UNIVERSITY PEDIATRIC ASSOCIATES INC: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization
UNIVERSITY PEDIATRIC ASSOCIATES INC (EIN 23-7328642)
Tax period
2011-07-01 to 2012-06-30
Filed
2013-02-05
IRS object ID
201300369349300235
Schema version
2011v1.2
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

FieldValueIRS element (for citing)
Timestamp2013-02-05T14:20:19-06:00Timestamp
Tax Period End Date2012-06-30TaxPeriodEndDate

Preparer Firm PreparerFirm

FieldValueIRS element (for citing)
EIN352123203EIN

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1KSM BUSINESS SERVICES INCBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1PO BOX 40857AddressLine1
CityINDIANAPOLISCity
StateINState
ZIP Code462400857ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2011-07-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN237328642EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1UNIVERSITY PEDIATRIC ASSOCIATES INCBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlUNIVNameControl
Phone3172741201Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1550 NORTH MERIDIAN STREET NO 228AddressLine1
CityINDIANAPOLISCity
StateINState
ZIP Code46202ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameDR D WADE CLAPPName
TitleCHAIRMAN OF THE BOARDTitle
Phone3172741201Phone
Date Signed2013-01-31DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameDON BOEZEMANName
PTINP01000722PTIN
Phone3175802000Phone
Date Prepared2013-01-31DatePrepared
FieldValueIRS element (for citing)
Tax Year2011TaxYear
Build TS2016-02-25 16:41:14ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonDR D WADE CLAPPNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1550 N MERIDIAN ST SUITE 228AddressLine1
CityINDIANAPOLISCity
StateINState
ZIP Code46202ZIPCode
FieldValueIRS element (for citing)
Gross Receipts99312341GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteN/AWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1973YearFormation
State Legal DomicileINStateLegalDomicile
Activity Or Mission DescriptionTHE 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.ActivityOrMissionDescription
Nbr Voting Members Governing Body15NbrVotingMembersGoverningBody
Nbr Independent Voting Members15NbrIndependentVotingMembers
Total Nbr Employees0TotalNbrEmployees
Total Nbr Volunteers0TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year1749541ContributionsGrantsPriorYear
Contributions Grants Current Year2422306ContributionsGrantsCurrentYear
Program Service Revenue Prior Year66551342ProgramServiceRevenuePriorYear
Program Service Revenue CY69539580ProgramServiceRevenueCY
Investment Income Prior Year1521728InvestmentIncomePriorYear
Investment Income Current Year1820089InvestmentIncomeCurrentYear
Other Revenue Prior Year0OtherRevenuePriorYear
Other Revenue Current Year366062OtherRevenueCurrentYear
Total Revenue Prior Year69822611TotalRevenuePriorYear
Total Revenue Current Year74148037TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year32878804GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY33804332GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year6566605SalariesEtcPriorYear
Salaries Etc Current Year8933596SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year33817676OtherExpensePriorYear
Other Expenses Current Year39344512OtherExpensesCurrentYear
Total Expenses Prior Year73263085TotalExpensesPriorYear
Total Expenses Current Year82082440TotalExpensesCurrentYear
Revenues Less Expenses Prior Year-3440474RevenuesLessExpensesPriorYear
Revenues Less Expenses CY-7934403RevenuesLessExpensesCY
Total Assets BOY37882732TotalAssetsBOY
Total Assets EOY30459111TotalAssetsEOY
Total Liabilities BOY0TotalLiabilitiesBOY
Total Liabilities EOY0TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY37882732NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY30459111NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionTHE 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.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense33031755Expense
Grants33031755Grants
DescriptionVARIOUS CONTRIBUTIONS TO INDIANA UNIVERSITY FOUNDATION AND INDIANA UNIVERSITY SCHOOL OF MEDICINEDescription

Activity2 Activity2

FieldValueIRS element (for citing)
Expense772577Expense
Grants772577Grants
DescriptionCHARITABLE CONTRIBUTIONS TO VARIOUS MEDICAL INSTITUTIONSDescription

Activity3 Activity3

FieldValueIRS element (for citing)
Expense186719Expense
DescriptionTHE ORGANIZATION PROVIDES ADMINISTRATIVE AND COLLECTION SERVICES FOR INDIANA UNIVERSITY FACULTY AND PHYSICIANSDescription

Activity Other ActivityOther

FieldValueIRS element (for citing)
Expense32728084Expense
DescriptionPHYSICIAN CONTRACTS FOR RESEARCH, EDUCATION, AND PATIENT CAREDescription
FieldValueIRS element (for citing)
Total Of Other Program Service Exp32728084TotalOfOtherProgramServiceExp
Total Program Service Expense66719135TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required0ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
Subject To Proxy Tax0SubjectToProxyTax
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets0ReportOtherAssets
Report Other Liabilities0ReportOtherLiabilities
Report Fin48 Footnote1ReportFin48Footnote
Independent Audit Financial Stmt1IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt0ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital0Hospital
Grants To Organizations1GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds0TaxExemptBonds
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Transaction Related Entity0TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With10960NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Number Of Employees0NumberOfEmployees
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members15NbrVotingGoverningBodyMembers
Number Independent Voting Members15NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders0MembersOrStockholders
Election Of Board Members0ElectionOfBoardMembers
Decisions Subject To Approval0DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy0WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other0CompensationProcessOther
Investment In Joint Venture1InvestmentInJointVenture
Written Policy Or Procedure1WrittenPolicyOrProcedure
States Where Copy Of Return Is FiledINStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1HELEN BRODY ADMINISTRATIVE DIRECTOBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number3172741211TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1550 NORTH MERIDIAN STREETAddressLine1
CityINDIANAPOLISCity
StateINState
ZIP Code46204ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (18 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationHighest Compensated EmployeeHighestCompensatedEmployee
DR RANDALL L CALDWELL
SECRETARY/TREASURER40.00XX20998100
DR D WADE CLAPP
CHAIRMAN OF THE BOARD40.00XX14041500
DR HOWARD EIGEN
BOARD MEMBER40.00X32500000
DR ROBERT J FALLON
BOARD MEMBER40.00X15897506500
DR SHARON P ANDREOLI
BOARD MEMBER40.00X9810400
DR ERICA A EUGSTER
BOARD MEMBER40.00X13639404920
DR DAVID A INGRAM JR
PRESIDENT40.00XX26331408083
DR EUGENIA P MOLLESTION
BOARD MEMBER40.00X21800004920
DR JOHN C CHRISTENSON
BOARD MEMBER40.00X15939508000
DR STEPHEN M DOWNS
BOARD MEMBER40.00X13768109000
DR STEPHANIE DAVIS
BOARD MEMBER40.00X14737500
DR ABIGAIL F KLEMSZ
BOARD MEMBER40.00X26147409000
DR VAUGHN I RICKERT
BOARD MEMBER40.00X11496408000
DR JAMES A LEMONS
BOARD MEMBER40.00X18991700
DR ALEXANDRE T ROTTA
PHYSICIAN40.0044840009000X
DR MARK RIGBY
PHYSICIAN40.0040630000X
DR SHEKHAR RAJ
PHYSICIAN40.00391479010000X
DR DAVID HERTZ
PHYSICIAN40.0031352606360X
FieldValueIRS element (for citing)
Total Reportable Comp From Org4120694TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation83783TotalOtherCompensation
Number Individuals GT100 K17NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources
Number Of Contractors GT100 K0NumberOfContractorsGT100K
Government Grants2422306GovernmentGrants
Total Contributions2422306TotalContributions

Program Service Revenue ProgramServiceRevenue

FieldValueIRS element (for citing)
DescriptionPATIENT SERVICESDescription
Business Code621110BusinessCode
Total Revenue Column69539580TotalRevenueColumn
Related Or Exempt Function Income69539580RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Program Service Revenue69539580TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column803349TotalRevenueColumn
Exclusion$803,349ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities26181044Securities

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities25164304Securities

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities1016740Securities

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column1016740TotalRevenueColumn
Exclusion$1,016,740ExclusionAmount

Other Revenue Misc OtherRevenueMisc

FieldValueIRS element (for citing)
DescriptionROC SURGERY CENTER K-1Description
Business Code621400BusinessCode
Total Revenue Column366062TotalRevenueColumn
Related Or Exempt Function Income366062RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Other Revenue366062TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column74148037TotalRevenueColumn
Related Or Exempt Function Income69905642RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$1,820,089ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total33804332Total
Program Services33804332ProgramServices

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total7363513Total
Management And General7363513ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total1570083Total
Management And General1570083ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total45983Total
Management And General45983ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total174237Total
Management And General174237ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total1053861Total
Program Services186719ProgramServices
Management And General867142ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total404627Total
Management And General404627ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total1229399Total
Management And General1229399ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total376225Total
Management And General376225ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
PHYSICIAN CONTRACTS3272808432728084
OUTSIDE SERVICE EXPENSE11695681169568
MALPRACTICE INSURANCE11367951136795
MISCELLANEOUS853498853498

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total172235Total
Management And General172235ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total82082440Total
Program Services66719135ProgramServices
Management And General15363305ManagementAndGeneral
Fundraising0Fundraising

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY5888671BOY
EOY5896014EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

FieldValueIRS element (for citing)
BOY390000BOY
EOY0EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis3107300LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec605303LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY707199BOY
EOY2501997EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY30784005BOY
EOY21967769EOY

Investments Program Related InvestmentsProgramRelated

FieldValueIRS element (for citing)
BOY112857BOY
EOY93331EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY37882732BOY
EOY30459111EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY37882732BOY
EOY30459111EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY37882732BOY
EOY30459111EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY37882732BOY
EOY30459111EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses-7934403ReconcilationRevenueExpenses
Reconcilation Other Changes510782ReconcilationOtherChanges
Info In Schedule O Part XIIXInfoInScheduleOPartXII
Method Of Accounting CashXMethodOfAccountingCash
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement SeparateXFinancialStatementSeparate
Federal Grant Audit Required1FederalGrantAuditRequired
Federal Grant Audit Performed1FederalGrantAuditPerformed

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org170b1 AviXPubliclySupportedOrg170b1Avi

Gifts Grants Contrib Received170 GiftsGrantsContribReceived170

FieldValueIRS element (for citing)
Current Tax Year Minus3 Years1108741CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years1396376CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year1749541CurrentTaxYearMinus1Year
Current Tax Year2422306CurrentTaxYear
Total6676964Total

Total170 Total170

FieldValueIRS element (for citing)
Current Tax Year Minus3 Years1108741CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years1396376CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year1749541CurrentTaxYearMinus1Year
Current Tax Year2422306CurrentTaxYear
Total6676964Total
FieldValueIRS element (for citing)
Public Support Total1706676964PublicSupportTotal170

Gross Investment Income170 GrossInvestmentIncome170

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years1823690CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years1160495CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years946270CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year924962CurrentTaxYearMinus1Year
Current Tax Year803349CurrentTaxYear
Total5658766Total
FieldValueIRS element (for citing)
Total Support12335730TotalSupport
Gross Receipts From Admissions Etc319864600GrossReceiptsFromAdmissionsEtc
Public Support Pertcentage1700.54130PublicSupportPertcentage170
Public Support Pertcent Prior Year0.46700PublicSupportPertcentPriorYear
Thirty Three Percnt Tests CY170XThirtyThreePercntTestsCY170

Schedule D IRS990ScheduleD

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis2787154OtherCostOrOtherBasis
Depreciation542938Depreciation
Book Value2244216BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis320146OtherCostOrOtherBasis
Depreciation62365Depreciation
Book Value257781BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings2501997TotalOfBookValueLandBuildings
Total Revenue74148037TotalRevenue
Total Expenses82082440TotalExpenses
Excess Or Deficit For Year-7934403ExcessOrDeficitForYear
Net Unrealized GL On Investments-1813427NetUnrealizedGLOnInvestments
Other$2,324,209OtherAmount
Total Adjustments510782TotalAdjustments
Excess Or Deficit Per FS-7423621ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt74658819TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments-1813426NetUnrealizedGainsInvestments
Other Revenues2324208OtherRevenues
Revenue Not Rptd F990510782RevenueNotRptdF990
Revenue Subtotal74148037RevenueSubtotal
Revenue Not Rptd On Fin Stmt0RevenueNotRptdOnFinStmt
Total Revenue Per Form99074148037TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt82062914TotExpensesEtcAuditedFinclStmt
Other Expenses Included-19526OtherExpensesIncluded
Expenses Not Rptd F990-19526ExpensesNotRptdF990
Expenses Subtotal82082440ExpensesSubtotal
Expenses Not Rptd On Fin Stmt0ExpensesNotRptdOnFinStmt
Total Expenses Per Form99082082440TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (4 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48:PART X: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, 2012 AND 2011. 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 2009.
PART XI, LINE 8 - OTHER ADJUSTMENTS:INCOME FROM INVESTMENTS 2,324,209.
PART XII, LINE 2D - OTHER ADJUSTMENTS:INCOME FROM INVESTMENT 2,324,208.
PART XIII, LINE 2D - OTHER ADJUSTMENTS:LOSS FROM JOINT VENTURE -19,526.

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records Maintained1RecordsMaintained

Recipient Table RecipientTable (2 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEIN Of RecipientEINOfRecipientIRC SectionIRCSectionAmount Of Cash GrantAmountOfCashGrantPurpose Of GrantPurposeOfGrant
INDIANA UNIV FOUNDATION
S STATE ROAD 46BLOOMINGTONIN47401356018940501(C)(3)33031755TO 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.
VARIOUS MEDICAL PROGRAMS
S STATE ROAD 46BLOOMINGTONIN47401772577TO 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.
FieldValueIRS element (for citing)
Total Nbr Of501 C3 And Govt Grants4TotalNbrOf501C3AndGovtGrants

Form990 Schedule I Part IV Form990ScheduleIPartIV

FieldValueIRS element (for citing)
IdentifierPROCEDURE FOR MONITORING GRANTS IN THE U.S.:Identifier
Return ReferencePART I, LINE 2:ReturnReference
ExplanationSCHEDULE I, 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.Explanation

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Substantiation Required1SubstantiationRequired
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan0SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org0CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments0AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (12 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
DR RANDALL L CALDWELL
209981000000000209981000
DR HOWARD EIGEN
325000000000000325000000
DR ROBERT J FALLON
158975000006500000165475000
DR DAVID A INGRAM JR
263314000008083000271397000
DR EUGENIA P MOLLESTION
218000000004920000222920000
DR JOHN C CHRISTENSON
159395000008000000167395000
DR ABIGAIL F KLEMSZ
261474000009000000270474000
DR JAMES A LEMONS
189917000000000189917000
DR ALEXANDRE T ROTTA
448400000009000000457400000
DR MARK RIGBY
406300000000000406300000
DR SHEKHAR RAJ
3914790000010000000401479000
DR DAVID HERTZ
313526000006360000319886000

Form990 Schedule J Part III Form990ScheduleJPartIII

FieldValueIRS element (for citing)
IdentifierSUPPLEMENTAL INFORMATIONIdentifier
Return ReferencePART IIIReturnReference
ExplanationCOMPENSATION RELATES TO MEDICAL SERVICES PROVIDED, NOT AS COMPENSATION FOR SERVING ON THE BOARD.Explanation

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (7 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
FORM 990, PART VI, SECTION B, LINE 11FORM 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 12CUPA BOARD REVIEWS AND MONITORS ALL COMPLIANCE IN ACCORDANCE WITH UPA'S CONFLICT OF INTEREST POLICY.
FORM 990, PART VI, SECTION B, LINE 15AUPA BOARD WILL VOTE AND DETERMINE THE COMPENSATION BASED ON EXTERNAL AND INTERNAL FACTORS.
FORM 990, PART VI, SECTION C, LINE 18AVAILABLE UPON REQUEST.
FORM 990, PART VI, SECTION C, LINE 19AVAILABLE UPON REQUEST
FORM 990, PART XI, LINE 5:NET UNREALIZED LOSSES ON INVESTMENTS: -1,813,427. INCOME FROM INVESTMENTS 2,324,209. TOTAL TO FORM 990, PART XI, LINE 5: 510,782.CHANGES IN NET ASSETS OR FUND BALANCES:
FORM 990, PART XII, LINE 2C: NO CHANGE FROM PRIOR YEAR.

Schedule R IRS990ScheduleR

Form990 Schedule R Part III Form990ScheduleRPartIII (3 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivityPrimaryActivityLegal Domicile StateLegalDomicileStatePredominant Income TypePredominantIncomeTypeShare Of Total IncomeShareOfTotalIncomeDisproportionate AllocationsDisproportionateAllocationsGeneral Or Managing PartnerGeneralOrManagingPartnerShare Of EOY AssetsShareOfEOYAssets
PICU INVESTMENTS LLC
575 WEST DR ROOM XE 010INDIANAPOLISIN46209201530701INVESTMENT HOLDINGSININVESTMENT165250200
NICU INVESTMENTS LLC
575 WEST DR ROOM XE 010INDIANAPOLISIN46209201530584INVESTMENT HOLDINGSININVESTMENT82626800
ROC SURGERY LLC
340 WEST 10TH STREETINDIANAPOLISIN46202271497960AMBULATORY SURGERY CENTER PERFORMING ONLY OUTPATIENT PROCEDURESINRELATED36606200225000
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org0GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org0GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs0RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs0RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs0PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs0PerformOfServicesByOtherOrgs
Sharing Of Facilities0SharingOfFacilities
Sharing Of Paid Employees0SharingOfPaidEmployees
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg

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