Attach to Form 990 or Form 990-EZ.
Go to
www.irs.gov/Form990 for instructions and the latest information.
| (i) Name of supported organization | (ii) EIN | (iii) Type of organization (described on lines 1- 10 above (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 | 0 | 0 | |
|
Total 1
|
||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2016 | (b) 2017 | (c) 2018 | (d) 2019 | (e) 2020 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") .. | ||||||
| 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) 2016 | (b) 2017 | (c) 2018 | (d) 2019 | (e) 2020 | (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) 2016 | (b) 2017 | (c) 2018 | (d) 2019 | (e) 2020 | (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) 2016 | (b) 2017 | (c) 2018 | (d) 2019 | (e) 2020 | (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 0.015 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 0.035 | 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 | ||||
| Section D - Distributions | Current Year | |
|---|---|---|
| 1 Amounts paid to supported organizations to accomplish exempt purposes | 1 | |
|
2
Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity |
2 | |
| 3 Administrative expenses paid to accomplish exempt purposes of supported organizations | 3 | |
| 4 Amounts paid to acquire exempt-use assets | 4 | |
| 5 Qualified set-aside amounts (prior IRS approval required - provide details in Part VI) | 5 | |
| 6 Other distributions (describe in Part VI). See instructions | 6 | |
| 7Total annual distributions. Add lines 1 through 6. | 7 | |
|
8
Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions |
8 | |
| 9 Distributable amount for 2020 from Section C, line 6 | 9 | |
| 10 Line 8 amount divided by Line 9 amount | 10 | |
| Section E - Distribution Allocations (see instructions) |
(i) Excess Distributions |
(ii) Underdistributions Pre-2020 |
(iii) Distributable Amount for 2020 |
|
|---|---|---|---|---|
| 1 Distributable amount for 2020 from Section C, line 6 | ||||
|
2
Underdistributions, if any, for years prior to 2019 (reasonable cause required-- explain in Part VI). See instructions. |
||||
| 3 Excess distributions carryover, if any, to 2020: | ||||
| a From 2015....... | ||||
| b From 2016....... | ||||
| c From 2017....... | ||||
| d From 2018....... | ||||
| e From 2019....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2020 distributable amount | ||||
|
i
Carryover from 2015 not applied (see instructions) |
||||
| j Remainder. Subtract lines 3g, 3h, and 3i from line 3f. | ||||
| 4Distributions for 2020 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2020 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from line 4. | ||||
|
5
Remaining underdistributions for years prior to 2020, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions. |
||||
|
6
Remaining underdistributions for 2020. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions. |
||||
|
7 Excess distributions carryover to 2021. Add lines 3j and 4c. |
||||
| 8 Breakdown of line 7: | ||||
| a Excess from 2016..... | ||||
| b Excess from 2017..... | ||||
| c Excess from 2018..... | ||||
| d Excess from 2019..... | ||||
| e Excess from 2020..... | ||||
| Facts And Circumstances Test |
|---|
| Return Reference | Explanation |
|---|
| Software ID: | |
| Software Version: |
Attach to Form 990 or 990-EZ.
Go to www.irs.gov/Form990 for the latest information.
| Return Reference | Explanation |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 6 | CLASSES OF MEMBERS: BOARD OF MEMBERS CONSIST OF 3 CLASS A MEMBERS AND 2 CLASS B MEMBERS AND ARE CLASSIFIED ON FORM 990, PART VII. CLASS A MEMBERS SHALL CONSIST OF INDIVIDUALS SERVING IN THE FOLLOWING ROLES OR THEIR DESIGNEE: A.) CHAIR OF BOARD OF HEALTH AND HOSPITAL CORPORATION OF MARION COUNTY (HHC) B.) EXECUTIVE DIRECTOR OF HHC C.) TREASURER OF HHC CLASS B MEMBERS SHALL CONSIST OF: A.) A PHYSICIAN EMPLOYEE OF THE CORPORATION ELECTED BY THE OUTPATIENT HEALTH CARE PROFESSIONALS B.) A PHYSICIAN EMPLOYEE OF THE CORPORATION ELECTED BY THE INPATIENT HEALTH CARE PROFESSIONALS |
| FORM 990, PART VI, SECTION A, LINE 7A | POWER TO ELECT OR APPOINT ONE OR MORE MEMBERS OF THE GOVERNING BODY: THE BOARD OF DIRECTORS OF THE CORPORATION SHALL CONSIST OF 7 VOTING DIRECTORS WHO SHALL BE DESIGNATED AS CLASS A DIRECTORS AND CLASS B DIRECTORS. THE BOARD OF DIRECTORS SHALL ALSO INCLUDE, AS A NON-VOTING, EX OFFICIO DIRECTOR, THE CEO OF THE CORPORATION. THE VOTING DIRECTORS SHALL BE APPOINTED AS FOLLOWS: THE CORPORATION SHALL HAVE 3 CLASS A VOTING DIRECTORS WHO SHALL BE APPOINTED BY THE CLASS A MEMBERS AT THE ANNUAL MEETING OF THE MEMBERS. THE CORPORATION SHALL HAVE 1 ADDITIONAL CLASS A VOTING DIRECTOR (THE HHC PHYSICIAN APPOINTEE), WHO SHALL BE APPOINTED BY THE CLASS A MEMBERS AT THE ANNUAL MEETING OF THE MEMBERS AND WHO SHALL BE A PHYSICIAN EMPLOYED BY THE CORPORATION; PROVIDED, FURTHER, THAT AT ANY TIME WHEN THE ACADEMIC AFFILIATION AGREEMENT OR ANY SUCCESSOR AGREEMENT IS IN PLACE BETWEEN HHC AND THE TRUSTEE OF INDIANA UNIVERSITY ON BEHALF OF ITS SCHOOL OF MEDICINE, THE HHC PHYSICIAN APPOINTEE OR ANOTHER CLASS A VOTING DIRECTOR SHALL BE A MEMBER OF THE SCHOOL'S FACULTY. THE CORPORATION SHALL HAVE 3 CLASS B VOTING DIRECTORS, WHO SHALL BE APPOINTED BY THE CLASS B MEMBERS AT THE ANNUAL MEETING OF THE MEMBERS; PROVIDED, FURTHER THAT AT ANY TIME WHEN THE AFFILIATION AGREEMENT IS IN PLACE BETWEEN HHC AND THE TRUSTEES ON BEHALF OF THE SCHOOL, THE DEAN OF INDIANA UNIVERSITY SCHOOL OF MEDICINE SHALL HAVE AUTHORITY TO NOMINATE 1 CLASS B VOTING DIRECTOR, WHO SHALL BE A PHYSICIAN EMPLOYED BY THE CORPORATION AND AN EMPLOYED MEMBER OF THE SCHOOL'S FACULTY WITH THE QUALIFICATIONS SPECIFIED IN THE MEMORANDUM OF THE UNDERSTANDING BETWEEN THE CORPORATION AND THE SCHOOL, AS AMENDED FROM TIME TO TIME, AND THE CLASS B MEMBERS EITHER SHALL AFFIRM SUCH NOMINATION OR SHALL WORK COLLABORATIVELY WITH THE DEAN TO IDENTIFY AN ALTERNATIVE CANDIDATE. |
| FORM 990, PART VI, SECTION A, LINE 7B | GOVERNANCE DECISIONS OF THE ORGANIZATION: ANY VOTING DIRECTOR MAY BE REMOVED AT ANY TIME, WITH OR WITHOUT CAUSE, BY A MAJORITY VOTE OF THE MEMBERS OF THE CLASS THAT APPOINTED SUCH DIRECTOR. THE EX-OFFICIO DIRECTOR MAY BE REMOVED FROM THE BOARD ONLY BY REMOVING HIM OR HER FROM THE POSITION OF CEO. THE BYLAWS MAY BE ALTERED, AMENDED OR REPEALED AND NEW AND OTHER BYLAWS MAY BE MADE AND ADOPTED, ONLY BY THE MEMBERS; PROVIDED, HOWEVER, THAT THE PROCESS OF ALTERING, AMENDING, OR REPEALING THESE BYLAWS AND MAKING AND ADOPTING NEW BYLAWS MAY BE INITIATED EITHER BY THE MEMBERS THEMSELVES OR BY THE BOARD OF DIRECTORS. |
| FORM 990, PART VI, SECTION B, LINE 11B | PROCESS TO REVIEW THE FORM 990: THE FORM 990 IS REVIEWED BY THE TREASURER AND A COPY IS SENT TO EVERY VOTING MEMBER OF THE GOVERNING BOARD OF DIRECTORS PRIOR TO FILING WITH THE IRS. THE FORM 990 IS ALSO REVIEWED BY AN INDEPENDENT ACCOUNTING FIRM PRIOR TO BEING FILED. |
| FORM 990, PART VI, SECTION B, LINE 12C | PROCESS FOR MONITORING COMPLIANCE WITH 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 CANNOT 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, SECTION B, LINE 15A & 15B | REVIEW OF CEO OR TOP MANAGEMENT AND OTHER OFFICERS COMPENSATION: EMG BOARD OF DIRECTORS REVIEWS CEO COMPENSATION ANNUALLY AND THE EXTERNAL COMPENSATION COMMITTEE REVIEWS ALL COMPENSATION INCLUDING THE CEO ANNUALLY. THE COMPENSATION COMMITTEE UTILIZES MARKET COMPENSATION STUDIES AND THE RECOMMENDATIONS OF EXPERTS EXTERNAL TO EMG TO ENSURE THE COMPENSATION OF THE CEO IS REASONABLE. THE DECISIONS AND DELIBERATIONS ARE DOCUMENTED IN THE COMMITTEE MINUTES. |
| FORM 990, PART VI, SECTION C, LINE 19 | OTHER ORGANIZATION DOCUMENTS PUBLICLY AVAILABLE: THE ORGANIZATION'S CONFLICT OF INTEREST POLICY, GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. |
| FORM 990, PART VII | DAVID CRABB AND LISA HARRIS ARE NOT EMPLOYEES OF ESKENAZI MEDIAL GROUP OR THE RELATED ORGANIZATION, HEALTH AND HOSPITAL CORPORATION OF MARION COUNTY. SOME OF THEIR TIME IS REIMBURSED BY THE RELATED ORGANIZATION AND THIS DETAIL IS AVAILABLE UPON REQUEST. |
| Software ID: | |
| Software Version: |