2019-04-23T14:36:32-05:00 2018-06-30 352123203 KSM BUSINESS SERVICES INC PO BOX 40857 INDIANAPOLIS IN 462400857 990 2017-07-01 237328642 UNIVERSITY PEDIATRIC ASSOCIATES INC UNIV 3177776435 6640 INTECH BLVD NO 300 INDIANAPOLIS IN 46278 DR D WADE CLAPP CHAIRMAN OF THE BOARD 3177776435 2019-02-14 1 DONALD R BOEZEMAN P01000722 3175802000 2019-02-14 64.132.79.19 2019-02-14 08:50:31 ES P BBDC66540045C57DF7301DCF6EDAFB3C14A56A71 6E5B2F373A5FE26123368FD6809FEC2FE3CBA098 2017 2019-02-21 02:37:17Z DR D WADE CLAPP 6640 INTECH BLVD SUITE 300 INDIANAPOLIS IN 46278 68971447 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 63035169 66407380 420665 822974 750000 900000 64205834 68130354 5323591 191324 0 0 165439 25000 0 0 0 63776042 65981187 69265072 66197511 -5059238 1932843 18295906 20622273 0 0 18295906 20622273 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 64939831 150000 67261583 VARIOUS CONTRIBUTIONS TO INDIANA UNIVERSITY FOUNDATION AND INDIANA UNIVERSITY SCHOOL OF MEDICINE 41324 41324 42802 CHARITABLE CONTRIBUTIONS TO VARIOUS MEDICAL INSTITUTIONS 2892 2995 THE ORGANIZATION PROVIDES ADMINISTRATIVE AND COLLECTION SERVICES FOR INDIANA UNIVERSITY FACULTY AND PHYSICIANS PHYSICIAN CONTRACTS FOR RESEARCH, EDUCATION, AND PATIENT CARE 64984047 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 34 0 1 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 45000 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 SHARON P ANDREOLI 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 STEPHANIE D DAVIS 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 45000 0 0 0 0 0 0 HELEN BRODY 6640 INTECH BLVD STE 300 INDIANAPOLIS IN 46278 ADMINISTRATION 243497 1 PATIENT SERVICES 621110 66407380 66407380 66407380 536824 536824 1127243 841093 286150 286150 286150 ROC SURGERY CENTER K-1 621400 900000 900000 900000 68130354 67307380 0 822974 191324 191324 25000 25000 8982 8982 9660 9660 762123 2892 759231 135064 135064 19273 19273 PHYSICIAN SERVICES 64789831 64789831 MISCELLANEOUS 190719 190719 BANK & SETTLEMENT FEES 34735 34735 MALPRACTICE INSURANCE 30800 30800 66197511 64984047 1213464 0 6616771 7806322 11404135 12540951 275000 275000 18295906 20622273 0 0 X 18295906 20622273 18295906 20622273 18295906 20622273 1932843 393524 0 X 0 0 0 X 2217283 1186027 0 0 0 3403310 85390417 75007410 62497669 63035169 66407380 352338045 87607700 76193437 62497669 63035169 66407380 355741355 0 0 0 355741355 471442 406459 485743 349561 536824 2250029 471442 406459 485743 349561 536824 2250029 867651 1141628 790000 750000 900000 4449279 88946793 77741524 63773412 64134730 67844204 362440663 0.98150 0.98350 0.00620 0.00580 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: ROC SURGERY CENTER K-1 INCOME - 2013 AMOUNT: $ 710,000. 2014 AMOUNT: $ 720,000. 2015 AMOUNT: $ 790,000. 2016 AMOUNT: $ 750,000. 2017 AMOUNT: $ 900,000. OTHER INCOME - 2013 AMOUNT: $ 157,651. 2014 AMOUNT: $ 421,628. 1 INDIANA UNIV FOUNDATION S STATE ROAD 46 BLOOMINGTON IN 47401 356018940 501(C)(3) 150000 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 DIRECTOR'S 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 900000 275000 0 0 0.12350 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0