2012-11-15T13:30:03-06:00 2011-12-31 352123203 KSM BUSINESS SERVICES INC PO BOX 40857 INDIANAPOLIS IN 462400857 990 2011-01-01 364550324 INDIANA HEALTH INFORMATION EXCHANGE INC INDI 3176441720 846 N SENATE AVENUE NO 300 INDIANAPOLIS IN 46202 BRIAN MODIANO 3176441720 2012-11-15 1 SCOTT A SCHUSTER P00019243 3175802000 2012-11-14 2011 2016-02-24 21:20:13Z BRIAN MODIANO 846 N SENATE AVE INDIANAPOLIS IN 46202 12761221 0 X WWW.IHIE.ORG X 2004 IN OUR MISSION IS TO USE INFORMATION TECHNOLOGY AND SHARED CLINICAL INFORMATION TO: - IMPROVE THE QUALITY, SAFETY, AND EFFICIENCY OF HEALTH CARE - CREATE UNPARALLELED RESEARCH CAPABILITIES FOR HEALTH RESEARCHERS- EXHIBIT A SUCCESSFUL MODEL OF HEALTH INFORMATION EXCHANGE FOR THE REST OF THE COUNTRY 16 7 78 0 0 0 0 0 8184331 12828211 7833 4963 -633325 -71953 7558839 12761221 0 0 0 0 4914574 6674128 0 0 0 2918594 6115317 7833168 12789445 -274329 -28224 2867869 5301958 776946 3239259 2090923 2062699 X OUR MISSION IS TO USE INFORMATION TECHNOLOGY AND SHARED CLINICAL INFORMATION TO: - IMPROVE THE QUALITY, SAFETY, AND EFFICIENCY OF HEALTH CARE - CREATE UNPARALLELED RESEARCH CAPABILITIES FOR HEALTH RESEARCHERS- EXHIBIT A SUCCESSFUL MODEL OF HEALTH INFORMATION EXCHANGE FOR THE REST OF THE COUNTRY 0 0 5971476 0 0 CLINICAL MESSAGING - PROVIDE PATIENTS ELECTRONIC MEDICAL INFORMATION AND TEST RESULTS TO INDIANA HOSPITALS. 4356352 0 0 CLINICAL QUALITY - TO PROVIDE MEASUREMENT OF CLINICS TREATMENT OF PATIENTS - GOAL IS TO IMPROVE HEALTH CARE. 99055 0 0 TRANSFORMATION - PROJECT WITH GOAL OF GETTING HEALTH CARE MEASUREMENT TO SOUTHERN INDIANA HOSPITALS. 10426883 1 0 0 1 0 0 0 0 0 0 1 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 12 0 1 78 1 0 0 0 0 0 0 0 0 0 0 0 X 16 7 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 IN X THE CONTROLLERSHIP GROUP INC 3175721225 10412 ALLISONVILLE RD STE 109 FISHERS IN 46038 VINCENT C CAPONI 2.00 X X 0 1996638 52250 WILLIAM R CAST 2.00 X 0 0 0 DAVID COOK 2.00 X 0 0 0 DANIEL F EVANS JR 2.00 X 0 1449996 839848 MATTHEW R GUTWEIN 2.00 X 0 348267 13962 DAVID L JOHNSON 2.00 X X 0 388909 22050 NED LAMKIN 2.00 X 0 0 0 TERESA L LOVINS 2.00 X 0 0 0 BRYAN A MILLS 2.00 X 0 0 0 WILLIAM R TIERNEY 2.00 X X 0 296509 91461 D CRAIG BRATER 2.00 X 0 601420 419018 ROBERT BRODY 2.00 X 0 865014 1215312 VIRGINIA CAINE 2.00 X 0 246556 3655 WAYNE DEVEYDT 2.00 X 0 0 0 JOHN ELLIS 2.00 X 0 0 0 DOUGLAS J LEONARD 2.00 X 0 604979 188880 HAROLD APPLE 40.00 X 232211 0 2139 THOMAS P PENNO 40.00 X 233500 0 9401 JOSEPH M OVERHAGE 20.00 X 74829 0 1549 BRIAN MODIANO 40.00 X 44213 0 0 JOHN P KANSKY 40.00 X 176674 0 13817 ERIC A MILLER 40.00 X 170000 0 3178 KEITH W KELLEY 40.00 X 161200 0 11958 CHRISTOPHER C SCHULTZ 40.00 X 147669 0 10783 ERIC T THIEME 40.00 X 130622 0 10135 JAMES S HILL 40.00 X 131250 0 4776 DEBRA J HEMLER 40.00 X 130139 0 5267 1632307 6798288 2919439 19 0 1 0 REGENSTRIEF INSTITUTE 410 WEST 10TH STREET STE 2000 INDIANAPOLIS IN 46202 HEALTHCARE RESEARCH 978492 ST VINCENT HEALTH 10330 NORTH MERIDIAN STREET INDIANAPOLIS IN 46290 IMPLEMENTATION AND PROJECT MANAGEMENT 398368 ANCHOR POINT TECHNOLOGY RESOURCES 8440 WOODFIELD CROSSING BLVD STE INDIANAPOLIS IN 46240 TECHNOLOGY STAFFING 348205 HEALTHCARE OPTIONS INC 3901 WEST 86TH STREET SUITE 270 INDIANAPOLIS IN 46268 BEACON PROJECT MANAGEMENT & DEVELOPMENT 216320 ROBERT K STIMAC 6359 DOVER ROAD INDIANAPOLIS IN 46220 PROJECT MANAGEMENT 132692 6 IMPLEMENTATION/SUPPORT 519100 7721495 7721495 VARIABLE FEES 519100 3980969 3980969 SUBSCRIPTION FEES 519100 1035664 1035664 CONSULTING 541900 90083 90083 12828211 4963 4963 OTHER INCOME 900099 12212 12212 LOSS ON MERGETICS 900099 -84165 -84165 -71953 12761221 12828211 0 -66990 961510 317051 644459 4718350 4297767 420583 129227 99142 30085 397745 302977 94768 467296 358702 108594 106182 106182 157866 157866 72000 72000 61193 46422 14771 43428 21400 22028 28877 1000 27877 616398 564735 51663 253847 253847 113213 89974 23239 26276 7126 19150 941863 874740 67123 40630 8259 32371 CONSULTANTS 3395082 3357976 37106 EQUIPMENT LEASING 47726 32462 15264 SUPPLIES 42992 15733 27259 REIMBURSABLE EXPENSE 40735 40735 127009 31417 95592 12789445 10426883 2362562 0 683869 1208009 770921 691422 794943 1562162 91755 499096 2336477 955339 1321708 1381138 -814837 -899002 839623 19510 19510 2867869 5301958 716714 2280645 60232 0 0 958614 776946 3239259 X 1774309 2062699 316614 0 2090923 2062699 2867869 5301958 -28224 0 X X 0 1 1 X 1 1 X X X 0 0 0 CLARIAN HEALTH PARTNERS INC 351955872 LINE 3 1 1 1 0 COMMUNITY HOSPITALS OF INDIANA 350983617 LINE 3 1 1 1 0 HEALTH & HOSPITAL CORPORATION 356065697 LINE 6 1 1 1 0 INDIANA STATE MEDICAL ASSOCIATION 350411650 LINE 9 1 1 1 0 INDIANA UNIVERSITY 356001673 LINE 6 1 1 1 0 THE INDIANAPOLIS MEDICAL SOCIETY 127566088 LINE 9 1 1 1 0 MARION COUNTY HEALTH DEPARTMENT 356065697 LINE 6 1 1 1 0 SISTERS OF ST FRANCIS HEALTH SERVICES 350913537 LINE 3 1 1 1 0 ST VINCENT HOSPITAL & HEALTH CARE 352052591 LINE 3 1 1 1 0 CENTRAL INDIANA CORPORATE PARTNERSHIP 352065459 LINE 9 1 1 1 0 INDIANA HOSPITAL ASSOCIATION INC 350988753 LINE 9 1 1 1 0 INDIANA STATE DEPARTMENT OF HEALTH 356000158 LINE 6 1 1 1 0 12 0 0 0 0 0 0 0 1 72000 0 0 72000 0 EXPLANATION OF LOBBYING ACTIVITIES: PART II-B, LINE 1: THE ORGANIZATION ENGAGES A REGISTERED LOBBYIST IN THE STATE OF INDIANA TO REPRESENT ITS INTERESTS AT THE STATE LEGISLATIVE AND EXECUTIVE BRANCHES. WHILE THE ORGANIZATION ENGAGES A LOBBYIST AT $6,000/MONTH, NOT ALL ACTIVITIES CONDUCTED ARE "LOBBYING" UNDER THE DEFINITION IN INTERNAL REVENUE CODE (IRC) SECTION 4911 BECAUSE NOT ALL SUCH ACTIVITIES CONSTITUTE "INFLUENCING LEGISLATION," AS DEFINED IN IRC SECTION 4911(D)(1); HOWEVER, THE ORGANIZATION IS REPORTING HEREIN THE ENTIRE EXPENDITURE, WHICH NEVERTHELESS REPRESENTS AN INSUBSTANTIAL PART OF THE ORGANIZATION'S OVERALL EXPENDITURES. 51817 16380 35437 2284660 938959 1345701 1381138 12761221 12789445 -28224 -28224 12789746 28525 28525 12761221 0 12761221 12817970 28525 28525 12789445 0 12789445 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: IHIE IS EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THEREFORE, NO PROVISION OR LIABILITY FOR INCOME TAXES HAS BEEN INCLUDED IN THE CONSOLIDATED FINANCIAL STATEMENTS. IN ADDITION, IHIE HAS BEEN DETERMINED BY THE INTERNAL REVENUE SERVICE NOT TO BE A PRIVATE FOUNDATION WITHIN THE MEANING OF SECTION 509(A) OF THE INTERNAL REVENUE CODE. THERE WAS NO UNRELATED BUSINESS INCOME FOR THE YEARS ENDED DECEMBER 31, 2011 AND 2010. THE ORGANIZATION FILES TAX RETURNS IN THE U.S. FEDERAL JURISDICTION AND IN THE STATE OF INDIANA. THE ORGANIZATION IS NO LONGER SUBJECT TO U.S. FEDERAL AND STATE INCOME TAX EXAMINATIONS BY TAX AUTHORITIES FOR YEARS BEFORE 2008. X X X X X X 0 0 0 0 0 0 0 0 0 VINCENT C CAPONI 0 886967 0 1109671 0 0 0 38500 0 13750 0 2048888 0 0 DANIEL F EVANS JR 0 1020135 0 373097 0 56764 0 818859 0 20989 0 2289844 0 0 MATTHEW R GUTWEIN 0 315767 0 32500 0 0 0 0 0 13962 0 362229 0 0 DAVID L JOHNSON 0 358789 0 30000 0 120 0 22050 0 0 0 410959 0 0 WILLIAM R TIERNEY 0 246509 0 0 0 50000 0 39310 0 52151 0 387970 0 0 D CRAIG BRATER 0 601420 0 0 0 0 0 356250 0 62768 0 1020438 0 0 ROBERT BRODY 0 816500 0 0 0 48514 0 1200668 0 14644 0 2080326 0 0 VIRGINIA CAINE 0 246556 0 0 0 0 0 0 0 3655 0 250211 0 0 DOUGLAS J LEONARD 0 592281 0 0 0 12698 0 154820 0 34060 0 793859 0 0 HAROLD APPLE 232211 0 0 0 0 0 0 0 2139 0 234350 0 0 0 THOMAS P PENNO 200000 0 33500 0 0 0 0 0 9401 0 242901 0 0 0 JOHN P KANSKY 176674 0 0 0 0 0 0 0 13817 0 190491 0 0 0 ERIC A MILLER 170000 0 0 0 0 0 0 0 3178 0 173178 0 0 0 KEITH W KELLEY 161200 0 0 0 0 0 0 0 11958 0 173158 0 0 0 CHRISTOPHER C SCHULTZ 147669 0 0 0 0 0 0 0 10783 0 158452 0 0 0 FORM 990, PART VI, SECTION B, LINE 11 THE 990 IS SUBMITTED TO THE FINANCE & AUDIT COMMITTEE FOR REVIEW AND APPROVAL. THE RETURN IS THEN SUBMITTED TO THE BOARD BEFORE FILING. FORM 990, PART VI, SECTION B, LINE 12C THE BOARD OF DIRECTORS OF INDIANA HEALTH INFORMATION EXCHANGE, INC. (THE CORPORATION), HAS ADOPTED A CONFLICT OF INTEREST POLICY (THE "POLICY") THAT REQUIRES EACH DIRECTOR, OFFICER AND MEMBER OF A BOARD COMMITTEE (DEFINED IN THE POLICY) TO PROVIDE THE CORPORATION AN ANNUAL DISCLOSURE OF ACTUAL OR POTENTIAL CONFLICTS OF INTEREST THAT ARISE AS A RESULT OF AN INDIVIDUAL SERVING AS A DIRECTOR, OFFICER OR MEMBER OF A BOARD COMMITTEE. THE POLICY ALSO REQUIRES CERTAIN ACTIONS TO APPROVE OR RATIFY A CONTRACT OR OTHER TRANSACTION BETWEEN THE CORPORATION AND AN INTERESTED PERSON (DEFINED IN THE POLICY). TO HELP ENSURE REGULAR AND CONSISTENT COMPLIANCE WITH THE POLICY, THE CORPORATION'S MANAGEMENT HAS ADOPTED THIS CONFLICT OF INTEREST MONITORING AND COMPLIANCE PROCEDURE. RESPONSIBLE INDIVIDUAL: THE CORPORATION'S CHIEF OPERATING OFFICER (THE "COO"). PROCEDURE: 1. THE COO WILL ANNUALLY COLLECT A WRITTEN DISCLOSURE OF ACTUAL OR POTENTIAL CONFLICTS OF INTEREST FROM EACH DIRECTOR, OFFICER AND MEMBER OF A BOARD COMMITTEE. 2. THE COO WILL PREPARE AND DISTRIBUTE TO EACH DIRECTOR, OFFICER AND MEMBER OF A BOARD COMMITTEE A LIST OF ALL ACTUAL AND POTENTIAL CONFLICTS DISCLOSED TO THE CORPORATION. 3. AT EACH MEETING OF THE BOARD OF DIRECTORS AND EACH BOARD COMMITTEE MEETING, THE COO WILL BE RESPONSIBLE FOR MONITORING COMPLIANCE WITH AND ENFORCING THE POLICY. FORM 990, PART VI, SECTION B, LINE 15 THE CORPORATION'S BYLAWS PROVIDE THAT THE CORPORATION'S EXECUTIVE COMMITTEE SHALL SERVE AS THE CORPORATION'S COMPENSATION COMMITTEE AND SHALL REVIEW AND, IF IN THE BEST INTEREST OF THE CORPORATION, APPROVE ALL COMPENSATION ARRANGEMENTS WITH KEY EMPLOYEES OF THE CORPORATION, PROVIDED, HOWEVER, THAT (1) EMPLOYMENT OF A PRESIDENT/CEO REQUIRES THE AFFIRMATIVE VOTE OF 2/3 OF THE CORPORATION'S DIRECTORS, (2) ANY COMPENSATION ARRANGEMENT IN EXCESS OF $100,000 AND LESS THAN $500,000 MUST BE APPROVED BY THE CORPORATION'S FINANCE AND AUDIT COMMITTEE AND (3) ANY COMPENSATION ARRANGEMENT IN EXCESS OF $500,000 MUST BE APPROVED BY 2/3 OF THE CORPORATION'S DIRECTORS. THE CORPORATION'S EXECUTIVE COMMITTEE CONSISTS OF THE OFFICERS OF THE CORPORATION AND TWO ADDITIONAL MEMBERS OF THE CORPORATION'S BOARD OF DIRECTORS ELECTED BY SUCH OFFICERS. THE PRESIDENT/CEO OF THE CORPORATION IS A NON VOTING, EX OFFICIO MEMBER OF THE EXECUTIVE COMMITTEE. THE PRESIDENT/CEO HAS NO INVOLVEMENT IN THE PROCESS OF SETTING HIS OR HER OWN COMPENSATION. FORM 990, PART VI, SECTION C, LINE 18 THE CORPORATION'S ARTICLES OF INCORPORATION ARE AVAILABLE TO THE PUBLIC THROUGH THE INDIANA SECRETARY OF STATE'S WEBSITE AT HTTPS://SECURE.IN.GOV/SOS/BUS_SERVICE/ONLINE_CORPS/NAME_SEARCH.ASPX. THE CORPORATION'S BYLAWS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS MAY BE MADE AVAILABLE TO THE PUBLIC UPON REQUEST ON A CASE-BY-CASE BASIS. FORM 990, PART VI, SECTION C, LINE 19 THE CORPORATION'S FORM 990 AND FORM 1023 ARE AVAILABLE TO THE PUBLIC UPON REQUEST IN ACCORDANCE WITH APPLICABLE LAW. CENTRAL INDIANA CORPORATE PARTNERSHIP INC 111 MONUMENT CIRCLE STE 1800 INDIANAPOLIS IN 46204 352065459 PROMOTE GROWTH AND OPPORTUNITY IN CENTRAL INDIANA IN 501(C)(6) N/A 0 CLARIAN HEALTH PARTNERS INC 950 NORTH MERIDAN ST GATEWAY INDIANAPOLIS IN 46204 351955872 PROVISION OF HEALTHCARE SERVICES IN 501(C)(3) 509(A)(1) N/A 0 COMMUNITY HOSPITAL OF INDIANA INC 1500 N RITTER AVE INDIANAPOLIS IN 46219 350983617 PROVISION OF HEALTHCARE SERVICES IN 501(C)(3) 509(A)(1) N/A 0 INDIANA STATE MEDICAL ASSOCIATION 322 CANAL WALK INDIANAPOLIS IN 46202 350411650 EXTEND MEDICAL KNOWLEDGE, ADVANCE MEDICAL SCIENCE, PROMOTE HEALTH CARE IN 501(C)(3) 509(A)(2) N/A 0 SISTERS OF ST FRANCIS HEALTH SERVICES INC 1515 DRAGOON TRL MISHAWAKA IN 46544 350913537 PROVISION OF CHARITABLE HEALTHCARE IN 501(C)(3) 509(A)(1) N/A 0 ST VINCENT HOSPITAL & HEALTH CARE 2001 W 86TH ST INDIANAPOLIS IN 46260 352052591 PROVISION OF HEALTHCARE SERVICES IN 501(C)(3) 509(A)(1) N/A 0 INDIANA HOSPITAL ASSOCIATION INC ONE AMERICA SQUARE NO 1900 INDIANAPOLIS IN 46282 350988753 EXTEND MEDICAL KNOWLEDGE, ADVANCE MEDICAL SCIENCE, PROMOTE HEALTH CARE IN 501(C)(6) N/A 0 HEALTH AND HOSPITAL CORPORATION OF MARION COUNTY DBA WISHARD HEALTH SERVIC 1001 W TENTH STREET INDIANAPOLIS IN 46202 356065597 EXTEND MEDICAL KNOWLEDGE, ADVANCE MEDICAL SCIENCE, PROMOTE HEALTH CARE IN 501(C)(3) 509(A)(1) N/A 0 INDIANA UNIVERSITY 107 S INDIANA AVE BLOOMINGTON IN 47405 356001673 EDUCATION IN 501(C)(3) 509(A)(1) N/A 0 THE INDIANAPOLIS MEDICAL SOCIETY INC 631 E NEW YORK ST INDIANAPOLIS IN 46202 127566088 EXTEND MEDICAL KNOWLEDGE, ADVANCE MEDICAL SCIENCE, PROMOTE HEALTH CARE IN 501(C)(3) 509(A)(2) N/A 0 MARION COUNTY HEALTH DEPARTMENT 3838 NORTH RURAL ST INDIANAPOLIS IN 46205 356065697 EXTEND MEDICAL KNOWLEDGE, ADVANCE MEDICAL SCIENCE, PROMOTE HEALTH CARE IN 501(C)(3) 509(A)(1) N/A 0 INDIANA STATE DEPARTMENT OF HEALTH 402 W WASHINGTON ST INDIANAPOLIS IN 46202 356000158 EXTEND MEDICAL KNOWLEDGE, ADVANCE MEDICAL SCIENCE, PROMOTE HEALTH CARE IN 501(C)(3) 509(A)(1) N/A 0 MERGETICS INC 846 NORTH SENATE AVENUE STE 300 INDIANAPOLIS IN 46202 261566118 HEALTH INFORMATION IN INDIANA HEALTH INFORMATION EXCHANGE C 10530 0.93000 0 0 0 0 0 0 0 0 0 0 1 0 1 0 1 0 0 0 MERGETICS INC O 2165 FMV CLARIAN HEALTH PARTNERS INC K 1188917 FMV ST FRANCIS HOSPITAL & HEALTH CENTERS K 911362 FMV ST VINCENT HOSPITAL & HEALTH CARE CENTER INC K 730074 FMV HEALTH AND HOSPITAL CORPORATION OF MARION COUNTY DBA WISHARD HEALTH SERV K 200000 FMV COMMUNITY HOSPITAL OF INDIANA INC K 565631 FMV CENTRAL INDIANA CORPORATE PARTNERSHIP INC K INDIANA STATE MEDICAL ASSOCIATION K THE INDIANAPOLIS MEDICAL SOCIETY INC K MARION COUNTY HEALTH DEPARTMENT K INDIANA STATE DEPARTMENT OF HEALTH K