2014-01-29T12:42:44-06:00 2013-06-30 351178661 BLUE & COMPANY ONE AMERICAN SQUARE 2200 INDIANAPOLIS IN 46282 990 2012-07-01 352134193 INDIANA UNIVERSITY HEALTH PROTON THERAPY CENTER LLC INDI 8123495074 2425 N MILO B SAMPSON LANE BLOOMINGTON IN 474081368 JOHN R KERSTIENS CPA 8123495028 2014-01-24 1 AMBER KOCHER CPA P01286298 3176334705 2012 2015-11-30 17:44:51Z MIDWEST PROTON RADIOTHERAPY INSTITUTE LLC DR PETER JOHNSTONE 2425 N MILO B SAMPSON LANE BLOOMINGTON IN 474081368 17963884 0 X WWW.IUHEALTHPROTONTHERAPY.ORG X LLC - LIMITED LIABILITY COMPANY 2001 IN CANCER TREATMENT CENTER THAT UTILIZES UNIQUE PROTON BEAM TECHNOLOGY TO TREAT CANCER PATIENTS. 5 5 71 0 0 0 105982 1736112 18660957 16221548 3202 3090 2980 3134 18773121 17963884 28500 8873 0 0 4877556 5124374 0 0 0 14394487 15166827 19300543 20300074 -527422 -2336190 24909929 22671251 16516808 16614320 8393121 6056931 TO LEVERAGE OUR UNIQUE TECHNOLOGY TO IMPROVE OUR PATIENTS' HEALTH AND PROMOTE INNOVATION IN EDUCATION AND RESEARCH. 0 0 18945547 8873 16221548 IU HEALTH PROTON THERAPY CENTER (THE CENTER) USES PROTON BEAM ENERGY TO TREAT CANCER PATIENTS. OUR PATIENTS ARE SELECTED BASED ON TYPE OF CANCER, EFFICIENCY OF TREATMENT AND WITHOUT REGARD TO THE PATIENTS' ABILITY TO PAY. UNINSURED CARE WAS APPROXIMATELY $659,465 FOR THE YEAR ENDED JUNE 30, 2013.THE CENTER IS AN ACADEMIC AND RESEARCH-ORIENTED HEALTHCARE FACILITY THAT WORKS IN CLOSE PARTNERSHIP WITH INDIANA UNIVERSITY SCHOOL OF MEDICINE, ONE OF THE LARGEST MEDICAL SCHOOLS IN THE COUNTRY. WE PROVIDE A PATIENT ORIENTED EXPERIENCE THAT IS EFFECTIVE, INFORMATIVE AND COMFORTABLE. WE STRIVE TO MAKE THE OVERALL PATIENT EXPERIENCE POSITIVE AND UPLIFTING RATHER THAN WORRISOME AND OFF-PUTTING. OUR FRIENDLY, KNOWLEDGEABLE STAFF MEMBERS ARE ENTHUSIASTIC ABOUT PATIENTS' CARE AND RECOVERY AND ARE DEDICATED TO THEIR HEALTH AND WELL-BEING. WE ONLY EMPLOY HIGHLY SKILLED AND PROFICIENT TEAM MEMBERS THAT WORK TOGETHER FOR THE COMMON GOOD OF THE PATIENT.PROTON BEAM THERAPY IS A UNIQUE TREATMENT THAT HAS PROVED TO BE AS EFFECTIVE AS, AND IN SOME CASES MORE EFFECTIVE THAN, OTHER FORMS OF CANCER TREATMENT. IT IS A HIGHLY PRECISE, NON-INVASIVE, NON-SURGICAL PROCEDURE. THIS FORM OF RADIATION THERAPY TARGETS THE TUMOR AND CAUSES MINIMAL DAMAGE TO SURROUNDING TISSUES AS COMPARED TO CONVENTIONAL RADIATION THERAPY. THE RESULTS ARE HIGHLY EFFECTIVE, AND THE SIDE EFFECTS ARE GENERALLY MINIMAL OR NON-EXISTENT. THIS COMBINATION OF EFFECTIVENESS AND REDUCED SIDE EFFECTS HAS LED THOUSANDS OF PEOPLE WORLD-WIDE TO CHOOSE PROTON THERAPY INSTEAD OF SURGERY OR OTHER FORMS OF RADIATION THERAPY. 18945547 1 1 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1 5 0 1 71 1 0 0 0 0 0 0 0 0 0 0 X 5 5 0 0 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 0 1 0 IN X JOHN KERSTIENS CPA 8123495074 2425 N MILO B SAMPSON LN BLOOMINGTON IN 47408 DR PETER JOHNSTONE 16.00 X X 0 0 0 HOLLY GOE 1.00 X 0 0 0 TOM MARTIN 1.00 X 0 0 0 JOAN HAGEN 1.00 X 0 0 0 ERIN LEWIS 1.00 X 0 0 0 TONY ARMSTRONG 1.00 X 0 0 0 JOHN KERSTIENS 40.00 X 177258 0 22296 KARIN CAMPBELL 40.00 X 89992 0 23225 AMANDA BURNHAM 40.00 X 76812 0 14706 MARK WOLANSKI 40.00 X 147655 0 33830 CHRIS ALLGOWER 40.00 X 142502 0 38107 LENILSON COUTINHO 40.00 X 106933 0 20245 LEIA FANELLI 40.00 X 107045 0 19260 LI ZHAO 40.00 X 101617 0 33466 TERESA OLDHAM 40.00 X 142291 0 22146 1092105 0 227281 7 0 1 0 UNIVERSITY RADIATION ONCOLOGY ASSOC 535 BARNHILL DRIVE INDIANAPOLIS IN 46202 PHYSICIAN AND PHYSICISTS 2361310 BLOOMINGTON ANESTHESIOLOGISTS PO BOX 2121 DEPT 1438 MEMPHIS TN 38159 ANESTHESIOLOGISTS 337799 VARIAN MEDICAL SYSTEMS 8900 KEYSTONE CROSSING STE 100 INDIANAPOLIS IN 46240 COMPUTERIZED MEDICAL SYSTEM SERVICES 214456 SIEMENS MEDICAL SOLUTIONS PO BOX 120001 DEPT 0733 DALLAS TX 75312 MEDICAL EQUIPMENT SOLUTIONS/SERVICE 200000 ELEKTA 13723 CORPORATE LAKE DR MARYLAND HEIGHTS MO 63043 COMPUTERIZED MEDICAL SYSTEM SERVICES 114480 5 1736112 1695389 1736112 NET PATIENT SERVICE REVENUE 621110 16221548 16221548 16221548 3090 3090 OTHER INCOME 541900 3134 3134 3134 17963884 16221548 0 6224 X 8873 8873 293781 249714 44067 3585081 3585081 369113 313746 55367 602621 512228 90393 273778 232711 41067 40442 40442 47356 47356 4087126 4087126 37755 37755 399904 335919 63985 1737745 1390196 347549 50941 50941 11493 11493 237445 237445 2327343 1978242 349101 49188 49188 PROTON BEAM EXPENSE 6030362 6030362 DUES & SUBSCRIPTIONS 68690 68690 RECRUITING 6312 6312 34725 34725 20300074 18945547 1354527 0 75 75 1850642 1899757 1613545 1549113 40140 136714 21859224 9149247 14375060 12709977 6950000 6350000 80467 25615 24909929 22671251 924353 578204 598253 681444 14994202 15354672 16516808 16614320 X 8312654 6031316 80467 25615 8393121 6056931 24909929 22671251 -2336190 0 X X 0 1 X 0 0 X SCHEDULE A, PART IV, SUPPLEMENTAL INFORMATION: THE IRS HAS DETERMINED THAT IU HEALTH PROTON THERAPY CENTER IS A PUBLIC CHARITY UNDER INTERNAL REVENUE CODE SECTION 107(B)(1)(A)(III). PER SCHEDULE H INSTRUCTIONS, ONLY ORGANIZATIONS THAT OPERATE AT LEAST ONE FACILITY THAT IS, OR IS REQUIRED TO BE LICENSED, REGISTERED, OR SIMILARLY RECOGNIZED BY A STATE AS A HOSPITAL ARE REQUIRED TO COMPLETE THIS SCHEDULE. IU HEALTH PROTON THERAPY CENTER IS A CANCER TREATMENT CENTER AND IS NOT LICENSED AS A HOSPITAL BY THE STATE OF INDIANA. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 80467 54852 25615 85000 4533 80467 1.00000 0 0 14772495 5048947 9723548 5766687 2947574 2819113 1320042 1152726 167316 12709977 RELATED PARTY PAYABLES 15354672 15354672 X 17963884 0 17963884 0 17963884 20300074 0 20300074 0 20300074 DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: THE ORGANIZATION HAS TEMPORARILY RESTRICTED NET ASSETS AVAILABLE FOR THE PURPOSE OF PURCHASING EQUIPMENT. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X, LINE 2: IUHPTC IS EXEMPT FROM INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND, AS SUCH, IS NOT REQUIRED TO PAY FEDERAL OR STATE INCOME TAXES ON EXCESS REVENUES RELATED TO THEIR TAX-EXEMPT ACTIVITIES. ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY IUHPTC AND RECOGNIZE A TAX LIABILITY IF IUHPTC HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY VARIOUS FEDERAL AND STATE TAXING AUTHORITIES. MANAGEMENT HAS ANALYZED THE TAX POSITIONS TAKEN BY IUHPTC, AND HAS CONCLUDED THAT AS OF JUNE 30, 2013 AND 2012, THERE ARE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY OR DISCLOSURE IN THE ACCOMPANYING FINANCIAL STATEMENTS. IUHPTC IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. IUHPTC IS GENERALLY EXEMPT FROM INCOME TAXES. HOWEVER, IUHPTC IS REQUIRED TO FILE FEDERAL FORM 990 - RETURN OF ORGANIZATION FROM INCOME TAX, WHICH IS AN INFORMATIONAL RETURN ONLY. 1 JILL'S HOUSE 751 E TAMARACK TRAIL BLOOMINGTON IN 47408 352139920 501(C)(3) 8873 PATIENT SUPPORT 1 0 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: SUPPORT PROVIDED TO 501(C)(3) PUBLIC CHARITY FOR PATIENT SUPPORT. THE ORGANIZATION DOES NOT MONITOR THE USE OF THESE FUNDS BY THE PUBLIC CHARITY LISTED. 0 0 0 0 0 0 0 0 0 JOHN KERSTIENS 177258 0 0 0 0 0 15752 0 6544 0 199554 0 0 0 MARK WOLANSKI 147655 0 0 0 0 0 16295 0 17535 0 181485 0 0 0 CHRIS ALLGOWER 142502 0 0 0 0 0 16335 0 21772 0 180609 0 0 0 TERESA OLDHAM 142291 0 0 0 0 0 20963 0 1183 0 164437 0 0 0 X IN-KIND CONTRIBUTION:CONSTRUCTION LOAN FORGIVENESS 1 1680671 FMV 0 0 0 METHOD FOR DETERMINING NUMBER OF CONTRIBUTIONS: PART I, COLUMN (B): INKIND CONTRIBUTION: FORGIVENESS OF CONSTRUCTION LOAN PAYMENTS FOR FISCAL YEAR 2013 ON ACCOUNTS PAYABLE TO INDIANA UNIVERSITY. FORM 990, PART VI, SECTION A, LINE 6 THE ORGANIZATION IS ORGANIZED AS A DOMESTIC LIMITED LIABILITY COMPANY WITH TWO CORPORATE MEMBERS AND A BOARD OF MANAGERS. FORM 990, PART VI, SECTION A, LINE 7A THE ORGANIZATION'S CORPORATE MEMBERS, INDIANA UNIVERSITY RESEARCH AND TECHNOLOGY CORPORATION AND INDIANA UNIVERSITY HEALTH, INC., EACH APPOINT TWO INDIVIDUAL BOARD MANAGERS TO SERVE ON THE GOVERNING BOARD OF MANAGERS. TOGETHER THE FOUR APPOINTED INDIVIDUALS ELECT ONE ADDITIONAL UNRELATED INDIVIDUAL TO SERVE ON THE GOVERNING BOARD OF MANAGERS. FORM 990, PART VI, SECTION B, LINE 11 THE PROCESS FOR REVIEWING THE FORM 990 INCLUDES A DETAILED REVIEW OF THE FORM 990 BY THE ORGANIZATION'S COO/CFO AND EACH CORPORATE MEMBERS' TAX DEPARTMENTS. THE ORGANIZATION'S GOVERNING BODY REVIEWS AND APPROVES THE FORM 990. PRIOR TO FILING EACH VOTING MEMBER OF THE ORGANIZATION'S GOVERNING BODY IS PROVIDED AN ELECTRONIC COPY OF THE FINAL FORM 990 INCLUDING REQUESTED SCHEDULES, AS ULTIMATELY FILED WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION HAS A WRITTEN CONFLICT OF INTEREST POLICY, THE PURPOSE OF WHICH IS, TO PREVENT ANY POTENTIAL FOR PERSONAL PROFIT OR GAIN, EITHER DIRECTLY OR INDIRECTLY, BY REASON OF AN INDIVIDUAL?S ASSOCIATION WITH OR EMPLOYMENT BY THE ORGANIZATION. THE SCOPE OF THE POLICY INCLUDES ALL MEMBERS OF THE ORGANIZATION?S BOARD OF MANAGERS, OFFICERS, EMPLOYEES, AND INDEPENDENT CONTRACTORS. THE POLICY IS REGULARLY AND CONSISTENTLY MONITORED AND ENFORCED FOR COMPLIANCE BY THE OFFICE OF THE DIRECTOR OF HUMAN RESOURCES/ADMINISTRATION. A COVERED INDIVIDUAL IS REQUIRED TO DISCLOSE ANY POTENTIAL CONFLICT OF INTEREST TO THE ORGANIZATION'S LEADERSHIP AND REFRAIN FROM OBTAINING ANY LIST OF THE ORGANIZATION'S PATIENTS, REFERRING PHYSICIANS, AND VENDORS FOR ANY PERSONAL OR PRIVATE USE. ANY POTENTIAL CONFLICT OF INTEREST IS REVIEWED BY THE ORGANIZATION'S COMPLIANCE PERSONNEL AND BOARD OF MANAGERS. IF THE DISCLOSURE IS MADE BY A COVERED INDIVIDUAL SERVING ON THE BOARD OF MANAGERS, SUCH INDIVIDUAL IS REQUIRED TO RECUSE THEMSELVES FROM PARTICIPATION IN THE GOVERNING BODY'S REVIEW REGARDING SUCH DISCLOSURE. FORM 990, PART VI, SECTION B, LINE 15B THE CEO (TOP MANAGEMENT OFFICIAL) OF THE ORGANIZATION HAS BEEN SELECTED BY THE ORGANIZATION'S CORPORATE MEMBERS TO SERVE AS BOARD MEMBER AND TOP MANAGEMENT OFFICIAL FOR THE ORGANIZATION. THE CEO DOES NOT RECEIVE COMPENSATION FROM THE ORGANIZATION AND THEREFORE, NO COMPENSATION DETERMINATION PROCESS IS USED FOR THE CEO BY THE ORGANIZATION. THE PROCESS ESTABLISHED FOR DETERMINING THE COMPENSATION OF THE COO AND ALL OTHER ORGANIZATION'S OFFICERS AND KEY EMPLOYEES INCLUDES OBTAINING COMPARABLE COMPENSATION DATA FROM ITS CORPORATE MEMBERS AND LOCAL PROVIDERS AND USING WRITTEN EMPLOYMENT CONTRACTS DOCUMENTING APPLICABLE COMPENSATION ARRANGEMENTS. ALL COMPENSATION ARRANGEMENTS ARE SUBJECT TO THE REVIEW AND APPROVAL OF THE ORGANIZATION'S GOVERNING BODY WITH ANY DELIBERATION BEING CONTEMPORANEOUSLY DOCUMENTED IN THE MINUTES OF THE BOARD OF MANAGERS. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC. SUCH REQUESTS CAN BE MADE EITHER BY PHONE OR MAIL. OTHER FEES FORM 990, PART IX, LINE 11G PURCHASED PROFESSIONAL SERVICES : PROGRAM SERVICE EXPENSES 248,152. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 248,152. PROFESSIONAL MEDICAL FEES : PROGRAM SERVICE EXPENSES 3,838,974. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,838,974. OVERSIGHT OF THE AUDIT FORM 990, PART XII, LINE 2C THE BOARD OF MANAGERS ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF THE FINANCIAL STATEMENTS AND NO PROCESSES HAVE CHANGED FROM PRIOR YEAR.