UNION HOSPITAL FOUNDATION INC: Form 990, tax year 2010

View the entire original 990 at ProPublica ↗

Organization: UNION HOSPITAL FOUNDATION INC (EIN 35-1642823)
Tax period: 2010-09-01 to 2011-08-31
Filed: 2012-07-12
IRS object ID: 201241949349300439
Schema version: 2010v3.4
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
Form 990
Schedule A
Schedule B
Schedule D
Schedule I
Schedule J
Schedule O
Schedule R

Return header ReturnHeader

Field	Value	IRS element (for citing)
Timestamp	2012-07-12T14:14:44-05:00	Timestamp
Tax Period End Date	2011-08-31	TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

Field	Value	IRS element (for citing)
Business Name Line1	BLUE & CO LLC	BusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

Field	Value	IRS element (for citing)
Address Line1	ONE AMERICAN SQUARE 2200	AddressLine1
City	INDIANAPOLIS	City
State	IN	State
ZIP Code	46282	ZIPCode

Field	Value	IRS element (for citing)
Return Type	990	ReturnType
Tax Period Begin Date	2010-09-01	TaxPeriodBeginDate

Filer Filer

Field	Value	IRS element (for citing)
EIN	351642823	EIN

Name Name

Field	Value	IRS element (for citing)
Business Name Line1	UNION HOSPITAL FOUNDATION INC	BusinessNameLine1

Field	Value	IRS element (for citing)
Name Control	UNIO	NameControl
Phone	8122387534	Phone

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	1606 NORTH SEVENTH STREET	AddressLine1
City	TERRE HAUTE	City
State	IN	State
ZIP Code	478042780	ZIPCode

Officer Officer

Field	Value	IRS element (for citing)
Name	DONALD SCOTT	Name
Title	VICE CHAIRMAN	Title
Phone	8122387534	Phone
Date Signed	2012-07-11	DateSigned
Authorize Third Party	1	AuthorizeThirdParty

Preparer Preparer

Field	Value	IRS element (for citing)
Name	CARRIE A MERRILL CPA	Name
Phone	3176334705	Phone

Field	Value	IRS element (for citing)
Tax Year	2010	TaxYear
Build TS	2016-02-24 21:20:13Z	BuildTS

Form 990 IRS990

Field	Value	IRS element (for citing)
Name Of Principal Officer Person	DONALD SCOTT	NameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

Field	Value	IRS element (for citing)
Address Line1	1606 NORTH SEVENTH STREET	AddressLine1
City	TERRE HAUTE	City
State	IN	State
ZIP Code	478042780	ZIPCode

Field	Value	IRS element (for citing)
Gross Receipts	2104807	GrossReceipts
Group Return For Affiliates	0	GroupReturnForAffiliates
Organization501c3	X	Organization501c3
Web Site	WWW.UNIONHOSPITALFOUNDATION.ORG	WebSite
Type Of Organization Corporation	X	TypeOfOrganizationCorporation
Year Formation	1985	YearFormation
State Legal Domicile	IN	StateLegalDomicile
Activity Or Mission Description	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.	ActivityOrMissionDescription
Nbr Voting Members Governing Body	29	NbrVotingMembersGoverningBody
Nbr Independent Voting Members	25	NbrIndependentVotingMembers
Total Nbr Employees	0	TotalNbrEmployees
Total Nbr Volunteers	60	TotalNbrVolunteers
Total Gross UBI	0	TotalGrossUBI
Net Unrelated Business Txbl Income	0	NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year	685524	ContributionsGrantsPriorYear
Contributions Grants Current Year	193972	ContributionsGrantsCurrentYear
Program Service Revenue Prior Year	0	ProgramServiceRevenuePriorYear
Program Service Revenue CY	0	ProgramServiceRevenueCY
Investment Income Prior Year	49414	InvestmentIncomePriorYear
Investment Income Current Year	342772	InvestmentIncomeCurrentYear
Other Revenue Prior Year	104310	OtherRevenuePriorYear
Other Revenue Current Year	92858	OtherRevenueCurrentYear
Total Revenue Prior Year	839248	TotalRevenuePriorYear
Total Revenue Current Year	629602	TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year	744323	GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY	223396	GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year	0	BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY	0	BenefitsPaidToMembersCY
Salaries Etc Prior Year	347599	SalariesEtcPriorYear
Salaries Etc Current Year	339969	SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year	1875	TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY	0	TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year	72172	TotalFundrsngExpCurrentYear
Other Expense Prior Year	338981	OtherExpensePriorYear
Other Expenses Current Year	221106	OtherExpensesCurrentYear
Total Expenses Prior Year	1432778	TotalExpensesPriorYear
Total Expenses Current Year	784471	TotalExpensesCurrentYear
Revenues Less Expenses Prior Year	-593530	RevenuesLessExpensesPriorYear
Revenues Less Expenses CY	-154869	RevenuesLessExpensesCY
Total Assets BOY	13669907	TotalAssetsBOY
Total Assets EOY	11777645	TotalAssetsEOY
Total Liabilities BOY	7103922	TotalLiabilitiesBOY
Total Liabilities EOY	5622380	TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY	6565985	NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY	6155265	NetAssetsOrFundBalancesEOY
Mission Description	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.	MissionDescription
Significant New Program Services	0	SignificantNewProgramServices
Significant Change	0	SignificantChange
Expense	170120	Expense
Grants	170120	Grants
Description	VARIOUS GRANTS TO UNION HOSPITAL, INC. TO FURTHER ITS DELIVERY OF HEALTHCARE SERVICES TO THE WABASH VALLEY.	Description

Activity2 Activity2

Field	Value	IRS element (for citing)
Expense	32279	Expense
Grants	32279	Grants
Description	ACADEMIC SCHOLARSHIP AWARD TO BE APPLIED TO THE TUITION AND RELATED EDUCATION EXPENSES OF NUMEROUS STUDENTS ATTENDING VARIOUS COLLEGES AND UNIVERSITIES.	Description

Activity3 Activity3

Field	Value	IRS element (for citing)
Expense	17152	Expense
Grants	17152	Grants
Description	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.	Description

Activity Other ActivityOther

Field	Value	IRS element (for citing)
Expense	3845	Expense
Grants	3845	Grants

Field	Value	IRS element (for citing)
Total Of Other Program Service Exp	3845	TotalOfOtherProgramServiceExp
Total Of Other Program Service Grnt	3845	TotalOfOtherProgramServiceGrnt
Total Program Service Expense	223396	TotalProgramServiceExpense
Described In501 C3	1	DescribedIn501C3
Schedule B Required	1	ScheduleBRequired
Political Activities	0	PoliticalActivities
Lobbying Activities	0	LobbyingActivities
Donor Advised Funds	0	DonorAdvisedFunds
Conservation Easements	0	ConservationEasements
Collections Of Art	0	CollectionsOfArt
Credit Counseling	0	CreditCounseling
Term Or Permanent Endowments	1	TermOrPermanentEndowments
Report Land Bldg Equip	1	ReportLandBldgEquip
Report Invest Oth Securities	1	ReportInvestOthSecurities
Report Prog Rel Invest	0	ReportProgRelInvest
Report Other Assets	1	ReportOtherAssets
Report Other Liabilities	0	ReportOtherLiabilities
Report Fin48 Footnote	1	ReportFin48Footnote
Independent Audit Financial Stmt	0	IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt	1	ConsolidatedAuditFinancialStmt
School	0	School
Foreign Office	0	ForeignOffice
Foreign Activities	0	ForeignActivities
More Than5000 K To Organizations	0	MoreThan5000KToOrganizations
More Than5000 K To Individuals	0	MoreThan5000KToIndividuals
Professional Fundraising	0	ProfessionalFundraising
Fundraising Activities	0	FundraisingActivities
Gaming	0	Gaming
Hospital	0	Hospital
Grants To Organizations	1	GrantsToOrganizations
Grants To Individuals	1	GrantsToIndividuals
Schedule J Required	1	ScheduleJRequired
Tax Exempt Bonds	0	TaxExemptBonds
Excess Benefit Transaction	0	ExcessBenefitTransaction
Prior Excess Benefit Transaction	0	PriorExcessBenefitTransaction
Loan To Officer Or DQP	0	LoanToOfficerOrDQP
Grant To Related Person	0	GrantToRelatedPerson
Bsnss Rltnshp With Organization	0	BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member	0	BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp	0	OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions	0	DeductibleNonCashContributions
Deductible Contributions Of Art	0	DeductibleContributionsOfArt
Terminated	0	Terminated
Partial Liquidation	0	PartialLiquidation
Disregarded Entity	0	DisregardedEntity
Related Entity	1	RelatedEntity
Related Org Controlled Entity	1	RelatedOrgControlledEntity
Transaction Related Entity	0	TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org	0	TransfersToExemptNonChrtblOrg
Activities Conducted Partnership	0	ActivitiesConductedPartnership
Schedule O Required	1	ScheduleORequired
Number Forms Transmitted With1096	12	NumberFormsTransmittedWith1096
Number W2 G Included	0	NumberW2GIncluded
Compliance With Backup Witholding	1	ComplianceWithBackupWitholding
Number Of Employees	0	NumberOfEmployees
Unrelated Business Income	0	UnrelatedBusinessIncome
Foreign Financial Account	0	ForeignFinancialAccount
Prohibited Tax Shelter Trans	0	ProhibitedTaxShelterTrans
Taxable Party Notification	0	TaxablePartyNotification
Non Deductible Contributions	0	NonDeductibleContributions
Quid Pro Quo Contributions	0	QuidProQuoContributions
Form8282 Property Disposed Of	0	Form8282PropertyDisposedOf
Funds To Pay Premiums	0	FundsToPayPremiums
Premiums Paid	0	PremiumsPaid
Indoor Tanning Services	0	IndoorTanningServices
Info In Schedule O Part VI	X	InfoInScheduleOPartVI
Nbr Voting Governing Body Members	29	NbrVotingGoverningBodyMembers
Number Independent Voting Members	25	NumberIndependentVotingMembers
Family Or Business Relationship	1	FamilyOrBusinessRelationship
Delegation Of Management Duties	0	DelegationOfManagementDuties
Changes To Organizing Docs	0	ChangesToOrganizingDocs
Material Diversion Or Misuse	0	MaterialDiversionOrMisuse
Members Or Stockholders	0	MembersOrStockholders
Election Of Board Members	0	ElectionOfBoardMembers
Decisions Subject To Approval	0	DecisionsSubjectToApproval
Minutes Of Governing Body	1	MinutesOfGoverningBody
Minutes Of Committees	1	MinutesOfCommittees
Officer Mailing Address	0	OfficerMailingAddress
Local Chapters	0	LocalChapters
Form990 Provided To Governing Body	1	Form990ProvidedToGoverningBody
Conflict Of Interest Policy	1	ConflictOfInterestPolicy
Annual Disclosure Covered Persons	1	AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement	1	RegularMonitoringEnforcement
Whistleblower Policy	0	WhistleblowerPolicy
Document Retention Policy	0	DocumentRetentionPolicy
Compensation Process CEO	1	CompensationProcessCEO
Compensation Process Other	0	CompensationProcessOther
Investment In Joint Venture	0	InvestmentInJointVenture
States Where Copy Of Return Is Filed	IN	StatesWhereCopyOfReturnIsFiled
Upon Request	X	UponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

Field	Value	IRS element (for citing)
Business Name Line1	WAYNE R HUTSON	BusinessNameLine1

Field	Value	IRS element (for citing)
Telephone Number	8122387601	TelephoneNumber

Address US AddressUS

Field	Value	IRS element (for citing)
Address Line1	1606 NORTH SEVENTH STREET	AddressLine1
City	TERRE HAUTE	City
State	IN	State
ZIP Code	47804	ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (30 entries)

TitleTitle	Average Hours Per WeekAverageHoursPerWeek	Individual Trustee Or DirectorIndividualTrusteeOrDirector	OfficerOfficer	Reportable Comp From OrganizationReportableCompFromOrganization	Reportable Comp From Related OrgsReportableCompFromRelatedOrgs	Other CompensationOtherCompensation
MARK FUSON
CHAIRMAN	4.00	X	X	0	0	0
DONALD SCOTT
VICE CHAIRMAN	1.00	X	X	0	0	0
DAVID DOERR
DIRECTOR	6.00	X		0	296764	20311
DIANN MCKEE
SECRETARY	1.00	X	X	0	0	0
CINDY MARTIN
TREASURER	1.00	X	X	0	0	0
PATRICK BOARD
DIRECTOR	1.00	X		0	0	0
RICHARD BURGER
DIRECTOR	1.00	X		0	0	0
MARY ANN CARROLL
DIRECTOR	1.00	X		0	0	0
JOHN DINKEL
DIRECTOR	1.00	X		0	0	0
MARY DOTI
DIRECTOR	1.00	X		0	0	0
JO EINSTANDIG
DIRECTOR	1.00	X		0	0	0
VERN FELLOWS
DIRECTOR	1.00	X		0	0	0
MARGOT GILLESPIE
DIRECTOR	1.00	X		0	0	0
WILLIAM GRIMES
DIRECTOR	1.00	X		0	0	0
ROBERT HAERR MD
DIRECTOR	1.00	X		0	0	0
TROY HELMAN
DIRECTOR	1.00	X		0	0	0
WARD HUBBARD
DIRECTOR	1.00	X		0	0	0
W EDWARD JUKES
DIRECTOR	1.00	X		0	0	0
JANET KORZINEK
DIRECTOR	1.00	X		0	0	0
SALLY LOWERY
DIRECTOR	1.00	X		0	0	0
JOHN LUKENS
DIRECTOR	1.00	X		0	0	0
ROBERT MEISSEL MD
DIRECTOR	1.00	X		0	0	0
BETTY MOONEY
DIRECTOR	1.00	X		0	0	0
FRED RUBEY
DIRECTOR	1.00	X		0	0	0
RANDY STEVENS MD
DIRECTOR	1.00	X		0	185772	21853
DAVID SULLIVAN
DIRECTOR	1.00	X		0	0	0
DAN TANOOS
DIRECTOR	1.00	X		0	0	0
SCOTT TEFFETELLER
DIRECTOR	1.00	X		0	287164	26327
ANN WELCH
DIRECTOR	1.00	X		0	0	0
JIM BERTOLI
EXECUTIVE DIRECTOR	60.00		X	0	115272	22829

Field	Value	IRS element (for citing)
Total Reportable Comp From Org	0	TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs	884972	TotalReportableCompFrmRltdOrgs
Total Other Compensation	91320	TotalOtherCompensation
Number Individuals GT100 K	0	NumberIndividualsGT100K
Formers Listed	0	FormersListed
Total Comp GT150 K	1	TotalCompGT150K
Compensation From Other Sources	0	CompensationFromOtherSources
Number Of Contractors GT100 K	0	NumberOfContractorsGT100K
All Other Contributions	193972	AllOtherContributions
Total Contributions	193972	TotalContributions

Investment Income InvestmentIncome

Field	Value	IRS element (for citing)
Total Revenue Column	114298	TotalRevenueColumn
Exclusion	$114,298	ExclusionAmount

Gross Rents GrossRents

Field	Value	IRS element (for citing)
Real	44000	Real

Less Rental Expenses LessRentalExpenses

Field	Value	IRS element (for citing)
Real	29946	Real

Rental Income Or Loss RentalIncomeOrLoss

Field	Value	IRS element (for citing)
Real	14054	Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

Field	Value	IRS element (for citing)
Total Revenue Column	14054	TotalRevenueColumn
Exclusion	$14,054	ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

Field	Value	IRS element (for citing)
Securities	1673733	Securities

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

Field	Value	IRS element (for citing)
Securities	1445259	Securities

Gain Or Loss GainOrLoss

Field	Value	IRS element (for citing)
Securities	228474	Securities

Net Gain Or Loss Investments NetGainOrLossInvestments

Field	Value	IRS element (for citing)
Total Revenue Column	228474	TotalRevenueColumn
Exclusion	$228,474	ExclusionAmount

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescription	Business CodeBusinessCode	Total Revenue ColumnTotalRevenueColumn	ExclusionExclusionAmount
VENDING INCOME	999999	64573	$64,573
REMAINDER TRUST CHANGE	999999	13557	$13,557
RETAIL REVENUE	999999	674	$674

Field	Value	IRS element (for citing)
Total Other Revenue	78804	TotalOtherRevenue

Total Revenue TotalRevenue

Field	Value	IRS element (for citing)
Total Revenue Column	629602	TotalRevenueColumn
Related Or Exempt Function Income	0	RelatedOrExemptFunctionIncome
Unrelated Business Revenue	0	UnrelatedBusinessRevenue
Exclusion	$435,630	ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

Field	Value	IRS element (for citing)
Total	191117	Total
Program Services	191117	ProgramServices

Grants To Domestic Individuals GrantsToDomesticIndividuals

Field	Value	IRS element (for citing)
Total	32279	Total
Program Services	32279	ProgramServices

Other Salaries And Wages OtherSalariesAndWages

Field	Value	IRS element (for citing)
Total	246429	Total
Management And General	246429	ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

Field	Value	IRS element (for citing)
Total	76715	Total
Management And General	76715	ManagementAndGeneral

Payroll Taxes PayrollTaxes

Field	Value	IRS element (for citing)
Total	16825	Total
Management And General	16825	ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

Field	Value	IRS element (for citing)
Total	2347	Total
Management And General	2347	ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

Field	Value	IRS element (for citing)
Total	66607	Total
Management And General	66607	ManagementAndGeneral

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

Field	Value	IRS element (for citing)
Total	24034	Total
Management And General	24034	ManagementAndGeneral

Fees For Services Other FeesForServicesOther

Field	Value	IRS element (for citing)
Total	2469	Total
Management And General	2469	ManagementAndGeneral

Advertising Advertising

Field	Value	IRS element (for citing)
Total	5642	Total
Fundraising	5642	Fundraising

Office Expenses OfficeExpenses

Field	Value	IRS element (for citing)
Total	31724	Total
Management And General	3647	ManagementAndGeneral
Fundraising	28077	Fundraising

Information Technology InformationTechnology

Field	Value	IRS element (for citing)
Total	13753	Total
Management And General	13753	ManagementAndGeneral

Occupancy Occupancy

Field	Value	IRS element (for citing)
Total	12270	Total
Management And General	7497	ManagementAndGeneral
Fundraising	4773	Fundraising

Travel Travel

Field	Value	IRS element (for citing)
Total	9187	Total
Management And General	9187	ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

Field	Value	IRS element (for citing)
Total	6872	Total
Management And General	6872	ManagementAndGeneral

Insurance Insurance

Field	Value	IRS element (for citing)
Total	935	Total
Management And General	935	ManagementAndGeneral

Other Expenses OtherExpenses (5 entries)

DescriptionDescription	TotalTotal	FundraisingFundraising	Management And GeneralManagementAndGeneral
CATERING	18920	18920
RECOGNITION EXPENSE	8632	8632
CONTRIBUTION EXPENSES	6350		6350
DUES & SUBSCRIPTIONS	3515		3515
LICENSES AND FEES	2		2

All Other Expenses AllOtherExpenses

Field	Value	IRS element (for citing)
Total	7847	Total
Management And General	1719	ManagementAndGeneral
Fundraising	6128	Fundraising

Total Functional Expenses TotalFunctionalExpenses

Field	Value	IRS element (for citing)
Total	784471	Total
Program Services	223396	ProgramServices
Management And General	488903	ManagementAndGeneral
Fundraising	72172	Fundraising

Savings And Temp Cash Investments SavingsAndTempCashInvestments

Field	Value	IRS element (for citing)
BOY	334068	BOY
EOY	658193	EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

Field	Value	IRS element (for citing)
BOY	3325344	BOY
EOY	2348834	EOY

Accounts Receivable AccountsReceivable

Field	Value	IRS element (for citing)
BOY	113887	BOY
EOY	38266	EOY

Field	Value	IRS element (for citing)
Land Buildings Equipment Basis	764814	LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec	255536	LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

Field	Value	IRS element (for citing)
BOY	542287	BOY
EOY	509278	EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

Field	Value	IRS element (for citing)
BOY	6147714	BOY
EOY	5412567	EOY

Investments Other Securities InvestmentsOtherSecurities

Field	Value	IRS element (for citing)
BOY	2487363	BOY
EOY	2077706	EOY

Other Assets Total OtherAssetsTotal

Field	Value	IRS element (for citing)
BOY	719244	BOY
EOY	732801	EOY

Total Assets TotalAssets

Field	Value	IRS element (for citing)
BOY	13669907	BOY
EOY	11777645	EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

Field	Value	IRS element (for citing)
BOY	750462	BOY
EOY	763840	EOY

Escrow Account Liability EscrowAccountLiability

Field	Value	IRS element (for citing)
BOY	6296179	BOY
EOY	4693540	EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

Field	Value	IRS element (for citing)
BOY	57281	BOY
EOY	165000	EOY

Total Liabilities TotalLiabilities

Field	Value	IRS element (for citing)
BOY	7103922	BOY
EOY	5622380	EOY

Field	Value	IRS element (for citing)
Follow SFAS117	X	FollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

Field	Value	IRS element (for citing)
BOY	4096660	BOY
EOY	3489640	EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

Field	Value	IRS element (for citing)
BOY	1422889	BOY
EOY	1524091	EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

Field	Value	IRS element (for citing)
BOY	1046436	BOY
EOY	1141534	EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	6565985	BOY
EOY	6155265	EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	13669907	BOY
EOY	11777645	EOY

Field	Value	IRS element (for citing)
Info In Schedule O Part XI	X	InfoInScheduleOPartXI
Reconcilation Revenue Expenses	-154869	ReconcilationRevenueExpenses
Reconcilation Other Changes	-255851	ReconcilationOtherChanges
Info In Schedule O Part XII	X	InfoInScheduleOPartXII
Method Of Accounting Accrual	X	MethodOfAccountingAccrual
Accountant Compile Or Review	0	AccountantCompileOrReview
FS Audited	1	FSAudited
Audit Committee	1	AuditCommittee
Financial Statement Consolidated	X	FinancialStatementConsolidated
Federal Grant Audit Required	0	FederalGrantAuditRequired

Schedule A IRS990ScheduleA

Field	Value	IRS element (for citing)
Supporting Organization509a3	X	SupportingOrganization509a3
Supporting Org509a3 Type3 Func Int	X	SupportingOrg509a3Type3FuncInt
Contrib By Controlling Individual	0	ContribByControllingIndividual
Contribution By Related Party	0	ContributionByRelatedParty
Contrib By35 Controlled Entity	0	ContribBy35ControlledEntity

Supported Org Information SupportedOrgInformation (3 entries)

EINEIN	Type Of OrganizationTypeOfOrganization	Listed In Governing DocListedInGoverningDoc	Supported Organization NotifiedSupportedOrganizationNotified	Organized In USOrganizedInUS	AmountAmount
UNION HOSPITAL INC
350876396	3	0	1	1	$170,120
UNION HOSPITAL HEALTH SERVICES INC
351642805	9	0	1	1	$0
VISITING NURSE ASSOCIATION INC
350869064	7	0	1	1	$0

Field	Value	IRS element (for citing)
Total Number Of Supported Orgs	3	TotalNumberOfSupportedOrgs
Sum Of Amounts	170120	SumOfAmounts

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

Field	Value	IRS element (for citing)
Contributor Number	RESTRICTED	ContributorNumber

Contributor Name Business ContributorNameBusiness

Field	Value	IRS element (for citing)
Business Name Line1	RESTRICTED	BusinessNameLine1

Contributor Address US ContributorAddressUS

Field	Value	IRS element (for citing)
Address Line1	RESTRICTED	AddressLine1
Address Line2	RESTRICTED	AddressLine2
City	RESTRICTED	City
State	RESTRICTED	State
ZIP Code	RESTRICTED	ZIPCode

Field	Value	IRS element (for citing)
Aggregate Contributions	RESTRICTED	AggregateContributions

Schedule D IRS990ScheduleD

Field	Value	IRS element (for citing)
Agent Trustee Etc	0	AgentTrusteeEtc
Included On FS	1	IncludedOnFS

Current Year CurrentYear

Field	Value	IRS element (for citing)
Beginning Of Year Balance	3101660	BeginningOfYearBalance
Contributions	140376	Contributions
Investment Earnings Or Losses	221707	InvestmentEarningsOrLosses
Grants Or Scholarships	95730	GrantsOrScholarships
End Of Year Balance	3368013	EndOfYearBalance

Current Year Minus1 Year CurrentYearMinus1Year

Field	Value	IRS element (for citing)
Beginning Of Year Balance	2876487	BeginningOfYearBalance
Contributions	180566	Contributions
Investment Earnings Or Losses	126601	InvestmentEarningsOrLosses
Grants Or Scholarships	81994	GrantsOrScholarships
End Of Year Balance	3101660	EndOfYearBalance

Current Year Minus2 Years CurrentYearMinus2Years

Field	Value	IRS element (for citing)
Beginning Of Year Balance	3260052	BeginningOfYearBalance
Contributions	141735	Contributions
Investment Earnings Or Losses	-291787	InvestmentEarningsOrLosses
Grants Or Scholarships	233513	GrantsOrScholarships
End Of Year Balance	2876487	EndOfYearBalance

Field	Value	IRS element (for citing)
Board Designated EOY Balance	0.20850	BoardDesignatedEOYBalance
Permanent Endowment EOY Balance	0.33890	PermanentEndowmentEOYBalance
Term Endowment EOY Balance	0.45250	TermEndowmentEOYBalance
Endowments Held By Unrelated Orgs	0	EndowmentsHeldByUnrelatedOrgs
Endowments Held By Related Orgs	0	EndowmentsHeldByRelatedOrgs

Land Land

Field	Value	IRS element (for citing)
Investment Cost Or Other Basis	51000	InvestmentCostOrOtherBasis
Other Cost Or Other Basis	45834	OtherCostOrOtherBasis
Book Value	96834	BookValue

Buildings Buildings

Field	Value	IRS element (for citing)
Investment Cost Or Other Basis	339000	InvestmentCostOrOtherBasis
Other Cost Or Other Basis	237382	OtherCostOrOtherBasis
Depreciation	191523	Depreciation
Book Value	384859	BookValue

Equipment Equipment

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	91598	OtherCostOrOtherBasis
Depreciation	64013	Depreciation
Book Value	27585	BookValue

Field	Value	IRS element (for citing)
Total Of Book Value Land Buildings	509278	TotalOfBookValueLandBuildings

Closely Held Equity Interests CloselyHeldEquityInterests

Field	Value	IRS element (for citing)
Book Value	2077706	BookValue
Method Of Valuation	C	MethodOfValuation

Field	Value	IRS element (for citing)
Total Of Book Value Securities	2077706	TotalOfBookValueSecurities

Other Assets OtherAssets

Field	Value	IRS element (for citing)
Description	CHARITABLE REMAINDER TRUST	Description
Book Value	732801	BookValue

Field	Value	IRS element (for citing)
Total Book Value Other Assets	732801	TotalBookValueOtherAssets

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (3 entries)

Return ReferenceReturnReference	ExplanationExplanation	IdentifierIdentifier
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 THAT ARE GENERALLY ESTABLISHED FOR ONE OF THE FOLLOWING PURPOSES AT AUGUST 31, 2011: 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 VILLAGE AND RECOGNIZE A TAX LIABILITY IF THE FOUNDATION 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 HAS CONCLUDED THAT AS OF AUGUST 31, 2011 AND 2010, 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 IS 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

Field	Value	IRS element (for citing)
Records Maintained	1	RecordsMaintained

Recipient Table RecipientTable (2 entries)

Address Line1AddressUS/AddressLine1	CityAddressUS/City	StateAddressUS/State	ZIP CodeAddressUS/ZIPCode	EIN Of RecipientEINOfRecipient	IRC SectionIRCSection	Amount Of Cash GrantAmountOfCashGrant	Purpose Of GrantPurposeOfGrant
SAINT ANN CLINIC - PROVIDENCE SELF SUFFICIENCY MINISTRIES
1436 LOCUST STREET	TERRE HAUTE	IN	47807	351947580	501 (C) 3	17152	PAYMENT OF INSURANCE PREMIUMS AND EKG MACHINE
UNION HOSPITAL
1606 N 7TH STREET	TERRE HAUTE	IN	47804	350876396	501 (C) 3	170120	CHARITABLE GRANT

Field	Value	IRS element (for citing)
Total Nbr Of501 C3 And Govt Grants	2	TotalNbrOf501C3AndGovtGrants
Total Nbr Of Other Organizations	0	TotalNbrOfOtherOrganizations

Form990 Schedule I Part III Form990ScheduleIPartIII

Field	Value	IRS element (for citing)
Type Of Grant	SCHOLARSHIPS	TypeOfGrant
Number Of Recipients	35	NumberOfRecipients
Amount Of Cash Grant	32279	AmountOfCashGrant

Form990 Schedule I Part IV Form990ScheduleIPartIV

Field	Value	IRS element (for citing)
Identifier	PROCEDURE FOR MONITORING GRANTS IN THE U.S.:	Identifier
Return Reference	PART I, LINE 2:	ReturnReference
Explanation	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.	Explanation

Schedule J IRS990ScheduleJ

Field	Value	IRS element (for citing)
Board Or Committee Approval	X	BoardOrCommitteeApproval
Severance Payment	0	SeverancePayment
Supplemental Nonqual Retire Plan	0	SupplementalNonqualRetirePlan
Equity Based Comp Arrangement	0	EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org	0	CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs	0	CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org	0	CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs	0	CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments	0	AnyNonFixedPayments
Initial Contract Exception	0	InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (3 entries)

Base Compensation Filing OrgBaseCompensationFilingOrg	Comp Based On Related OrgsCompBasedOnRelatedOrgs	Bonus Filing OrgBonusFilingOrg	Bonus Related OrgsBonusRelatedOrgs	Other Compensation Filing OrgOtherCompensationFilingOrg	Other Compensation Related OrgsOtherCompensationRelatedOrgs	Deferred Comp Filing OrgDeferredCompFilingOrg	Deferred Comp Related OrgsDeferredCompRelatedOrgs	Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg	Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs	Total Compensation Filing OrgTotalCompensationFilingOrg	Total Compensation Related OrgsTotalCompensationRelatedOrgs	Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg	Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
DAVID DOERR
0	279034	0	0	0	17730	0	1396	0	18915	0	317075	0	0
RANDY STEVENS MD
0	181759	0	338	0	3675	0	4395	0	17458	0	207625	0	0
SCOTT TEFFETELLER
0	245820	0	0	0	41344	0	4954	0	21373	0	313491	0	0

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (7 entries)

IdentifierIdentifier	ExplanationExplanation	Return ReferenceReturnReference
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.
	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 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 12C
	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 B, LINE 15A
	THE FOUNDATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICIES, AND AUDITED FINANCIAL STATEMENTS AVAILABLE UPON REQUEST AT THE ORGANIZATION'S OFFICE.	FORM 990, PART VI, SECTION C, LINE 19
CHANGES IN NET ASSETS OR FUND BALANCES:	NET UNREALIZED GAINS ON INVESTMENTS: 153,806. SUBSIDIARY EARNINGS -409,657. TOTAL TO FORM 990, PART XI, LINE 5: -255,851.	FORM 990, PART XI, LINE 5:
OVERSIGHT OF AUDIT	THE AUDIT COMMITTEE ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF THE FINANCIAL STATEMENTS AND NO PROCESSES HAVE CHANGED FROM THE PRIOR YEAR.	FORM 990, PART XI, LINE 2C

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (4 entries)

Address Line1AddressUS/AddressLine1	CityAddressUS/City	StateAddressUS/State	ZIP CodeAddressUS/ZIPCode	EINEIN	Primary ActivitiesPrimaryActivities	Legal Domicile StateLegalDomicileState	Exempt Code SectionExemptCodeSection	Public Charity StatusPublicCharityStatus	Direct Controlling Entity NADirectControllingEntityNA	Controlled OrgControlledOrg	Business Name Line1DirectControllingEntityName/BusinessNameLine1
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
UNION HOSPITAL INC
1606 N 7TH STREET	TERRE HAUTE	IN	478042706	350876396	HEALTH CARE	IN	501(C)(3)	LINE 3		0	UNION HOSPITAL HEALTH SERVICES INC
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		0	UNION HOSPITAL FOUNDATION INC
SERVICE LEAGUE OF UNION HOSPITAL
1606 N 7TH STREET	TERRE HAUTE	IN	47804	351586347	FUNDRAISING	IN	501(C)(4)	N/A	N/A	0

Field	Value	IRS element (for citing)
Receipt Of Int Ann Rents Royalties	0	ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org	1	GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org	0	GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org	0	LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org	0	LoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other Org	0	SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org	0	PurchaseOfAssetsFromOtherOrg
Exchange Of Assets	0	ExchangeOfAssets
Rental Of Facilities To Other Orgs	1	RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs	1	RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs	0	PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs	0	PerformOfServicesByOtherOrgs
Sharing Of Facilities	0	SharingOfFacilities
Sharing Of Paid Employees	1	SharingOfPaidEmployees
Reimbursement Paid To Other Org	1	ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org	0	ReimbursementPaidByOtherOrg
Other Transfer To Other Org	0	OtherTransferToOtherOrg
Other Transfer From Other Org	1	OtherTransferFromOtherOrg