UNIVERSITY PEDIATRIC ASSOCIATES INC: Form 990, tax year 2014
View the entire original 990 at ProPublica ↗
- Organization
- UNIVERSITY PEDIATRIC ASSOCIATES INC (EIN 23-7328642)
- Tax period
- 2014-07-01 to 2015-06-30
- Filed
- 2016-02-08
- IRS object ID
- 201610399349300721
- Schema version
- 2014v6.0
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2016-02-08T10:13:17-06:00 | ReturnTs |
| Tax Period End | 2015-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 352123203 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | KSM BUSINESS SERVICES INC | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 40857 | AddressLine1Txt |
| City | INDIANAPOLIS | CityNm |
| State Abbreviation | IN | StateAbbreviationCd |
| ZIP | 462400857 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2014-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 237328642 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | UNIVERSITY PEDIATRIC ASSOCIATES INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | UNIV | BusinessNameControlTxt |
| Phone | 3177776435 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 6640 INTECH BOULEVARD NO 300 | AddressLine1Txt |
| City | INDIANAPOLIS | CityNm |
| State Abbreviation | IN | StateAbbreviationCd |
| ZIP | 46278 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | DR D WADE CLAPP | PersonNm |
| Person Title | CHAIRMAN OF THE BOARD | PersonTitleTxt |
| Phone | 3172741201 | PhoneNum |
| Signature | 2016-01-22 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | TERENCE M O'NEIL | PreparerPersonNm |
| PTIN | P00737156 | PTIN |
| Phone | 3175802000 | PhoneNum |
| Preparation | 2016-01-22 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2014 | TaxYr |
| Build TS | 2016-04-25 22:37:26Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Change | Yes (X) | AddressChangeInd |
| Principal Officer | DR D WADE CLAPP | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 6640 INTECH BOULEVARD SUITE 300 | AddressLine1Txt |
| City | INDIANAPOLIS | CityNm |
| State Abbreviation | IN | StateAbbreviationCd |
| ZIP | 46278 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $84,815,923 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | N/A | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1973 | FormationYr |
| Legal Domicile State | IN | LegalDomicileStateCd |
| Activity Or Mission | 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. | ActivityOrMissionDesc |
| Voting Members Governing Body | 18 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 18 | VotingMembersIndependentCnt |
| Total Employee | 416 | TotalEmployeeCnt |
| Total Volunteers | 0 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $2,217,283 | PYContributionsGrantsAmt |
| CY Contributions Grants | $1,186,027 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $84,522,766 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $73,865,782 | CYProgramServiceRevenueAmt |
| PY Investment Income | $1,497,486 | PYInvestmentIncomeAmt |
| CY Investment Income | $236,100 | CYInvestmentIncomeAmt |
| PY Other Revenue | $867,651 | PYOtherRevenueAmt |
| CY Other Revenue | $1,141,628 | CYOtherRevenueAmt |
| PY Total Revenue | $89,105,186 | PYTotalRevenueAmt |
| CY Total Revenue | $76,429,537 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $34,200,947 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $16,857,427 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $13,205,658 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $9,793,449 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $42,273,524 | PYOtherExpensesAmt |
| CY Other Expenses | $48,282,490 | CYOtherExpensesAmt |
| PY Total Expenses | $89,680,129 | PYTotalExpensesAmt |
| CY Total Expenses | $74,933,366 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$574,943 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $1,496,171 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $23,562,621 | TotalAssetsBOYAmt |
| Total Assets EOY | $24,513,771 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $0 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $0 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $23,562,621 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $24,513,771 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | 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. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $43,568,110 | ExpenseAmt |
| Grant | $16,792,586 | GrantAmt |
| Revenue | $53,346,947 | RevenueAmt |
| Desc | VARIOUS CONTRIBUTIONS TO INDIANA UNIVERSITY FOUNDATION AND INDIANA UNIVERSITY SCHOOL OF MEDICINE | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $64,841 | ExpenseAmt |
| Grant | $64,841 | GrantAmt |
| Revenue | $79,395 | RevenueAmt |
| Desc | CHARITABLE CONTRIBUTIONS TO VARIOUS MEDICAL INSTITUTIONS | Desc |
Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $47,021 | ExpenseAmt |
| Revenue | $57,575 | RevenueAmt |
| Desc | THE ORGANIZATION PROVIDES ADMINISTRATIVE AND COLLECTION SERVICES FOR INDIANA UNIVERSITY FACULTY AND PHYSICIANS | Desc |
Prog Srvc Accom Acty Other ProgSrvcAccomActyOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $17,578,100 | ExpenseAmt |
| Revenue | $21,523,493 | RevenueAmt |
| Desc | PHYSICIAN CONTRACTS FOR RESEARCH, EDUCATION, AND PATIENT CARE | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Prog Srvc Expense | $17,578,100 | TotalOtherProgSrvcExpenseAmt |
| Total Other Prog Srvc Revenue | $21,523,493 | TotalOtherProgSrvcRevenueAmt |
| Total Program Service Expenses | $61,258,072 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | 0 | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Temp Or Permanent Endowments | 0 | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | 0 | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | 0 | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (1) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | 0 | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | Yes (1) | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 15 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 416 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 18 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 18 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | 0 | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | Yes (1) | InvestmentInJointVentureInd |
| Written Policy Or Procedure | Yes (1) | WrittenPolicyOrProcedureInd |
| States Where Copy Of Return Is Fld | IN | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | TERESA HUTCHISON | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 3177776435 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 6640 INTECH BOULEVARD SUITE 300 | AddressLine1Txt |
| City | INDIANAPOLIS | CityNm |
| State Abbreviation | IN | StateAbbreviationCd |
| ZIP | 46278 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (22 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|
| DR RANDALL L CALDWELL | |||||||
| SECRETARY/TREASURER | 40.00 | Yes (X) | Yes (X) | $222,489 | $0 | $0 | |
| DR D WADE CLAPP | |||||||
| CHAIRMAN OF THE BOARD | 40.00 | Yes (X) | Yes (X) | $210,897 | $0 | $0 | |
| THOMAS M LOCK | |||||||
| BOARD MEMBER | 40.00 | Yes (X) | $142,328 | $0 | $8,000 | ||
| DR ROBERT J FALLON | |||||||
| BOARD MEMBER | 40.00 | Yes (X) | $174,449 | $0 | $6,500 | ||
| DR SHARON P ANDREOLI | |||||||
| BOARD MEMBER | 40.00 | Yes (X) | $93,609 | $0 | $0 | ||
| DR ERICA A EUGSTER | |||||||
| BOARD MEMBER | 40.00 | Yes (X) | $127,809 | $0 | $4,920 | ||
| DR DAVID A INGRAM JR | |||||||
| PRESIDENT | 40.00 | Yes (X) | Yes (X) | $329,851 | $0 | $8,000 | |
| DR EUGENIA P MOLLESTON | |||||||
| BOARD MEMBER | 40.00 | Yes (X) | $247,932 | $0 | $4,920 | ||
| DR JOHN C CHRISTENSON | |||||||
| BOARD MEMBER | 40.00 | Yes (X) | $154,631 | $0 | $8,000 | ||
| DR STEPHANIE DAVIS | |||||||
| BOARD MEMBER | 40.00 | Yes (X) | $175,567 | $0 | $8,000 | ||
| DR HOWARD EIGEN | |||||||
| BOARD MEMBER | 40.00 | Yes (X) | $189,583 | $0 | $15,000 | ||
| DR ABIGAIL F KLEMSZ | |||||||
| BOARD MEMBER | 40.00 | Yes (X) | $204,983 | $0 | $9,000 | ||
| DR MARA NITU | |||||||
| BOARD MEMBER | 40.00 | Yes (X) | $303,500 | $0 | $9,000 | ||
| DR KATHLEEN O'NEILL | |||||||
| BOARD MEMBER | 40.00 | Yes (X) | $178,475 | $0 | $8,000 | ||
| DR STEPHEN M DOWNS | |||||||
| BOARD MEMBER | 40.00 | Yes (X) | $143,583 | $0 | $8,083 | ||
| DR VAUGHN I RICKERT | |||||||
| BOARD MEMBER | 40.00 | Yes (X) | $114,599 | $0 | $8,000 | ||
| DR JAMES A LEMONS | |||||||
| EMERITUS BOARD MEMBER | 40.00 | Yes (X) | $186,051 | $0 | $0 | ||
| DR RICHARD L SCHREINER | |||||||
| EMERITUS BOARD MEMBER | 40.00 | Yes (X) | $82,994 | $0 | $0 | ||
| KENNETH HERRMANN | |||||||
| PHYSICIAN | 40.00 | $314,180 | $0 | $9,000 | Yes (X) | ||
| SUSAN QUIGLEY | |||||||
| PHYSICIAN | 40.00 | $147,500 | $0 | $4,250 | Yes (X) | ||
| DR DAVID HERTZ | |||||||
| PHYSICIAN | 40.00 | $328,268 | $0 | $6,360 | Yes (X) | ||
| ANDREAS DEYMANN | |||||||
| PHYSICIAN | 40.00 | $181,000 | $0 | $9,000 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $4,254,278 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $134,033 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 148 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp
Contractor Name ContractorName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | CHARLES JOSEPH DIETZEN MD PSC | PersonNm |
Contractor Address ContractorAddress
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 550 N MERIDIAN ST SUITE 228 | AddressLine1Txt |
| City | INDIANAPOLIS | CityNm |
| State Abbreviation | IN | StateAbbreviationCd |
| ZIP | 46204 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Services | PATIENT CARE SERVICES | ServicesDesc |
| Compensation | $126,450 | CompensationAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 1 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $1,186,027 | GovernmentGrantsAmt |
| Total Contributions | $1,186,027 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | PATIENT SERVICES | Desc |
| Business | 621110 | BusinessCd |
| Total Revenue Column | $73,865,782 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $73,865,782 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $73,865,782 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $406,459 | TotalRevenueColumnAmt |
| Exclusion | $406,459 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $7,231,297 | SecuritiesAmt |
| Other | $984,730 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $6,639,131 | SecuritiesAmt |
| Other | $1,747,255 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $592,166 | SecuritiesAmt |
| Other | -$762,525 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$170,359 | TotalRevenueColumnAmt |
| Exclusion | -$170,359 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| ROC SURGERY CENTER K-1 | 621400 | $720,000 | $720,000 |
| MALPRACTICE INSURANCE REFUND | 621400 | $421,628 | $421,628 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $1,141,628 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $76,429,537 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $75,007,410 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $236,100 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $16,857,427 | TotalAmt |
| Program Services | $16,857,427 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,854,715 | TotalAmt |
| Management And General | $2,854,715 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,053,074 | TotalAmt |
| Management And General | $5,053,074 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,885,660 | TotalAmt |
| Management And General | $1,885,660 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $16,336 | TotalAmt |
| Management And General | $16,336 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $31,805 | TotalAmt |
| Management And General | $31,805 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $866,645 | TotalAmt |
| Program Services | $148,663 | ProgramServicesAmt |
| Management And General | $717,982 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $542,726 | TotalAmt |
| Management And General | $542,726 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,145,091 | TotalAmt |
| Management And General | $1,145,091 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $98,706 | TotalAmt |
| Management And General | $98,706 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| PHYSICIAN SERVICES | $26,775,524 | $26,775,524 | |
| PHYSICIAN CONTRACTS | $17,476,458 | $17,476,458 | |
| OUTSIDE SERVICE EXPENSE | $1,158,085 | $1,158,085 | |
| MISCELLANEOUS | $113,857 | $113,857 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $57,257 | TotalAmt |
| Management And General | $57,257 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $74,933,366 | TotalAmt |
| Program Services | $61,258,072 | ProgramServicesAmt |
| Management And General | $13,675,294 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,757,414 | BOYAmt |
| EOY | $7,244,132 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $0 | LandBldgEquipCostOrOtherBssAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,845,961 | BOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $16,588,668 | BOYAmt |
| EOY | $16,899,061 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $370,578 | BOYAmt |
| EOY | $370,578 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $23,562,621 | BOYAmt |
| EOY | $24,513,771 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $23,562,621 | BOYAmt |
| EOY | $24,513,771 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $23,562,621 | BOYAmt |
| EOY | $24,513,771 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $23,562,621 | BOYAmt |
| EOY | $24,513,771 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $1,496,171 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | -$545,021 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| Method Of Accounting Cash | Yes (X) | MethodOfAccountingCashInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | Yes (1) | FederalGrantAuditRequiredInd |
| Federal Grant Audit Performed | Yes (1) | FederalGrantAuditPerformedInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Organization170 | Yes (X) | PublicOrganization170Ind |
Gifts Grants Contri Rcvd170 GiftsGrantsContriRcvd170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $1,749,541 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $2,422,306 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $2,346,861 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $2,217,283 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $1,186,027 | CurrentTaxYearAmt |
| Total | $9,922,018 | TotalAmt |
Total Calendar Year170 TotalCalendarYear170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $1,749,541 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $2,422,306 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $2,346,861 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $2,217,283 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $1,186,027 | CurrentTaxYearAmt |
| Total | $9,922,018 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total170 | $9,922,018 | PublicSupportTotal170Amt |
Gross Investment Income170 GrossInvestmentIncome170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $924,962 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $803,349 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $476,094 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $471,442 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $406,459 | CurrentTaxYearAmt |
| Total | $3,082,306 | TotalAmt |
Other Income170 OtherIncome170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus3 Years | $366,062 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $465,596 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $867,651 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $1,141,628 | CurrentTaxYearAmt |
| Total | $2,840,937 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Support | $15,845,261 | TotalSupportAmt |
| Gross Receipts Rltd Activities | $374,714,805 | GrossReceiptsRltdActivitiesAmt |
| Public Support CY170 | 0.62620 | PublicSupportCY170Pct |
| Public Support PY170 | 0.70850 | PublicSupportPY170Pct |
| Thirty Thr Pct Suprt Tests CY170 | Yes (X) | ThirtyThrPctSuprtTestsCY170Ind |
Form990 Schedule A Part VI Form990ScheduleAPartVIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: | FormAndLineReferenceDesc |
| Explanation | OTHER REVENUE - 2011 AMOUNT: $ 366,062. 2012 AMOUNT: $ 465,596. 2013 AMOUNT: $ 867,651. 2014 AMOUNT: $ 1,141,628. | ExplanationTxt |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $0 | TotalBookValueLandBuildingsAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $75,462,888 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | -$545,021 | NetUnrealizedGainsInvstAmt |
| Revenue Not Reported | -$545,021 | RevenueNotReportedAmt |
| Revenue Subtotal | $76,007,909 | RevenueSubtotalAmt |
| Other Revenues Not Included | $421,628 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | $421,628 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $76,429,537 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $74,511,738 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Not Reported | $0 | ExpensesNotReportedAmt |
| Expenses Subtotal | $74,511,738 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $421,628 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $421,628 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $74,933,366 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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, 2015 AND 2014. 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 2012. |
| PART XI, LINE 4B - OTHER ADJUSTMENTS: | MALPRACTICE INSURANCE REFUND 421,628. |
| PART XII, LINE 4B - OTHER ADJUSTMENTS: | MALPRACTICE INSURANCE REFUND 421,628. |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (1) | GrantRecordsMaintainedInd |
Recipient Table RecipientTable (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | Recipient EINRecipientEIN | IRC SectionIRCSectionDesc | Cash GrantCashGrantAmt | Purpose Of GrantPurposeOfGrantTxt |
|---|---|---|---|---|---|---|---|
| INDIANA UNIV FOUNDATION | |||||||
| S STATE ROAD 46 | BLOOMINGTON | IN | 47401 | 356018940 | 501(C)(3) | $16,802,427 | 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. |
| (no name) | |||||||
| 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. | |||||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 4 | Total501c3OrgCnt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 2: | FormAndLineReferenceDesc |
| Explanation | 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. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (18 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| DR RANDALL L CALDWELL | ||||||||||||||
| SECRETARY/TREASURER | $222,489 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $222,489 | $0 | $0 | $0 |
| DR D WADE CLAPP | ||||||||||||||
| CHAIRMAN OF THE BOARD | $152,959 | $0 | $57,938 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $210,897 | $0 | $0 | $0 |
| THOMAS M LOCK | ||||||||||||||
| BOARD MEMBER | $133,526 | $0 | $8,802 | $0 | $0 | $0 | $0 | $0 | $8,000 | $0 | $150,328 | $0 | $0 | $0 |
| DR ROBERT J FALLON | ||||||||||||||
| BOARD MEMBER | $174,449 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $6,500 | $0 | $180,949 | $0 | $0 | $0 |
| DR DAVID A INGRAM JR | ||||||||||||||
| PRESIDENT | $276,651 | $0 | $53,200 | $0 | $0 | $0 | $0 | $0 | $8,000 | $0 | $337,851 | $0 | $0 | $0 |
| DR EUGENIA P MOLLESTON | ||||||||||||||
| BOARD MEMBER | $247,932 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $4,920 | $0 | $252,852 | $0 | $0 | $0 |
| DR JOHN C CHRISTENSON | ||||||||||||||
| BOARD MEMBER | $154,631 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $8,000 | $0 | $162,631 | $0 | $0 | $0 |
| DR STEPHANIE DAVIS | ||||||||||||||
| BOARD MEMBER | $175,567 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $8,000 | $0 | $183,567 | $0 | $0 | $0 |
| DR HOWARD EIGEN | ||||||||||||||
| BOARD MEMBER | $189,583 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $15,000 | $0 | $204,583 | $0 | $0 | $0 |
| DR ABIGAIL F KLEMSZ | ||||||||||||||
| BOARD MEMBER | $154,856 | $0 | $50,127 | $0 | $0 | $0 | $0 | $0 | $9,000 | $0 | $213,983 | $0 | $0 | $0 |
| DR MARA NITU | ||||||||||||||
| BOARD MEMBER | $263,500 | $0 | $40,000 | $0 | $0 | $0 | $0 | $0 | $9,000 | $0 | $312,500 | $0 | $0 | $0 |
| DR KATHLEEN O'NEILL | ||||||||||||||
| BOARD MEMBER | $178,475 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $8,000 | $0 | $186,475 | $0 | $0 | $0 |
| DR STEPHEN M DOWNS | ||||||||||||||
| BOARD MEMBER | $143,583 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $8,083 | $0 | $151,666 | $0 | $0 | $0 |
| DR JAMES A LEMONS | ||||||||||||||
| EMERITUS BOARD MEMBER | $173,467 | $0 | $12,584 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $186,051 | $0 | $0 | $0 |
| KENNETH HERRMANN | ||||||||||||||
| PHYSICIAN | $314,180 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $9,000 | $0 | $323,180 | $0 | $0 | $0 |
| SUSAN QUIGLEY | ||||||||||||||
| PHYSICIAN | $122,500 | $0 | $25,000 | $0 | $0 | $0 | $0 | $0 | $4,250 | $0 | $151,750 | $0 | $0 | $0 |
| DR DAVID HERTZ | ||||||||||||||
| PHYSICIAN | $290,779 | $0 | $37,489 | $0 | $0 | $0 | $0 | $0 | $6,360 | $0 | $334,628 | $0 | $0 | $0 |
| ANDREAS DEYMANN | ||||||||||||||
| PHYSICIAN | $181,000 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $9,000 | $0 | $190,000 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE J, PART III: | FormAndLineReferenceDesc |
| Explanation | COMPENSATION RELATES TO MEDICAL SERVICES PROVIDED, NOT AS COMPENSATION FOR SERVING ON THE BOARD. | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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. |
Schedule R IRS990ScheduleR
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp
Related Organization Name RelatedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ROC SURGERY LLC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 340 WEST 10TH STREET | AddressLine1Txt |
| City | INDIANAPOLIS | CityNm |
| State Abbreviation | IN | StateAbbreviationCd |
| ZIP | 46202 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 271497960 | EIN |
| Primary Activities | AMBULATORY SURGERY CENTER PERFORMING ONLY OUTPATIENT PROCEDURES | PrimaryActivitiesTxt |
| Legal Domicile State | IN | LegalDomicileStateCd |
| Predominant Income Type | RELATED | PredominantIncomeTypeTxt |
| Share Of Total Income | $720,000 | ShareOfTotalIncomeAmt |
| Share Of EOY Assets | $275,000 | ShareOfEOYAssetsAmt |
| Disproportionate Allocations | 0 | DisproportionateAllocationsInd |
| General Or Managing Partner | 0 | GeneralOrManagingPartnerInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | 0 | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | 0 | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
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