2014-07-14T07:20:24-05:00 2013-08-31 351178661 BLUE & CO LLC ONE AMERICAN SQUARE 2200 INDIANAPOLIS IN 46282 990 2012-09-01 351642823 UNION HOSPITAL FOUNDATION INC UNIO 8122387534 1606 NORTH SEVENTH STREET TERRE HAUTE IN 478042780 DONALD SCOTT 8122387534 2014-07-10 1 CARRIE A MERRILL CPA P00832283 3176334705 2012 2015-11-30 17:44:51Z DONALD SCOTT 1606 NORTH SEVENTH STREET TERRE HAUTE IN 478042780 4449870 0 X WWW.UNIONHOSPITALFOUNDATION.ORG X 1985 IN SUPPORT ADVANCES IN MEDICAL CARE AND INITIATIVES TO IMPROVE HEALTH FOR THE RESIDENTS OF WABASH VALLEY BY MAKING GRANTS TO UNION HOSPITAL, INC. UNION HOSPITAL HEALTH SERVICES, INC. AND OTHER QUALIFIED ORGANIZATIONS WHICH SERVE THIS PURPOSE. 28 24 4 60 0 0 256632 262386 0 0 173692 371892 151418 132665 581742 766943 193176 100291 0 0 282484 328022 0 0 38789 228441 183864 704101 612177 -122359 154766 14629689 12421691 7716918 5522519 6912771 6899172 X SUPPORT ADVANCES IN MEDICAL CARE AND INITIATIVES WHICH IMPROVE HEALTH FOR THE RESIDENTS OF THE WABASH VALLEY BY MAKING GRANTS TO UNION HOSPITAL, INC., UNION HOSPITAL HEALTH SERVICES, INC. AND OTHER QUALIFIED ORGANIZATIONS WHICH SERVE THIS PURPOSE. 0 0 52612 52612 VARIOUS GRANTS TO UNION HOSPITAL, INC. TO FURTHER ITS DELIVERY OF HEALTHCARE SERVICES TO THE WABASH VALLEY. 35250 35250 ACADEMIC SCHOLARSHIP AWARD TO BE APPLIED TO THE TUITION AND RELATED EDUCATION EXPENSES OF NUMEROUS STUDENTS ATTENDING VARIOUS COLLEGES AND UNIVERSITIES. 10429 10429 GRANTS TO ST. ANN'S CLINIC FOR THE PAYMENT OF INSURANCE PREMIUMS. ST. ANN'S CLINIC SERVES APPROXIMATELY 7,000 PATIENTS PER YEAR AT ITS PRESENT LEVEL OF OPERATION. 2000 2000 GRANT TO SHELDON SWOPE ART MUSEUM. 2000 2000 100291 1 1 0 0 0 0 0 0 0 1 1 1 0 1 0 1 0 1 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 11 0 1 4 1 0 0 0 0 0 0 0 0 0 0 X 28 24 1 0 0 0 0 0 0 1 1 0 0 1 1 1 1 0 0 1 0 0 IN X WAYNE R HUTSON 8122387601 1606 NORTH SEVENTH STREET TERRE HAUTE IN 47804 DONALD SCOTT 4.00 0.00 X X 0 0 0 DIANN MCKEE 1.00 0.00 X X 0 0 0 MARY DOTI 1.00 0.00 X X 0 0 0 CINDY MARTIN 1.00 0.00 X X 0 0 0 MARGARET DOUGLAS 1.00 0.00 X 0 0 0 WAYNE HUTSON 1.00 40.00 X 0 282462 26220 PATRICK BOARD 1.00 42.00 X 0 433796 0 JULIE BOWERS 1.00 0.00 X 0 0 0 ROBERT BROWN 1.00 0.00 X 0 0 0 RICHARD BURGER 1.00 0.00 X 0 0 0 MARY ANN CARROLL 1.00 0.00 X 0 0 0 JOHN DINKEL 1.00 0.00 X 0 0 0 JO EINSTANDIG 1.00 0.00 X 0 0 0 VERN FELLOWS 1.00 0.00 X 0 0 0 MARK FUSON 1.00 2.00 X 0 0 0 MARGOT GILLESPIE 1.00 0.00 X 0 0 0 TOM GOSS 1.00 0.00 X 0 0 0 WILLIAM GRIMS 1.00 4.00 X 0 0 0 ROBERT HAERR MD 1.00 2.00 X 0 0 0 TROY HELMAN 1.00 0.00 X 0 0 0 WARD HUBBARD 1.00 2.00 X 0 0 0 SALLY LOWERY 1.00 0.00 X 0 0 0 JOHN LUKENS 1.00 4.00 X 0 0 0 BETTY MOONEY 1.00 0.00 X 0 0 0 MINDY SMITH 1.00 0.00 X X 0 0 0 RANDY STEVENS MD 1.00 40.00 X 0 169603 48161 DAN TANOOS 1.00 0.00 X 0 0 0 ANN WELCH 1.00 0.00 X 0 0 0 SCOTT TEFFETELLER 1.00 40.00 X 0 477766 37395 DAVID DOERR 1.00 40.00 X 0 294964 43107 W EDWARD JUKES 1.00 0.00 X 0 0 0 ROBERT MEISSEL MD 1.00 0.00 X 0 0 0 DAVID SULLIVAN 1.00 0.00 X 0 0 0 JOEL HARBAUGH 60.00 0.00 X 0 40845 7777 0 1699436 162660 0 0 1 0 0 262386 5249 262386 107707 107707 241524 191231 50293 50293 50293 3755881 3491696 264185 264185 264185 VENDING INCOME 900099 56030 56030 CHARITABLE REMAINDER TRUST INCOME 900099 25671 25671 RETAIL REVENUE 900099 671 671 82372 766943 0 0 504557 65041 65041 35250 35250 237873 237873 73213 73213 16936 16936 2020 2020 60244 60244 25739 25739 6765 6765 3948 3948 21881 8978 12903 4336 4336 2873 162 2711 3418 3418 19902 19902 1351 1351 CATERING 14569 1457 13112 LICENSES AND FEES 4389 4389 DUES & SUBSCRIPTIONS 2999 2999 CONTRIBUTION EXPENSES 2800 2800 6630 515 6115 612177 100291 473097 38789 1044515 456003 1090772 64924 25501 23962 3293583 393695 3008413 2899888 5597419 5430339 3068914 2726748 794155 819827 14629689 12421691 1050964 719621 18283 0 3894993 2357452 2752678 2445446 7716918 5522519 X 4033200 3871467 1738037 1886171 1141534 1141534 6912771 6899172 14629689 12421691 X 154766 173801 -342166 X X 0 1 X 1 0 X X 0 0 0 UNION HOSPITAL INC 350876396 3 0 1 1 52612 UNION HOSPITAL HEALTH SERVICES INC 351642805 9 0 1 1 0 VISITING NURSE ASSOCIATION INC 350869064 7 0 1 1 0 3 52612 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 X 3542633 56649 203883 49768 3753397 3368013 93118 206268 124766 3542633 3101660 140376 221707 95730 3368013 2876487 180566 126601 81994 3101660 3260052 141735 -291787 233513 2876487 0.19330 0.50250 0.30420 0 0 51000 86251 137251 2761906 204382 217002 2749286 98446 91598 176693 13351 2899888 2726748 F 2726748 CHARITABLE REMAINDER TRUST 819827 819827 X PART IV, LINE 2B: UNION HOSPITAL FOUNDATION RECEIVES MANY DONATIONS ON BEHALF OF UNION HOSPITAL AND OTHER CHARITABLE ORGANIZATIONS RELATED TO THE FOUNDATION'S MISSION. THESE DONATIONS HELD ON THE HOSPITAL'S BEHALF ARE RECORDED IN AGENCY LIABILITY ACCOUNTS ON THE FOUNDATION'S BOOKS AND THE BENEFICIARY ORGANIZATION IS MADE AWARE OF THE FUNDS HELD. EXPENSES RELATED TO CHARITABLE EVENTS ON BEHALF OF THESE OTHER ENTITIES ARE NETTED FROM THE AGENCY LIABILITY BALANCE. INVESTMENT INCOME/EXPENSE ALLOCATED TO THESE FUNDS IS ALSO POSTED TO THE AGENCY LIABILITY ACCOUNTS. DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: THE FOUNDATION'S ENDOWMENT CONSISTS OF APPROXIMATELY TWENTY-SIX INDIVIDUAL FUNDS (SEVEN PERMANENTLY RESTRICTED, FOURTEEN TEMPORARILY RESTRICTED, AND FIVE BOARD-DESIGNATED) THAT ARE GENERALLY ESTABLISHED FOR ONE OF THE FOLLOWING PURPOSES AS OF AUGUST 31, 2013: FOUNDATION OPERATING SUPPORT, SCHOLARSHIPS, SPECIFIC HOSPITAL DEPARTMENT SUPPORT, OR SPECIFIC HOSPITAL PATIENT SERVICE SUPPORT. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X, LINE 2: ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE FOUNDATION AND VNA AND RECOGNIZE A TAX LIABILITY IF THE FOUNDATION AND VNA HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY VARIOUS FEDERAL AND STATE TAXING AUTHORITIES. MANAGEMENT HAS ANALYZED THE TAX POSITIONS TAKEN BY THE FOUNDATION AND VNA, AND HAS CONCLUDED THAT AS OF AUGUST 31, 2013 AND 2012, THERE ARE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY OR DISCLOSURE IN THE ACCOMPANYING FINANCIAL STATEMENTS. THE FOUNDATION AND VNA ARE SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. 1 SAINT ANN CLINIC - PROVIDENCE SELF SUFFICIENCY MINISTRIES 1436 LOCUST STREET TERRE HAUTE IN 47807 351947580 501 (C) 3 10429 PAYMENT OF INSURANCE PREMIUMS UNION HOSPITAL 1606 N 7TH STREET TERRE HAUTE IN 47804 350876396 501 (C) 3 52612 CHARITABLE GRANT 2 0 SCHOLARSHIPS 45 35250 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: THE FOUNDATION RECEIVES A "GRANT OUTCOME REPORT" FROM GRANT RECIPIENTS. A GREAT MAJORITY OF THE FOUNDATION'S GRANTS ARE TO UNION HOSPITAL, INC. THE FOUNDATION'S BOARD OF DIRECTORS RECEIVES REGULAR VERBAL REPORTS FROM KEY MEMBERS OF THE HOSPITAL ADMINISTRATION. SCHOLARSHIP RECIPIENTS MUST PROVIDE GRADE REPORTS SHOWING SATISFACTORY PROGRESS BEFORE 2ND SEMESTER SCHOLARSHIP AWARDS ARE PAID. THE EXECUTIVE DIRECTOR OF UNION HOSPITAL FOUNDATION SERVES ON THE ST. ANN CLINIC ADVISORY BOARD. X 0 0 0 0 0 0 0 0 0 WAYNE HUTSON 0 202181 0 45938 0 34343 0 15105 0 11115 0 308682 0 0 PATRICK BOARD 0 433796 0 0 0 0 0 0 0 0 0 433796 0 0 RANDY STEVENS MD 0 164415 0 1513 0 3675 0 29515 0 18646 0 217764 0 0 SCOTT TEFFETELLER 0 413918 0 47500 0 16348 0 11592 0 25803 0 515161 0 0 DAVID DOERR 0 288261 0 0 0 6703 0 16075 0 27032 0 338071 0 0 FORM 990, PART VI, SECTION A, LINE 2 JOHN LUKENS AND SALLY LOWERY HAVE A BUSINESS RELATIONSHIP. FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 IS REVIEWED BY THE FOUNDATION'S EXECUTIVE DIRECTOR, ASSISTANT TREASURER, AND ACCOUNTANTS. THE GOVERNING BODY RECEIVES THE FORM 990 AND THE FINAL FORM 990 INCLUDING REQUESTED SCHEDULES, AS ULTIMATELY FILED WITH THE IRS, PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C THE WRITTEN CONFLICT OF INTEREST POLICY IS REGULARLY AND CONSISTENTLY MONITORED AND COMPLIANCE ENFORCED BY THE FOUNDATION'S EXECUTIVE DIRECTOR. THE SCOPE OF THIS POLICY INCLUDES ALL LEASED EMPLOYEES OF THE FOUNDATION AS WELL AS BOARD MEMBERS WHO HAVE AN INTEREST IN THE FOUNDATION'S DEALINGS. THE POLICY IS IN PLACE TO DETECT POTENTIAL CONFLICTS OF INTEREST THAT MAY ARISE. A SELF DISCLOSURE FROM COVERED PERSONS TO THE ORGANIZATION IS REQUIRED ON ANY POTENTIAL CONFLICTS OF INTEREST. THE REMAINING BOARD, COMMITTEE OR SUBCOMMITTEE MEMBERS SHALL DECIDE IF A CONFLICT OF INTEREST EXISTS. FORM 990, PART VI, SECTION B, LINE 15A THE EXECUTIVE DIRECTOR RECEIVES ANNUAL PERFORMANCE REVIEWS FROM BOTH THE PRESIDENT AND EXECUTIVE COMMITTEE. COMPENSATION OF EXECUTIVE DIRECTORS OF SIMILAR ORGANIZATIONS IS RESEARCHED AND OBTAINED FOR USE IN ESTABLISHING THE EXECUTIVE DIRECTOR'S COMPENSATION. FORM 990, PART VI, SECTION C, LINE 19 THE FOUNDATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICIES, AND AUDITED FINANCIAL STATEMENTS AVAILABLE UPON REQUEST AT THE ORGANIZATION'S OFFICE. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 9: INVESTMENT IN SUBSIDIARY EARNINGS -342,166. OVERSIGHT OF AUDIT FORM 990, PART XII, LINE 2C THE AUDIT COMMITTEE ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF THE FINANCIAL STATEMENTS AND NO PROCESSES HAVE CHANGED FROM THE PRIOR YEAR. VISITING NURSE ASSOCIATION OF THE WABASH VALLEY INC 400 8TH AVENUE TERRE HAUTE IN 47804 350869064 HOME HEALTH AND HOSPICE CARE IN 501(C)(3) LINE 7 UNION HOSPITAL FOUNDATION INC 1 UNION HOSPITAL INC 1606 N 7TH STREET TERRE HAUTE IN 478042706 350876396 HEALTH CARE IN 501(C)(3) LINE 3 UNION HEALTH SYSTEM 0 UNION HOSPITAL HEALTH SERVICES INC 1606 N 7TH STREET FLOOR 4 TERRE HAUTE IN 478042706 351642805 HEALTH CARE IN 501(C)(3) LINE 9 N/A 0 SERVICE LEAGUE OF UNION HOSPITAL 1606 N 7TH STREET TERRE HAUTE IN 47804 351586347 FUNDRAISING IN 501(C)(4) N/A N/A 0 0 1 0 0 0 0 0 0 0 1 1 0 0 0 1 1 0 0 1