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 | |||||
| (A)
INDIANA UNIVERSITY HEALTH |
351955872 | 3 | Yes | 0 | 0 | |
| (B)
COMMUNITY HOSPITALS OF INDIANA |
350983617 | 3 | Yes | 0 | 0 | |
| (C)
HEALTH & HOSPITAL CORPORATION |
356065697 | 6 | Yes | 0 | 0 | |
| (D)
INDIANA STATE MEDICAL ASSOCIATION |
350411650 | 501(C)(6) | Yes | 0 | 0 | |
| (E)
INDIANA UNIVERSITY |
356001673 | 6 | Yes | 0 | 0 | |
| (F)
THE INDIANAPOLIS MEDICAL SOCIETY |
127566088 | 501(C)(6) | Yes | 0 | 0 | |
| (G)
MARION COUNTY HEALTH DEPARTMENT |
356065697 | 6 | Yes | 0 | 0 | |
| (H)
SISTERS OF ST FRANCIS HEALTH SERVICES |
350913537 | 3 | Yes | 0 | 0 | |
| (I)
ST VINCENT HOSPITAL & HEALTH CARE |
352052591 | 3 | Yes | 0 | 0 | |
| (J)
CENTRAL INDIANA CORPORATE PARTNERSHIP |
352065459 | 501(C)(6) | Yes | 0 | 0 | |
| (K)
INDIANA HOSPITAL ASSOCIATION INC |
350988753 | 501(C)(6) | Yes | 0 | 0 | |
| (L)
INDIANA STATE DEPARTMENT OF HEALTH |
356000158 | 6 | Yes | 0 | 0 | |
Total 12
|
0 | |||||
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.") . | ||||||
| 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.) | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (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 VI.) .. | ||||||
| 13 | Total support. (Add lines 9, 10c, 11, and 12.).. | ||||||
| Section A - Adjusted Net Income | (A) Prior Year |
(B) Current Year (optional) |
||||
| 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 |
||||
|
2
Underdistributions, if any, for years prior to 2014 (reasonable cause required--see instructions) |
||||
| 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) |
||||
| 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) |
||||
|
6
Remaining underdistributions for 2014. Subtract lines 3h and 4b from line 1 (if amount greater than zero, see instructions) |
||||
|
7 Excess distributions carryover to 2015. Add lines 3j and 4c. |
||||
| 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 |
|---|
| Return Reference | Explanation |
|---|---|
| PART IV, SECTION A, LINE 2, SUPPORTING ORGANIZATIONS: | THE FOLLOWING GOVERNMENTAL ENTITIES ARE IHIE SUPPORTED ORGANIZATIONS: HEALTH AND HOSPITAL CORPORATION OF MARION COUNTY D/B/A ESKENAZI HEALTH F/K/A WISHARD HEALTH SERVICES; INDIANA STATE DEPARTMENT OF HEALTH; INDIANA UNIVERSITY; AND MARION COUNTY HEALTH DEPARTMENT (THE "GOVERNMENT ENTITIES"). THE GOVERNMENT ENTITIES ARE EACH DESCRIBED IN INTERNAL REVENUE CODE ("CODE") SECTION 509(A)(1) BECAUSE EACH IS ALSO DESCRIBED IN CODE SECTION 170(B)(1)(A)(V). THE FOLLOWING ORGANIZATIONS DESCRIBED IN CODE SECTION 501(C)(6) ARE ALSO IHIE SUPPORTED ORGANIZATIONS: CENTRAL INDIANA CORPORATE PARTNERSHIP, INC.; INDIANA HOSPITAL ASSOCIATION, INC.; INDIANA STATE MEDICAL ASSOCIATION, INC.; AND INDIANAPOLIS MEDICAL SOCIETY, INC. (THE "501(C)(6) ENTITIES"). AS DESCRIBED BELOW, THE 501(C)(6) ENTITIES EACH SATISFY THE TEST IN CODE SECTION 509(A)(2) AND WOULD QUALIFY AS PUBLIC CHARITIES IF THEY WERE DESCRIBED IN CODE SECTION 501(C)(3). |
| PART IV, SECTION A, LINE 3B, SUPPORTING ORGANIZATIONS: | IHIE PERFORMED CALCULATIONS WITH RESPECT TO CENTRAL INDIANA CORPORATE PARTNERSHIP, INC.; INDIANA STATE MEDICAL ASSOCIATION, INC.; INDIANAPOLIS MEDICAL SOCIETY, INC. AND INDIANA HOSPITAL ASSOCIATION, INC. TO VERIFY THAT THE PUBLIC SUPPORT TESTS UNDER CODE SECTION 509(A)(2) WERE SATISFIED. |
| PART IV, SECTION A, LINE 3C, SUPPORTING ORGANIZATIONS: | IHIE'S ARTICLES OF INCORPORATION PROVIDE THAT IHIE SHALL OPERATE EXCLUSIVELY TO BENEFIT, PERFORM, AND CARRY OUT THE CHARITABLE, EDUCATIONAL, AND OTHER EXEMPT PURPOSES OF ITS SUPPORTED ORGANIZATIONS, AS SUCH PURPOSES ARE DESCRIBED IN CODE SECTIONS 170(C)(2)(B), 501(C)(3), 2055(A)(2), AND 2522(A)(2). IHIE'S BOARD OF DIRECTORS AND MANAGEMENT ENSURE STRICT COMPLIANCE WITH THE FOREGOING THROUGH VIGILANT OVERSIGHT AND CONSULTATION WITH EXPERIENCED LEGAL COUNSEL AND ADVISORS. |
| PART IV, SECTION B, LINE 1, TYPE I SUPPORTING ORGANIZATIONS: | IHIE'S BYLAWS PROVIDE THAT EACH SUPPORTED ORGANIZATION HAS THE RIGHT TO APPOINT ONE INDIVIDUAL TO IHIE'S BOARD OF DIRECTORS. IHIE'S ARTICLES OF INCORPORATION AND BYLAWS PROVIDE THAT AT ALL TIMES THE MAJORITY OF THE DIRECTORS SHALL BE APPOINTED BY THE SUPPORTING ORGANIZATIONS. |
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Attach to Form 990 or 990-EZ.
Information about Schedule O (Form 990 or 990-EZ) and its instructions is at| Return Reference | Explanation |
|---|---|
| FORM 990, PART VI, SECTION B, LINE 11 | THE 990 IS SUBMITTED TO THE FINANCE & AUDIT COMMITTEE FOR REVIEW AND APPROVAL. THE RETURN IS THEN SUBMITTED TO THE BOARD BEFORE FILING. |
| FORM 990, PART VI, SECTION B, LINE 12C | THE BOARD OF DIRECTORS OF INDIANA HEALTH INFORMATION EXCHANGE, INC. (THE CORPORATION), HAS ADOPTED A CONFLICT OF INTEREST POLICY (THE "POLICY") THAT REQUIRES EACH DIRECTOR, OFFICER AND MEMBER OF A BOARD COMMITTEE (DEFINED IN THE POLICY) TO PROVIDE THE CORPORATION AN ANNUAL DISCLOSURE OF ACTUAL OR POTENTIAL CONFLICTS OF INTEREST THAT ARISE AS A RESULT OF AN INDIVIDUAL SERVING AS A DIRECTOR, OFFICER OR MEMBER OF A BOARD COMMITTEE. THE POLICY ALSO REQUIRES CERTAIN ACTIONS TO APPROVE OR RATIFY A CONTRACT OR OTHER TRANSACTION BETWEEN THE CORPORATION AND AN INTERESTED PERSON (DEFINED IN THE POLICY). TO HELP ENSURE REGULAR AND CONSISTENT COMPLIANCE WITH THE POLICY, THE CORPORATION'S MANAGEMENT HAS ADOPTED THIS CONFLICT OF INTEREST MONITORING AND COMPLIANCE PROCEDURE. RESPONSIBLE INDIVIDUAL: THE CORPORATION'S VP, GENERAL COUNSEL & COMPLIANCE OFFICER,(THE "COMPLIANCE OFFICER"). PROCEDURE: 1. THE COMPLIANCE OFFICER WILL ANNUALLY COLLECT A WRITTEN DISCLOSURE OF ACTUAL OR POTENTIAL CONFLICTS OF INTEREST FROM EACH DIRECTOR, OFFICER AND MEMBER OF A BOARD COMMITTEE. 2. THE COMPLIANCE OFFICER WILL PREPARE AND DISTRIBUTE TO EACH DIRECTOR, OFFICER AND MEMBER OF A BOARD COMMITTEE A LIST OF ALL ACTUAL AND POTENTIAL CONFLICTS DISCLOSED TO THE CORPORATION. 3. AT EACH MEETING OF THE BOARD OF DIRECTORS AND EACH BOARD COMMITTEE MEETING, THE COMPLIANCE OFFICER WILL BE RESPONSIBLE FOR MONITORING COMPLIANCE WITH AND ENFORCING THE POLICY. |
| FORM 990, PART VI, SECTION B, LINE 15 | THE CORPORATION'S BYLAWS PROVIDE THAT THE CORPORATION'S EXECUTIVE COMMITTEE SHALL SERVE AS THE CORPORATION'S COMPENSATION COMMITTEE AND SHALL REVIEW AND, IF IN THE BEST INTEREST OF THE CORPORATION, APPROVE ALL COMPENSATION ARRANGEMENTS WITH KEY EMPLOYEES OF THE CORPORATION, PROVIDED, HOWEVER, THAT (1) EMPLOYMENT OF A PRESIDENT/CEO REQUIRES THE AFFIRMATIVE VOTE OF 2/3 OF THE CORPORATION'S DIRECTORS, (2) ANY COMPENSATION ARRANGEMENT IN EXCESS OF $100,000 AND LESS THAN $500,000 MUST BE APPROVED BY THE CORPORATION'S FINANCE AND AUDIT COMMITTEE AND (3) ANY COMPENSATION ARRANGEMENT IN EXCESS OF $500,000 MUST BE APPROVED BY 2/3 OF THE CORPORATION'S DIRECTORS. THE CORPORATION'S EXECUTIVE COMMITTEE CONSISTS OF THE OFFICERS OF THE CORPORATION AND TWO ADDITIONAL MEMBERS OF THE CORPORATION'S BOARD OF DIRECTORS ELECTED BY SUCH OFFICERS. THE PRESIDENT/CEO OF THE CORPORATION IS A NON VOTING, EX OFFICIO MEMBER OF THE EXECUTIVE COMMITTEE. THE PRESIDENT/CEO HAS NO INVOLVEMENT IN THE PROCESS OF SETTING HIS OR HER OWN COMPENSATION. |
| FORM 990, PART VI, SECTION C, LINE 18 | THE CORPORATION'S FORM 990 AND FORM 1023 ARE AVAILABLE TO THE PUBLIC UPON REQUEST IN ACCORDANCE WITH APPLICABLE LAW. THE PUBLIC CAN ALSO ACCESS THE CORPORATION'S FORM 990 AT WWW.GUIDESTAR.ORG. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE CORPORATION'S ARTICLES OF INCORPORATION ARE AVAILABLE TO THE PUBLIC THROUGH THE INDIANA SECRETARY OF STATE'S WEBSITE AT HTTPS://SECURE.IN.GOV/SOS/BUS_SERVICE/ONLINE_CORPS/NAME_SEARCH.ASPX. THE CORPORATION'S BYLAWS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS MAY BE MADE AVAILABLE TO THE PUBLIC UPON REQUEST ON A CASE-BY-CASE BASIS. |
| FORM 990, PART XI, LINE 9: | LOSS ON CLOSING OF THRIVE -1,823,612. |
| FORM 990, PART XII, LINE 2C: | THE FINANCE COMMITTEE ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF ITS FINANCIAL STATEMENTS AND SELECTION OF AN INDEPENDENT AUDITOR. |
| GENERAL EXPLANATION- RELATIONSHIP WITH THRIVE | IN 2007, IHIE FORMED A FOR-PROFIT SUBSIDIARY, THRIVE HDS, INC. ("THRIVE," F/K/A MERGETICS, INC.), OF WHICH IHIE WAS THE LARGEST SHAREHOLDER. IN THE SUMMER OF 2013, IHIE'S BOARD OF DIRECTORS ADOPTED A PLAN TEMPORARILY TO TRANSITION A PORTION OF IHIE'S STAFF AND TECHNOLOGIES TO THRIVE. SUBSEQUENTLY, IHIE CONTRACTED WITH THRIVE TO OBTAIN THE TECHNOLOGY AND STAFFING SERVICES REQUIRED FOR IHIE TO CONTINUE AND EXPAND ITS DELIVERY OF SERVICES IN PURSUIT OF ITS EXEMPT PURPOSES FOR THE BENEFIT OF ITS SUPPORTED ORGANIZATIONS. TO IMPLEMENT THIS ARRANGEMENT, THRIVE ENTERED INTO A SERVICES REIMBURSEMENT AGREEMENT, PURSUANT TO WHICH IHIE REIMBURSED THRIVE FOR ITS ALLOCABLE SHARE OF EMPLOYEE TIME (INCLUDING CERTAIN IHIE EMPLOYEES WHO CHOSE TEMPORARILY TO BECOME EMPLOYEES OF THRIVE) AND OVERHEAD EXPENSES SPENT ON IHIE'S ACTIVITIES. THE TERMS OF THE SERVICES REIMBURSEMENT AGREEMENT ENSURED THAT NO PRIVATE BENEFIT WAS CONFERRED ON THRIVE, ITS EMPLOYEES, OR ITS SHAREHOLDERS AS A RESULT OF THE ARRANGEMENT, BECAUSE IHIE PAID NO MORE THAN COST FOR THE SERVICES THAT IT RECEIVED FROM THRIVE (IHIE ONLY COMPENSATED THRIVE FOR ACTUAL TIME SPENT ON CODE SECTION 501(C)(3) ACTIVITIES AND AN ALLOCABLE SHARE OF THRIVE'S OVERHEAD EXPENSES). THE SERVICES REIMBURSEMENT AGREEMENT WAS SUSPENDED ON JUNE 2, AND THE THRIVE-BASED IHIE STAFF AND TECHNOLOGIES WERE TRANSFERRED BACK TO IHIE. IMPORTANTLY, THROUGHOUT THE PERIOD IN WHICH IHIE TEMPORARILY REIMBURSED THRIVE FOR ITS ALLOCABLE SHARE OF EMPLOYEE TIME AND OVERHEAD EXPENSES, IHIE CONTINUED ITS PROGRAM OF EXCLUSIVELY FURTHERING THE EXEMPT PURPOSES OF ITS SUPPORTED ORGANIZATIONS BY ENHANCING COMMUNITY HEALTHCARE, SUPPORTING MEDICAL AND SCIENTIFIC RESEARCH, AND AUGMENTING THE PUBLIC HEALTH MANAGEMENT FUNCTIONS OF ITS SUPPORTED ORGANIZATIONS. IN 2014, THRIVE DISSOLVED AND FILED A FINAL C CORPORATION TAX RETURN, THUS TERMINATING THE RELATIONSHIP BETWEEN IHIE AND THRIVE. UPON THRIVE'S DISSOLUTION THE ENTITY'S ASSETS AND LIABILITIES WERE TRANSFERRED TO IHIE. |
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