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)
HEALTH AND HOSPITAL CORPORATION OF MARION COUNTY |
356005697 | 6 | Yes | 349,285 | 0 | |
| (B)
INDIANA UNIVERSITY SCHOOL OF MEDICINE |
356001673 | 6 | Yes | 0 | 0 | |
Total 2
|
349,285 | |||||
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 |
|---|---|
| Schedule A, Part IV, Section B, Line 1 Power to elect or appoint | Both supported organizations had equal power to appoint and/or remove directors |
| Software ID: | 14000329 |
| Software Version: | 2014v1.0 |
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, Line 1a Delegate broad authority to a committee | THE EXECUTIVE COMMITTEE SHALL CONSIST OF NOT LESS THAN 5 DIRECTORS AND SHALL HAVE AND EXERCISE THE AUTHORITY OF THE BOARD IN THE MANAGEMENT OF THE CORPORATION IN THE INTERIM PERIOD BETWEEN BOARD MEETINGS. THE EXECUTIVE COMMITTEE SHALL ENDEAVOR TO REGULARLY MEET ON A MONTHLY BASIS |
| Form 990, Part VI, Line 6 Classes of members or stockholders | ESKENAZI MEDICAL GROUP HAS TWO GOVERNING BODIES, THE BOARD OF MEMBERS AND THE BOARD OF DIRECTORS. THE MEMBERS OF ESKENAZI MEDICAL GROUP'S GOVERNING BODY DO NOT ALL HAVE THE SAME VOTING RIGHTS. BELOW OUTLINES THE RIGHTS OF BOTH THE BOARD OF DIRECTORS AND THE BOARD OF MEMBERS. VOTING RIGHTS OF THE BOARD OF DIRECTORS: 1. THE BUSINESS, PROPERTY AND AFFAIRS OF THE CORPORATION SHALL BE MANAGED AND CONTROLLED UNDER THE DIRECTION OF THE BOARD OF DIRECTORS AS FROM TIME TO TIME CONSTITUTED (THE "BOARD"). 2. THE BOARD SHALL EXERCISE ALL THE POWERS OF THE CORPORATION, SUBJECT TO THE RESTRICTIONS IMPOSED BY LAW, THE ARTICLES OF INCORPORATION AND THE CODE OF BY-LAWS. VOTING RIGHTS OF THE BOARD OF MEMBERS: 1. RATIFICATION OF THE CLASS A DIRECTORS WHO ARE ELECTED BY THE DELEGATES; 2. ELECTION OF THE CLASS B DIRECTORS WHO REPRESENT THE INDIANAPOLIS METROPOLITAN AREA BUSINESS COMMUNITY; 3. REMOVAL OF THE PRESIDENT OF THE CORPORATION; 4. APPROVAL ON AN ANNUAL BASIS OF THE CERTIFIED PUBLIC ACCOUNTING FIRM THAT AUDITS THE CORPORATION'S FINANCIAL BOOKS AND RECORDS; 5. THE APPROVAL OF, AND ONE OR MORE MATERIAL CHANGES IN, THE MISSION STATEMENT OR THE LONG-TERM STRATEGIC BUSINESS PLAN OF THE CORPORATION; 6. APPROVAL OF THE ANNUAL BUDGET OF THE CORPORATION; 7. APPROVAL OF THE SALE, LEASE, EXCHANGE OR DISPOSITION OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF THE CORPORATION, OR THE MERGER, CONSOLIDATION OR STRATEGIC JOINT VENTURE OF THE CORPORATION WITH ANY OTHER ENTITY; AND 8. AMENDMENT, ALTERATION, OR REPEAL OF THE ARTICLES OF INCORPORATION OR THE CODE OF BY-LAWS OF THE CORPORATION. |
| Form 990, Part VI, Line 7a Members or stockholders electing members of governing body | AS OUTLINED ABOVE, THE RIGHTS OF THE MEMBERS DO INCLUDE THE ELECTION OF MEMBERS TO THE GOVERNING BODY. |
| Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders | THE ORGANIZATION HAS A GOVERNING BODY MADE UP OF MEMBERS CALLED THE BOARD OF MEMBERS. CERTAIN DECISIONS ARE SUBJECT TO THE APPROVAL OF THE BOARD OF MEMBERS, AS OUTLINED BELOW: 1. RATIFICATION OF THE CLASS A DIRECTORS WHO ARE ELECTED BY THE DELEGATES; 2. ELECTION OF THE CLASS B DIRECTORS WHO REPRESENT THE INDIANAPOLIS METROPOLITAN AREA BUSINESS COMMUNITY; 3. REMOVAL OF THE PRESIDENT OF THE CORPORATION; 4. APPROVAL ON AN ANNUAL BASIS OF THE CERTIFIED PUBLIC ACCOUNTING FIRM THAT AUDITS THE CORPORATION'S FINANCIAL BOOKS AND RECORDS; 5. THE APPROVAL OF, AND ONE OR MORE MATERIAL CHANGES IN, THE MISSION STATEMENT OR THE LONG-TERM STRATEGIC BUSINESS PLAN OF THE CORPORATION; 6. APPROVAL OF THE ANNUAL BUDGET OF THE CORPORATION; 7. APPROVAL OF THE SALE, LEASE, EXCHANGE OR DISPOSITION OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF THE CORPORATION, OR THE MERGER, CONSOLIDATION OR STRATEGIC JOINT VENTURE OF THE CORPORATION WITH ANY OTHER ENTITY; AND 8. AMENDMENT, ALTERATION, OR REPEAL OF THE ARTICLES OF INCORPORATION OR THE CODE OF BY-LAWS OF THE CORPORATION. |
| Form 990, Part VI, Line 11b Review of form 990 by governing body | The tax return is prepared by Crowe Horwath LLP. The Form 990 is reviewed by the CFO and a copy is sent to every voting member of the governing board of directors prior to filing with the IRS. |
| Form 990, Part VI, Line 12c Conflict of interest policy | IN ACCORDANCE WITH ESKENAZI MEDICAL GROUP'S (EMG) CONFLICT OF INTEREST POLICY, ALL EMG PROVIDERS, EMPLOYEES, OFFICERS, AND MEMBERS OF THE BOARD OF MEMBERS, BOARD OF DIRECTORS, FINANCE COMMITTEE AND COMPENSATION COMMITTEE HAVE A DUTY TO DISCLOSE ALL FACTS MATERIAL FOR A REVIEW OF THE POTENTIAL CONFLICT. ANNUALLY, ALL OF EMG'S MEMBERS, OFFICERS, DIRECTORS AND BOARD COMMITTEE MEMBERS MUST COMPLETE A WRITTEN DISCLOSURE FORM, ALONG WITH THE DUTY TO UPDATE THE FORM AS NECESSARY IF ANY NEW INTERESTS OR CHANGES IN PREVIOUSLY REPORTED INTERESTS DEVELOP. ANY SITUATION THAT COULD GIVE RISE TO A POTENTIAL CONFLICT OF INTEREST IS REVIEWED BY A DISINTERESTED EMG OFFICER, OR THE OFFICERS AS A GROUP, OR THE EMG EXECUTIVE COMMITTEE OR THE BOARD OF DIRECTORS. THE REVIEW SHALL DETERMINE WHETHER EMG, WITH REASONABLE EFFORT, SHOULD OBTAIN A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT THAT WOULD NOT GIVE RISE TO A CONFLICT OF INTEREST. IF SUCH A TRANSACTION OR ARRANGEMENT CAN NOT REASONABLY BE ATTAINED, THEN THE REVIEWER SHALL DETERMINE WHETHER THE TRANSACTION OR ARRANGEMENT IS IN THE CORPORATION'S BEST INTEREST, AND IS FAIR AND REASONABLE TO EMG. IF AN ISSUE INVOLVING A POTENTIAL CONFLICT IS BROUGHT TO THE TABLE AT A BOARD MEETING, THE PERSON WITH THE POTENTIAL CONFLICT WOULD ABSTAIN FROM VOTING ON THE ISSUE. |
| Form 990, Part VI, Line 15a Process to establish compensation of top management official | Annually, the compensation of the CEO is reviewed by the ESKENAZI MEDICAL GROUP compensation committee. The committee is comprised of members from the finance committee who are independent from the management of ESKENAZI MEDICAL GROUP. The compensation committee uses compensation studies to ensure the compensation of the CEO is reasonable. The decisions and deliberations are documented in the committee minutes. This process was last undertaken in 2014. |
| Form 990, Part VI, Line 15b Process to establish compensation of other employees | Annually, the compensation of other officers is reviewed by the ESKENAZI MEDICAL GROUP compensation committee. The committee is comprised of members from the finance committee who are independent from the management of ESKENAZI MEDICAL GROUP. The compensation committee uses compensation studies to ensure the compensation is reasonable. The decisions and deliberations are documented in the committee minutes. This process was last undertaken in 2014. |
| Form 990, Part VI, Line 19 Required documents available to the public | The organization's conflict of interest policy, governing documents and financial statements are available to the public upon request. |
| Software ID: | 14000329 |
| Software Version: | 2014v1.0 |