2012-07-12T14:14:44-05:00 2011-08-31 BLUE & CO LLC ONE AMERICAN SQUARE 2200 INDIANAPOLIS IN 46282 990 2010-09-01 351642823 UNION HOSPITAL FOUNDATION INC UNIO 8122387534 1606 NORTH SEVENTH STREET TERRE HAUTE IN 478042780 DONALD SCOTT 8122387534 2012-07-11 1 CARRIE A MERRILL CPA 3176334705 2010 2016-02-24 21:20:13Z DONALD SCOTT 1606 NORTH SEVENTH STREET TERRE HAUTE IN 478042780 2104807 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. 29 25 0 60 0 0 685524 193972 0 0 49414 342772 104310 92858 839248 629602 744323 223396 0 0 347599 339969 1875 0 72172 338981 221106 1432778 784471 -593530 -154869 13669907 11777645 7103922 5622380 6565985 6155265 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 170120 170120 VARIOUS GRANTS TO UNION HOSPITAL, INC. TO FURTHER ITS DELIVERY OF HEALTHCARE SERVICES TO THE WABASH VALLEY. 32279 32279 ACADEMIC SCHOLARSHIP AWARD TO BE APPLIED TO THE TUITION AND RELATED EDUCATION EXPENSES OF NUMEROUS STUDENTS ATTENDING VARIOUS COLLEGES AND UNIVERSITIES. 17152 17152 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. 3845 3845 3845 3845 223396 1 1 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 12 0 1 0 0 0 0 0 0 0 0 0 0 0 X 29 25 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 MARK FUSON 4.00 X X 0 0 0 DONALD SCOTT 1.00 X X 0 0 0 DAVID DOERR 6.00 X 0 296764 20311 DIANN MCKEE 1.00 X X 0 0 0 CINDY MARTIN 1.00 X X 0 0 0 PATRICK BOARD 1.00 X 0 0 0 RICHARD BURGER 1.00 X 0 0 0 MARY ANN CARROLL 1.00 X 0 0 0 JOHN DINKEL 1.00 X 0 0 0 MARY DOTI 1.00 X 0 0 0 JO EINSTANDIG 1.00 X 0 0 0 VERN FELLOWS 1.00 X 0 0 0 MARGOT GILLESPIE 1.00 X 0 0 0 WILLIAM GRIMES 1.00 X 0 0 0 ROBERT HAERR MD 1.00 X 0 0 0 TROY HELMAN 1.00 X 0 0 0 WARD HUBBARD 1.00 X 0 0 0 W EDWARD JUKES 1.00 X 0 0 0 JANET KORZINEK 1.00 X 0 0 0 SALLY LOWERY 1.00 X 0 0 0 JOHN LUKENS 1.00 X 0 0 0 ROBERT MEISSEL MD 1.00 X 0 0 0 BETTY MOONEY 1.00 X 0 0 0 FRED RUBEY 1.00 X 0 0 0 RANDY STEVENS MD 1.00 X 0 185772 21853 DAVID SULLIVAN 1.00 X 0 0 0 DAN TANOOS 1.00 X 0 0 0 SCOTT TEFFETELLER 1.00 X 0 287164 26327 ANN WELCH 1.00 X 0 0 0 JIM BERTOLI 60.00 X 0 115272 22829 0 884972 91320 0 0 1 0 0 193972 193972 114298 114298 44000 29946 14054 14054 14054 1673733 1445259 228474 228474 228474 VENDING INCOME 999999 64573 64573 REMAINDER TRUST CHANGE 999999 13557 13557 RETAIL REVENUE 999999 674 674 78804 629602 0 0 435630 191117 191117 32279 32279 246429 246429 76715 76715 16825 16825 2347 2347 66607 66607 24034 24034 2469 2469 5642 5642 31724 3647 28077 13753 13753 12270 7497 4773 9187 9187 6872 6872 935 935 CATERING 18920 18920 RECOGNITION EXPENSE 8632 8632 CONTRIBUTION EXPENSES 6350 6350 DUES & SUBSCRIPTIONS 3515 3515 LICENSES AND FEES 2 2 7847 1719 6128 784471 223396 488903 72172 334068 658193 3325344 2348834 113887 38266 764814 255536 542287 509278 6147714 5412567 2487363 2077706 719244 732801 13669907 11777645 750462 763840 6296179 4693540 57281 165000 7103922 5622380 X 4096660 3489640 1422889 1524091 1046436 1141534 6565985 6155265 13669907 11777645 X -154869 -255851 X X 0 1 1 X 0 X X 0 0 0 UNION HOSPITAL INC 350876396 3 0 1 1 170120 UNION HOSPITAL HEALTH SERVICES INC 351642805 9 0 1 1 0 VISITING NURSE ASSOCIATION INC 350869064 7 0 1 1 0 3 170120 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 3101660 140376 221707 95730 3368013 2876487 180566 126601 81994 3101660 3260052 141735 -291787 233513 2876487 0.20850 0.33890 0.45250 0 0 51000 45834 96834 339000 237382 191523 384859 91598 64013 27585 509278 2077706 C 2077706 CHARITABLE REMAINDER TRUST 732801 732801 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 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 UNCERTAIN TAX POSITIONS UNDER FIN 48: 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. 1 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 2 0 SCHOLARSHIPS 35 32279 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 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 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 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 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 5: NET UNREALIZED GAINS ON INVESTMENTS: 153,806. SUBSIDIARY EARNINGS -409,657. TOTAL TO FORM 990, PART XI, LINE 5: -255,851. OVERSIGHT OF AUDIT FORM 990, PART XI, 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. 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 UNION HOSPITAL HEALTH SERVICES INC 0 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 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 1 1 0 0 0 1 1 0 0 1