2020-03-09T15:31:37-05:00 2019-06-30 352123203 KSM BUSINESS SERVICES INC PO BOX 40857 INDIANAPOLIS IN 462400857 990 2018-07-01 237328642 UNIVERSITY PEDIATRIC ASSOCIATES INC UNIV 3177776435 6640 INTECH BLVD NO 300 INDIANAPOLIS IN 46278 DR D WADE CLAPP CHAIRMAN OF THE BOARD 3177776435 2020-02-12 1 DONALD R BOEZEMAN P01000722 3175802000 2020-02-12 64.132.79.19 2020-02-12 07:13:33 ES P BBDC66540045C57DF7301DCF6EDAFB3C14A56A71 BBDC66540045C57DF7301DCF6EDAFB3C14A56A71 2018 2020-09-23 17:36:50Z DR D WADE CLAPP 6640 INTECH BLVD SUITE 300 INDIANAPOLIS IN 46278 74284079 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 15 0 0 0 0 66407380 71409271 822974 314081 900000 1120000 68130354 72843352 191324 700000 0 0 25000 20000 0 0 0 65981187 72306226 66197511 73026226 1932843 -182874 20622273 20556780 0 0 20622273 20556780 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 71871761 675000 72501031 VARIOUS CONTRIBUTIONS TO INDIANA UNIVERSITY FOUNDATION AND INDIANA UNIVERSITY SCHOOL OF MEDICINE TO ADVANCE THE STATE OF PEDIATRIC RESEARCH, EDUCATION AND SERVICE 25000 25000 25219 CHARITABLE CONTRIBUTIONS TO VARIOUS MEDICAL INSTITUTIONS 2995 3021 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 71899756 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 57 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 40.00 X X 25000 0 0 DR DAVID A INGRAM JR PRESIDENT 40.00 X X 0 0 0 DR RANDALL L CALDWELL SECRETARY/TREASURER 40.00 X X 0 0 0 DR THOMAS M LOCK BOARD MEMBER 40.00 X 0 0 0 DR DAVID HAINS BOARD MEMBER 40.00 X 0 0 0 DR ERICA A EUGSTER BOARD MEMBER 40.00 X 0 0 0 DR EUGENIA P MOLLESTON BOARD MEMBER 40.00 X 0 0 0 DR JOHN C CHRISTENSON BOARD MEMBER 40.00 X 0 0 0 DR JAMES CHMIEL BOARD MEMBER 40.00 X 0 0 0 DR MARA E NITU BOARD MEMBER 40.00 X 0 0 0 DR KATHLEEN M O'NEILL BOARD MEMBER 40.00 X 0 0 0 DR STEPHEN M DOWNS BOARD MEMBER 40.00 X 0 0 0 DR J DENNIS FORTENBERRY BOARD MEMBER 40.00 X 0 0 0 DR JAMIE L RENBARGER BORAD MEMBER 40.00 X 0 0 0 DR JAMES A LEMONS EMERITUS BOARD MEMBER 40.00 X 0 0 0 DR RICHARD L SCHREINER EMERITUS BOARD MEMBER 40.00 X 0 0 0 25000 0 0 0 0 0 0 HELEN BRODY 6640 INTECH BLVD STE 300 INDIANAPOLIS IN 46278 ADMINISTRATION 258995 1 PATIENT SERVICES 621110 71409271 71409271 71409271 535127 535127 1219681 1440727 -221046 -221046 -221046 INVESTMENT IN ROC SURGERY CENTER 621400 1120000 1120000 1120000 72843352 72529271 0 314081 700000 700000 20000 20000 3453 3453 6835 6835 717303 2995 714308 146337 146337 7804 7804 PHYSICIAN SERVICES 71196761 71196761 MISCELLANEOUS 149704 149704 MALPRACTICE INSURANCE 41716 41716 BANK & SETTLEMENT FEES 36313 36313 73026226 71899756 1126470 0 7806322 7417842 12540951 12863938 275000 275000 20622273 20556780 0 0 X 20622273 20556780 20622273 20556780 20622273 20556780 -182874 117381 0 X 0 0 0 X 1186027 1186027 75007410 62497669 63035169 66407380 71409271 338356899 76193437 62497669 63035169 66407380 71409271 339542926 0 0 0 339542926 406459 485743 349561 536824 535127 2313714 406459 485743 349561 536824 535127 2313714 1141628 790000 750000 900000 1120000 4701628 77741524 63773412 64134730 67844204 73064398 346558268 0.97980 0.98150 0.00670 0.00620 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: ROC SURGERY CENTER K-1 INCOME - 2014 AMOUNT: $ 720,000. 2015 AMOUNT: $ 790,000. 2016 AMOUNT: $ 750,000. 2017 AMOUNT: $ 900,000. 2018 AMOUNT: $ 1,120,000. OTHER REVENUE - 2014 AMOUNT: $ 421,628. 1 INDIANA UNIV FOUNDATION S STATE ROAD 46 BLOOMINGTON IN 47401 356018940 501(C)(3) 675000 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. 1 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 1120000 275000 0 0 0.12350 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0