2017-02-03T06:54:59-06:00 2016-06-30 352123203 KSM BUSINESS SERVICES INC PO BOX 40857 INDIANAPOLIS IN 462400857 990 2015-07-01 237328642 UNIVERSITY PEDIATRIC ASSOCIATES INC UNIV 3177776435 6640 INTECH BOULEVARD NO 300 INDIANAPOLIS IN 46278 DR D WADE CLAPP CHAIRMAN OF THE BOARD 3177776435 2017-01-24 1 DONALD R BOEZEMAN P01000722 3175802000 2017-01-24 2015 2021-01-29 14:40:06Z DR D WADE CLAPP 6640 INTECH BOULEVARD SUITE 300 INDIANAPOLIS IN 46278 82815388 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. 16 16 170 0 0 0 1186027 0 73865782 62497669 236100 1100770 1141628 790000 76429537 64388439 16857427 136991 0 0 9793449 1660330 0 0 0 48282490 63072898 74933366 64870219 1496171 -481780 24513771 22615823 0 0 24513771 22615823 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 61273538 98000 62501643 VARIOUS CONTRIBUTIONS TO INDIANA UNIVERSITY FOUNDATION AND INDIANA UNIVERSITY SCHOOL OF MEDICINE 38991 38991 39772 CHARITABLE CONTRIBUTIONS TO VARIOUS MEDICAL INSTITUTIONS 7745 7900 THE ORGANIZATION PROVIDES ADMINISTRATIVE AND COLLECTION SERVICES FOR INDIANA UNIVERSITY FACULTY AND PHYSICIANS 723845 738354 PHYSICIAN CONTRACTS FOR RESEARCH, EDUCATION, AND PATIENT CARE 723845 738354 62044119 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 17 0 1 170 1 0 0 0 0 0 0 0 0 0 0 X 16 16 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 BOULEVARD SUITE 300 INDIANAPOLIS IN 46278 DR D WADE CLAPP CHAIRMAN OF THE BOARD 40.00 X X 87250 0 7947 DR DAVID A INGRAM JR PRESIDENT 40.00 X X 75000 0 7500 DR RANDALL L CALDWELL SECRETARY/TREASURER 40.00 X X 0 0 0 DR SHARON P ANDREOLI BOARD MEMBER 40.00 X 0 0 0 DR JOHN C CHRISTENSON BOARD MEMBER 40.00 X 0 0 0 DR STEPHANIE DAVIS BOARD MEMBER 40.00 X 0 0 0 DR STEPHEN M DOWNS BOARD MEMBER 40.00 X 0 0 0 DR ERICA A EUGSTER BOARD MEMBER 40.00 X 0 0 0 JAMIE L RENBARGER BOARD MEMBER 40.00 X 0 0 0 J DENNIS FORTENBERRY BOARD MEMBER 40.00 X 0 0 0 THOMAS M LOCK BOARD MEMBER 40.00 X 10927 0 0 DR EUGENIA P MOLLESTON BOARD MEMBER 40.00 X 0 0 0 DR MARA NITU BOARD MEMBER 40.00 X 0 0 0 DR KATHLEEN O'NEILL BOARD 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 ANDREAS DEYMANN PHYSICIAN 40.00 X 131250 0 4375 KENNETH HERRMANN PHYSICIAN 40.00 X 183272 0 2618 NADINE LEE PHYSICIAN 40.00 X 153868 0 0 SUSAN QUIGLEY PHYSICIAN 40.00 X 122500 0 1750 764067 0 24190 4 1 1 0 HELEN P BRODY 6640 INTECH BLVD SUITE 300 INDIANAPOLIS IN 46278 ADMINISTRATION 209333 CHARLES JOSEPH DIETZEN MD PSC 6640 INTECH BLVD SUITE 300 INDIANAPOLIS IN 46278 PATIENT CARE SERVICES 139350 2 PATIENT SERVICES 621110 62497669 62497669 62497669 485743 485743 19041976 18426949 615027 615027 615027 ROC SURGERY CENTER K-1 621400 790000 790000 790000 64388439 63287669 0 1100770 136991 136991 162250 162250 162747 162747 1335333 1335333 29248 29248 53980 53980 566145 7745 558400 104091 104091 9899 9899 PHYSICIAN SERVICES 61175538 61175538 PHYSICIAN CONTRACTS 723845 723845 MISCELLANEOUS 263325 263325 LOSS ON JOINT VENTURE 77475 77475 69352 69352 64870219 62044119 2826100 0 7244132 12276723 16899061 10064100 370578 275000 24513771 22615823 0 0 X 24513771 22615823 24513771 22615823 24513771 22615823 -481780 -1416168 0 X X 0 1 X 1 0 X 2422306 2346861 2217283 1186027 0 8172477 2422306 2346861 2217283 1186027 8172477 8172477 803349 476094 471442 406459 485743 2643087 366062 465596 867651 1141628 790000 3630937 14446501 370661132 0.56570 0.62620 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: OTHER REVENUE - 2011 AMOUNT: $ 366,062. 2012 AMOUNT: $ 465,596. 2013 AMOUNT: $ 867,651. 2014 AMOUNT: $ 1,141,628. 2015 AMOUNT: $ 790,000. 0 X 62894796 -1416168 -77475 -1493643 64388439 0 64388439 64792744 -77475 -77475 64870219 0 64870219 PART X, LINE 2: UPA IS EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THEREFORE, NO PROVISION OR LIABILITY FOR INCOME TAXES HAS BEEN INCLUDED IN THE FINANCIAL STATEMENTS. IN ADDITION, UPA HAS BEEN DETERMINED BY THE INTERNAL REVENUE SERVICE NOT TO BE A PRIVATE FOUNDATION WITHIN THE MEANING OF SECTION 509(A) OF THE INTERNAL REVENUE CODE. THERE WAS NO UNRELATED BUSINESS INCOME FOR THE YEARS ENDED JUNE 30, 2016 AND 2015. UPA FILES U.S. FEDERAL AND STATE OF INDIANA INFORMATION RETURNS. UPA IS NO LONGER SUBJECT TO U.S. FEDERAL AND STATE OF INDIANA TAX EXAMINATIONS BY TAX AUTHORITIES FOR FISCAL YEARS BEFORE 2013. PART XI, LINE 2D - OTHER ADJUSTMENTS: LOSS FROM JOINT VENTURE -77,475. PART XII, LINE 2D - OTHER ADJUSTMENTS: LOSS FROM JOINT VENTURE -77,475. 1 INDIANA UNIV FOUNDATION S STATE ROAD 46 BLOOMINGTON IN 47401 356018940 501(C)(3) 123141 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. 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. 4 PART I, LINE 2: TERESA HUTCHISON RECEIVES REQUESTS FROM PEDIATRIC DEPARTMENTS TO SET UP PURCHASE ORDERS FOR PHYSICIANS UPA SALARIES ON FEDERAL AND NON-FEDERAL GRANTS. TERESA HUTCHISON THEN REQUESTS PURCHASE ORDERS WITH APPROVAL GOING THROUGH THE REQUESTING DEPARTMENT. ONCE APPROVAL OF THE PURCHASE ORDER IS RECEIVED, TERESA 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 TERESA CANNOT EXCEED THE AMOUNT OF THE INITIAL PURCHASE ORDER. X X X X 0 0 0 0 0 0 0 0 0 ANDREAS DEYMANN PHYSICIAN 131250 0 0 0 0 0 0 0 4375 0 135625 0 0 0 KENNETH HERRMANN PHYSICIAN 183272 0 0 0 0 0 0 0 2618 0 185890 0 0 0 NADINE LEE PHYSICIAN 153868 0 0 0 0 0 0 0 0 0 153868 0 0 0 SUSAN QUIGLEY PHYSICIAN 122500 0 0 0 0 0 0 0 1750 0 124250 0 0 0 SCHEDULE J, PART III: COMPENSATION RELATES TO MEDICAL SERVICES PROVIDED, NOT AS COMPENSATION FOR SERVING ON THE BOARD. FORM 990, PART VI, SECTION B, LINE 11 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 FROM 990, PART XII, LINE 2C: THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. ROC SURGERY LLC 340 WEST 10TH STREET INDIANAPOLIS IN 46202 271497960 AMBULATORY SURGERY CENTER PERFORMING ONLY OUTPATIENT PROCEDURES IN RELATED 790000 275000 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0