2021-05-10T15:50:53-05:00 2020-06-30 352123203 KSM BUSINESS SERVICES INC PO BOX 40857 INDIANAPOLIS IN 46240 990 2019-07-01 237328642 UNIVERSITY PEDIATRIC ASSOCIATES INC UNIV 3177776435 6640 INTECH BLVD NO 300 INDIANAPOLIS IN 46278 DR D WADE CLAPP CHAIRMAN OF THE BOARD 3177776435 2021-05-05 1 DONALD R BOEZEMAN P01000722 3175802000 2021-05-05 2019 2022-09-23 18:48:47Z DR D WADE CLAPP 6640 INTECH BLVD NO 300 INDIANAPOLIS IN 46278 84291649 0 X N/A X 1973 IN THE ORGANIZATION'S PRIMARY EXEMPT PURPOSE IS TO ENGAGE ACTIVELY AND CONTINUOUSLY IN MEDICAL RESEARCH AND TO PROVIDE MEDICAL EDUCATION AND MEDICAL RESEARCH IN CONJUNCTION WITH SERVING AS AN AUXILIARY TO THE OPERATION OF THE DEPARTMENT OF PEDIATRICS OF INDIANA UNIVERSITY SCHOOL OF MEDICINE AND ITS HOSPITALS. 14 14 0 14 0 0 0 0 71409271 81046969 314081 666764 1120000 0 72843352 81713733 700000 875000 0 0 20000 0 0 0 0 72306226 79950159 73026226 80825159 -182874 888574 20556780 21213297 0 0 20556780 21213297 X THE ORGANIZATION'S PRIMARY EXEMPT PURPOSE IS TO ENGAGE ACTIVELY AND CONTINUOUSLY IN MEDICAL RESEARCH AND TO PROVIDE MEDICAL EDUCATION AND MEDICAL RESEARCH IN CONJUNCTION WITH SERVING AS AN AUXILIARY TO THE OPERATION OF THE DEPARTMENT OF PEDIATRICS OF INDIANA UNIVERSITY SCHOOL OF MEDICINE AND ITS HOSPITALS. 0 0 79122700 125000 80284234 VARIOUS CONTRIBUTIONS TO INDIANA UNIVERSITY FOUNDATION AND INDIANA UNIVERSITY SCHOOL OF MEDICINE TO ADVANCE THE STATE OF PEDIATRIC RESEARCH, EDUCATION AND SERVICE 750000 750000 761010 CHARITABLE CONTRIBUTIONS TO VARIOUS MEDICAL INSTITUTIONS 1700 1725 THE ORGANIZATION PROVIDES ADMINISTRATIVE AND COLLECTION SERVICES FOR INDIANA UNIVERSITY FACULTY AND PHYSICIANS SERVE THE PUBLIC GOOD BY ENSURING CHILDREN HAVE ACCESS TO EXCEPTIONAL HEALTHCARE 79874400 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 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 0 0 1 0 0 0 1 35 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 X 14 14 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 0 1 1 0 1 1 IN X TERESA HUTCHISON 3177776435 6640 INTECH BLVD SUITE 300 INDIANAPOLIS IN 46278 DR D WADE CLAPP CHAIRMAN OF THE BOARD 2.00 X X 20000 0 0 DR DAVID A INGRAM JR PRESIDENT 2.00 X X 0 0 0 DR RANDALL L CALDWELL SECRETARY/TREASURER 2.00 X X 0 0 0 DR THOMAS M LOCK BOARD MEMBER 2.00 X 0 0 0 DR DAVID HAINS BOARD MEMBER 2.00 X 0 0 0 DR ERICA A EUGSTER BOARD MEMBER 2.00 X 0 0 0 DR EUGENIA P MOLLESTON BOARD MEMBER 2.00 X 0 0 0 DR JOHN C CHRISTENSON BOARD MEMBER 2.00 X 0 0 0 DR JAMES CHMIEL BOARD MEMBER 2.00 X 0 0 0 DR MARA E NITU BOARD MEMBER 2.00 X 0 0 0 DR KATHLEEN M O'NEILL BOARD MEMBER 2.00 X 0 0 0 DR STEPHEN M DOWNS BOARD MEMBER 2.00 X 0 0 0 DR J DENNIS FORTENBERRY BOARD MEMBER 2.00 X 0 0 0 DR JAMIE L RENBARGER BOARD MEMBER 2.00 X 0 0 0 20000 0 0 0 0 0 0 HELEN BRODY 6640 INTECH BLVD STE 300 INDIANAPOLIS IN 46278 ADMINISTRATION 266146 1 PATIENT SERVICES 621110 79956969 79956969 SURGICAL CENTER INCOME 621400 1090000 1090000 81046969 461023 461023 2783657 2577916 205741 205741 205741 81713733 81046969 0 666764 875000 875000 975 975 9150 9150 32406 32406 650402 1700 648702 147815 147815 7804 7804 PHYSICIAN SERVICES 78997700 78997700 MALPRACTICE INSURANCE 40396 40396 BANK AND SETTLEMENT FEE 31865 31865 HOSPITALITY 31646 31646 80825159 79874400 950759 0 7417842 7737750 12863938 13200547 275000 275000 20556780 21213297 0 0 X 20556780 21213297 20556780 21213297 20556780 21213297 888574 -232057 0 X 0 0 0 X 62497669 63035169 66407380 71409271 79956969 343306458 62497669 63035169 66407380 71409271 79956969 343306458 0 0 0 343306458 485743 349561 536824 535127 461024 2368279 485743 349561 536824 535127 461024 2368279 790000 750000 900000 1120000 1090000 4650000 63773412 64134730 67844204 73064398 81507993 350324737 0.98000 0.97980 0.00680 0.00670 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: ROC SURGERY CENTER K-1 INCOME - 2015 AMOUNT: $ 790,000. 2016 AMOUNT: $ 750,000. 2017 AMOUNT: $ 900,000. 2018 AMOUNT: $ 1,120,000. 2019 AMOUNT: $ 1,090,000. 1 INDIANA UNIV FOUNDATION S STATE ROAD 46 BLOOMINGTON IN 47401 356018940 501(C)(3) 125000 TO PROVIDE MEDICAL EDUCATION AND MEDICAL RESEARCH IN CONJUNCTION WITH SERVING AS AN AUXILIARY TO THE OPERATION OF THE DEPARTMENT OF PEDIATRICS OF INDIANA UNIVERSITY SCHOOL OF MEDICINE AND ITS HOSPITALS. RILEY CHILDREN'S FOUNDATION 30 S MERIDIAN ST INDIANAPOLIS IN 46204 350868147 501(C)(3) 750000 TO SUPPORT THE MISSION OF THE ORGANIZATION BY FUNDING PEDIATRIC RESEARCH, EDUCATION AND CARE 2 2 PART I, LINE 2: THE ORGANIZATION RECEIVES REQUESTS FROM PEDIATRIC DEPARTMENTS TO SET UP PURCHASE ORDERS FOR PHYSICIANS' UPA SALARIES ON FEDERAL AND NON-FEDERAL GRANTS. THE ORGANIZATION THEN REQUESTS PURCHASE ORDERS WITH APPROVAL GOING THROUGH THE REQUESTING DEPARTMENT. ONCE APPROVAL OF THE PURCHASE ORDER IS RECEIVED, UPA BILLS BASED ON THE IU SALARY PERCENTAGE CHARGED TO THE ACCOUNT. THE REQUESTING DEPARTMENT MONITORS THE OVERALL SPENDING OF THE GRANT ACCOUNTS. THE BILLING OF THE SALARY BY UPA CANNOT EXCEED THE AMOUNT OF THE INITIAL PURCHASE ORDER. FORM 990, PART VI, SECTION B, LINE 11B FORM 990, WHICH IS PREPARED BY A CPA FIRM, IS REVIEWED IN DETAIL BY THE ORGANIZATION'S BUSINESS MANAGER, ADMINISTRATOR AND OTHER ACCOUNTING PERSONNEL. IN ADDITION, FORM 990 IS PRESENTED TO THE BOARD OF DIRECTORS FOR REVIEW AND APPROVAL. FORM 990, PART VI, SECTION B, LINE 12C UPA BOARD REVIEWS AND MONITORS ALL COMPLIANCE IN ACCORDANCE WITH UPA'S CONFLICT OF INTEREST POLICY. FORM 990, PART VI, SECTION B, LINE 15A UPA BOARD WILL VOTE AND DETERMINE THE COMPENSATION BASED ON EXTERNAL AND INTERNAL FACTORS. FORM 990, PART VI, SECTION C, LINE 18 AVAILABLE UPON REQUEST. FORM 990, PART VI, SECTION C, LINE 19 AVAILABLE UPON REQUEST ROC SURGERY LLC 340 WEST 10TH STREET INDIANAPOLIS IN 46202 271497960 AMBULATORY SURGERY CENTER PERFORMING ONLY OUTPATIENT PROCEDURES IN N/A RELATED 1090000 275000 0 0 0.12350 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0