UNION HOSPITAL FOUNDATION INC: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization
UNION HOSPITAL FOUNDATION INC (EIN 35-1642823)
Tax period
2011-09-01 to 2012-08-31
Filed
2013-07-12
IRS object ID
201321939349300202
Schema version
2011v1.5
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2013-07-12T07:21:54-05:00Timestamp
Tax Period End Date2012-08-31TaxPeriodEndDate

Preparer Firm PreparerFirm

FieldValueIRS element (for citing)
EIN351178661EIN

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1BLUE & CO LLCBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1ONE AMERICAN SQUARE 2200AddressLine1
CityINDIANAPOLISCity
StateINState
ZIP Code46282ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2011-09-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN351642823EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1UNION HOSPITAL FOUNDATION INCBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlUNIONameControl
Phone8122387534Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line11606 NORTH SEVENTH STREETAddressLine1
CityTERRE HAUTECity
StateINState
ZIP Code478042780ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameDONALD SCOTTName
TitleVICE CHAIRMANTitle
Phone8122387534Phone
Date Signed2013-07-10DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameCARRIE A MERRILL CPAName
PTINP00832283PTIN
Phone3176334705Phone
FieldValueIRS element (for citing)
Tax Year2011TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonDONALD SCOTTNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line11606 NORTH SEVENTH STREETAddressLine1
CityTERRE HAUTECity
StateINState
ZIP Code478042780ZIPCode
FieldValueIRS element (for citing)
Gross Receipts2974784GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.UNIONHOSPITALFOUNDATION.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1985YearFormation
State Legal DomicileINStateLegalDomicile
Activity Or Mission DescriptionSUPPORT 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.ActivityOrMissionDescription
Nbr Voting Members Governing Body32NbrVotingMembersGoverningBody
Nbr Independent Voting Members27NbrIndependentVotingMembers
Total Nbr Employees0TotalNbrEmployees
Total Nbr Volunteers60TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year193972ContributionsGrantsPriorYear
Contributions Grants Current Year256632ContributionsGrantsCurrentYear
Program Service Revenue Prior Year0ProgramServiceRevenuePriorYear
Program Service Revenue CY0ProgramServiceRevenueCY
Investment Income Prior Year342772InvestmentIncomePriorYear
Investment Income Current Year173692InvestmentIncomeCurrentYear
Other Revenue Prior Year92858OtherRevenuePriorYear
Other Revenue Current Year151418OtherRevenueCurrentYear
Total Revenue Prior Year629602TotalRevenuePriorYear
Total Revenue Current Year581742TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year223396GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY193176GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year339969SalariesEtcPriorYear
Salaries Etc Current Year282484SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year42368TotalFundrsngExpCurrentYear
Other Expense Prior Year221106OtherExpensePriorYear
Other Expenses Current Year228441OtherExpensesCurrentYear
Total Expenses Prior Year784471TotalExpensesPriorYear
Total Expenses Current Year704101TotalExpensesCurrentYear
Revenues Less Expenses Prior Year-154869RevenuesLessExpensesPriorYear
Revenues Less Expenses CY-122359RevenuesLessExpensesCY
Total Assets BOY11777645TotalAssetsBOY
Total Assets EOY14629689TotalAssetsEOY
Total Liabilities BOY5622380TotalLiabilitiesBOY
Total Liabilities EOY7716918TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY6155265NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY6912771NetAssetsOrFundBalancesEOY
Mission DescriptionSUPPORT 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.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense133306Expense
Grants133306Grants
DescriptionVARIOUS GRANTS TO UNION HOSPITAL, INC. TO FURTHER ITS DELIVERY OF HEALTHCARE SERVICES TO THE WABASH VALLEY.Description

Activity2 Activity2

FieldValueIRS element (for citing)
Expense32950Expense
Grants32950Grants
DescriptionACADEMIC SCHOLARSHIP AWARD TO BE APPLIED TO THE TUITION AND RELATED EDUCATION EXPENSES OF NUMEROUS STUDENTS ATTENDING VARIOUS COLLEGES AND UNIVERSITIES.Description

Activity3 Activity3

FieldValueIRS element (for citing)
Expense26920Expense
Grants26920Grants
DescriptionGRANTS 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.Description
FieldValueIRS element (for citing)
Total Program Service Expense193176TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
Subject To Proxy Tax0SubjectToProxyTax
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments1TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities1ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets1ReportOtherAssets
Report Other Liabilities0ReportOtherLiabilities
Report Fin48 Footnote1ReportFin48Footnote
Independent Audit Financial Stmt0IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt1ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital0Hospital
Grants To Organizations1GrantsToOrganizations
Grants To Individuals1GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds0TaxExemptBonds
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions1DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity1RelatedOrgControlledEntity
Transaction Related Entity0TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With10968NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees0NumberOfEmployees
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members32NbrVotingGoverningBodyMembers
Number Independent Voting Members27NumberIndependentVotingMembers
Family Or Business Relationship1FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs1ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders0MembersOrStockholders
Election Of Board Members0ElectionOfBoardMembers
Decisions Subject To Approval0DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy0WhistleblowerPolicy
Document Retention Policy0DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other0CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
States Where Copy Of Return Is FiledINStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1WAYNE R HUTSONBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number8122387601TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line11606 NORTH SEVENTH STREETAddressLine1
CityTERRE HAUTECity
StateINState
ZIP Code47804ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (33 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensation
DONALD SCOTT
CHAIRMAN4.00XX000
DIANN MCKEE
VICE CHAIRMAN1.00XX000
MARY DOTI
SECRETARY1.00XX000
CINDY MARTIN
TREASURER1.00XX000
MARGARET DOUGLAS
ASSISTANT SECRETARY1.00X000
WAYNE HUTSON
ASSISTANT TREASURER1.00X022137922003
PATRICK BOARD
DIRECTOR1.00X000
ROBERT BROWN
DIRECTOR1.00X000
RICHARD BURGER
DIRECTOR1.00X000
MARY ANN CARROLL
DIRECTOR1.00X000
JOHN DINKEL
DIRECTOR1.00X000
DAVID DOERR
DIRECTOR1.00X034786641205
JO EINSTANDIG
DIRECTOR1.00X000
VERN FELLOWS
DIRECTOR1.00X000
MARK FUSON
DIRECTOR1.00X000
MARGOT GILLESPIE
DIRECTOR1.00X000
TOM GOSS
DIRECTOR1.00X000
WILLIAM GRIMES
DIRECTOR1.00X000
ROBERT HAERR MD
DIRECTOR1.00X000
TROY HELMAN
DIRECTOR1.00X000
WARD HUBBARD
DIRECTOR1.00X000
W EDWARD JUKES
DIRECTOR1.00X000
SALLY LOWERY
DIRECTOR1.00X000
JOHN LUKENS
DIRECTOR1.00X000
ROBERT MEISSEL MD
DIRECTOR1.00X000
BETTY MOONEY
DIRECTOR1.00X000
RANDY STEVENS MD
DIRECTOR1.00X01888440
DAVID SULLIVAN
DIRECTOR1.00X000
DAN TANOOS
DIRECTOR1.00X000
SCOTT TEFFETELLER
DIRECTOR1.00X039219132100
ANN WELCH
DIRECTOR1.00X000
CAROLE STOKES
DIRECTOR1.00X000
JOEL HARBAUGH
EXECUTIVE DIRECTOR60.00X000
FieldValueIRS element (for citing)
Total Reportable Comp From Org0TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs1150280TotalReportableCompFrmRltdOrgs
Total Other Compensation95308TotalOtherCompensation
Number Individuals GT100 K0NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources
Number Of Contractors GT100 K0NumberOfContractorsGT100K
All Other Contributions256632AllOtherContributions
Noncash Contributions29000NoncashContributions
Total Contributions256632TotalContributions

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column109878TotalRevenueColumn
Exclusion$109,878ExclusionAmount

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real76566Real

Less Rental Expenses LessRentalExpenses

FieldValueIRS element (for citing)
Real41062Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real35504Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column35504TotalRevenueColumn
Exclusion$35,504ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities2415794Securities

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities2351980Securities

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities63814Securities

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column63814TotalRevenueColumn
Exclusion$63,814ExclusionAmount

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnExclusionExclusionAmount
CHARITABLE REMAINDER T90009961354$61,354
VENDING INCOME90009954053$54,053
RETAIL REVENUE900099507$507
FieldValueIRS element (for citing)
Total Other Revenue115914TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column581742TotalRevenueColumn
Related Or Exempt Function Income0RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$325,110ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total160226Total
Program Services160226ProgramServices

Grants To Domestic Individuals GrantsToDomesticIndividuals

FieldValueIRS element (for citing)
Total32950Total
Program Services32950ProgramServices

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total201985Total
Management And General201985ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total64597Total
Management And General64597ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total15902Total
Management And General15902ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total586Total
Management And General586ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total70849Total
Management And General70849ManagementAndGeneral

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total28092Total
Management And General28092ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total260Total
Management And General260ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total3582Total
Fundraising3582Fundraising

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total19346Total
Management And General9957ManagementAndGeneral
Fundraising9389Fundraising

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total13717Total
Management And General13717ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total11402Total
Management And General641ManagementAndGeneral
Fundraising10761Fundraising

Travel Travel

FieldValueIRS element (for citing)
Total6860Total
Management And General6860ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total25502Total
Management And General25502ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total1168Total
Management And General1168ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalManagement And GeneralManagementAndGeneralFundraisingFundraising
CATERING264831421812265
CONTRIBUTION EXPENSES765576550
DUES, SUBSCRIPTIONS, LI55635563
RECOGNIZATION EXPENSE33373337

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total4039Total
Management And General1005ManagementAndGeneral
Fundraising3034Fundraising

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total704101Total
Program Services193176ProgramServices
Management And General468557ManagementAndGeneral
Fundraising42368Fundraising

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY658193BOY
EOY1044515EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
BOY2348834BOY
EOY1090772EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY38266BOY
EOY25501EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis3287664LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec279251LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY509278BOY
EOY3008413EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY5412567BOY
EOY5597419EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY2077706BOY
EOY3068914EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY732801BOY
EOY794155EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY11777645BOY
EOY14629689EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY763840BOY
EOY1050964EOY

Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
BOY0BOY
EOY18283EOY

Escrow Account Liability EscrowAccountLiability

FieldValueIRS element (for citing)
BOY4693540BOY
EOY3894993EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY165000BOY
EOY2752678EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY5622380BOY
EOY7716918EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY3489640BOY
EOY4033200EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY1524091BOY
EOY1738037EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY1141534BOY
EOY1141534EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY6155265BOY
EOY6912771EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY11777645BOY
EOY14629689EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses-122359ReconcilationRevenueExpenses
Reconcilation Other Changes879865ReconcilationOtherChanges
Info In Schedule O Part XIIXInfoInScheduleOPartXII
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Supporting Organization509a3XSupportingOrganization509a3
Supporting Org509a3 Type3 Func IntXSupportingOrg509a3Type3FuncInt
Contrib By Controlling Individual0ContribByControllingIndividual
Contribution By Related Party0ContributionByRelatedParty
Contrib By35 Controlled Entity0ContribBy35ControlledEntity

Supported Org Information SupportedOrgInformation (3 entries)

EINEINType Of OrganizationTypeOfOrganizationListed In Governing DocListedInGoverningDocSupported Organization NotifiedSupportedOrganizationNotifiedOrganized In USOrganizedInUSAmountAmount
UNION HOSPITAL INC
3508763963011$133,306
UNION HOSPITAL HEALTH SERVICES INC
3516428059011$0
VISITING NURSE ASSOCIATION INC
3508690647011$0
FieldValueIRS element (for citing)
Total Number Of Supported Orgs3TotalNumberOfSupportedOrgs
Sum Of Amounts133306SumOfAmounts

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Agent Trustee Etc0AgentTrusteeEtc
Included On FS1IncludedOnFS

Current Year CurrentYear

FieldValueIRS element (for citing)
Beginning Of Year Balance3368013BeginningOfYearBalance
Contributions93118Contributions
Investment Earnings Or Losses206268InvestmentEarningsOrLosses
Grants Or Scholarships124766GrantsOrScholarships
End Of Year Balance3542633EndOfYearBalance

Current Year Minus1 Year CurrentYearMinus1Year

FieldValueIRS element (for citing)
Beginning Of Year Balance3101660BeginningOfYearBalance
Contributions140376Contributions
Investment Earnings Or Losses221707InvestmentEarningsOrLosses
Grants Or Scholarships95730GrantsOrScholarships
End Of Year Balance3368013EndOfYearBalance

Current Year Minus2 Years CurrentYearMinus2Years

FieldValueIRS element (for citing)
Beginning Of Year Balance2876487BeginningOfYearBalance
Contributions180566Contributions
Investment Earnings Or Losses126601InvestmentEarningsOrLosses
Grants Or Scholarships81994GrantsOrScholarships
End Of Year Balance3101660EndOfYearBalance

Current Year Minus3 Years CurrentYearMinus3Years

FieldValueIRS element (for citing)
Beginning Of Year Balance3260052BeginningOfYearBalance
Contributions141735Contributions
Investment Earnings Or Losses-291787InvestmentEarningsOrLosses
Grants Or Scholarships233513GrantsOrScholarships
End Of Year Balance2876487EndOfYearBalance
FieldValueIRS element (for citing)
Board Designated EOY Balance0.18720BoardDesignatedEOYBalance
Permanent Endowment EOY Balance0.32220PermanentEndowmentEOYBalance
Term Endowment EOY Balance0.49060TermEndowmentEOYBalance
Endowments Held By Unrelated Orgs0EndowmentsHeldByUnrelatedOrgs
Endowments Held By Related Orgs0EndowmentsHeldByRelatedOrgs

Land Land

FieldValueIRS element (for citing)
Investment Cost Or Other Basis51000InvestmentCostOrOtherBasis
Other Cost Or Other Basis86251OtherCostOrOtherBasis
Book Value137251BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Investment Cost Or Other Basis2755987InvestmentCostOrOtherBasis
Other Cost Or Other Basis204382OtherCostOrOtherBasis
Depreciation194637Depreciation
Book Value2765732BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Investment Cost Or Other Basis98446InvestmentCostOrOtherBasis
Other Cost Or Other Basis91598OtherCostOrOtherBasis
Depreciation84614Depreciation
Book Value105430BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings3008413TotalOfBookValueLandBuildings

Closely Held Equity Interests CloselyHeldEquityInterests

FieldValueIRS element (for citing)
Book Value3068914BookValue
Method Of ValuationFMethodOfValuation
FieldValueIRS element (for citing)
Total Of Book Value Securities3068914TotalOfBookValueSecurities

Other Assets OtherAssets

FieldValueIRS element (for citing)
DescriptionCHARITABLE REMAINDER TRUSTDescription
Book Value794155BookValue
FieldValueIRS element (for citing)
Total Book Value Other Assets794155TotalBookValueOtherAssets

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (3 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
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.
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, 2012: FOUNDATION OPERATING SUPPORT, SCHOLARSHIPS, SPECIFIC HOSPITAL DEPARTMENT SUPPORT, OR SPECIFIC HOSPITAL PATIENT SERVICE SUPPORT.DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS:
PART X: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, 2012 AND 2011, 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.DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48:

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records Maintained1RecordsMaintained

Recipient Table RecipientTable (2 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEIN Of RecipientEINOfRecipientIRC SectionIRCSectionAmount Of Cash GrantAmountOfCashGrantPurpose Of GrantPurposeOfGrant
SAINT ANN CLINIC - PROVIDENCE SELF SUFFICIENCY MINISTRIES
1436 LOCUST STREETTERRE HAUTEIN47807351947580501 (C) 326920PAYMENT OF INSURANCE PREMIUMS AND EKG MACHINE
UNION HOSPITAL
1606 N 7TH STREETTERRE HAUTEIN47804350876396501 (C) 3133306CHARITABLE GRANT
FieldValueIRS element (for citing)
Total Nbr Of501 C3 And Govt Grants2TotalNbrOf501C3AndGovtGrants

Form990 Schedule I Part III Form990ScheduleIPartIII

FieldValueIRS element (for citing)
Type Of GrantSCHOLARSHIPSTypeOfGrant
Number Of Recipients45NumberOfRecipients
Amount Of Cash Grant32950AmountOfCashGrant

Form990 Schedule I Part IV Form990ScheduleIPartIV

FieldValueIRS element (for citing)
IdentifierPROCEDURE FOR MONITORING GRANTS IN THE U.S.:Identifier
Return ReferencePART I, LINE 2:ReturnReference
ExplanationSCHEDULE 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.Explanation

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan0SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org0CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments0AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (4 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
WAYNE HUTSON
0222431000-105201350908494024338200
DAVID DOERR
030423000043636015925025280038907100
RANDY STEVENS MD
018884400000000018884400
SCOTT TEFFETELLER
03797600001243108320023780042429100

Schedule M IRS990ScheduleM

Real Estate Residential RealEstateResidential

FieldValueIRS element (for citing)
Non Cash CheckboxXNonCashCheckbox
Number Of Contributions1NumberOfContributions
Noncash Contribs Rptd F99029000NoncashContribsRptdF990
Method Of Determining RevenuesFMV - APPRAISEDMethodOfDeterminingRevenues
FieldValueIRS element (for citing)
Any Property That Must Be Held0AnyPropertyThatMustBeHeld
Review Process Unusual NC Gifts1ReviewProcessUnusualNCGifts
Third Parties Used0ThirdPartiesUsed

Form990 Schedule M Part II Form990ScheduleMPartII

FieldValueIRS element (for citing)
IdentifierMETHOD FOR DETERMINING NUMBER OF CONTRIBUTORS:Identifier
Return ReferencePART I, COLUMN (B):ReturnReference
ExplanationTHERE WAS ONE CONTRIBUTION OF REAL ESTATE PROPERTY.Explanation

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (8 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
FORM 990, PART VI, SECTION A, LINE 2JOHN LUKENS AND SALLY LOWERY HAVE A BUSINESS RELATIONSHIP.
FORM 990, PART VI, SECTION A, LINE 4THE FOUNDATION UPDATED ITS BYLAWS FOR AN ADDITION TO THE VOTING MEMBERS OF THE BOARD TO INCLUDE THE CEO OF UNION HOSPITAL SYSTEM, THE CEO OF UNION HOSPITAL, THE CEO OF UAPC, AND THE SERVICE LEAGUE PRESIDENT.
FORM 990, PART VI, SECTION B, LINE 11THE 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 12CTHE 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 EXECUTIVE DIRECTOR IS AWARE OF ALL REPORTED CONFLICTS OF INTEREST AND CONSIDERS THE POTENTIAL IMPACT OF THESE CONFLICTS AT ALL TIMES.
FORM 990, PART VI, SECTION B, LINE 15ATHE 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 19THE FOUNDATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICIES, AND AUDITED FINANCIAL STATEMENTS AVAILABLE UPON REQUEST AT THE ORGANIZATION'S OFFICE.
FORM 990, PART XI, LINE 5:NET UNREALIZED GAINS ON INVESTMENTS: 388,657. INVESTMENT IN SUBSIDIARY EARNINGS 491,208. TOTAL TO FORM 990, PART XI, LINE 5: 879,865.CHANGES IN NET ASSETS OR FUND BALANCES:
FORM 990, PART XI, LINE 2CTHE AUDIT COMMITTEE ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF THE FINANCIAL STATEMENTS AND NO PROCESSES HAVE CHANGED FROM THE PRIOR YEAR.OVERSIGHT OF AUDIT

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (4 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Controlled OrgControlledOrgDirect Controlling Entity NADirectControllingEntityNA
VISITING NURSE ASSOCIATION OF THE WABASH VALLEY INC
400 8TH AVENUETERRE HAUTEIN47804350869064HOME HEALTH AND HOSPICE CAREIN501(C)(3)LINE 7UNION HOSPITAL FOUNDATION INC1
UNION HOSPITAL INC
1606 N 7TH STREETTERRE HAUTEIN478042706350876396HEALTH CAREIN501(C)(3)LINE 3UNION HEALTH SYSTEM0
UNION HOSPITAL HEALTH SERVICES INC
1606 N 7TH STREET FLOOR 4TERRE HAUTEIN478042706351642805HEALTH CAREIN501(C)(3)LINE 90N/A
SERVICE LEAGUE OF UNION HOSPITAL
1606 N 7TH STREETTERRE HAUTEIN47804351586347FUNDRAISINGIN501(C)(4)N/A0N/A
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org1GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org0GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs1RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs1RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs0PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs0PerformOfServicesByOtherOrgs
Sharing Of Facilities0SharingOfFacilities
Sharing Of Paid Employees1SharingOfPaidEmployees
Reimbursement Paid To Other Org1ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org1OtherTransferFromOtherOrg

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