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
CLARIAN TRANSPLANT INSTITUTE INC
Employer identification number
13-4350599
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.") .
300,181
1,491,141
1,199,996
0
0
2,991,318
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......
9,821,150
9,854,903
8,982,045
11,453,924
10,017,712
50,129,734
3
Gross receipts from activities that are not an unrelated trade or business under section 513..
596,938
1,983
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.
10,121,331
11,346,044
10,778,979
11,455,907
10,017,712
53,719,973
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.
2,547,514
1,715,928
1,785,630
2,845,129
2,928,102
11,822,303
c
Add lines 7a and 7b..
2,547,514
1,715,928
1,785,630
2,845,129
2,928,102
11,822,303
8
Public support (Subtract line 7c from line 6.)
41,897,670
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...
10,121,331
11,346,044
10,778,979
11,455,907
10,017,712
53,719,973
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 IV.)
..
0
13
Total support. (Add lines 9, 10c, 11, and 12.)..
10,121,331
11,346,044
10,778,979
11,455,907
10,017,712
53,719,973
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
77.993 %
16
Public support percentage from 2012 Schedule A, Part III, line 15
...............
16
78.341 %
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2013 (line 10c, column (f) divided by line 13, column (f))
......
17
0 %
18
Investment income percentage from 2012 Schedule A, Part III, line 17
.............
18
0.001 %
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
CLARIAN TRANSPLANT INSTITUTE INC
Employer identification number
13-4350599
Return Reference
Explanation
Part IV, Lines 25a and 25b - Possible Excess Benefit Transaction
During an internal review, Clarian Transplant Institute, Inc. determined that it erroneously paid several invoices from its outside legal counsel that included charges for services provided for the benefit of an Officer and/or an Officer's family member. These amounts were not included in taxable income. The amounts have been repaid in full.
Part VI, Section A, Line 1b - Number of Voting Members that are Indep.
Clarian Transplant Institute, Inc. is part of a multi-entity hospital system controlled by Indiana University Health, Inc., 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. serve on the Board of Managers of Health Venture Management, LLC. No additional compensation is provided to these individuals for their service. A. Joseph Tector, M.D. serves on the board of directors of University Surgeons, Inc. ("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, Inc. ("Clarian Transplant Institute") is Indiana University Health, Inc. ("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 Indiana University School of Medicine ("IUSOM"); - Chairman of the Department of Surgery of IUSOM 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
Clarian Transplant Institute, Inc. has established the following process for reviewing Form 990: The Form 990 and related schedules are reviewed by the Secretary. After the Secretary 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
Clarian Transplant Institute, Inc. ("Clarian Transplant Institute") is part of the Indiana University Health, Inc. ("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, Inc. ("Clarian Transplant Institute") has a Conflict of Interest Policy, the purpose of which is, to protect Clarian Transplant Institute's interests when it is contemplating entering into a transaction or arrangement that might benefit the private interest of an officer or director. Each employee, including those employed by related entities, officer and member of the board of 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/her knowledge and approval of the interest. The form then goes to Corporate Compliance. If the disclosure is by the Chief Medical Officer, it goes to the board chairman for approval. If the disclosure is by a member of the board of directors, the General Counsel/Chief Compliance Officer reviews the disclosures and determines whether to consent.
Part VI, Section B, Line 19 - Public Disclosure
Clarian Transplant Institute, Inc.'s ("Clarian Transplant Institute") 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 Indiana University Health, Inc. ("IU Health"). The consolidated financial statements for IU Health are available to the public through its bond filings.
Part IX, Line 11g - Other Fees for Services
Line 11g includes amounts paid for the following: Shared Services/Leased Employees - $8,135,299
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.