions | Current Year | |
|---|---|---|
| 1 Amounts paid to supported organizations to accomplish exempt purposes | ||
|
2
Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity |
||
| 3 Administrative expenses paid to accomplish exempt purposes of supported organizations | ||
| 4 Amounts paid to acquire exempt-use assets | ||
| 5 Qualified set-aside amounts (prior IRS approval required) | ||
| 6 Other distributions (describe in Part VI). See instructions | ||
| 7Total annual distributions. Add lines 1 through 6. | ||
|
8
Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions |
||
| 9 Distributable amount for 2014 from Section C, line 6 | ||
| 10 Line 8 amount divided by Line 9 amount | ||
| Section E - Distribution Allocations (see instructions) |
(i) Excess Distributions |
(ii) Underdistributions Pre-2014 |
(iii) Distributable Amount for 2014 |
|
|---|---|---|---|---|
|
1
Distributable amount for 2014 from Section C, line 6 |
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|
2
Underdistributions, if any, for years prior to 2014 (reasonable cause required--see instructions) |
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| 3 Excess distributions carryover, if any, to 2014: | ||||
| a From 2009.......X | ||||
| b From 2010.......X | ||||
| c From 2011.......X | ||||
| d From 2012.......X | ||||
| e From 2013....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2014 distributable amount | ||||
|
i
Carryover from 2009 not applied (see instructions) |
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| j Remainder. Subtract lines 3g, 3h, and 3i from 3f. | ||||
| 4Distributions for 2014 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2014 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from 4. | ||||
|
5
Remaining underdistributions for years prior to 2014, if any. Subtract lines 3g and 4a from line 2 (if amount greater than zero, see instructions) |
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|
6
Remaining underdistributions for 2014. Subtract lines 3h and 4b from line 1 (if amount greater than zero, see instructions) |
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|
7 Excess distributions carryover to 2015. Add lines 3j and 4c. |
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| 8 Breakdown of line 7: | ||||
| a From 2010.......X | ||||
| b From 2011.......X | ||||
| c From 2012.......X | ||||
| d From 2013....... | ||||
| e From 2014....... | ||||
| Facts And Circumstances Test |
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| Return Reference | Explanation |
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| Software ID: | |
| Software Version: |
Attach to Form 990 or 990-EZ.
Information about Schedule O (Form 990 or 990-EZ) and its instructions is at| Return Reference | Explanation |
|---|---|
| Part IV, Lines 25a and 25b - Possible Excess Benefit Transactions | During an internal review, Clarian Transplant Institute determined that it erroneously paid several invoices that included expenses for the benefit of disqualified persons. These amounts were not included in taxable compensation reportable to said persons. The amounts have been repaid in full. |
| Part VI, Section A, Line 1b - Number of Voting Members that are Indep. | Clarian Transplant Institute is part of a multi-entity hospital system controlled by IU Health, a 501(c)(3) 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 C. Kohne, M.D. and John F. Fitzgerald, M.D. served on the Board of Managers of Health Venture Management, LLC. No additional compensation was provided to these individuals for their service. Mary Beth Claus and John F. Fitzgerald, M.D. served on the Board of Directors of IUH Assurance SPC, Ltd. and IU Health Risk Retention Group, Inc. No additional compensation was provided to these individuals for their service. Johnathan F. Fitzgerald, M.D. and Jonathan R. Gottlieb, M.D. served on the Board of Directors of Indiana University Health ACO, Inc. No additional compensation was provided to these individuals for their services. A. Joseph Tector, M.D. serves on the board of directors of University Surgeons. Gary L. Dunnington, M.D. serves as the President and is the sole owner of University Surgeons. Additionally, Jonathan A. Fridell, M.D., Richard S. Mangus, M.D., and John A. Powelson, M.D. are employees of University Surgeons. |
| Part VI, Section A, Lines 6, 7a and 7b - Members or Stockholders | Line 6: The sole member of Clarian Transplant Institute is IU Health, a 501(c)(3) tax-exempt hospital. Line 7A: The control and management of the affairs of Clarian Transplant Institute is vested in a Board of Directors of twelve (12) members, subject to the limitation that the Board shall never be reduced to less than three (3) nor increased to more than thirteen (13) Directors. IU Health, as the sole member of Clarian Transplant Institute, elects three (3) Directors on the Board while the remaining directors are elected according to their designation as follows: - Chief Medical Officer of IU Health; - Chief Medical Officer of University Hospital of IU Health; - Chief Medical Officer of Clarian Transplant Institute; - Chief Operating Officer of Clarian Transplant Institute; - President and Chief Executive Officer of Methodist Hospital and University Hospital of IU Health; - Chairman of the Department of Medicine of IU School of Medicine; - Chairman of the Department of Surgery of IU School of Medicine Line 7B: The Board of Directors may not undertake certain actions without the prior approval of IU Health, as the sole member. Actions that require prior approval include the following: - Authorization of any merger, consolidation, reorganization, sale or transfer of all or substantially all of the assets of Clarian Transplant Institute; - Authorization of any plan of dissolution of Clarian Transplant Institute, any liquidating distribution of Clarian Transplant Institute's assets or other actions related to the dissolution or liquidation of Clarian Transplant Institute; - Authorization of any voluntary declaration of bankruptcy of Clarian Transplant Institute; - The amendment, repeal, revision or adoption of changes to the organizational documents of Clarian Transplant Institute; - Authorization of the consolidation of any entity with, or acquisition of any entity by Clarian Transplant Institute; - Authorization of any agreement to act as primary obligor, or to serve as a guarantor, surety or co-obligor with respect to the indebtedness of any other party, to borrow amounts from third-party lenders or to loan money to any person or entity; - Approval of strategic plans and amendments; - Authorization of any pledge of, or grant of any security interest or mortgage in, or otherwise encumber, any tangible assets in excess of an appropriate monetary threshold, other than in the ordinary course of business or pursuant to an approved budget or strategic plan; - Approval of any management agreement for the management of all or a substantial part of Clarian Transplant Institute's operations; or - Authorization of the establishment or acquisition by Clarian Transplant Institute of any subsidiaries, affiliates or joint venture arrangements or the acquisition by Clarian Transplant Institute of the stock or other equity interest or substantially all the assets of any other business or entity. |
| Part VI, Section A, Line 11b - Review of Form 990 | The Secretary reviewed and approved the Form 990. Following the Director/Secretary's review and approval, a complete copy of the Form 990 was made available to each board member prior to its filing. Each member was also informed of the availability of IU Health's Tax Department to answer any questions. |
| Part VI, Section B, Lines 12, 13, 14, and 16b - Policies | Clarian Transplant Institute is part of the IU Health system. As the sole member and controlling parent of Clarian Transplant Institute, IU Health and its Board of Directors have mandated that certain policies be followed to ensure greater standardization throughout the system. Thus, Clarian Transplant Institute's 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, Line 12c - Conflict of Interest Policy | Clarian Transplant Institute follows IU Health's Conflict of Interest Policy. IU Health's Conflict of Interest Policy includes the following provisions: All IU Health employees, associates, colleagues and contracted personnel, including employed physicians and paid medical directors ("IU Health Representatives") are covered by and subject to its Conflict of Interest Policy. IU Health regularly and consistently monitors and enforces compliance with the policy through the following procedures: (a) On an annual basis, each IU Health Representative at the level of Manager or above, together with every other person designated by the Corporate Compliance Department ("Department"), must complete, sign and submit a Conflict of Interest Questionnaire ("Questionnaire") to the Department. Governing board members, committee members, corporate officers, medical staff and researchers must comply with the administrative requirements noted in the respective policies and procedures relative to those areas. (b) An IU Health Representative must supplement a Questionnaire in writing, if after completion of the original Questionnaire, a situation arises, or may reasonably be expected to arise, that would change any answer or information on the original Questionnaire if the situation had existed or been anticipated at the time of completion of the original Questionnaire. (c) If a fully and properly completed Questionnaire reveals facts or other information that might reasonably indicate a Conflict of Interest or violation of the policy, the IU Health Representative completing the questionnaire must secure approval by his/her supervisor, evidenced in writing. (d) The Department will review each Questionnaire and determine whether a Conflict of Interest exists and, if so, whether and how it should or may be eliminated, avoided or managed in order to comply with the spirit of the policy and with the best interests of IU Health and its patients. In making the determination, the Corporate Compliance Department may consult with the IU Health Representative's supervisor and other appropriate individuals and groups. (e) The scope of the policy is not limited to those who are required to complete Questionnaires. If an IU Health Representative is involved in a situation or relationship that would constitute a violation of the policy in the absence of disclosure and approval as described above, then the IU Health Representative must disclose the matter to his/her supervisor, secure his/her supervisor's approval in writing, and disclose the matter to the Department. Otherwise, the IU Health Representative is in violation of the policy and subject to corrective action, up to and including termination. (f) The Chief Compliance Officer, in consultation with onsite Compliance personnel, may from time to time appoint standing or ad hoc committees to assist in resolving issues that arise under provisions of the policy. |
| Part VI, Section B, Line 19 - Public Disclosure | Clarian Transplant Institute's Articles of Incorporation are available to the public through the Indiana Secretary of State's web-site. Clarian Transplant Institute's conflict of interest policy is described on Form 990, Schedule O. Clarian Transplant Institute is a consolidated subsidiary in the consolidated financial statements for IU Health. The consolidated financial statements for IU Health are available to the public through its bond filings. |
| FORM 990 PART IX LINE 11G | DESCRIPTION:SHARED SERVICES/LEASED EMP. TOTAL FEES:8655952 |
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